1
|
Zagler J, Yu N, Cleland A. "The system allows for it to happen": the experiences of human service workers in engaging with Aboriginal participants of the National Disability Insurance Scheme. Disabil Rehabil 2024:1-9. [PMID: 39126154 DOI: 10.1080/09638288.2024.2388874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE The purpose of this study was to explore the experiences of human service workers (HSWs) in engaging with Aboriginal participants of the National Disability Insurance Scheme (NDIS). METHODS Semi-structured interviews were undertaken with HSWs engaging with Aboriginal participants of the NDIS on Kaurna Country (Adelaide, South Australia). Data were analyzed using thematic analysis. RESULTS In total, n = 10 HSWs participated in the study. Three themes impacting upon HSWs ability to effectively engage with Aboriginal participants were identified: (1) lack of access to training, support and supervision, (2) difficulties in navigating assessment and intervention, and (3) limited availability of culturally specific services. CONCLUSIONS This study contributes to Australian disability policy and practice with insights gained from the experiences of human service workers engaging with aboriginal participants of the NDIS. Systemic changes are required within policy and funding arrangements to create a system flexible enough to respond to the needs of Aboriginal Peoples with disability.
Collapse
Affiliation(s)
- Jonathon Zagler
- Justice and Society, University of South Australia, Magill, South Australia, Australia
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Nilan Yu
- Justice and Society, University of South Australia, Magill, South Australia, Australia
| | - Amy Cleland
- Justice and Society, University of South Australia, Magill, South Australia, Australia
| |
Collapse
|
2
|
Kelly C, Dansereau L, FitzGerald M, Lee Y, Williams A. Inequities in access to directly-funded home care in Canada: a privilege only afforded to some. BMC Health Serv Res 2023; 23:51. [PMID: 36653820 PMCID: PMC9847438 DOI: 10.1186/s12913-023-09048-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. METHODS Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. RESULTS The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. CONCLUSIONS Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language.
Collapse
Affiliation(s)
- Christine Kelly
- grid.21613.370000 0004 1936 9609Department of Community Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Lisette Dansereau
- grid.21613.370000 0004 1936 9609Department of Community Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Maggie FitzGerald
- grid.25152.310000 0001 2154 235XDepartment of Political Studies, University of Saskatchewan, Saskatoon, SK Canada
| | - Yeonjung Lee
- grid.254224.70000 0001 0789 9563Social Welfare, Chung-Ang University, Seoul, South Korea ,grid.22072.350000 0004 1936 7697School of Social Work, University of Calgary, Calgary, AB Canada
| | - Allison Williams
- grid.25073.330000 0004 1936 8227School of Earth, Environment & Society, McMaster University, Hamilton, ON Canada
| |
Collapse
|
3
|
Roesler A, Probst Y. Insights from dietitians providing individualised dietetic care to people living with disabilities: A single site exploration in the community. J Hum Nutr Diet 2023; 36:657-663. [PMID: 36604984 DOI: 10.1111/jhn.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND The present study aims to share insights and lessons learnt by dietitians providing individualised care to people living with disabilities in the community. This is important to build the evidence to inform dietetic best practice standards. METHODS The study involved a cross-sectional data audit of dietitian reports for clients living with a disability seen at a metropolitan dietitian clinic in South Australia. Content analysis of the reports was conducted. Initial coding occurred deductively followed by inductive qualitative content analysis. RESULTS Thirty-one participants consented to have their dietitian reports included in the study. Intellectual disabilities made up the majority (48%) of disabilities reported in the sample. Nutrition diagnoses predominantly related to energy imbalances (54%). Barriers to dietary change included a reliance on others and limitations in the disability support system. Kitchen skills and cooking were the most often employed nutrition strategy suggested by dietitians. Following dietetic intervention, improvements were seen in the types of foods people with a disability consumed along with changes to their body weight. Dietitians reported the importance of effective communication with the care team and providing engaging methods to instigate dietary behaviour change. CONCLUSIONS The present study highlights that there are opportunities to build on individualised dietetic care provided to people living with disabilities. These opportunities include addressing excess energy consumption, fostering collaborations with other health providers and understanding how to better work with carers. Further research is required to understand how to progress these opportunities forward and to understand the generalisability of the findings.
