Making it work: a workforce guide for disability service providers

This guide provides strategies for disability service providers to draw upon when creating and sustaining a workforce of support workers to meet the aims of DisabilityCare Australia and implement the National Disability Insurance Scheme Act 2013. In particular, the Guide is designed to assist providers develop a workforce strategy that will enable support workers to: i)    support the independence and social and economic participation of people with disability ii)    provide reasonable and necessary supports, and iii)    enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports. The essence of DisabilityCare Australia is to be supportive, responsive, flexible and creative. This Guide offers a wealth of ideas and practical suggestions without being prescriptive. It includes ideas relating directly to support workers as well as to their interactions with service users and their employing service provider, and there are varying cost implications. The Guide does not attempt to provide one integrated workforce management strategy. Instead, it is intended that providers will take away ideas to develop their own unique workforce strategy relevant to their environment and provider type. The aim of this guide is to contribute to the development of enthusiastic, competent and satisfied workers who will embrace the aims of DisabilityCare Australia and provide excellent support to people with disability. The Guide is organised around the following themes: Communication Organisational culture, values and expectations Recruitment Flexible, responsive and creative work Training, mentoring and support Recognition and incentives Career Pathways Authors: Dr Carmel Laragy, RMIT University Associate Professor Paul Ramcharan, RMIT University Associate Professor Karen Fisher, Social Policy Research Centre, University of NSW Karen McCraw, CEO, Karden Disability Support Foundation Robbi Williams, CEO, Purple Orange (Julia Farr Foundation

The social relations of a health walk group: an ethnographic study

It is already well established that regular walks are conducive to health and wellbeing. This paper considers the production of social relations of regular, organized weekly group walks for older people. It is based on an ethnographic study of a Walking for Health group in a rural area of the United Kingdom. Different types of social relations are identified arising from the walk experience. The social relations generated are seen to be shaped by organizational factors that are constitutive of the walks, the resulting culture having implications for the sustainability of the experience. Since there appears to be no single uniting theory linking group walk experiences to the production of social relations at this time, the findings are considered against therapeutic landscape, therapeutic mobility and social capital theorizing. Finally, implications for the continuance of walking schemes for older people and for further research are considered

COVID-19 in congenital heart disease (COaCHeD) study

Background: COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care.// Objective: Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes.// Methods: Multicentre UK study undertaken 1 March 2020–30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation.// Results: There were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)).// Conclusions: Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

Experiences of restrictive practices: A view from people with disabilities and family carers

&nbsp;&nbsp; •&nbsp;Under the Disability Act 2006, the Senior Practitioner seeks to manage one interface between individual freedom and public good, that is, to manage behaviour that is of danger to the person with disability or to others, or to their property. • Authorised Program Officers (APOs) are required to identify ‘behaviours of concern’ and to say, within a Behaviour Support Plan (BSP), what restrictive interventions will be used to change the person’s behaviour. • In this research, focus groups and interactive theatre work with twenty-three people with disabilities and interviews with eleven family carers were undertaken to find out their views on restrictive practices and behaviours of concern. This report of the views and analysis of these views shows that: • Feeling safe is a priority for people with disabilities and their family carers; yet many people feel unsafe. • Many behaviours seen as being ‘of concern’ can be understood better as adaptive behaviours to maladaptive environments. These behaviours can be seen as forms of ‘resistance’ or ‘protest’. • Behaviours of ‘resistance’ and ‘protest’ should be seen as legitimate responses to difficult environments and situations, and not a reason for restrictions designed to change the person and their behaviour. • Restrictive practices challenge human rights and give rise to concerns over social justice. Changing the person and their behaviour should not be the starting point. Rather, it is necessary initially to examine how to change services, systems and environments as a means of changing behaviour. Authors: Paul Ramcharan, Co-ordinator Research and Public Policy, Australian Centre for Human Rights Education, RMIT University Karen Nankervis, Associate Professor, Division of Disability Studies, RMIT University Maria Strong, Self Advocate and co-researcher, Division of Disability Studies, RMIT University Alan Robertson, Self Advocate and co-researcher, Division of Disability Studies, RMIT University &nbsp; Download Experiences of restrictive practices (doc 465.5 KB) Experiences of restrictive practices - easy read (doc 64.5 KB) Experiences of Restrictive Practices (PDF 469.3 KB) Experiences of restrictive practices - easy read (PDF 109.2 KB) &nbsp

Understanding the NDIS: a history of disability welfare from ‘deserving poor’ to consumers in control

The National Disability Insurance Scheme (NDIS) is the only national scheme of its kind in the world. Its introduction has been likened to a generational shift with some saying the scheme’s impact will be similar to that of Medicare. Choice and control are the fundamental principles of the NDIS, which represents a break from previous welfare approaches. The scheme aims to empower consumers with a disability to use funds given to them to purchase services that reflect their lifestyle and aspirations. It’s hoped these changes will see the service sector reflect the interests of people with disabilities. This is the culmination of society’s evolution towards respecting, protecting and ensuring the rights of people with a disability

Human rights education in Australia: reflections on the meaningful application of rights and values in practice

Human rights are statements of values and putting them into practice can present a range of challenges. In Australia, these challenges are compounded by the widespread belief that human rights are only at issue somewhere else. In 2006 human rights legislation entitled the 'Charter of Human Rights and Responsibilities Act', based on the British Human Rights Act, was introduced in the Australian state of Victoria, locating the acknowledgement of, and respect for, civil and political rights firmly 'in our own backyard'. The Australian Centre for Human Rights Education (ACHRE) developed a teaching and training programme to assist the implementation of this legislation. In this practice note we analyse how ACHRE has used education to advance the civil and political rights covered by 'the Charter' from guiding principles into practical applications in organizational settings. We explore the pedagogical approach by reviewing teaching and learning materials and participant responses to activities. We evaluate how effective the programme is in achieving understandings of how to apply human rights in local organizational contexts. We argue that the methodology is strengthened by using a human rights based approach to the design, documentation and application of course materials. This approach offers the potential for wide scale application of human rights values and principles in organizational settings. Importantly, it develops an understanding of human rights as relevant in local contexts

Judging the Ethics of Qualitative Research: Considering the ‘Ethics as Process’ Model

Decision-making about the ethics of qualitative research is problematic where the research design is emergent, and the balance between risks and benefits for research subjects are difficult to ascertain prior to study implementation. The discourses of health/medical research ethics and those of social research are shown to be divergent and, furthermore, where ethics committees tie themselves to the health/medical model of ethical decision-making, qualitative research approaches can be disadvantaged. Having demonstrated the dual discourses and their relevance to qualitative research ethics, a critical review of current approaches to maximising the success of qualitative research proposals being considered for approval by ethics committees is undertaken. This leads to a call for a system of monitoring qualitative research so that the ‘benefit to risk’ ratio is always on the side of benefit. This has implications for the ways in which ethics committees are organised and the ways in which they function