Outreach and People with 

Disabilities from Diverse Cultures:

A Review of the Literature 

National Council on Disability 

Cultural Diversity Initiative 

1331 F Street, NW, Suite 850 

Washington, DC 20004 

202-272-2004 Voice 

202-272-2074 TTY 

202-272-2022 Fax 

Lex Frieden, Chairperson 

November 20, 2003
Contents 

Executive Summary..........................................................................4 

I. Introduction.................................................................................9 

Background 

Method and Scope 

II. Prior NCD Diversity Reports and Findings............................................13 

III. Definitions of Outreach..................................................................18 

IV. Principal Themes of Outreach..........................................................21 

Value Placed on Target Population 

Assessment of Needs 

Advocacy 

Transformation of social behaviors/attitudes 

Dissemination of information 

Strengthening communities 

V. Outreach Models. .......................................................................23 

Community-based 

Grassroots 

Train-the-Trainer 

Peer-to-Peer 

Partnership 

Support Socialization 

VI. Summary of Findings of the CDI Resource Mapping Project.....................29 

VII. Challenges to Outreach...............................................................36 

Lack of Culturally Appropriate Outreach 

Limited Funding 

Lack of an Assessment of Needs 

Failure to Engage Local Leaders 

Failure to use Peers 

Language and Communication Barriers 

Attitudinal barriers 

Shortage of individuals from diverse cultures in disability services professions 

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Lack of information about resources 

Lack of Coordinated Services 

Limited Use of Client Focused Services 

Demographics 

Limited Attention to Interconnectivity 

Cultural Competence 

Different Cultural Constructs of Disability 

Collectivist vs. Individualistic Orientations 

VIII. Findings and Recommendations...................................................51 

IX. Conclusions.............................................................................54 

X. References.................................................................................56 

XI. Appendices...............................................................................64 

A. Examples of Outreach Programs, Models, and Strategies 

B. Mission of the National Council on Disability 

Acknowledgments 

The National Council on Disability expresses its appreciation to Theda Zawaiza, Ph.D. 

and Claudia Gordon, Esq., for drafting this paper, with research assistance from

Phuonglinh Dang. 

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Executive Summary 

Overview. People with disabilities who are also from diverse cultures are significantly 

hampered in realizing outcomes of full participation in all aspects of society due to a host 

of barriers to the benefits of civil and human rights. A small but growing body of 

research on this issue indicates that barriers include the lack of culturally appropriate 

outreach, language and communication barriers, attitudinal barriers, and the shortage of 

individuals from diverse cultures in the disability services professions (National Council 

on Disability, 2000b). While strategies for reaching out to people with disabilities exist 

(Hasnain, Sotnik, and Ghiloni, 2003; Edwards and Livingston, 1990), research-based 

evidence is sparse regarding interventions aimed at eliminating barriers. Even more scant 

is research on outreach as a compelling strategy and its degree of efficacy in engaging 

people from diverse cultures and ultimately, improving outcomes. 

The objectives of the review were to articulate the principal themes of outreach, describe 

outreach models, illuminate the many challenges to effective outreach, and to document 

the nature and prevalence of national disability/diversity outreach by the federal 

government. The research literature was systematically searched and a preliminary scan 

of nine federal agencies’ disability/diversity outreach activities was conducted using a 

resource mapping inquiry. 

Background. For over a decade, the National Council on Disability (NCD) has worked 

to make national disability policies, laws, programs, and services more responsive to 

people with disabilities from the broad array of cultures that enrich our country. Despite 

concerns regarding the prevalence of disabilities and health disparities among people 

with disabilities from diverse cultures, there remains a significant gap in the empirical 

knowledge base about promising practices in delivering effective services to these 

diverse groups. As a part of its Cultural Diversity Initiative (CDI), NCD sought to answer 

fundamental questions about outreach: What is it? What are current outreach definitions, 

themes, models, and challenges? What is the state of disability/diversity outreach at the 

national level by the federal government? This review of literature was one of three 

projects of the NCD CDI, along with an outreach forum held in July 2003, designed to 

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inform the development of the third component - an outreach toolkit for use by federal 

agencies to enhance their outreach efforts. 

Findings. The review showed a paucity of empirical studies of outreach as an 

intervention and few studies evaluating the effectiveness of outreach activities. While 

there is an extensive body of literature documenting and reporting on racial and ethnic 

health disparities, there were relatively few studies on outreach as an intervention. The 

review identified operational definitions of outreach and principal outreach themes found 

in the literature. Types of outreach were described, and examples provided. The 

challenges of outreach are discussed within the framework of barriers to access and 

appropriate services for full community integration and independent participation by 

people with disabilities from diverse cultures. Major findings include: 

1. Outreach, as an intervention, is a frequently recommended strategy designed to 

improve services to underserved groups, but about which little is known 

empirically. Proponents claim various outreach models show promise, but the 

lack of consistency across studies makes it difficult to generalize about the 

effectiveness of any given approach. Rarely is the term “outreach” operationally 

defined or empirically studied, making it an elusive, yet ubiquitous construct. 

2. Although outreach efforts are highly eclectic, some major themes were found to 

recur in the literature, including: value placed on target population, assessment of 

needs, advocacy, transformation of social behaviors/attitudes, dissemination of 

information and the strengthening of communities. 

3. The models of outreach found in the literature were categorized as: the communitybased model, wherein focus is placed on building the capacity of current 

community organizations; the grassroots model, often using indigenous, nativespeakers in venues not typically used by service organizations; the train-thetrainer model, in which trusted community members are trained so that the 

community maintains the needed knowledge after outreach workers have

departed; the peer-to-peer model, which emphasizes the mutual understanding of 

contemporaries; the partnership model which builds on the partner’s expertise 

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and community trust, and the support socialization model which couples outreach 

with popular events to attract the community. 

 4. Challenges to comprehensive outreach activities include the lack of culturally 

appropriate outreach; failure to engage local leaders; the lack of needs 

assessments; language and communication barriers; attitudinal barriers, and the 

shortage of individuals from diverse cultures in disability services professions. 

5. Self-reports by the nine participating agencies did not fully capture the depth and 

breadth of current national disability/diversity outreach efforts in those agencies. 

Several agencies used outreach as an intervention strategy extensively while 

others only utilized it periodically, if at all. Methodological limitations 

constrained the ability to make definitive statements about the nature and 

prevalence of outreach programs to people with disabilities from diverse cultures. 

6. All of the federal agency programs and activities addressed disability and/or 

diversity separately. With a single exception, the federal agency responses to 

NCD’s inquiry represented only one of several offices, divisions or branches 

within each agency (e.g., the U.S. Department of Health and Human Services 

(DHHS) Office of Civil Rights (OCR) responded only for OCR; however, absent 

were responses from other DHHS offices with established work and track records 

in the area of cultural sensitivity and outreach programs such as in the mental 

health area.) Not all definitions of outreach were consistent with NCD’s 

operational definition provided as a part of the information given to each agency. 

Finally, agency information was not always responsive to the areas of inquiry. 

The combined effect of these observations posed a challenge for a systematic 

analysis of the information collected.

7. Research syntheses are needed to systematically identify and evaluate outreach 

programs for people with disabilities from diverse cultures. The scarcity of such 

research precludes empirically based decisions about the efficacy and 

effectiveness of outreach efforts. Research syntheses are useful in that they 

increase the accessibility of the research and facilitate its interpretation and use in 

the field (Gersten, 2000). 

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The purpose of this review was to explore what research literature tells us about outreach 

and its feasibility as a viable method to reach under-served populations. It is intended to 

be a resource for federal agencies and parties interested in national outreach to people 

with disabilities from diverse cultures. This data provide a preliminary, albeit spotty, scan 

of the state of disability/diversity outreach at the national level by nine federal agencies. 

This data can be used to encourage future dialogue and federal interagency collaboration 

wherein agencies may share their promising practices with each other and by so doing, 

enhance their programs and ultimately increase involvement of people with disabilities

from diverse cultures in their programs. One of the goals of the inter-agency dialogue on 

outreach to this population will include developing a reliable and valid set of baseline 

data for each agency on programs, policies, products, and procedures that agencies can 

share with each other and the public, possibly in the form of a regularly-updated CDRom toolkit containing resources helpful in developing comprehensive outreach 

programs. The review pointed out several gaps in the knowledge about outreach, its 

effectiveness and its limitations. The following recommendations are offered to address 

those gaps in knowledge. 

Recommendations. 

1. Outreach Feasibility Studies: The feasibility of federal agencies using outreach 

as a reliable and valid strategy to reach people with disabilities should be 

systematically analyzed. The prevalence of disability in diverse cultures is 

significant and, in most cases, disproportionately high. Equal representation of 

people with disabilities from diverse cultures in federal programs can be enhanced 

by reaching out to these populations in culturally sensitive ways, evaluating the 

effectiveness of the efforts, disseminating the results and encouraging replication 

of promising practices. 

2. Assessment of Federal Outreach Competencies: Federal agencies should be 

encouraged to undertake a comprehensive self-assessment of their outreach 

competencies, and a thorough inventory of outreach practices to gauge future 

training and development needs and to share promising practices, policies, 

products and procedures with other federal agencies. 

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3. Support Interagency Outreach Collaboration: Interagency agreement and 

funding on outreach knowledge information dissemination and exchange should 

be encouraged. A technical expert panel comprised of interagency representatives 

and grassroots leaders should be formed to develop and pilot cultural competence 

standards and outreach guidelines for federal agencies and their partners. 

Agencies should ensure the meaningful participation of people with disabilities 

from diverse cultures in the development of programs and strategies. 

4. Efficacy Research: Research is needed to weigh the comparative effectiveness 

of specific strategies, including comprehensive outreach, and improving services, 

access and protections for diverse populations with disabilities. 

The review provides a summary of findings from the literature, a discussion of challenges 

to outreach and recommendations to address the information and research gaps identified.

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Outreach and People with Disabilities from Diverse Cultures

A Review of the Literature 

I. Introduction

People with disabilities who are also from diverse cultures are significantly hampered in 

realizing outcomes of full participation in all aspects of society due to a host of barriers to 

the full benefits of civil and human rights. A small but growing body of research on this 

issue indicates that barriers include the lack of culturally appropriate outreach, language 

and communication barriers, attitudinal barriers, and the shortage of individuals from

diverse cultures in the disability services professions (National Council on Disability, 

2000b). While strategies for reaching out to people with disabilities exist (Hasnain, 

Sotnik and Ghiloni, 2003; Edwards and Livingston, 1990), research-based evidence is 

sparse regarding strategies aimed at eliminating barriers. Even more scant is evaluative 

research on strategies such as outreach and its degree of efficacy in improving outcomes 

for people with disabilities from diverse cultures. 

A common notion in federal disability laws and policies developed over the past twentyfive years (e.g., Individuals with Disabilities Education Act and the Vocational 

Rehabilitation Act of 1973, as amended) is that disability is a natural part of the human 

experience and in no way diminishes the right of individuals to live independently, enjoy 

self-determination, make choices, contribute to society, pursue meaningful careers and 

enjoy full inclusion and integration in the economic, political, social, cultural, and 

educational mainstream of society. Community integration and self-determination are 

policy concepts endorsed further in President Bush’s New Freedom Initiative, Executive 

Order 13217 and legislative proposals.1

 However, the promise of these policies has not 

been realized by people with disabilities from underserved populations. 

The purpose of this review was to explore what research literature tells us about outreach 

and its feasibility as a viable method to reach under-served populations. The review is an 

 

 

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informational piece designed to raise awareness and understanding regarding a strategy 

that is highly recommended, about which little is known empirically, designed to improve 

services to under-served groups. It offers a classification schema to explore the concept 

and practice of outreach. The target audience is federal agencies and parties interested in 

federal outreach to people with disabilities from diverse cultures. This review can serve 

as a preliminary research base for the development of technical assistance and training on 

outreach strategies. 

Rationale for a Focus on Outreach. Recurring themes in National Council on Disability 

(NCD) literature include the observation that federal programs are failing to adequately

serve people with disabilities and that people with disabilities from diverse cultures are

sorely under-served. For over a decade, NCD, in its advice to Congress, has 

recommended actions such as outreach and interagency collaboration. Now it has 

reviewed the outreach literature to provide federal agencies with an informational base 

from which they can develop and/or enhance their provision of services and their ability 

to reach underserved people. 