Collapse
Affiliation(s)
- Anna Roesler
- Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Yasmine Probst
- School Medical, Indigenous and Health Sciences, Wollongong University, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| |
Collapse
|
4
|
Douglas J, D'Cruz K, Winkler D, Topping M, Bucolo C, Finis C. Development and preliminary evaluation of a novel participant-led video intervention to train disability support workers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2414-2425. [PMID: 35920613 PMCID: PMC10087932 DOI: 10.1111/hsc.13961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/10/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
This paper describes the development and preliminary evaluation of a novel participant-led video (PLV) intervention to support people with disability (PWD) and cognitive and communication impairments to communicate their needs and preferences to their disability support workers. The PLV intervention was designed following a scoping literature review and workshop with PWD and close others. Subsequently, it was piloted with five primary participants with acquired brain injury and cognitive and communication impairments, five close other supporters and five facilitators. An independent mixed methods evaluation of the pilot was conducted with participants, close others and facilitators. All pilot evaluation participants reported high levels of satisfaction with the PLV intervention (mean ratings: primary participants 4.5/5.0; supporters 5.0/5.0; facilitators 4.8/5.0). When primary participants and their supporters were asked to rate how likely they were to recommend the PLV intervention, responses were extremely positive with the mean rating exceeding eight on a 10-point scale. Qualitative analysis of interview data revealed the PLV to be a person-centred experience for primary participants that was structured around sense of self and included having a voice and taking control in directing their lives, personal growth through participation and feeling validated through the experience. The production and use of PLV training resources has much potential to improve the delivery of support and maximise support outcomes by enabling people with cognitive and communication impairments to have choice and control, set their own goals and direct their supports. Further research is required with a larger sample size and longitudinal evaluation of participant outcomes.
Collapse
Affiliation(s)
- Jacinta Douglas
- La Trobe UniversityMelbourneVictoriaAustralia
- Summer FoundationMelbourneVictoriaAustralia
| | - Kate D'Cruz
- La Trobe UniversityMelbourneVictoriaAustralia
- Summer FoundationMelbourneVictoriaAustralia
| | - Di Winkler
- La Trobe UniversityMelbourneVictoriaAustralia
- Summer FoundationMelbourneVictoriaAustralia
| | - Megan Topping
- La Trobe UniversityMelbourneVictoriaAustralia
- Summer FoundationMelbourneVictoriaAustralia
| | | | | |
Collapse
|
5
|
Cashin A, Pracilio A, Wilson NJ. A proposed remedy to the inequitable representation of nursing in the Australian National Disability Insurance Scheme. Collegian 2022. [DOI: 10.1016/j.colegn.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
Burgemeister FC, Hokke S, Crawford SB, Hackworth NJ, Nicholson JM. Does place matter in the implementation of an evidence-based program policy in an Australian place-based initiative for children? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5786-e5800. [PMID: 36073974 PMCID: PMC10087806 DOI: 10.1111/hsc.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 07/26/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Policy-mandated requirements for use of evidence-based programs (EBP) in place-based initiatives are becoming more common. Little attention has been paid to the geographic aspects of uneven market development and urbanicity in implementing EBPs in large place-based initiatives. The aim of this study was to explore geographic variation in knowledge, attitudes, and experiences of service providers who implemented an EBP policy in Australia's largest place-based initiative for children, Communities for Children. A cross-sectional online survey of Communities for Children service providers was conducted in 2018-2019, yielding 197 participants from all of Australia's eight states and territories. Relationships between two measures of 'place' (thick and thin market states; urbanicity: urban, regional and remote) and study-designed measures of knowledge, attitudes, and implementation experiences were analyzed using adjusted logistic and multinomial regressions. Participants from thin market states (outside the Eastern Seaboard) were more resistant to the policy and experienced greater implementation challenges than those from thick market states (Eastern Seaboard). Regional participants reported greater knowledge about EBPs but experienced greater dissatisfaction and implementation challenges with the policy than both urban and remote participants. Our study found that place does matter when implementing EBPs in a place-based initiative.
