The choice agenda in the Australian supported housing context: a timely reflection

The last 30 years has seen significant developments in the Australian housing sector for people with disabilities. Despite much change in the sector, and advancements in disability services, the range of current supported housing options for younger Australian adults with a neurological disability remains vastly under-developed. This is despite a widely accepted and endorsed recognition that, as is the general population, people with all forms of disability have a right to housing of their choice. This paper presents a timely critique of the key actions made by the Australian disability and housing sectors and subsequently proposes a more informed approach to supported housing design and development: one that is based on a comprehensive understanding of consumer housing priorities and preferences, and is conducive to a person’s biopsychosocial health

Design principles in housing for people with complex physical and cognitive disability: towards an integrated framework for practice

To develop a research-based environmental framework to guide the design and construction of suitable residential dwellings for individuals with complex disability. An environmental approach to housing design and development recognises that there are physical, psychological and social components relating to housing design, dwelling location and the neighbourhood context, and that these elements interact to affect the physical, psychological, and social wellness of individuals. Following theoretical review and synthesis, a comprehensive set of design features that are conducive to residents’ wellness and quality of life are described. It is clear that housing design and development for people with complex disability ought to consider the physical, social, natural, symbolic, and care environment in relation to housing design, dwelling location, and the neighbourhood context for improved housing outcomes. An integrated housing design and development framework is presented. It is hoped this practical matrix/evaluative tool will inform future inclusive housing design and development decisions in Australia and internationally. The application of this framework is especially relevant to political climates striving to achieve design innovation to increase housing choice for people with complex disability

Geographical information systems: an effective planning and decision-making platform for community health coalitions in Australia

The development of locally-based healthcare initiatives, such as community health coalitions that focus on capacity building programs and multi-faceted responses to long-term health problems, have become an increasingly important part of the public health landscape. As a result of their complexity and the level of investment, it has become necessary to develop innovative ways to help manage these new healthcare approaches. Geographical Information Systems (GIS) have been suggested as one of the innovative approaches that will allow community health coalitions to better manage and plan their activities. The focus of this paper is to provide a commentary on the use of GIS as a tool for community coalitions and discuss some of the potential benefits and issues surrounding the development of these tools

Breaking traditions of practice: workforce challenges in implementing disability service standards within purpose-built accommodation for younger adults

Inadequate community housing and support for adults under 65 years with complex health needs often leads to residential aged care placement. In 2006, Australian government authorities funded a range of supported housing alternatives for younger adults requiring access to 24-hour support including the Integrated Living Model (ILM). The ILM provided purpose-built accommodation for 10-20 people and represented a change in practice from traditional 24/7 nursing care toward a more holistic, individualised approach. Aim: Examine workforce challenges in implementing disability service standards (DSS) within an ILM. Method: Thematic Analysis of workforce practices was conducted by coding staff interviews (n=20) against the prevailing DSS. Results: Emerging challenges identified against each standard were: expectation management; coordination; client expertise; blurred boundaries; role confusion; valued status beyond client; unclear practice boundaries; multilayered communication; reflective practices; and mixed service model responses. Conclusion: This ILM setting requires workforce development in rights-based practice, personalisation and effective communication. Key paradigm shifts are also recommended

Vocational rehabilitation following traumatic brain injury: a quantitative synthesis of outcome studies

This study is a quantitative synthesis of research relating to Traumatic Brain Injury (TBI) and employment outcomes. Using broad inclusion criteria, 26 studies were selected for review. The study comprised a combined sample of 3688 participants aged 16 years and above who had sustained a TBI as an adult. Aggregate results across selected studies indicated that individuals with TBI returned to competitive employment and other productive activities earlier with vocational intervention than without intervention. The current synthesis also demonstrated that the use of a narrow definition of return-to-work (i.e., full-time competitive work only) produced more apparent unemployment than an inclusive definition (i.e., any competitive work or productive activity). Although this finding is not surprising, full-time employed persons seemed more likely to remain 'employed' over time compared to those who were in any type of employment or productive activity. These findings have important implications regarding the timeliness of vocational interventions and highlight the need for competitive employment (full-time) preparation to ensure optimal long-term outcomes following TBI. The definition of employment and the nature of pre-injury employment is crucial to any interpretation of return-to-work in TBI. The current study also highlights the importance of measuring employment outcomes using multiple points over time, rather than single data points or first return-to-work

Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators

People with complex chronic conditions frequently need to navigate their own way through and around a fragmented and siloed health care system. Care coordination is a defi ning principle of primary care and is frequently proposed as a solution to this problem. However, care coordination requires more time and effort than primary care physicians alone have the capacity to deliver. Although registered nurses (RNs) are skilled team members who can be included in the delivery of coordinated patient care, any model of care coordination that involves RNs needs to fi t within the existing health care delivery system. In this study, which used qualitative techniques based on grounded theory and included face-to-face interviews and open coding and theoretical sampling until data saturation was achieved, and which was one component of a larger action research study, we aimed to gain an understanding of the difference between usual chronic condition care and the work of chronic condition care coordination. The researchers interviewed general practitioners and RNs from various general practice sites who were actively coordinating care. Four unique processes were found to defi ne care coordination implementation, namely: (1) moving beyond usual practice by spanning boundaries; (2) relationship-based care; (3) agreed roles and routines among relevant parties; and (4) committing to chronic condition care coordination. The fi ndings suggested that existing professional and organisational cultures required negotiation before care coordination could be integrated into existing contexts. The challenge, however, seems to be in acknowledging and overcoming professional practice boundaries that defi ne existing care through refl ective practice and shared resourcing