 

The choice of outreach as the focus of the review was not random; rather, it was arrived 

at through methodical deliberation. Outreach is a strategy often recommended, 

anecdotally perceived as promising (according to anecdotes of grassroots, disability 

constituencies), and legislatively required for at least one cabinet-level department 

(Department of Education). The disparities in health, education, employment and 

independent living of people with disabilities from diverse cultures are significant, well 

documented, and persistent despite years of general acknowledgement. The impetus for 

selecting outreach as a compelling strategy to explore was spawned by the facts of those 

disparities and the confluence of several other factors: (1) repeated recommendations for 

outreach in the testimony of grassroots, disability constituencies (e.g., poor, rural, urban); 

(2) recommendations from the U.S. Commission on Civil Rights in its Ten-Year CheckUp: Have Federal Agencies Responded to Civil Rights Recommendations?; (3) the 

mandate for community living (and by extension, live-able communities) found in the 

Supreme Court’s Olmstead decision and the subsequent Executive Order 13217 directing 

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its swift implementation; and (4) the trend in the federal government toward increased 

program accountability. 

Civil Rights. Last year, the U.S. Commission on Civil Rights (USCCR) reprised its 

recommendations in which it expressed concern that people in particular areas and 

communities were not being reached by federal programs. “The Commission asked 

federal agencies to ensure that their programs reached participants and beneficiaries in 

rural and inner-city areas as well as underserved populations, such as African Americans, 

Asian Pacific Americans, Hispanic Americans, Native Americans, migrant and seasonal 

farm workers and their children, and women. It asked federal agencies to find alternate or 

innovative methods of reaching such areas and groups” (USCCR, 2002, p.31). The 

Commission requested that “...federal agencies mount inter-agency coordinated 

outreach” (Ibid, p.33). 

Olmstead. In the Olmstead case, the Supreme Court found that, in certain instances, the 

Americans with Disabilities Act (ADA) requires states to provide services in the 

community for persons with disabilities and finds unwarranted institutionalization of a 

person with a disability discriminatory under the ADA. “ The Executive Order [13217] 

required federal agencies to promote community living for persons with disabilities by 

providing coordinated technical assistance to states; identifying specific barriers in 

federal law, regulation, policy, and practice that impede community participation; and 

enforcing the rights of persons with disabilities” (NCD, 2003a, p.4). The same NCD 

report, entitled Olmstead: Reclaiming Institutionalized Lives, points out that agencies’ 

reports on their programs show obstacles to community-living still exist. Outreach was 

offered as one of many viable agency options. 

Program Accountability. As more people with disabilities from diverse cultures live in 

communities across the country instead of in institutions, federal agency programs will be 

pressed to be responsive to a more diverse constituency. Over a decade ago, Congress 

enacted the Government Performance and Results Act of 1993 (GPRA) to, among other 

things, “improve federal program effectiveness and public accountability by promoting a 

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new focus on results, service quality, and customer satisfaction” (GPRA, 1993, p. 1). 

GPRA required programs to have performance standards and indicators and other means 

of accountability. Taken together, these factors gave ample and compelling reason to

undertake this effort. 

Background. The Cultural Diversity Initiative (CDI) is a NCD response to begin 

addressing problems highlighted in the findings and recommendations of earlier NCD 

reports on the inadequacy of current systems and methods in reaching people with 

disabilities from diverse cultures. CDI is designed to provide opportunities for federal 

agencies and other stakeholders to jointly identify promising outreach efforts and 

strategies for including un-served and under-served populations in the development of 

federal policies, programs, and activities.2

This project includes a review of the literature on outreach and people with disabilities 

from diverse cultures, identification of salient variables in current outreach efforts and a 

summary of challenges to outreach. In this paper, people with disabilities from diverse 

cultures refers to people with disabilities of African-American, Hispanic/Latino, 

Asian/Pacific Islander, American Indian, or Alaska Native heritage. People with 

disabilities from these under-served populations often reside in inner cities or rural, tribal 

and/or remote communities. They may also be economically poor, linguistically diverse 

migrant or seasonal farm workers, and recent immigrants. “People in these communities 

historically have been overlooked in research, poorly served in policy and practice and 

consequently, underachieve on all traditional measures of success and well-being” 

(Zawaiza et al, 2002, p. 4). 

Method and Scope. The extant research and literature was reviewed and analyzed for 

information on outreach. NCD conducted several searches of published literature in ERIC 

databases, Emory University on-line library, Questia on-line library and other on-line 

databases scanning studies from 1988-2003 that met the inclusion criteria (i.e., focused 

on and/or included the key words outreach, minority, disability and/or diversity). NCD’s 

 

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search topics included: outreach to people with disabilities from diverse cultures, 

outreach to people with disabilities, outreach to people from diverse cultures and 

outreach to various under-served populations (e.g., people who are homeless). 

Other advanced searches included specific disability categories (e.g., diabetes) and 

specific races and ethnicities. NCD conducted searches of the web sites of the nine 

agencies included in the CDI project, and sites for people with disabilities from diverse 

cultures to identify relevant unpublished studies, progress reports, briefing papers, and 

position statements. NCD also searched publications of several national databases. A 

pool of relevant literature was scaled down to include only those publications in which an 

outreach intervention was implemented or recommended for an under-served group. 

Studies conducted in other countries or written in a language other than English were 

excluded. 

The paper identifies and discusses outreach definitions, themes, models, and challenges. 

Models are included as examples and should not be considered endorsement of any 

particular approach. Further, systematic evaluation of these examples to determine 

effectiveness is beyond the scope of this review; however, NCD recognizes the 

importance of evaluative research and the need for sets of criteria against which outreach 

approaches can be viewed. NCD found few pertinent publications on outreach programs 

that targeted people with disabilities from diverse cultures and even fewer reports that 

evaluated the effectiveness of any particular approach to outreach. In essence, the 

available studies on outreach did not use as their primary subjects people with disabilities 

from diverse cultural backgrounds. Because such outreach information is sparse, this 

review examines outreach studies from a broader perspective. 

II. Prior NCD Diversity Reports and Findings 

“Effective outreach programs, which are important vehicles for communicating public 

policy and involving underserved groups in the public policy process, can not be 

initiated, implemented and/or sustained without respect, understanding, and sensitivity 

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toward racial, ethnic and geographic diversity” (National Council on Disability, 1997, p. 

2). 

NCD’s leadership in exploring effective ways of addressing issues and concerns of 

people with disabilities from diverse cultures has been accomplished through national 

and regional opportunities for information collection from grassroots community-based 

groups and individuals. For example, in 1992 NCD convened a national conference 

attended mostly by persons from diverse racial and ethnic backgrounds who considered a 

wide range of disability issues. Policy recommendations were developed for improving 

the lives of people with disabilities from diverse cultures and were reported to the public. 

In August 1998, NCD held a series of follow-up public hearings in San Francisco, 

Atlanta and New Orleans to develop recommendations for improving the ability of 

federal policies and programs to serve diverse communities effectively. 

Grassroots witnesses in the series of public hearings reported that: 

[T]he best way to empower minorities with disabilities and their families to take 

full advantage of federal laws, programs, and services is to provide them with 

easy-to-understand, culturally appropriate information about what their rights are 

under various federal laws (e.g., ADA, the Vocational Rehabilitation Act, IDEA, 

the Fair Housing Act) and how best to exercise those rights when a violation 

occurs (National Council on Disability, 1999, p. 3). 

In another report, Lift Every Voice – Modernizing Disability Policies and Programs to 

Serve a Diverse Nation, NCD highlighted a recommendation with particular potential to 

promote joint, culturally responsive federal policies, products, practices and programs. 

The recommendation called for representatives from the U.S. Departments of Education, 

Labor, Health and Human Services, Justice, and Housing and Urban Development, along 

with the Equal Employment Opportunity Commission, Small Business Administration, 

and Federal Communications Commission to work collaboratively. These federal 

agencies were challenged to develop and implement a large-scale outreach and training

 

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program targeted to people with disabilities from diverse cultural backgrounds and their 

families that would provide information (including that referenced above as well as 

information on other opportunities) directly to the target audiences through a series of 

forums, workshops, and seminars across the country. At the writing of this paper, there 

was no evidence of this recommendation having been implemented. 

NCD has generated the following reports that include specific recommendations 

regarding implementation and enforcement of the civil and human rights of people with 

disabilities from diverse cultures: ADA Watch – Year One: A Report to the President and 

the Congress on Progress in Implementing the Americans with Disabilities Act (April 5, 

1993); Meeting the Unique Needs of Minorities with Disabilities: A Report to the 

President and the Congress (April 26, 1993); Achieving Independence: The Challenge 

for the 21st Century – A Decade of Progress in Disability Policy – Setting an Agenda for 

the Future (July 26, 1996); Outreach to Minorities with Disabilities and People with 

Disabilities from Rural Communities (August 4, 1997); Grassroots Experience with 

Government Programs and Disability Policy (October 1, 1998); Lift Every Voice – 

Modernizing Disability Policies and Programs to Serve a Diverse Nation (July 26, 

1999); Back to School on Civil Rights: Advancing the Federal Commitment to Leave No 

Child Behind (January 25, 2000); Carrying on the Good Fight: Summary Paper From 

Think Tank 2000—Advancing the Civil and Human Rights of People With Disabilities 

From Diverse Cultures (August 23, 2000); Closing the Gap: A Ten Point Strategy for the 

Next Decade of Disability Civil Rights Enforcement (August 10, 2000); Implementation 

Plan for Executive Order 13166 – Improving Access to Services for Persons with Limited 

English Proficiency (December 12, 2000); and, People with Disabilities on Tribal Lands: 

Education, Health Care, Vocational Rehabilitation, and Independent Living (August, 

2003). According to an NCD synthesis of its seven reports addressing disability and 

diversity that were issued between April 1993 and January 2000, “people with disabilities 

from diverse cultures have not been full participants in our country’s effort to eliminate 

disparities, remove barriers, and to protect civil and human rights through enactment of 

federal laws and initiatives” (National Council on Disability, 2000b, p. 2) 

 

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Subsequently, in May 2000, NCD convened Think Tank 2000: Advancing the Civil and 

Human Rights of People with Disabilities from Diverse Cultures. In initiating Think 

Tank 2000, NCD indicated, “years of technical assistance and model programs have not 

changed the status of the most disenfranchised. Across the board, people with disabilities 

from diverse cultures receive unequal protection and unequal benefit under the same

federal laws being implemented in the larger disability community.” Think Tank 2000 

was a meeting of representatives from diverse cultural, professional and disability 

backgrounds charged with developing action steps for fully implementing disability 

rights laws at the community level for people with disabilities from diverse cultures and 

other under-served groups. Effective outreach to people with disabilities from diverse 

cultures was among the key issues addressed by the group. 

Within a month of this meeting, NCD convened a second group of participants in the 

Civil Rights Retreat, to build upon the Think Tank 2000 plan of action and the Unequal 

Protection Under Law series of reports.3

 These participants, also from diverse cultural, 

professional and disability backgrounds, were charged with mapping out the elements of 

a ten-point strategy for more effective civil rights enforcement. In summarizing the ten 

point strategy, the group acknowledged that the greatest civil and human rights laws of 

this country have spurred a new era of progress for the nation, but they also recognized 

that much greater progress depends upon overcoming systemic and other artificial 

barriers. 

Select NCD Diversity Findings. The following is a sampling of NCD diversity findings 

provided to highlight the wide spectrum of challenges that exist in disability services 

policy and practice relative to race and ethnicity. These are just a few of the NCD 

documents addressing areas of interest to this report. In The Well Being Of Our Nation: 

An Inter-Generational Vision of Effective Mental Health Services and Supports (NCD, 

2002), language and cultural barriers were noted as follows: “Most state mental health 

systems still lack the ability to serve people of color and language minorities in their own 

 

 

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traditions and their own language. The Surgeon General recently reported ‘striking 

disparities’ in mental health care for racial and ethnic minorities, and that these disparities 

‘impose a greater disability burden on minorities,’ and that people from diverse cultures 

collectively experience a greater disability burden from mental illness than do whites. 