Collapse
Affiliation(s)
- Fiona C. Burgemeister
- Judith Lumley Centre, School of Nursing & MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Stacey Hokke
- Judith Lumley Centre, School of Nursing & MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Sharinne B. Crawford
- Judith Lumley Centre, School of Nursing & MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Naomi J. Hackworth
- Judith Lumley Centre, School of Nursing & MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- Parenting Research CentreEast MelbourneVictoriaAustralia
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Jan M. Nicholson
- Judith Lumley Centre, School of Nursing & MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Queensland University of TechnologyBrisbaneQueenslandAustralia
| |
Collapse
|
7
|
Prowse A, Wolfgang R, Little A, Wakely K, Wakely L. Lived experience of parents and carers of people receiving services in rural areas under the National Disability Insurance Scheme. Aust J Rural Health 2022; 30:208-217. [PMID: 35076137 DOI: 10.1111/ajr.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/15/2021] [Accepted: 12/18/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the lived experience of parenting or caring for a person with a disability receiving services under the National Disability Insurance Scheme in rural Australia. DESIGN Qualitative study guided by the phenomenology of practice. SETTING Rural areas of New South Wales (MM 3-7). PARTICIPANTS Participants were 5 parents and one carer of people receiving National Disability Insurance Scheme services who resided in rural New South Wales. DESIGN Participants engaged in a semi-structured interview about their lived experiences caring for someone accessing services under the National Disability Insurance Scheme in rural New South Wales. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS Three themes emerged from the data analysis. 'More than a disability' described the absence of understanding of family and carer challenges when National Disability Insurance Scheme plans were designed and implemented. 'Fighting for funding and services' described that while the National Disability Insurance Scheme increased funding support, parents and carers experienced limited support navigating the National Disability Insurance Scheme. 'Cold as Ice' encompassed parents' and carers' descriptions of their relationship with National Disability Insurance Scheme staff. These challenges were further impacted by the limited choice and availability of health service providers in rural areas. CONCLUSION Participants felt that the National Disability Insurance Scheme had created additional stress and confusion in their lives and at times had hindered the achievement of the goals of their family member with a disability. The voices of parents and carers is a critical one, and it is essential that rural parents' and carers' needs are considered and supported in future planning of the National Disability Insurance Scheme.
Collapse
Affiliation(s)
- Alexandra Prowse
- University of Newcastle, School of Health Sciences, Callaghan, NSW, Australia
| | - Rebecca Wolfgang
- University of Newcastle Department of Rural Health, Tamworth, NSW, Australia
| | - Alexandra Little
- University of Newcastle Department of Rural Health, Tamworth, NSW, Australia
| | - Katrina Wakely
- University of Newcastle Department of Rural Health, Tamworth, NSW, Australia
| | - Luke Wakely
- University of Newcastle Department of Rural Health, Tamworth, NSW, Australia
| |
Collapse
|
8
|
Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 278] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | | | | |
Collapse
|
9
|
Kavanagh MM, Norato L, Friedman EA, Armbrister AN. [Planning for health equity in the Americas: an analysis of national health plansPlanejamento para equidade em saúde nas Américas: uma análise dos planos nacionais de saúde]. Rev Panam Salud Publica 2021; 45:e106. [PMID: 34737769 PMCID: PMC8559664 DOI: 10.26633/rpsp.2021.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/29/2021] [Indexed: 12/05/2022] Open
Abstract
