Responding to the ‘thin' markets of rural and remote disability services. Quantitative and spatial analysis is part of the picture

Policymakers, funding bodies and service provider agencies require objective indicators to ensure quality, equity and access. We sought to depict the availability of rural and remote allied health and disability services in Queensland using one such indicator (spatial analysis) to explore concepts related to ‘thin’ markets, including market sufficiency and market diversity. Our findings suggested, counter-intuitively, that more remote settings had greater disability service sufficiency and diversity than larger regional centres. While on careful interpretation this face-value observation can be rationalised, it can also be used to influence decision making to the detriment of remote area consumers and communities. Most importantly, it does not adequately incorporate consumer, community and service provider realities in remote areas. This led us to consider additional factors that should routinely be acknowledged to broaden planning for disability services in rural and remote settings. We suggest a number of additional considerations that should also inform policy, funding and service planning decisions. The challenge facing all stakeholders is to develop new indicators that are meaningfully reflective of the realities of rural and remote consumers, families, communities and service providers, as well as market realities

Responding to health care complexity: suggestions for integrated and interprofessional workplace learning

This report highlights complexity in health care and the relevance of integrated and interprofessional care and learning. It is proposed that appropriate workforce training in response to complexity should be contextually relevant and workplace integrated, and should focus on building interprofessional capability for reflective practice and critical thinking. This training should be interprofessional and foster systems thinking. It is suggested that the World Health Organization\u27s International Classification of Functioning, Disability and Health (ICF) is a useful integrating framework

Front-Line Worker Perspectives on Indigenous Youth Suicide in Central Australia: Contributors and Prevention Strategies

Articles are licensed under the terms of the Creative Commons Attribution 2.0 Generic (CC BY 2.0) license (http://creativecommons.org/licenses/by/2.0/) which permits unrestricted distribution and reproduction in any medium, providing that the work is properly cited.ABSTRACT: This paper presents the perspectives of Central Australian workers in relation to Aboriginal youth suicide. Interviews were conducted as part of a project to develop a data collection system and referral pathway for Indigenous youth suicide and suicide attempts. Twenty-two in-depth interviews were conducted with a range of practitioners who have front-line contact in suicide related issues (such as police, primary health, community support, youth services). The interview schedule reflected the project aims, but the transcripts revealed a much broader consideration of the issue. This paper reports on a secondary analysis of the data. The two major themes of salient contributing factors and service prevention strategies provide insights into these workers’ attempts to understand and respond to this issue. There is a need to ensure workers develop and maintain strong networks, are well informed about local socio-cultural factors and skilled to work with local elders, traditional healers and community members, and are well supported in their roles to ensure longevity and relationships. The results contribute to the Aboriginal and Torres Strait Islander suicide prevention sector with particular relevance for remote Australia

Evaluation of the state-wide implementation of an allied health workforce redesign system: Utilisation of the Calderdale framework

Background: Increasing demand for allied health services is driving workforce redesign towards greater productivity within budgetary constraints. To date, there has been limited research into workforce redesign tools at an organisational level. The aim of this article was to evaluate an implementation of The Calderdale Framework for state-wide service delivery workforce redesign within allied health settings across Queensland. Method: A multi-phase methodology with mixed methods of data collection was used. This included analysis of documents, staff surveys, and semi-structured, in-depth interviews with staff from work units utilising the Framework across the state. Findings: The primary mechanisms for implementation were staff training and provision of centralised resources. Across the state, all health services engaged in training and most completed associated workforce redesign projects. However, the number and type of projects varied across the state as did the successful projects. Feedback from staff indicated the structured nature of the framework was viewed positively, but was time intensive to perform. Local contextual factors heavily influenced workforce redesign success. Conclusion Key factors pertaining to state-wide workforce redesign include: providing coordinated and centralised systems to support staff, ensuring adequate training, prioritising the development of key local staff, and proactively managing local contextual factors

Remote disability and leprosy services via basic communications technology

This short report describes the rationale for and process of developing and refining a manual to assist professionals, workers, families, volunteers, and people with disabilities in low- and middle-income countries (LMIC), to make better use of appropriate and accessible communications technology. The manual is intended as a basic step towards enhancing disability and leprosy services where they are not accessible and/or affordable to people in remote areas of LMIC. A semi-formal process comprising several layers of feedback and review, and subsequent preliminary evaluation was encouraging. It suggests that the pilot version warrants further implementation as well as more formal research to rigorously evaluate the effectiveness and to refine the content of the manual

Influences on Participation in Life After Spinal Cord Injury: Qualitative Inquiry Reveals Interaction of Context and Moderators