This burden is directly attributable to the fact that people from diverse cultures 

systemically receive less care and poorer quality of care, rather than from their illnesses 

being inherently more severe or prevalent in the community.”(p. 16) 

Investing in Independence: Transition Recommendations for President George W. Bush

(NCD, 2001) addressed cultural diversity by saying: 

The United States consists of a diverse population and we must make a conscious 

effort to meet the needs of all our people. The Bush Administration must establish 

an inclusive agenda for America that makes ongoing and emerging issues that 

impact people with disabilities from diverse cultures an integral part of all work 

regarding federal agency program administration and implementation, public 

policy, and legislative/regulatory work. 

The Investing in Independence report made the following recommendations to effectively 

address cultural diversity among people with disabilities: 

[T]he best way to empower minorities with disabilities and their families is to 

provide them with easy-to-understand culturally appropriate information about 

what their rights are under various federal laws... 

A federal interagency team should develop and implement a large-scale outreach 

and training program targeted to people with disabilities from diverse cultural 

backgrounds and their families. (p. 7) 

Reorienting Disability Research (NCD, 1998) called for a refining of current data: 

Ensure that the broadest range of people with disabilities (including children, 

those with hidden disabilities, and minorities with disabilities) are sampled. To 

understand the unique aspects of all people with disabilities, it is critical that all 

groups be adequately sampled. Frequently, too few people with a particular 

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disability or of a particular age or ethnicity are sampled to allow for statistically 

sound analysis. 

 

 The report also recommended, with regard to the development of new data collection 

instruments, that policy makers "[E]nsure that any new disability questions reflect 

variations in ethnic cultural understanding of disability." (p. 6) 

In Improving the Implementation of the Individuals with Disabilities Education Act: 

Making Schools Work for All of America’s Children (NCD, 1995), testing in the student's

native language and mode of communication was recognized as a critical factor in a 

culturally sensitive evaluation. 

Other Findings on Services to People with Disabilities from Diverse Cultures. NCD’s 

contention that people with disabilities from diverse cultures are under-served is 

supported by other research and reports conducted over the decade of the 1990s. For 

example, researchers Feist-Price (1995) and Kundu (1993) found that barriers such as 

lack of information about resources, few culturally competent service providers, limited 

inclusion in policy making, rehabilitation, or other service provider training, and 

discrimination related to language, low socio-economic status, or national origin, are not 

encountered to the same extent by others in the general population or other people with 

disabilities. As such, the quality of service and outcomes is less favorable for people 

with disabilities from diverse cultures across our nation. 

 

The next section of this paper presents a summary of outreach definitions, themes, and 

models from a broad perspective. This information can be used to inform the 

development and/or expansion of outreach policies and strategies. 

III. Definitions of Outreach

Outreach is conducted on many social levels by numerous organizations, communities, 

governments, and educational institutions. These endeavors range from disability rights

training, health education, international aid, and projects for the homeless, to college 

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recruitment of people from diverse cultures. Although the term “outreach” is used to 

describe all of these programs, a definition of the word is seldom found in the literature. 

The scarcity of efforts to define outreach in the literature makes it an elusive term. As a 

result, entities that employ outreach often interpret and define the concept as it fits into 

their specific programs. A typical dictionary definition of outreach is “a systematic 

attempt to provide services beyond conventional limits as to particular segments of a 

community” (American Heritage Dictionary, 1984). Other definitions emphasize 

particular parts of this generic one and elaborate on various themes; for example, 

definitions in the next sections - the U.S. Department of Agriculture definition and the 

Advocacy definition of outreach - both stress the under-served nature of the targeted 

group. The last definitions described - categorical definitions - emphasize the activity to 

be undertaken; for example, education outreach to teach a particular skill. 

U.S. Department of Agriculture. The U.S. Department of Agriculture (USDA) defines 

“outreach” as “a way of conducting business to ensure that underserved individuals and 

groups throughout the United States and its territories are made aware of, understand and 

have a working knowledge of . . . programs and services. Outreach will ensure that these 

programs and services are equitable and made accessible to all” (USDA, 2003, website). 

Notably, the USDA points out that outreach involves a number of components, including 

an understanding of the under-served customers; using communication techniques that 

are most appropriate for the under-served customers; earning the trust and acceptance of 

the under-served customers; developing partnerships and working relationships with 

under-served customers and their community organizations. 

Advocacy. Outreach has also been defined in terms of reaching out and assisting through 

personal contacts with people excluded from, unaware of, or unreceptive to certain 

information or services (Bannon, 1973). The agency can be a social service group, local, 

state or federal government, educational institution, or community group. Advocacy, an 

essential component of outreach, differentiates traditional forms of community services 

from programs that are conducted to develop those services. Through advocacy, outreach 

 

 

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programs can extend the endeavors of community services to eradicate the problem, or at 

least ameliorate the situation. 

Categorical. Alternatively, Penn State University at Erie (2003) defined outreach by 

dividing the concept into three categories: research, education, and service. Research 

outreach refers to the dissemination of a discovery’s results or the gathering of 

information for a discovery. This can include technology transfer, policy reviews, and 

creative works in the arts. Educational outreach is characterized by teaching or 

demonstrating an expertise in a particular subject to increase the “potential of individuals 

or groups” (Penn State University at Erie, 2003, p.1) Programs such as diabetes nutrition 

classes for African Americans, mobile dental units in low-income communities, and 

smoking cessation classes for incarcerated individuals are all examples of educational 

outreach. Service outreach focuses on performing a function that benefits the targeted

population. These services may include HIV testing, needle exchange for IV drug users, 

and prenatal care for teenage mothers. 

The definitions of outreach described above (USDA, Advocacy and Categorical) 

illustrate the broad range of specifications that organizations use to describe their efforts 

to connect with under-served people. According to Edwards and Livingston a 

comprehensive outreach approach has eleven features: 

1. Target audience(s) 

2. Needs assessments of the target audience(s)

3. Short and long term goals and objectives for responding to the needs 

4. Outreach activities that address those needs 

5. A timetable 

6. A coordinator of outreach activities 

7. Accurate, updated mailing lists with a specific individual named 

8. An evaluation plan to monitor success 

9. Outreach messages and materials that are current, easily understood, positive, 

structured in such a way as to lead the receiver to "the next level" of information, 

need or services, and highlight something unique and realistic 

 - 20 -
10. Repetition of distinct messages in varied forms to maximize outreach to the 

targeted audience 

11. Ongoing research, both formal and informal, for effective outreach 

(Edwards and Livingston, 1990) 

Outreach efforts need not contain all eleven points to be meaningful. Differences in 

definitions and applications of outreach have enabled programs and projects to fit within 

broad parameters. As such, producing a single, all-inclusive working definition of 

outreach may have limited utility and may not be feasible since the concept of the word 

outreach differs among organizations. However, the literature includes recurring themes 

that characterize outreach. These themes may prove to be practical ways to describe and 

discuss outreach efforts as presented in the section that follows. 

IV. Principal Themes of Outreach 

Similar to defining the term “outreach,” pinpointing principal themes may be challenging 

or problematic, given the variability of definitions. Although the literature shows that 

outreach efforts are highly eclectic, major themes include: value placed on target 

population, assessment of needs, advocacy, transformation of social behaviors/attitudes, 

dissemination of information, and the strengthening of communities. 

Value Placed on Target Population. The particular population for whom the outreach

program is intended must be aware that efforts are made to welcome and include their 

perspectives and respect their customs. Outreach projects usually start with the 

identification of a population that would benefit from a certain knowledge or skill 

(Edwards and Livingston, 1990). From the outset, the organization conducting the 

outreach typically has a special interest in the population and believes that the population 

is a valued constituency. 

Assessment of Needs. After the population of interest is identified, an assessment of 

needs is conducted to evaluate the type of outreach that would be most beneficial to the 

community (Wood, 2003). The community may be dealing with numerous concerns. The 

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outreach project must determine which issue has the greatest impact on quality of life and 

which is most likely to be addressed effectively through outreach activities. 

Advocacy. Whether it is teaching caregivers how to cope with family members affected 

by Alzheimer’s or educating seniors on proper vision care, outreach projects are designed 

to disseminate certain information or provide particular services. Bannon (1973) states 

that advocacy serves as the distinguishing factor between “benign forms of community 

help” and outreach. Thus, outreach programs are created on the basis of promoting a 

message that would result in transformation of lives (Edwards and Livingston, 1990). 

Transformation of Social Behaviors/Attitudes. The goal of many outreach projects is 

to transform social behaviors and/or attitudes of the target population. Since some people 

with disabilities from diverse cultures may have negative perceptions of governmental 

agencies, access to programs, services or information may be limited (Kramer, 1992; 

Burroughs, 1998). Therefore, appropriate information regarding the purpose of the 

outreach can break down negative views that can act as barriers to change.

Dissemination of Information. Dissemination of the most current and accurate 

information can be accomplished in several ways. Local organizational newsletters, 

community calendars of events, print media, radio and TV shows, and public service 

announcements are some of the commonly used venues that organizations have found to 

be successful for spreading information widely about an outreach project (Edwards and 

Livingston, 1990). For the distribution of information to be effective, attention to 

language and the cultural relevance of the materials is crucial to the perceived value of

the information. Even when the information is current and accurate, it may be considered 

useless if it does not adhere to the cultural and social context of the audience. 

Strengthening Communities. Strengthening communities is another principal theme of

outreach. In order to achieve stated goals, outreach projects emphasizing this theme must 

develop and/or strengthen the communities that can be responsible for maintaining 

desired behavioral transformations. Communities can include organizations, agencies, 

 - 22 -
coalitions, families, social groups/clubs, and extended support networks such as the 

church. These six themes are evident in the outreach models described in the next section. 

V. Outreach Models 

Based on analyses of available published papers, NCD determined that the information 

on outreach could be grouped into six categories. The models in each category have 

common traits; however, they are included as examples and should not be considered an 

endorsement of any particular approach. Further, systematic evaluation of these examples 

to determine effectiveness is beyond the scope of this review. Among the models of 

outreach described in this paper are: the community-based model, the grassroots model, 

the train-the-trainer model, the peer-to-peer model, the partnership model, and the 

support socialization model. More specifically, the community-based model is one 

wherein focus is placed on building the capacity of current community organizations. The 

grassroots model often uses indigenous, native-speakers in venues not typically used by 

service organizations. The train-the-trainer model trains trusted community members who 

then train other members of the community so that the community maintains the 

necessary knowledge after outreach workers have departed. The peer-to-peer model 

emphasizes the mutual understanding of contemporaries. The partnership model builds 

on the community partner’s expertise and trustworthiness, while the support socialization 

model couples outreach with popular events to attract the community. What distinguishes 

the models from each other is the degree to which they are designed to transform

systems, communities, and lives. Each is described as follows: 

Community-based Model. As the most common method of outreach, community-based 

projects focus on creating relationships with the existing networks of organizations in the 

community prior to conducting outreach. Members of the community are encouraged to 

be involved with all aspects of the project including its design, implementation, and 

maintenance. The involvement of community leaders and organizations provides a level 

of credibility to the outreach project that can enable it to be trusted by the population 

(Wood, 2003). Community members serve as the most valuable resource to outreach 

workers since they are aware of current issues and problems people in the community are 

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facing. The community-based projects are usually site-specific so that people’s cultural 

backgrounds can be well accessed and built into the project. 

When outreach projects seek full community participation in strategies for increasing 

knowledge or changing behaviors, capacity building is enhanced and the community can 

continue the outreach after the project is over. A community adopts the outreach model if 

value is seen in the results. Incorporating existing community groups into the outreach 

project also builds a network of organizations focused on a particular topic or concern. 

(Fife, 2001). Examples of community-based projects are church-based outreach programs 

to African Americans, Project DIRECT, and the Tribal Connections Project. A 

description of these projects is included under examples of outreach programs, models, 

and strategies in Appendix A. 