Cada vez más se reconoce que las mejoras en la salud y el bienestar no se han registrado por igual en las poblaciones de la Región de las Américas. En este artículo se analizan 32 políticas, estrategias y planes nacionales del sector de la salud en diez áreas diferentes de la equidad en la salud para comprender, desde una perspectiva, cómo se está abordando el tema de la equidad en la Región. Se encontraron variaciones significativas en la sustancia y estructura de la manera en que los planes de salud manejan el problema. Casi todos los países incluyen explícitamente la equidad en la salud como un objetivo claro y la mayoría de los países abordan los determinantes sociales de la salud. Los procesos participativos documentados seguidos en la formulación de estos planes abarcan desde inexistentes hasta extensos y bien concebidos. Muchos planes incluyen políticas sólidas centradas en la equidad, como las destinadas a mejorar la accesibilidad física de la atención de salud y aumentar el acceso asequible a los medicamentos, pero ningún país incluye todos los aspectos examinados. Los países consideran a las poblaciones marginadas en sus planes, aunque solo una cuarta parte incluye específicamente a los afrodescendientes y más de la mitad no abordan a los pueblos indígenas, incluso algunos con grandes poblaciones indígenas. Cuatro incluyen atención a los migrantes. A pesar de que incluyen objetivos sobre la equidad en la salud y datos sobre las inequidades como parámetros de referencia, menos de la mitad de los países se fijan objetivos con plazos específicos para reducir las desigualdades absolutas o relativas en el ámbito de la salud. Rara vez se encuentran en los planes mecanismos claros de rendición de cuentas, como la educación, la presentación de informes o mecanismos para hacer respetar los derechos. El compromiso casi unánime entre los países de la Región de las Américas con la equidad en la salud ofrece una oportunidad importante. Aprender de los planes más sólidos centrados en la equidad podría proporcionar una hoja de ruta para los esfuerzos tendientes a traducir las metas amplias en objetivos con plazos definidos y, finalmente, aumentar la equidad.
Collapse
Affiliation(s)
- Matthew M Kavanagh
- Departamento de Salud Internacional Universidad de Georgetow Washington D.C. Estados Unidos de América Departamento de Salud Internacional, Universidad de Georgetown, Washington, D.C., Estados Unidos de América
| | - Laura Norato
- Departamento de Salud Internacional Universidad de Georgetow Washington D.C. Estados Unidos de América Departamento de Salud Internacional, Universidad de Georgetown, Washington, D.C., Estados Unidos de América
| | - Eric A Friedman
- Departamento de Salud Internacional Universidad de Georgetow Washington D.C. Estados Unidos de América Departamento de Salud Internacional, Universidad de Georgetown, Washington, D.C., Estados Unidos de América
| | - Adria N Armbrister
- Organización Panamericana de la Salud Washington, D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América
| |
Collapse
|
10
|
Yates S, Dickinson H, Smith C, Tani M. Flexibility in individual funding schemes: How well did Australia's National Disability Insurance Scheme support remote learning for students with disability during COVID-19? SOCIAL POLICY & ADMINISTRATION 2021; 55:906-920. [PMID: 33362318 PMCID: PMC7753504 DOI: 10.1111/spol.12670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/30/2020] [Accepted: 11/12/2020] [Indexed: 06/12/2023]
Abstract
Individualized funding schemes are designed to offer people with disability greater choice and control over the services they receive. In this research, we report on a survey of over 700 families to explore how Australia's National Disability Insurance Scheme (NDIS) supported children and young people and their families to learn remotely during COVID-19. NDIS funding to support education during the first COVID-19 lockdown period forms an important case study of the flexibility of individualized funding schemes. Our results suggest that participant experiences varied widely, with some people able to make the changes they required and others left with a significant service gap. This shows that individual funding schemes are not necessarily more flexible than traditional systems in an emergency situation-useful flexibility depends on many factors, such as clarity of information giving, all actors having a shared message, proactive support of flexibility initiatives, and participants' ability to quickly navigate a complicated system. This research also highlights problems with the interface between the NDIS and mainstream services such as education.