Background: Greater understanding of the influences on participation in life after spinal cord injury (SCI) can inform rehabilitation theory and practice. Careful qualitative inquiry can reveal subjective meanings associated with the relevant experiences, strategies, and perceptions of those with lived experience of SCI. A search of literature, followed by a thematic synthesis of qualitative studies, was undertaken to bring together these insights in a meaningful way. Methods: The research question guiding the literature review and synthesis was, What do people with SCI perceive to be the influences on their participation in life? Three critical databases were searched for qualitative studies examining influences on participation in life after SCI. Peer-reviewed studies published after 2006, involving adults with SCI living in countries with advanced economies, were included. Data were extracted from 24 articles and subjected to three-level thematic synthesis—the coding of primary data from the studies, the development of descriptive themes based on an organization of those codes, and the generation of analytical themes. Results: The synthesis yielded five analytical themes, supported by 17 descriptive themes. The analytical themes were (1) external contextual influences, (2) personal physical context, (3) personal psychological context, (4) potential moderators of participation outcomes, and (5) temporal dimensions of participating in life after SCI. Interpretation: These themes highlight the complex interactions that shape participation from the perspective of people with SCI. Closer examination of the potential moderators may provide insights into effective rehabilitation interventions. Conclusions: Synthesis of qualitative inquiry provides valuable insights into the perceptions of influences on participation in life from the point of view of people with SCI. The findings of this synthesis are instructive for rehabilitation theory and practice. It can complement what we learn from using the ICF to understand participatio

Evaluation of a Peer Group Model of Supervision for the Allied Health Workforce in Queensland: A descriptive overview

Purpose: An evaluation of a large scale implementation of a peer group model of professional supervision was conducted to inform service planning and guide policy and practice. A descriptive overview of the findings is presented. Method: Allied health staff trained in peer group supervision were surveyed about their experience of the model, its challenges and benefits. Interviews were also conducted with senior managers. Results: Analysis of 248 responses indicated that 72% of trained staff had participated in peer group supervision, and that these peer groups had continued for an average of 17.2 months. The majority of groups adhered to the guidelines presented at training, and found the model easy to implement and adaptable to a range of professions, settings and needs. Reported benefits included skill development as well as increased support and confidence. Improved relationships and team culture were also described. Management support and attendance at training were considered important to successful implementation. Conclusions: The evaluation demonstrated that a model of peer group supervision can be successfully implemented with a diverse and geographically dispersed allied health workforce. This model allowed professional supervision needs to be met in a group setting without the requirement for an expert supervisor. A number of benefits for individual clinicians and their teams were identified, and the need for further evaluation, in the context of widespread health reform is noted

A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: A single-case experimental design

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home: and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional Outcome in real life settings

Key sources of strength and resilience for persons receiving services for Hansen's disease (leprosy) in Porto Velho, Brazil:What can we learn for service development?

Background: Individuals affected by Hansen's disease (leprosy) often experience stigma and discrimination. Greater psychosocial resilience may enable people to deal with such discrimination. This study aimed to explore sources of strength and resilience for individuals affected by Hansen's disease in Brazil. Methods: We used a cross-sectional study design with a qualitative approach. Semistructured focus groups were conducted. Analysis comprised thematic categorisation of transcripts. Results: Thirty-one participants were included: 23 individuals affected by Hansen's disease and 8 healthcare providers. We found that while a few individuals affected were provided with formal psychological support in the early phases of their treatment, many noted the importance of providing such support at this time. Most participants described relationships with and social support from family members, friends and with others affected by Hansen's disease as their primary source of resilience. A key context for building resilience was through the peer-level sharing and engagement experienced in self-care and support groups. Participants also emphasised the importance of providing appropriate information about Hansen's disease and the importance of beliefs and spirituality. Conclusions: Hansen's disease services should seek to build resilience in early treatment through counselling and during treatment and beyond by having people affected getting together. Across both settings supporting family and social relationships, providing accurate information and acknowledging spiritual beliefs are important.</p

Comparison of individual, group and combined intervention formats in a randomized controlled trial for facilitating goal attainment and improving psychosocial function following acquired brain injury

To compare individual, group and combined intervention formats for improving goal attainment and psychosocial function following acquired brain injury. Design: Randomized controlled trial, waiting list controls. Participants: Thirty-five participants with a mean time of 5.29 years (standard deviation = 3.9) since acquired brain injury were randomly allocated into 6 groups involving an intervention or waiting list control condition for 1 of 3 intervention formats. Methods: Interventions were 3 h/week for 8 weeks. Formats included: group-based support (n = 12), individual occupation-based support (n = 11), and a combined group and individual support intervention (n = 12). Participant outcomes were examined at pre-, post-, and 3-month follow-up assessment on the Canadian Occupational Performance Measure, Patient Competency Rating Scale, and Brain Injury Community Rehabilitation Outcome 39 Scales. Results: Overall, the findings indicated that the individual intervention component appeared to contribute particularly to gains in performance in goal-specific areas. The combined intervention was associated with maintained gains in performance and satisfaction. However, gains in behavioural competency and psychological well-being were more likely to occur after the group and individual interventions. Conclusion: These findings generally support the efficacy of brief intervention formats following acquired brain injury, although further research is needed to examine clients’ suitability for particular interventions. Authors