Grassroots Model. The grassroots model overlaps the community-based model in that it 

also taps into the existing network of organizations to promote outreach efforts. However, 

the grassroots model has a strong emphasis on building the innermost circles of the 

under-served population’s support system. This is in addition to the community level 

support found in the community-based model. Informal gatherings at places such as 

laundromats, beauty parlors, neighborhood meeting venues, and local small businesses 

are used to spread information about the outreach project. Spreading information through 

word of mouth is also common within this model because many of the outreach workers 

are members of the community. 

An intensive effort is required to mobilize the underserved groups to spread information 

in the community. As one example, the El Portal: Latino Alzheimer’s Project was able to 

increase the number of people served through extensive grassroots efforts in Latino 

communities. The community members were reached through brochures, hotlines, and 

extensive residential mailings (Aranda, 2003). Although significant resources must be 

dedicated to the project for the grassroots model to produce desired results, it can be a 

meaningful way to get the whole community involved in promoting outreach efforts. 

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Train-the-Trainer Model. The train-the-trainer model refers to a strategy that outreach 

workers use to ensure that communities will be able to continue working toward the goals 

of an outreach project once the project is over. In this model, the outreach workers teach 

a specific skill or information to trusted members of the community. In turn, those trusted 

members then teach the desired skills to other people. Thus, even after the outreach 

workers are gone, the community can maintain the knowledge needed to address certain 

concerns or needs. 

The Families Who Care project adapted the train-the-trainer model to teach people living 

in rural areas, and African American caregivers how to take care of elderly people who 

are living with conditions associated with aging. Religious and community leaders were 

trained during a two-day course on Alzheimer’s and dementia, and on the support needed 

for caregivers. The trained leaders returned to their own communities and held training 

sessions for caregivers (Coogle, 2002). This model can address cultural adaptation since 

local leaders, who understand the community, are used as the trainers. 

Peer-to-Peer Model. The peer-to-peer model of outreach uses contemporaries of the 

under-served population to conduct the outreach. The peer-to-peer model is based on 

people’s tendency to learn from their familiar colleagues rather than from outside groups. 

Peers tend to share the same age-related concerns, cultural barriers, and attitudes that 

foster a mutual understanding and respect for each other. 

Project INSIGHT adopted the peer-to-peer model in outreach efforts to educate older 

adults on vision loss and the benefits of vision rehabilitation. Senior volunteers were 

trained to run educational programs that promoted healthy vision care, support services, 

and information on rehabilitation. The volunteers were able to educate and motivate their 

contemporaries because they were experiencing similar vision issues and were accepted 

for their ability to relate (Buonocore, 2002). Using the peer population as outreach 

workers minimizes the need to devote resources to addressing cultural, linguistic, and 

attitudinal barriers since the outreach workers are already knowledgeable about the 

people who need to be contacted about receiving the services. 

 - 25 -
Partnership Model. The partnership model provides an opportunity for proponents of 

outreach programs to work with trusted local, regional, public, and private organizations, 

and agencies at all levels of government to address the needs of the population of interest. 

For the partnership model, outreach efforts are centered on developing and expanding the 

existing services that the collaborating entities offer (Fleisher, 1998). By partnering with 

various organizations and agencies, the outreach program is able to reach underserved

populations using the partner’s expertise and community trust. 

For example, through the partnership model the nationally coordinated Cancer 

Information Service Outreach program teamed with organizations and government 

agencies to distribute information on cancer, especially to people from diverse cultures 

and other underserved populations. The CIS staff provided technical assistance tailored to 

the cultural and regional needs of the partners. Coalition building, media placement, and 

access to the most up-to-date cancer information were some of the technical assistance

services offered to partners (Fleisher, 1998). Through these partnerships, the CIS 

Outreach program was successful in reaching under-served people in order to provide 

culturally and regionally appropriate cancer information. 

Support Socialization. Support socialization refers to identifying crucial social activities 

that are popular among the target population and then using these activities as an 

intervention point for the outreach program. The activities are endorsed and supported so 

that the outreach agenda can be coupled with the activities. The activities serve as a 

“hook” that brings people into the outreach project (Hartmann, 2003). The social force of 

the activities appeals to the population’s interests and passions and thus creates the stage 

for social intervention. 

An example of support socialization is the creation of after-school and summer sports 

programs to keep young adults away from drugs and crime. Program developers use 

sports as a social intervention method to teach young people the value of teamwork, 

perseverance, and responsibility. Although the level of impact remains unclear regarding 

 - 26 -
whether sports alone can alter the mindset of at-risk youths, the data suggested that sports 

coupled with other non-sports-based programs could provide the comprehensive 

intervention necessary to improve the future of this population (Hartmann, 2003). 

Arguably, other appealing social activities can be coupled with outreach activities to 

increase the number of people reached and enhance receptivity of the message being 

conveyed. According to the World Wrestling Entertainment, Vince McMahon has teamed 

up with Russell Simmons of the Hip Hop Summit Action Network to promote voter 

registration among young people. Using a support socialization model, they plan to 

sponsor entertainment events coupled with on-site voter registration using the catchy 

phrase, “Two million more by 2004!” (World Wrestling Entertainment, 2003). 

Examples of Legislatively Mandated Federal Outreach. Outreach by a federal agency 

to people with disabilities from diverse cultures was legislatively mandated in the 

Individuals with Disabilities Education Act (IDEA) and the Vocational Rehabilitation 

Act of 1973, as amended, in the early 1990s. Under the IDEA authority, the U.S. 

Department of Education was instructed by Congress to use agency funds to assist 

minority institutions in building their capacity to compete for special education personnel 

preparation grants. The Department currently funds the Monarch Center that uses the 

partnership outreach model. It provides technical assistance and dissemination to promote 

access to and participation by predominantly African American, Hispanic/Latino, and 

other institutions the Department of Education identifies as “minority” institutions in 

discretionary programs authorized by the Individuals with Disabilities Education Act 

(IDEA). According to their project description: “technical assistance services are 

provided by a nationwide cadre of content experts and trainers through workshops, 

seminars, conferences, individual mentoring, and follow-up coaching. Additionally, 

partnerships and cooperative activities are established with a range of [Office of Special 

Education Programs, Technical Assistance & Development] providers, research and 

development projects, national centers, and organizations.” (Office of Special Education 

Programs, 2003, p. 1) 

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Outreach services to entities serving people from diverse cultures to expand research 

capacity were also mandated by IDEA legislation. Two projects of note are located at the 

University of South Florida. The first, Linking Academic Scholars to Educational 

Resources (LASER), will ensure the development and implementation of a research 

agenda on urban special education, with the ultimate goal of improving schooling for 

urban children and youth with, or suspected of having disabilities. The project description 

summarizes their mission as follows: “to: 1) develop cadres of faculty and graduate 

students in minority institutions who will conduct and sustain urban special education 

research/scholarship; 2) develop a national strength-based model that documents 

strategies for enhancing individual and institutional research capacities; and 3) define and 

coordinate a national agenda that narrows the gap between research and urban school 

practice.” (Ibid, p. 1) 

The second project, Engaging Cross-Cultural Leadership in Preparation for Special 

Education (Project ECLIPSE), “is a four-year project designed to recruit and prepare a 

cross-cultural cohort of ethnic minority and majority scholars for careers as urban special 

education researchers and teacher-educators. The project will provide competitive 

research fellowships, opportunities for collaborative research and mentoring seminars, 

and tiered formal and informal mentorship experiences.” (Ibid, p. 1) 

The University of Texas - El Paso (UTEP) in western Texas will implement Project 

AIMED (American Indian Masters degree) to train highly qualified educators to work 

with American Indian students with disabilities. “The purpose of this project is to recruit 

and train 40 teachers to provide culturally and linguistically appropriate educational 

programs to students with disabilities who are American Indian, and to graduate qualified 

educators who will implement a high-quality bilingual special education program on four 

different American Indian reservations: the Tigua of western Texas, the Tortugas of 

southern New Mexico, the Apaches of eastern Arizona, and the Apaches of eastern New 

Mexico.” (Ibid, p. 1) These are just a few of the legislatively mandated, federal outreach 

programs that can provide viable, sustainable changes in under-served communities 

across the country. 

 

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It is NCD’s contention that federal agencies must reach out to customers with disabilities 

from diverse cultures to ensure equality in opportunities for program and service 

awareness as well as participation. To assure that programs and services are sensitive to 

cultural differences, federal agencies should undertake a self-assessment. Programs and 

services need to be systematically evaluated to determine their efficacy in serving people 

most in need. Broadly, such self-assessments should look at how an agency is prepared to 

adjust systems and operations within the context of the country’s changing demographics. 

Some agencies have done just that and are in the vanguard of those interested in 

culturally sensitive and responsive service provision (e.g., Office of Minority Health’s 

Culturally and Linguistically Appropriate Services, CLAS). Some other agencies are just 

beginning this assessment and can learn from the experiences of other agencies. 

VI. Summary of Findings of the CDI Resource Mapping Project 

As a part of its Cultural Diversity Initiative launched in fiscal year 2003, the National 

Council on Disability (NCD) requested the cooperation of nine federal agencies in a 

resource-mapping project. The resource-mapping project was designed to engage each 

agency in a self-assessment of internal and external outreach efforts for broad inclusion 

of people with disabilities from diverse cultures in federal agency-sponsored programs, 

services, products, and activities. NCD asked each agency for assistance with 

documenting outreach efforts already underway within the federal government. 

The self-assessment addressed five areas through responses to an NCD inquiry and 

included: (1) funding, (2) disability and diversity, (3) evaluation plans, (4) information 

accessibility, and (5) ongoing agency research. At the time this paper was developed, 

NCD had received responses from eight of the nine selected agencies. 

Based on review and analysis of the data, NCD made several observations that might 

impact (a) the expansion of these or similar efforts to include additional federal agencies, 

(b) the focus of a planned follow-up dialogue with the federal agencies, as well as (c) the 

design of future data collection work in this area. First, all of the federal agency programs 

and activities addressed disability and/or diversity separately. Second, with a single 

 - 29 -
exception, the federal agency responses to NCD’s inquiry represented only one of several 

offices, divisions or branches within each agency. For example, the U.S. Department of 

Health and Human Services (DHHS) Office of Civil Rights (OCR) responded only for 

OCR; however, absent were responses from other DHHS offices with established work 

and track records in the area of cultural sensitivity and outreach programs such as in the 

mental health area. Third, not all definitions of outreach were consistent with NCD’s 

operational definition that was included as a part of the information provided to each 

agency. Finally, agency information was not always responsive to the areas of inquiry. 

The combined effect of these observations posed a challenge for a systematic analysis of 

the information collected. While the data summaries may not reflect the full scope of 

each agency’s outreach efforts, the information reported in this paper serves as a starting 

point - paving the way for future inquiries and follow-up activities at the discretion of the 

participating agencies. 

For the purposes of the resource mapping inquiry, outreach was defined as 

“a systematic attempt to provide services beyond conventional limits, to particular 

segments of a community.” The “...particular segments of a community” referred to 

people with disabilities from racially and ethnically diverse cultures in the United States

and “services” encompassed anything the named federal agencies do in fulfilling, 

advancing, and/or furthering their mission; i.e., the full range of services, programs and 

activities that the named federal agencies undertake, including informing their consumers 

of their rights under the ADA as they pertain to that agency. 

 

Prior to reviewing published articles from the literature search or reviewing the results of 

the resource mapping inquiry, NCD was, to a great extent, informed of the numerous and 

long-standing outreach efforts initiated within the federal government, particularly in a 

number of offices within the Department of Health and Human Services (including the 

Office of the Surgeon General, the Office of Minority Health and the Office of Indian 

Health), and within the Department of Education (the Office of Special Education and 

Rehabilitative Services). The outreach by these offices to various people with disabilities 

from diverse cultures has often taken the form of a high-priority campaign (e.g., to 

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eliminate health disparities by a time certain). Various programs under HHS exemplify 

each of the outreach models described above and many HHS reports cite the unique 

challenges of reaching people from diverse racial and ethnic backgrounds (US Surgeon 

General, 1999). Outreach strategies are recommended and used frequently, yet are rarely 

systematically analyzed or compared. 