Collapse
Affiliation(s)
- Sophie Yates
- Public Service Research Group, School of BusinessUNSW CanberraCanberraAustralian Capital TerritoryAustralia
| | - Helen Dickinson
- Public Service Research Group, School of BusinessUNSW CanberraCanberraAustralian Capital TerritoryAustralia
| | - Catherine Smith
- Melbourne Graduate School of EducationUniversity of MelbourneMelbourneVictoriaAustralia
| | - Massimiliano Tani
- Public Service Research Group, School of BusinessUNSW CanberraCanberraAustralian Capital TerritoryAustralia
| |
Collapse
|
11
|
Kavanagh MM, Norato LF, Friedman EA, Armbrister AN. Planning for health equity in the Americas: an analysis of national health plans. Rev Panam Salud Publica 2021; 45:e29. [PMID: 33936182 PMCID: PMC8080947 DOI: 10.26633/rpsp.2021.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/29/2021] [Indexed: 01/15/2023] Open
Abstract
There is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.
Collapse
Affiliation(s)
- Matthew M Kavanagh
- Georgetown University Washington D.C. United States of America Georgetown University, Washington D.C., United States of America
| | - Laura Fernanda Norato
- Georgetown University Washington D.C. United States of America Georgetown University, Washington D.C., United States of America
| | - Eric A Friedman
- Georgetown University Washington D.C. United States of America Georgetown University, Washington D.C., United States of America
| | - Adria N Armbrister
- Pan American Health Organization Washington D.C. United States of America Pan American Health Organization, Washington D.C., United States of America
| |
Collapse
|
12
|
Lewis AK. Cultural and Linguistic Diversity Among Children and Families Referred for Diagnostic Evaluation of Developmental Delay and Disability: Implications for Service Delivery. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Amelia K. Lewis
- Disability Specialist Unit Sydney Local Health District Sydney New South Wales Australia
| |
Collapse
|
13
|
Topping M, Douglas JM, Winkler D. Factors that influence the quality of paid support for adults with acquired neurological disability: scoping review and thematic synthesis. Disabil Rehabil 2020; 44:2482-2499. [PMID: 33049158 DOI: 10.1080/09638288.2020.1830190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Theoretically, individualised funding schemes empower people with disability (PWD) to choose high quality support services in line with their needs and preferences. Given the importance of support, the aim of this scoping review was to understand the factors that influence the quality of paid disability support for adults with acquired neurological disability. METHODS A comprehensive scoping review of the published literature from 2009-2019 was conducted on five databases: Medline, CINAHL, Embase, PsycINFO and Scopus. RESULTS Of the 3391 records retrieved, 16 qualitative articles were eligible for review. Thematic synthesis of the findings revealed six key interrelated themes: (1) choice and control, (2) individualised support, (3) disability support worker (DSW) qualities, (4) DSW competence, (5) PWD - DSW relationship, and (6) accessing consistent support. The themes depict factors influencing the quality of paid disability support from the perspective of PWD, close others and DSWs. CONCLUSIONS Although the evidence base is sparse, the factors identified were in line with international rights legislation and policy ideals. The findings can provide insights to PWD hiring and managing support, and facilitate the delivery of quality disability support. Further research is required to understand the interactions between the factors and how to optimise support in practice.Implications for rehabilitationThe quality of paid disability support is determined by a multitude of interrelated factors influenced by the disability support worker's qualities and competencies, the interaction between the person with disability and the disability support worker, as well as external contextual factors.Optimising choice and control for adults with acquired neurological disability and providing individualised support should be a significant focus for disability support workers.Training modules for disability support workers can be informed by five of the identified themes: (1) choice and control, (2) individualised support, (3) DSW qualities, (4) DSW competence and (5) the relationship between PWD and DSWs.