For example, in 1998 the Office of Minority Health (OMH) initiated an assessment of the 

health infrastructure for people from diverse cultures in selected states and territories and 

examined the capacity of these jurisdictions to address health disparities by race and 

ethnicity. The study examined data collection and analysis, cultural competence, access 

to health care and health professions development. Using information from site visits and 

interviews, and information gathered from key informants, the study revealed “outreach 

to the minority communities was the most frequently used approach to engage minorities 

in prevention or health care. Connected to outreach were efforts to provide health 

education through the development of culturally and linguistically appropriate health 

education and promotion materials and through social marketing campaigns” (OMH, 

2003, p. 6) Again, a systematic evaluation of these efforts was not a part of this study. 

The General Accounting Office (GAO) was recently asked by Congress to identify 

promising approaches to address racial and ethnic health disparities, and noted that

outreach is among the many interventions used to address these disparities. “HHS has 

focused on racial and ethnic disparities in health access and outcomes in six areas: cancer 

screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, 

immunizations, and infant mortality. HHS offices and agencies, researchers at 

philanthropic foundations, and private organizations such as employers and health plans 

have efforts underway to try to address racial and ethnic disparities in health care, using 

interventions such as disease management programs, disease prevention programs, health 

literacy and language service projects, and education and outreach programs.” (GAO, 

2003, p. 1) 

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The following is a brief summary of the initial resource mapping inquiry findings. This 

data provide a preliminary scan, albeit spotty, of the state of disability/diversity outreach 

at the national level by the federal government. This data can be used to encourage future 

dialogue and federal inter-agency collaboration wherein agencies may share their 

promising practices with each other and by so doing, enhance their programs and 

ultimately increase involvement of people with disabilities from diverse cultures in 

agency programs. 

Funding. In the eight agencies NCD reviewed, five earmarked funds for disability 

outreach and two agencies earmarked funds for diversity outreach. The Department of 

Transportation (DOT) submitted ten separate responses for its ten divisions; therefore, 

DOT warranted an independent assessment. Eight of the ten DOT divisions earmarked 

funds for disability outreach and six of the ten divisions also earmarked funds for 

diversity outreach. DOT has a one-stop shop Disability Resource Center (DRC) that 

provides services, technical assistance and training to ensure that applicants and 

employees with disabilities in DOT can participate fully in all aspects of DOT work, 

programs, and services. A number of DOT divisions specifically noted in their responses 

that they contribute funds annually to support DOT-DRC. It is not clear if all DOT 

divisions are required to do so. 

Outreach funding levels vary widely across the eight agencies. The levels of outreach 

funds ranged from $0 to $16.5 million. Agencies based their calculation of outreach 

funds on various factors and such factors varied widely across the eight agencies. For 

instance, a number of agencies provided a breakdown of funds devoted to certain 

outreach programs and activities while other agencies accounted for salaries of Full Time

Equivalents (FTE) focusing on disability and/or diversity issues within the agency. 

Additionally, disability and diversity related grant awards by agency was the basis of the 

response provided by one agency. It is also worth noting that the disability outreach funds 

listed by a number of DOT divisions were specifically noted as the funds that the 

particular division contributed annually to support DOT-DRC. 

 - 32 -
A recurring explanation of disability and/or diversity outreach being integrated into an 

agency’s day-to-day work and that such funds are incorporated in the overall agency’s 

outreach budget was echoed by agencies with no funds earmarked for disability and/or 

diversity outreach. 

Disability and Diversity Outreach. The agencies used various strategies to reach out to 

people with disabilities and people from diverse cultures. For example, the Department of 

Housing and Urban Development (HUD) spearheads a diversity outreach program known 

as Community Development Work Study Program (CDWSP). The CDWSP program is 

designed to ensure that graduate students from economically disadvantaged and diverse 

cultural backgrounds pursue careers in community and economic development. The 

Department of Labor (DOL) offers millions of dollars in federal grants supporting 

strategic planning and implementation of activities designed to improve the employment 

and career advancement of people with disabilities. A number of the DOL grants 

specifically target the development of model demonstration programs that will enhance

the capacity of DOL to serve youth with disabilities. Likewise, the Equal Employment 

Opportunity Commission (EEOC) conducts extensive technical assistance and training on 

the Americans with Disabilities Act (ADA) and other disability laws and issues to a wide 

variety of employer, advocacy, legal and general audiences. The Department of 

Education hosts mentees from the DOL sponsored National Disability Mentoring Day 

program as an outreach effort to individuals with disabilities. The program provides an 

opportunity for individuals with disabilities to spend a day learning about the Department 

of Education and the kind of employment opportunities available at the agency. 

DRC is a division within DOT that serves as the agency’s internal one-stop technical 

assistance resource to all of DOT’s programs. DOT-DRC conducts extensive disability 

outreach such as training and educational workshops to DOT’s staff/employee and 

consumer/customers. In addition to the DOT-DCR outreach efforts on behalf of DOT as a 

whole, the other nine DOT divisions provided comprehensive summaries of their 

respective efforts in disability and diversity outreach. An overview of the outreach efforts 

and activities of each of these DOT offices is beyond the scope of this summary; 

however, commonalities included targeted recruitment programs designed to reach 

 - 33 -
people with disabilities and people from diverse backgrounds, disability and diversity 

awareness education for transportation personnel, dissemination of awareness building 

and technical assistance information ranging from safety, security, nondiscrimination and 

access that target air travelers with disabilities from diverse cultures, including those with 

limited English proficiency, through informational websites, fact sheets, telephone 

hotlines, employee trainings and the sponsoring of employee attendance at conferences. 

Evaluation Plan. The agencies use various informal evaluation plans to measure the 

success of their respective outreach efforts. EEOC was the only agency that illustrated a 

formal evaluation plan that measures the success of its strategic objectives. The most 

common evaluation approach among the other agencies was the assessment of whether 

the recruitment of targeted individuals results in an increase in the applications as well as 

the hiring of persons with disabilities and people from diverse cultures. DOT Federal 

Transit Administration (FTA) measures effectiveness based on reduction in the number 

of complaints received and the increase in the number of requests for technical assistance. 

The Department of Justice (DOJ) relies on its Equal Employment Opportunity (EEO) 

report as a method of measuring the success of its outreach efforts. 

Accessibility of Agency Information. All eight agencies that responded to NCD’s 

inquiry indicated to a certain degree that they accommodate various types of disabilities 

and language modes in the ADA and agency information they disseminate. Specifically, 

this entails making print reports, brochures, CD-Roms, videotapes and the agency’s Web 

site accessible through various means, such as the TTY, captioning for audio output on

the Internet, alternative formats such as Braille, and languages other than English. 

 - 34 -
Ongoing Research. Only two of the ten DOT offices and three of the seven other 

agencies responded affirmatively to NCD’s inquiry regarding studies in place or in FY04 

budget requests to examine the nature of the participation of people with disabilities and 

people from diverse cultural groups in an agency’s programs, services and activities. 

EEOC pointed out that while it conducts no formal disability or diversity related studies, 

the agency documents data regarding the disabilities most frequently cited in complaints. 

For ongoing research relating to diversity, SSA noted that the agency is conducting a 

study on how to improve its hiring, promotion and retention of employees with 

disabilities. The Department of Education indicated that most of the agency’s studies 

address diversity in some way and other studies target disability. HUD cited various 

ongoing studies by that address disability and/or diversity. One such study examines the 

trend towards greater integration into the community by providing mainstream housing 

opportunities for persons with disabilities. Another HUD study, the Housing 

Discrimination Study, involves an ambitious effort to measure the extent of housing 

discrimination in the United States based on race or ethnicity. DOT Federal Transit 

Administration listed four ongoing assessment studies: 1) Fare Increase (studies that 

examine if a fare increase is discriminatory and whether equity issues were taken into

consideration when planning for change); 2) Multilingual Information and Signage; 3) 

Equitable Allocation of Resources; and 4) Service Changes. These studies assess specific 

areas that appear to be recurrent concerns with transit customers who file Title VI 

complaints or lawsuits. Finally, DOT Federal Highway Administration indicated that it is 

engaged in a Multi-Year Affirmative Employment Task Force to assess the status of the 

Agency’s current employment posture, identify barriers and under-representation, and set 

goals consistent with the Agency’s responsibilities under various Presidential initiatives 

to employ Hispanic/Latino Americans, Asian Americans, and Americans with 

disabilities. 

Observations. The key elements of each agency’s response to the NCD Resource 

Mapping Inquiry varied across the agencies. Although NCD provided a working 

definition of outreach for the purpose of the NCD Cultural Diversity Initiative (CDI) 

project, instances of varying interpretations of outreach were evidenced in some aspects 

 - 35 -
of the agencies’ responses. There were also several instances where information provided 

was not responsive to the particular inquiry. Readily visible from the eight responding 

agencies’ outreach information was the absence of any form of outreach that 

simultaneously targeted people with disabilities from diverse racial and ethnic 

backgrounds. The outreach programs and activities accounted for were all either within 

the disability category or the diversity category. It is also important to mention that the 

inquiry responses, with the exception of DOT, represent only one of several offices, 

divisions, or departments within each agency. All of this together poses a challenge for 

NCD to systematically analyze the information collected. Therefore, findings in this 

summary do not necessarily reflect the full scope of each agency’s outreach activities.

Next steps in the NCD CDI project include making the data from each agency more 

complete through inter-agency collaboration and further dialogue. One of the goals of the 

ongoing dialogue among agencies on outreach to people with disabilities from diverse 

backgrounds will include developing a reliable and valid set of baseline data for each 

agency on programs, policies, products, and procedures that agencies can share. 

VII. Challenges to Outreach 

This section discusses several factors identified in the literature as challenges and/or 

barriers to outreach efforts. These factors are similar to NCD’s findings and 

recommendations on the overall unmet needs of people with disabilities from 

diverse cultures. Among those factors are the lack of culturally appropriate outreach; 

failure to engage local leaders; the lack of needs assessments; language and 

communication barriers; attitudinal barriers and the shortage of individuals from diverse 

cultures in disability services professions. 

 Lack of Culturally Appropriate Outreach. Based on the multicultural make-up of the 

United States population, outreach programs must make a careful evaluation of a 

particular group’s culture before the start of any endeavor. Differences in culture reflect 

more than a person’s ethnic and racial background. Other relevant factors include place 

of residence and the demographics of people living in the area--age, health status, 

occupation, religion, sex, societal status, and so forth. These group characteristics must 

 - 36 -
be addressed so that the project design is sensitive to cultural factors. Otherwise, 

untailored projects may result in a community backlash towards the program or 

organization. For example, with the high prevalence of certain diseases, such as diabetes, 

among different ethnic groups, certain pharmaceutical companies set out to improve the 

health status of people from diverse cultures by advertising medications. In their publicity 

campaign, the pharmaceutical companies used multilingual transit ads to gain presence in 

communities. Although these ads do circulate in major ethnically diverse areas, their 

success is very limited due to the community’s distrust of the healthcare system. Many 

people with disabilities from diverse cultures feel that the pharmaceutical companies’ 

interests lie in company pocketbooks and not in alleviating community health problems. 

Therefore, without a credible, long term, grassroots-implemented campaign, many 

outreach projects will not yield the desired results (Goetzl, 2000). 

Limited Funding. When only limited funding is available, project leaders are unable to 

gain meaningful entry into the community, translate materials into different languages, 

hire culturally competent coordinators, or distribute information in the most useful 

manner. For instance, to decrease the undesired teenage pregnancy rate among members 

of an identified group, written pamphlets and brochures have been found to be 

unsuccessful in changing behaviors. However, intergenerational programs with limited 

funding that focus on oral traditions were much more helpful in decreasing the incidence 

rate of pregnancy for this population (Fife, 2001). 

Lack of Needs Assessment. To ensure an appropriate foundation is formed prior to 

starting a project, a comprehensive needs assessment must be conducted by the outreach 

program proponents. The literature identified several elements that outreach organizers 

have found to be essential to this process. The project Wood and his colleagues 

conducted (Wood et al, 2003) was geared toward facilitating access to the Internet and 

thus to health information available on the Web, to American Indians living on tribal 

lands. However, the fourteen elements that Wood, et al identified as key elements of a 

tribal community needs assessment may be beneficial to other project leaders entering a 

community. The elements are as follows: 

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1. Stop, look, and listen; enter with respect. 

2. Develop a mental image or picture of the community; onsite visits are essential. 

3. Do your homework; review in advance what is known about the demographics, 

health status and issues, local leadership, technical infrastructure, etc. 

4. Your goal is to understand the local community- its history, governance, 

members, interests, needs, priorities, and spirit. 

5. Identify, search out and connect with local organizations, leaders, and advocatesboth health and information technology (IT)-related. 

6. Understand the health information needs and users in the community and the 

facilitators and barriers to use. 

7. Benchmark the current technical infrastructure (computers, local/wide area

networks, Internet connections, IT staff support) in the community and 

specifically the health sector and related organizations (e.g., schools, libraries). 

8. Get feedback through discussions with leaders, key contacts, elders, and users. 

9. Look for partnership opportunities; be creative, work across boundaries. 

10. Create a partnership plan- with emphasis on sustainability and capacity building. 

11. Prepare technical, training, and outreach plans in collaboration with community 

leaders, and the health and IT staff. Remember it is their community, not yours. 

12. Build on already existing community initiatives and activities (e.g. health fairs, 

disease-specific patient groups, wellness programs) to the extent possible. 

13. Be prepared to be adaptive, iterative, supportive, and open-minded, yet be honest 

and realistic; balance vision with practicality. 

14. Build flexibility into the project schedule; the pacing and timing should give 

priority to the community's needs, capabilities, and readiness.

Overall, the fourteen elements emphasize the importance of respecting and understanding 

the community’s “needs, capabilities, and readiness.” Furthermore, it was deemed 

important to focus on working with community members to create a mutual 

understanding as the basis for a partnership created to produce a mutually beneficial 

project. 

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Failure to Engage Local Leaders. Outreach projects that utilize the community-based 

model can break down barriers to reaching the targeted population by working with local 

prominent and/or trusted leaders. Since many leaders have an understanding of the 

population, they can be valuable resources during the planning and implementation of the 

project. In addition to their expertise, the community leaders and the groups they 

represent can provide a bridge to gaining the trust and acceptance of the people who will 

benefit from outreach. In Burroughs’ research on maximizing African Americans’ 

participation in diabetes research, he cites the benefits of using leaders and local social 

groups for a Community Advisory Board (CAB) that acted as the “guardians” of the 

project. The CAB was created to ensure the community’s interests were served first and 

that the people conducting the outreach were mindful of what the community wanted 

from the outreach efforts (Burroughs, 1998). 

Failure to Use Peers. Another model of outreach that has the goal of cultural 

accommodation built into its approach is the peer-to-peer model. In this method, peers of 

the targeted group are hired to conduct the outreach so that the project employees are 

people ready to work in a manner that acknowledges and respects the culture. The 

success of the “Buddy Project” relied on caseworkers who were mental health survivors 

and who were once homeless reaching out to homeless people with psychiatric 

disabilities. “Outside” caseworkers that tried to reach this homeless population to 

encourage treatment met unreceptive people. The peer caseworkers were able to connect 

on the basis of their own experiences with similar mental and social states (Fisk, 2002). 

Although the sample in the outreach project was small, it nevertheless illustrates the 

promise of using peers of a target population to administer an outreach effort. 

Language and Communication Barriers. Once outreach organizers have a strong grasp 

of the environment, they can then disseminate information and communicate their 

objectives to the people who will be involved in the project. When organizers enter a 

community without listening to what the people want, projects will not reflect the interest 

of the people (Johnson, 1996). Thus, the outreach organizers must make communication 

a priority, since the meaningful outcome of the project can be determined by the degree 

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of open interaction and understanding among the people conducting the outreach and the 

people intended as beneficiaries. Projects for serving non-English speakers, people with 

low-level reading/writing skills, or who have disabilities, must give additional attention 

to removing language and communication barriers. For example, it would be 

counterproductive to reach out to these groups through written materials that are in 

English only and/or that have complex vocabulary and highly technical terms. 

With the rapidly changing demographics of the United States, multilingual information 

has become even more essential and critical than ever. Non-English and non-native 

English speakers face barriers to outreach projects when the informational materials and 

communication efforts have not been properly translated into an appropriate language. 

Translation may be a difficult task for projects that attempt to reach ethnic groups that 

have numerous subgroups with different languages and dialects. For instance, one 

translation would not suffice for the American Indian population. As an example, in Los 

Angeles, California, this population includes over eighty tribes and languages (Kramer, 

1992). Another example nationwide is the Chinese population that also speaks numerous 

dialects and languages such as Mandarin, Cantonese, Gan, Min, Xiang, and Hakka. 

Knowing how to communicate with a particular population and through appropriate 

language is imperative if outreach providers are to communicate their objectives and 

information without seriously compromising a project. In order to customize a project to 

the best interests of the population, resources must be adequate and used to create a 

communication approach that would enable meaningful dialogue. 

Attitudinal Barriers. Misperceptions held by outreach providers and/or by the target 

population can significantly hinder the progress of an outreach project. With negative 

perceptions of the “system” prevalent among people from diverse cultures, a sense of 

distrust is common when outsiders enter communities to provide information or to 

change behaviors without establishing trust and credibility. Along with negative, 

mistrustful views toward the system, some attitudes about disability and people with 

disabilities are barriers that breed prejudices or stereotypes and must be deconstructed. 

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Historical events have also impacted levels of trust and respect. For example, some

American Indians living in urban areas are reluctant to approach government agencies for 

any kind of aid because of the treatment they receive from workers. According to Kramer 

(1992) and NCD (2003), most government workers are unaware of American Indian 

culture and values, so they have been seen as “disrespectful at best or outright hostile at 

worst” (Kramer, 1992, p. 49). Similarly, Hanley (2003) states that, for African 

Americans, under-utilization of mental health services can be attributed, in part, to the 

racist manner in which services are provided by staff. Additionally, African Americans’ 

distrust of the U.S. government and its agencies may be attributed to experiences such as 

slavery and its impact on family and economic opportunity, as well as inhumane 

treatment of group members in studies such as the infamous Tuskegee Project. Hence, for 

outreach projects to survive and prosper among African Americans, the outreach 

administrators must understand what people have encountered and the attitudes towards 

“outsiders” who seek to implement programs (Pickett-Schenk, 2002). 

Besides addressing attitudes towards outsiders, outreach workers themselves must 

become knowledgeable about diverse views on disability. Cultural perceptions of 

disabilities such as diabetes must be acknowledged before the outreach project creates its 

plan of action. For instance, families may conceal diabetes if it carries a social stigma

(Burroughs, 1998). In some diverse cultures, having a disability designates a person as an 

outcast: someone who is incapable of being a functioning member of society. The 

disability may be viewed as the result of bad karma or a form of chastisement resulting 

from the family’s wrongful actions. For example, Tsao (1999) cites the stigma of being a 

“triple minority”, a Chinese woman with a disability, in a society that does not value 

differences. 

Community and partnership models of outreach can alleviate the pressures of attitudinal 

barriers when outreach proponents work with community members to strengthen service 

possibilities. When outreach projects work within the existing community to build a 

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network of services, the outreach projects are able to contribute to a lasting change in 

people’s lives, including integration into the broader community. 

 Shortage of Individuals from Diverse Cultures in Disability Services Professions. 

The lack of diverse service professionals can compromise the quality of service delivery 

to people from diverse cultures. Issues arise when culturally insensitive service providers 

are unaware of offensive actions. However, people with disabilities from diverse cultural 

groups often have demonstrated different levels of trust in service professionals of similar 

backgrounds. 

For instance, one community may perceive a physician as a “figure of legitimized 

authority and power,” (Aranda, 2003, p. 264) while another community may be more 

trusting of nurses than doctors. For the El Portal: Latino Alzheimer’s project, doctors 

were encouraged to provide information and education on Alzheimer’s disease to Latino 

families. This inter-organizational, community-based project utilized the most influential 

person in the Latino community to administer the outreach (Aranda, 2003) rather than 

assume doctors were always the professionals to provide this type of outreach. 

In another example, the Community Partnership Primary Care project (CPPC) required 

physicians and nurse practitioners to acquaint themselves with the community and to 

develop a dialogue with the members of the community (Courtney, 2003). Even though 

the project did not require the health professionals to come from diverse backgrounds, it 

did emphasize the need to learn about the community. The Rural Elder Outreach program

used nurses as caseworkers instead of social workers or psychiatrists to conduct outreach 

visits that linked families caring for elderly citizens to appropriate support services 

(Abraham, 1993). 

Lack of staff from diverse cultures may not only hinder services, but it may also close 

doors for people who need service benefits. In rehabilitation counseling, the absence of a 

bilingual counselor could result in a vague or completely inappropriate assessment of an 

individual’s capabilities, if the counselor is unable to communicate with the consumer. 

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Misunderstanding of the consumer’s cultural background could also prevent the 

counselor from being sensitive to family support issues and cultural perceptions of 

disabilities. Translators may be hired for assessment purposes, but the third party may 

inhibit the consumers from expressing real concerns out of fear or embarrassment 

(O’Brien, 1996). 

Lack of Information about Resources. Obtaining information about necessary 

resources has been one of the barriers that prevent people from accessing services. Since 

there are already few services available specifically for people with disabilities from

diverse cultures, information about existing services in the mainstream needs to be made 

widely available and culturally sensitive. For example, American Indians living in cities 

tend to be overlooked by service agencies because there is no centralized community 

mechanism to connect members of the population to services (Kramer, 1992). 

It is also difficult for people living in rural communities to spread information about 

resources because of secluded and difficult to reach areas. To reach out to the rural 

population, outreach programs must focus on building a community network support 

system that would act as a resource center to disseminate information and provide 

support (Abraham, 1993). 

Lack of Coordinated Services. This can further exacerbate the access gap because 

people receive fragmented instead of comprehensive solutions and services. In addition, 

resources may be duplicated or incomplete when there is no service coordination and this 

leads to frustration and lack of access to, and/or under utilization of, existing services.

For example, lawyers providing “pro bono” work have difficulty contacting people who 

need their services. Without a proper strategy to match people with lawyers, people who 

are economically disadvantaged may be left with huge attorneys’ fees or succumb to the 

legal charges against them. Even when lawyers want to volunteer their time to provide 

free services to their communities, their good intentions are often wasted by the lack of 

usage (Fiorella, 2003). 

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As another example of coordination needs, the El Portal: Latino Alzheimer’s project cited 

fragmented services as a barrier to people receiving comprehensive care for Alzheimer’s. 

It was reported that patients were often transferred to different providers and services that 

required different applications and methods of payment. As a result, patients often forgo 

care or settle on fragmented care instead of enduring the frustrations of dealing with these 

systems (Aranda, 2003). 

Limited Use of Client Focused Services. Assertive outreach has been reported to be 

quite successful in ensuring complete care for people with mental health disabilities. 

NCD noted in an earlier report, From Privileges to Rights, that this also applies to people 

who are mental health survivors (NCD, 2000). Under the client focused method, 

caseworkers focus on the client’s overall quality of life and not just health issues. The 

client-focused approach may be costly since time limits are not set with clients. However, 

the advantage is in improved outcomes where coordination of care for mental health 

patients is important (Winchester, 2002). 

 

Coordination of services through a community center has been reported as especially 

useful for people living in rural areas. Fife and colleagues suggest: 1) the most successful 

and long-lived programs are those that include community participation in their 

conception, design, and implementation, 2) those programs that are most convenient for 

participants to access will be the best received, and 3) feedback from participants and 

modification of these programs in accordance with this feedback should be part of any 

successful program. (Fife, 2001) 

 

Person-centered planning is one way of providing services that is gaining popularity due 

to its culturally responsive strategies. Hasnain, Sotnik and Ghiloni (2003) made three 

outreach recommendations to connect people with disabilities from diverse cultures with 

employment services and supports. They are: 

• Increase marketing efforts in ethnic communities to identify and address the 

unmet needs of underserved and unserved groups due to the lack of outreach to 

these populations by disability-related agencies. 

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• Use non-traditional outreach methods to inform ethnic and underseved 

communities of vocational rehabilitation service options, such as conducting 

informal presentations at community events and festivities, placing job notices 

with grassroots entities, and using ethnic cable stations and radio programs. 