Collapse
Affiliation(s)
- Megan Topping
- Living with Disability Research Centre, La Trobe University, Bundoora, Australia.,Summer Foundation Ltd, Blackburn, Australia
| | - Jacinta M Douglas
- Living with Disability Research Centre, La Trobe University, Bundoora, Australia.,Summer Foundation Ltd, Blackburn, Australia
| | - Dianne Winkler
- Living with Disability Research Centre, La Trobe University, Bundoora, Australia.,Summer Foundation Ltd, Blackburn, Australia
| |
Collapse
|
14
|
Lewis SB, Florio T, Srasuebkul P, Trollor JN. Impact of disability services on mental health service utilization in adults with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1357-1367. [PMID: 32864851 DOI: 10.1111/jar.12756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Can disability support services (DS) facilitate access to mental health services (MHS) for people with intellectual disability? This study utilized 10 years of data from 6,260 persons in NSW who had received DS and specific MHS to quantify the relationship between DS utilization and MHS utilization in adults with intellectual disability and co-existing mental illness. RESULTS Receipt of DS was associated with greater odds of accessing community mental health (CMH) services (36%, 95% CI 29%-43%) but not psychiatric admissions. Age, sex and social disadvantage did not affect the odds of psychiatric admission or CMH use. Individuals living in a remote area had greater odds of CMH use and lesser odds of psychiatric admission. CONCLUSIONS Receipt of DS was associated with greater CMH but not psychiatric hospital utilization in people with intellectual disability and co-existing mental illness.
Collapse
Affiliation(s)
- Sunali B Lewis
- School of Psychology, Australian College of Applied Psychology, Sydney, NSW, Australia
| | - Tony Florio
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
15
|
Kelly C, Jamal A, Aubrecht K, Grenier A. Emergent Issues in Directly-Funded Care: Canadian Perspectives. J Aging Soc Policy 2020; 33:626-646. [PMID: 32321374 DOI: 10.1080/08959420.2020.1745736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Direct Funding (DF) provides individuals with a budget to arrange their own home care instead of receiving publicly arranged services. DF programs have evolved in a number of countries since the 1970s. In Canada, while small-scale DF programs have existed since the early 1970s, the research on these programs remains limited. Responding to gaps identified by an umbrella review and using a health equity framework, this research extends the knowledge base on DF programs from a Canadian perspective through an environmental scan. The research asks: What are the features of DF programs across Canada? What are the emerging issues related to program design and policy development? The study employed a qualitative environmental scan design, gathering data through questionnaires and semi-structured interviews (n = 23). The findings include a summary table describing features of 20 programs and two interview themes: a lack of information on DF workers and concerns about the growing role of home care agencies. This study has the potential to contribute to long-term health equity monitoring research. The findings suggest that as DF expands in Canada, promoting hiring from personal networks may address inequities in rural access to home care services and improve social outcomes for linguistic, cultural, and sexual minorities. However, the findings underscore a need to monitor access to DF programs by people of lower-socioeconomic backgrounds in Canada and discourage policy design that requires independent self-management, which disadvantages people with compromised decision-making capacities.
Collapse
Affiliation(s)
- Christine Kelly
- Assistant Professor, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aliya Jamal
- Master's Student, School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Katie Aubrecht
- Canada Research Chair Tier 2 Health Equity & Social Justice and Assistant Professor, Department of Sociology, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Amanda Grenier
- Norman and Honey Schipper Chair in Gerontological Social Work and Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Carey G, Malbon ER, Weier M, Dickinson H, Duff G. Making markets work for disability services: The question of price setting. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e716-e723. [PMID: 31215103 DOI: 10.1111/hsc.12780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/06/2019] [Accepted: 04/15/2019] [Indexed: 06/09/2023]
Abstract
Personalisation schemes and associated markets for social care have been a growing trend in industrialised countries over recent decades. While there is no single approach to marketisation of social care and personalisation, often funds are devolved to clients of care services to be used to purchase services directly from market. Such arrangements are vulnerable to market failures and 'thin' markets, causing the need for stewardship of the social care markets. We present findings from a 2018 survey of 626 care service providers in the Australian National Disability Insurance Scheme market on their experience of market conditions. Over 46% of respondents listed 'addressing pricing' as their top action for addressing market problems. Qualitative findings show that central price setting is detached from service delivery realities, affecting service quality and capability building potential. We argue that devolution of price setting to, or at least flexibility and discretion at, the local level is likely to be a key to solving pricing dilemmas in personalisation schemes.