• Conduct focus groups to identify the authentic employment and vocational needs 

of racial and ethnic individuals with disabilities and to incorporate them into 

future programs. 

The person-centered planning project used the following outreach strategies and found 

they contributed to improved outcomes. 

Marketing Strategies 

 Provide examples/stories to explain abstract concepts 

 Take services to the community 

 Work with community-based organizations and identify a contact person as a 

collaborator

 Identify a gatekeeper (a representative of the community) 

 Consult with consumers and their communities 

 Avoid pushing American values of individualism into practice 

 Encourage community ownership 

 Avoid service acronyms and jargon 

Family and Cultural Influences 

 Spend extra time getting to know the family 

 Note family dynamics 

 Include extended family members and kin relationships 

 Address both the needs of individual and family 

 Be prepared to spend time with the family after the meeting 

 Accept refreshments or insistent dinner invitations

Communications Strategies 

 Be sincere, patient, and take the time to listen 

 Avoid ethnic stereotyping 

 Build relationships and trust 

 Avoid rushing or giving that impression because it can lead to distancing

 Respond in a nonjudgmental way 

 Give people time to respond to questions 

 Provide language and other related accommodations 

 Avoid the use of jargon and service delivery terminology 

 Note non-verbal communication cues and gestures 

 Make regular phone calls and meetings 

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Building Capacity 

 Use cultural informants to assist in working with their communities 

 Use the media to inform the community (via ethnic newspapers, ethnic cable and 

radio stations) 

 Work with existing entities where people gather (e.g., community centers, 

religious affiliations, public library)

 Use a community liaison to gather information and to generate possible referrals 

 Use network of consumers/parents to educate and inform other families about 

person-centered planning 

--Outreach Strategies for Working with Consumers and Families from Culturally Diverse 

Backgrounds (Hasnain, Sotnik and Ghiloni 2003, p. 40) 

Demographics. A compelling factor influencing the feasibility of outreach is the rapidly 

changing demography of the United States. Leung (1993) addressed the changing 

demographics and its effect on federal and state service delivery systems’ capabilities 

concerning people with disabilities from diverse cultures. During the last two decades

(1980-2000), the population of the United States has changed significantly with regard to 

its ethnic, racial, and cultural portrait; it has become more diverse and will continue to do 

so. Because of this shift, federal and state service delivery programs must respond to 

different needs that accompany demographic changes. 

Census 2000 data revealed that there were 281,000,000 people residing in the United 

States. One of every three Americans is of Hispanic/Latino, African, Asian, Hawaiian or 

Alaska Native, or American Indian descent. The rate of disability for persons from

diverse groups is substantially higher than for the general population. Therefore, the 

representation of these groups among the overall disability population is 

disproportionately high in comparison to their national Census count. One can reason that 

this disparity will likely continue to increase given the rapid growth of diverse racial and 

ethnic groups nationwide. 

Limited Attention to Interconnectivity. Another challenge of outreach is raising 

awareness about the interconnectivity of disability and other civil rights laws. People 

with disabilities from diverse cultures have experienced some of the worst outcomes in 

terms of self-sufficiency. Yet, civil rights groups rarely take on disability issues and 

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disability groups seldom broach diversity issues as routine agenda items. The literature

also shows a need to equalize opportunity for benefits among people with disabilities 

from diverse cultures and implicates the mentioned barriers to access as well as 

disparities in quantity and quality of services. People with disabilities from diverse 

cultures need to become a focus of federal agency policies, programs, activities and 

outreach efforts. 

People with disabilities from diverse cultures have not realized the promise of full 

inclusion and equal opportunity, although civil rights laws designed to prohibit 

discrimination are in place. For example, “the ADA placed disability discrimination on a 

par with race or gender discrimination, exposed the common experiences of prejudice 

and segregation and provided clear rationale for the elimination of disability 

discrimination in this country” (NCD, 2000a, p. 1). Still, discrimination persists and is 

compounded for people with disabilities from diverse cultures. The phenomena of 

“double jeopardy” and “triple jeopardy” have also been documented in the literature on 

civil and disability rights (Zawaiza et al, 2002). 

As with other civil rights laws, the ADA has created greater recognition and 

understanding of the manner in which the environment can pose discriminatory barriers. 

However, there remain vestiges of misunderstanding which thwart efforts to bring 

movements (i.e., disability rights and civil rights) together in a synergistic partnership. 

Similar to the authority of earlier civil rights laws, “federal agencies have a key 

responsibility to advance the interpretation and implementation of the ADA and other 

disability laws through enforcement actions, policy guidance, and participation in the 

development of precedent-setting court decisions” (NCD, 2000a, p. 1). 

Federal agencies can enhance the effectiveness of programs and, ultimately, the lives of 

consumers, by systematically reaching out to various constituencies in ways that support 

empowerment. Besides the fact that reaching all potential customers is good customer 

service, federal agencies that administer programs and services are required by law to 

serve all Americans, including individuals with disabilities. Other benefits of outreach 

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include increased customer satisfaction, a more positive public relations image in the 

target market and increased market volume. 

There has yet to be a comprehensive multi-agency outreach campaign to connect 

programs and services to people with disabilities from diverse cultures. Such a campaign 

could provide: 

1. Linguistically and culturally appropriate information about programs, services, 

products and contact information. 

2. Opportunities to raise awareness about protections through training and notices of 

civil and due process rights under pertinent federal laws in appropriate formats. 

Cultural Competence. Research on diversity outreach reports advantages for 

organizations to achieve a measure of cultural proficiency in order to improve customer 

service. The term “cultural competence” was coined by Cross (1989) to describe a level 

of proficiency necessary to engage customers effectively. According to Goode (2001),

there is no one definition of cultural competence. Goode explains further that the 

definitions of cultural competence have evolved from diverse perspectives, interests, and 

needs and are incorporated in state legislation, Federal statutes and programs, private 

organizations and academic settings (Goode, 2001). With slight variations, Cross (1989), 

Soriano (1995), and Goode (2001) define cultural competence as “a set of congruent 

behaviors, attitudes, and policies that come together in a system, agency or among 

professionals and enable that system, agency or professionals to work effectively in 

cross-cultural situations. The word culture is used because it implies the integrated 

pattern of human behavior that includes thoughts, communications, actions, 

customs, beliefs, values and institutions of a racial, ethnic, religious, or social 

group. The word competence is used because it implies having the capacity to 

function effectively.” (Goode, 2001, p. 1). 

The four common elements found among the various definitions and concepts of cultural 

competence include: 1) valuing diversity 2) having the capacity for cultural self-

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assessment 3)having the ability to institutionalize cultural knowledge 4) having 

the capacity and willingness to adapt service delivery, reflecting an understanding 

of cultural diversity. 

The dominant characteristics of programs that exemplified culturally competent 

principles/values were: (1) clearly defined philosophy and policies; (2) staffing patterns 

that reflect the ethnic makeup of the population served; and (3) an emphasis on training, 

education, and curriculum development to address cultural issues (Cross et al, 1989, p. 

39). 

Similarly, in adapting the work of Cross et al., Goode (2001) listed several values and 

principles that are considered integral to a culturally competent system of services and 

supports. The list includes: a service delivery system that is driven by culturally preferred 

choice, not by culturally neutral or culturally free interventions; working in conjunction 

with natural, informal support and helping networks within culturally diverse 

communities (e.g., neighborhoods, civic and advocacy associations, local/neighborhood 

merchants and alliance groups, ethnic groups, social and religious organizations, spiritual 

leaders and healers); and, extending the concept of self-determination. The National 

Center for the Dissemination of Disability Research (NCDDR, 1999) referred to 

empowerment as the most critical element of cultural competence. Accordingly, 

empowerment involves an orientation towards partnership with clients or consumers 

rather than assistance bestowed upon a passive recipient. NCDDR also cited Kalyanpur 

and Rao’s contention (1991) that, “Empowerment signifies changing the role of a service 

provider from that of an expert to that of an ally or friend who enables [individuals] to 

articulate what they need . . . It involves caring, which builds supportive relationships; 

respect, which builds reciprocity; and the acceptance of differences, which builds trust” 

(NCDDR, 1999, p. 35). 

Different Cultural Constructs of Disability. Among the factors that deter people with 

disabilities from diverse cultural backgrounds from seeking services are the different 

cultural conceptualizations of disability. Several authors reported that the term

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“disability” is a socially constructed concept (Harry, 2002) and is culturally derived 

(NCDDR, 1999). “There is no uniform definition of disability since the government 

agencies define disability differently” (Smart and Smart, 1997, p. 2). Similarly, Groce (in 

press) observed that all societies do seem to recognize individuals with a disability as 

having some physical, psychological or sensory attribute that distinguishes them from 

other non-disabled members of that society. Gallagher (1990) describes this as an 

“otherness.” However, it is the cultural interpretations of this “otherness” that are of 

concern and these cultural interpretations vary significantly from one society to the next. 

Collectivist vs. Individualistic Orientations. Different interpretations of the etiology 

and meaning of disability and of statutory concepts such as “independence” can affect the 

extent to which people with disabilities from diverse cultures avail themselves of federal 

services and supports. NCDDR (1999) pointed out that individualism is one of the most 

dominant values operating in mainstream American culture. Further “such value is 

evident in rehabilitation counseling and the work of independent living centers which 

primarily focus on the individual with the disability; services, procedures, and rules are 

geared to that person” (NCDDR, 1999, p. 25). 

While mainstream American cultures view disability as an individual matter and 

movement toward independence an appropriate objective, people from diverse racial and 

ethnic groups largely hold collectivist value orientations that emphasize the importance 

of family and interdependence. People from diverse cultures have also reported 

perceptions of disability as a reflection upon and responsibility of the entire family. NCD 

(1999) found that these cultural differences about concepts such as individual 

empowerment, self-sufficiency, independent living, control over one’s life, and minimal 

reliance on others, may be isolating and even offensive to a person with a disability from

a diverse culture if the concepts are not adequately translated and/or presented in a 

culturally appropriate manner (NCD, 1999, p. 15). 

Examples of findings and recommendations from published research include reports 

about Asian Americans by Choi and Wynne (1996), African Americans and 

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Hispanic/Latino Americans by Harry and Leung (1992), Wagner and Tata (1995), and 

Soriano (1995), and American Indians/Alaska Natives by Harry (1992) and NCD (2003). 

Commonalities across these reports include recognition of diversity within groups, key 

roles for families in the lives of people with disabilities, different ways of perceiving 

disability as a concept, and the role of cultural beliefs, customs and traditions that need to 

be respected. 

VIII. Findings and Recommendations 

Findings. The review showed a paucity of empirical studies of outreach as an 

intervention and few studies evaluating the effectiveness of outreach activities. Major 

findings include: 

1. Outreach, as an intervention, is a frequently recommended strategy designed to 

improve services to underserved groups, about which little is known empirically. 

Proponents claim various outreach models show promise but the lack of 

consistency across studies makes it difficult to generalize about the effectiveness 

of any given approach. Rarely is the term operationally defined or empirically 

studied, making it an elusive construct. 

2. Although outreach efforts are highly eclectic, some major themes were found to 

recur in the literature, including: value placed on target population, assessment of 

needs, advocacy, dissemination of information, transformation of social 

behaviors/attitudes, and the strengthening of communities. 

3. The models of outreach found in the literature were categorized as: the 

community-based model, wherein focus is placed on building the capacity of 

current community organizations; the grassroots model, often indigenous, nativespeakers using venues not typically used by service organizations; the train-thetrainer model, in which trusted community members are trained so that the 

community maintains the needed knowledge after outreach workers have

departed. The peer-to-peer model emphasizes the mutual understanding of 

contemporaries; the partnership model builds on the partner’s expertise and 

community trust while the support socialization model couples outreach with 

popular events to attract the community. 

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4. Challenges to comprehensive outreach activities include the lack of culturally 

appropriate outreach; failure to engage local leaders; the lack of needs 

assessments; language and communication barriers; attitudinal barriers and the 

shortage of individuals from diverse cultures in disability services professions. 

5. Self-reports by the nine participating agencies did not fully capture the depth and 

breadth of current national disability/diversity outreach efforts in those 

organizations. Several agencies used outreach as an intervention strategy 

extensively while others only utilized it periodically, if at all. Methodological 

limitations constrained the ability to make definitive statements about the nature 

and prevalence of outreach programs to diverse people with disabilities. 

6. All of the federal agency programs and activities reported addressed disability 

and/or diversity separately. With a single exception, the federal agency responses 

to NCD’s questionnaire represented only one of several offices, divisions or 

branches within each agency (e.g., the U.S. Department of Health and Human 

Services (DHHS) Office of Civil Rights (OCR) responded only for OCR; 

however, absent were responses from other DHHS offices with established work 

and track records in the area of cultural sensitivity, and outreach programs in 

areas such as mental health.) Not all definitions of outreach were consistent with 

NCD’s operational definition provided as a part of the information given to each 

agency. Finally, agency information was not always responsive to the areas of 

inquiry. The combined effect of these observations posed a challenge for a 

systematic analysis of the information collected. 

7. Research syntheses are needed to systematically identify and evaluate outreach 

programs for people with disabilities from diverse cultures. The scarcity of such 

research precludes empirically based decisions about the efficacy and 

effectiveness of outreach efforts. Research syntheses are useful in that they 

increase the accessibility of the research and facilitate its interpretation and use in 

the field (Gersten, 2000). 

Recommendations. The following recommendations are offered to address the apparent 

gaps in knowledge about outreach and people with disabilities from diverse cultures.

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1. Outreach Feasibility Studies: The feasibility of federal agencies using outreach 

as a reliable and valid strategy to reach people with disabilities should be 

systematically analyzed. The prevalence of disability in diverse cultures is 

significant and, in most cases, disproportionately high. Equitable representation of 

people with disabilities from diverse cultures in federal programs can be enhanced 

by reaching out to these populations in culturally sensitive ways, evaluating the 

effectiveness of the efforts, disseminating the results and encouraging replication 

of promising practices. 

2. Assessment of Federal Outreach Competencies: Encourage federal agencies to 

undertake a comprehensive self-assessment of outreach competencies and a 

thorough inventory of outreach practices to gauge future training and 

development needs and to share promising practices, policies, products and 

procedures with other federal agencies. 

3. Support Interagency Outreach Collaboration: Encourage interagency 

agreement and funding on outreach knowledge information dissemination and 

exchange. Form a technical expert panel comprised of interagency representatives 

and grassroots leaders to develop and pilot cultural competency standards and 

outreach guidelines for federal agencies and their partners. Ensure the meaningful 

participation of people with disabilities from diverse cultures in the development 

of programs and strategies. 

4. Efficacy Research: Research is needed to weigh the comparative effectiveness 

of specific strategies, including comprehensive outreach, in improving services, 

access and protections for diverse populations with disabilities. 

Future Outreach Research. Organizations looking to enhance their outreach activities 

could benefit from exploring the challenges to outreach presented here in tandem with 

issues relevant to people with disabilities from diverse cultures. Future research in this 

area might include recommendations discussed in a recent report (Zawaiza et al, 2002) on 

infusing issues of people with disabilities from under-served communities into a transdisciplinary research agenda in the behavioral and social sciences such as the following: 

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• Study the degree of awareness in the field of disabilities (e.g., researchers, 

providers, consumers) of cultural factors that impact services, treatment, families, 

consumers, and the community. 

• Research the correlation between program capacity, increased cultural 

competence, and outcomes (e.g., in educational achievement, economic selfsufficiency, social and community involvement) of people with disabilities from

diverse cultures. 

• Examine various training models for personnel preparation to identify salient 

features and promising practices. 

• Analyze why the existing body of research regarding promising practices has not 

made a difference in the employment and self-sufficiency of people with 

disabilities from diverse cultures. 

• Explore to what extent health, poor health care, and subsequent development of 

secondary conditions play a role in the ability of people with disabilities to secure 

and maintain employment. 

• Does the effectiveness of programs improve for people from diverse cultures as 

diverse professionals move into professional service systems?

• What role might under-utilized venues and leaders, e.g., community churches and 

ministers, play in improving outcomes for people with disabilities from diverse 

cultures? 

• What does Universal Design mean in the context of redesigning service delivery 

systems and systemic change? Is it equivalent to cultural competence? What are 

the elements of a system that is useable and accessible by the population at large 

including people who are of diverse ethnic, racial, cultural, and socio-economic 

backgrounds?

Conduct a meta-analysis and synthesis of studies aimed at understanding the complexities 

and special needs of people with disabilities from diverse cultures. 

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IX. Conclusions 

NCD, in its role of advising and assisting the executive branch, undertook this review to 

continue collaborating with federal agencies working to enhance their outreach efforts.

This paper identified several definitions of outreach and the principal outreach themes 

found in the literature. Models of outreach were described, creating a common lexicon of 

terms and meanings with examples of outreach types or models that elaborated on these 

descriptions. 

Over the past twenty-five years, the landscape of disability policy has become rich with 

consumer rights, protections, and opportunities, yet the systems in place to serve people 

with disabilities from diverse cultures still are unable to provide appropriate services. 

During the years covered by research addressed in this paper, national administrations

have sought to provide an inclusive, representative government that values this country’s 

diversity and fosters access to the mainstream of American life. Despite these efforts,

inequalities in education, employment, housing and other areas persist as central issues. 

This report has clear implications for research and policy focused on people with 

disabilities from diverse cultures. It identifies outreach themes and models that may have 

a positive impact on some of the more intractable obstacles facing people with disabilities 

from diverse cultures and the federal agencies mandated to serve them. Future 

contributions to the outreach knowledge base can only serve to further articulate the 

principal themes and models of--as well as illuminate the many challenges to--outreach. 

NCD intends to continue to help ameliorate this dismal situation. In addition to 

facilitating inter-agency dialogue on outreach to this population (see, 

http://www.ncd.gov/newsroom/advisory/cultural/forum_summary.html), NCD’s Cultural 

Diversity Initiative will include the development of a toolkit containing resources helpful 

in developing comprehensive federal outreach programs. 

“I am not an advocate for frequent changes in laws and constitutions, but laws and 

institutions must go hand in hand with the progress of the human mind. As that becomes 

more developed, more enlightened, as new discoveries are made, new truths discovered 

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and manners and opinions change, with the change of circumstances, institutions must 

advance also to keep pace with the times.” --Thomas Jefferson 

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Appendix A 

Examples of Outreach Programs, Models, and Strategies 

American Indian Elders Outreach Project- A demonstration outreach program

created to assess the needs and concerns about aging and service delivery to 

American Indians living in Los Angeles, CA. Contact information: Josea 

Kramer, Los Angeles Department of Community and Senior Citizens 

Services, 3175 W. 6th St, Los Angeles, CA 90020, (213) 738-2671 (Kramer, 

1992). 

Assertive Outreach- A client-focused approach to mental health that sends 

workers into the community to contact people in their own environment. The 

service focuses on working together to build on clients’ strengths – not simply 

on providing treatment, but also on improving each client’s quality of life and 

standard of living and improving community awareness and acceptance 

(Winchester, 2002). 

The Buddy Project- A support socialization project that employed formerly 

homeless persons with psychiatric disabilities in a community-based mental 

health outreach team to participate in social activities with “difficult to 

engage” homeless persons with psychiatric disabilities. This interaction is 

particularly important in community reintegration (i.e. housing, clinical and 

rehabilitative services) of this population. Contact information: Deborah Fisk, 

Connecticut Mental Health Center, 235 Nicoll St., New Haven, CT 06511, 

(203) 789-6912 x 306 (Fisk, 2002). 

Cancer Information Service Outreach Program- A nationally coordinated outreach 

program that uses the partnership model to establish an alliance with 

government, nonprofit, and private organizations to reach underserved and 

minority populations (Fleisher, 1998). 

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Church-based Support Groups- Utilizes church as an intervention setting to reach 

out to African American families coping with mental illness (Pickett-Schenk, 

2002). 

El Portal: Latino Alzheimer’s Project- An inter-organizational, community based 

collaborative model that is aimed at enhancing the community’s capacity to 

provide culturally and linguistically competent educational, medical, social, 

and support services for Latinos affected by dementia, and their caregivers. 

The project coordinated mainstream and ethnic agencies in Los Angeles 

County to provide appropriate services to Latino families affected by 

dementia (Aranda, 2003). 

Families Who Care Project- A train-the-trainer approach to outreach designed to 

educate African American and rural family caregivers in dealing with 

dementia in a culturally competent way. (Coogle, 2002). Contact information: 

Constance L. Coogle, Virginia Center on Aging, Virginia Commonwealth 

University, P.O. Box 980229, Richmond, VA 23298-0229 

Health-Peers- Utilizes retired senior volunteers to conduct programs designed to 

teach seniors how to reduce their risk factors for cardiovascular disease, 

cancer, osteoporosis, and injuries (Buonocore, 2002). 

Healthy Living, Healthy You- An educational program in Canada that identifies 

the specific health needs of immigrant women and then effectively presents 

the requested information. Although the information was presented only in 

English, the extensive use of audiovisual aids and translators enabled the 

project to educate the women on numerous health concerns (Murty, 1998). 

Peer-driven Intervention Model- Uses people from the target population as the 

caseworkers who are responsible for achieving the goals of the project. This 

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insures a built-in cultural and ethnic accommodation to the entire population 

of interest (Broadhead, 1995). 

Project DIRECT (Diabetes Interventions Reaching and Educating Communities 

Together)- A community-based outreach to maximize participation of African 

Americans in diabetes research. This project used a Community Advisory 

Board to build trust in the community and to ensure that the project would 

give back to the people (Burrus, 1998). 

Project InSights- A community vision education and outreach program that uses 

adult volunteers to educate their peers about age-related vision loss and the 

benefits of vision rehabilitation for the visually impaired (Buonocore, 2002) 

Project TAP outreach- A program funded by the U.S. Department of Education. 

This project provided outreach services to day care center staff to provide 

appropriate services to children with developmental delays who are from

diverse cultures. (U.S. Department of Education). 

Radio Outreach- Use of the radio as a mode of outreach to different target 

populations through the eclectic variety of stations. This type of marketing 

provides the outreach with mass exposure while being cost effective 

(Ingerstoll, 2003). 

Rural Elder Outreach Program- A health oriented outreach program that links 

formal and informal community-based services, volunteer efforts, and 

academic resources to strengthen the ability of the communities in the rural 

South to care for their elderly (Abraham, 1993). 

Seniors Teaching Seniors Program- Trains older adults to become teachers, 

leaders, and organizers of a broad range of educational programs for their 

peers (Buonocore, 2002). 

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Sport as a Social Intervention- Use of sports as an intervention method to 

encourage minorities, particularly African American youth, to improve their 

progress in school (Hartmann, 2003). 

Stay Well Program- Trained senior volunteers to conduct health promotion 

programs at senior centers, libraries, and other sites where older adults 

congregate (Buonocore, 2002). 

Targeted Outreach- A peer sponsored outreach program aimed at increasing 

minority’s awareness and interest in student organizations. This technique was 

used by a peer counselor organization to recruit people of color (Garman, 

1997). 

Tribal Connections Project – A National Library of Medicine initiated community 

based outreach program that established or improved Internet connections on 

Indian reservations and Alaska Native villages to develop tribal access to 

health information available on the Internet (Wood, 2003). 

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Endnotes

 1

 MiCASSA and HR 2032 and S 971, Medicaid Community-based Attendant Services 

and Supports Act. 

2 The research project reviewed the outreach efforts of the following departments: The 

Departments of Education, Labor, Transportation, Justice, Health and Human Services, 

Housing and Urban Development and the Social Security Administration, Equal 

Employment Opportunity Commission, and the Federal Communications Commission.

3

A series of NCD reports documenting findings and recommendations on the Air Carrier 

Access Act (ACAA), the Individuals with Disabilities Education Act (IDEA), and the 

Americans with Disabilities Act (ADA). Each showed that despite great strides toward 

equality, people with disabilities still deal with major ongoing barriers of discrimination 

and the consequences of weak federal enforcement. 

 

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