Collapse
Affiliation(s)
- Gemma Carey
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Eleanor R Malbon
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Megan Weier
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Helen Dickinson
- Public Service Research Group, University of New South Wales, Canberra, Australia
| | - Gordon Duff
- National Disability Services, Melbourne, Australia
| |
Collapse
|
17
|
Malbon E, Carey G, Meltzer A. Personalisation schemes in social care: are they growing social and health inequalities? BMC Public Health 2019; 19:805. [PMID: 31234807 PMCID: PMC6591823 DOI: 10.1186/s12889-019-7168-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background The connection between choice, control and health is well established in the literature on the social determinants of health, which includes choice and control of vital health and social services. However, even in the context of universal health and social care schemes, the ability to exercise choice and control can be distributed unequally. This paper uses the case of the Australian National Disability Insurance Scheme (NDIS) to examine these issues. The NDIS is a major policy reform based on an international trend towards personalisation in social care. It aims to increase choice and control over services and supports for people who have or acquire a permanent disability, thereby boosting citizen empowerment and improving health and social outcomes. Methods The research is a structured review of empirical evidence on the administration and outcomes of the NDIS to identify how social factors constrain or enable the ability of individuals to exercise choice within personalised care schemes. Results We show how social determinants of health at the individual level can collide with the complexity of policy delivery systems to entrench health inequalities. Conclusion Many social policy reforms internationally focus on improving empowerment through enabling choice and control. However, if administrative systems do not take account of existing structural inequities, then such schemes are likely to entrench or grow social inequality. Our research indicates that more attention must be given to the design of policy delivery systems for personalisation schemes to ensure health equity.
Collapse
Affiliation(s)
| | - Gemma Carey
- Centre for Social Impact, UNSW, Kensington, Australia.
| | | |
Collapse
|
18
|
Smith JA, Herriot M, Williams C, Judd J, Griffiths K, Bainbridge R. Health promotion: A political imperative. Health Promot J Austr 2019; 30:133-136. [DOI: 10.1002/hpja.242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- James A. Smith
- Wellbeing & Preventable Chronic Diseases DivisionMenzies School of Health Research Darwin Australia
- Menzies Centre for Health PolicyUniversity of Sydney Sydney Australia
| | | | | | - Jenni Judd
- Centre for Indigenous Health Equity ResearchCentral Queensland University Rockhampton Australia
- School of Health Medical and Applied SciencesCentral Queensland University Bundaberg Australia
| | - Kalinda Griffiths
- Wellbeing & Preventable Chronic Diseases DivisionMenzies School of Health Research Darwin Australia
- Centre for Big Research Data in HealthUniversity of New South Wales Sydney Australia
- Faculty of Health SciencesUniversity of Sydney Sydney Australia
| | - Roxanne Bainbridge
- Centre for Indigenous Health Equity ResearchCentral Queensland University Rockhampton Australia
- School of Health Medical and Applied SciencesCentral Queensland University Bundaberg Australia
| |
Collapse
|
19
|
Smith J, Griffiths K, Judd J, Crawford G, D'Antoine H, Fisher M, Bainbridge R, Harris P. Ten years on from the World Health Organization Commission of Social Determinants of Health: Progress or procrastination? Health Promot J Austr 2018; 29:3-7. [DOI: 10.1002/hpja.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- James Smith
- Menzies School of Health Research Casuarina NT Australia
- University of Sydney Sydney NSW Australia
- Charles Darwin University Casuarina NT Australia
- Australian Health Promotion Association Adelaide SA Australia
| | - Kalinda Griffiths
- Menzies School of Health Research Casuarina NT Australia
- University of Sydney Sydney NSW Australia
| | - Jenni Judd
- Central Queensland University Rockhampton QLD Australia
| | - Gemma Crawford
- Australian Health Promotion Association Adelaide SA Australia
- Curtin University Perth WA Australia
| | | | | | | | | |
Collapse
|