Current Service Delivery Research Articles

Predictors for Augmentative and Alternative Communication Clinical Service Provision: Closing the Gap.

At the core of the clinical services provided by a speech-language pathologist (SLP) is upholding the human right to communicate. Augmentative and alternative communication (AAC) modalities support communication across environments by offering temporary or permanent solutions. Barriers to AAC service provision include translation of knowledge into clinical practice, which remains problematic despite changes to AAC preservice training addressing the knowledge barrier. This study aims to understand the importance of factors impacting the provision of AAC clinical services. From the survey data of SLPs (N = 530) regarding current AAC service delivery practices, barriers, and professional development preferences in the United States, a hierarchical multiple regression identified the importance between individual and clinical practice variables of knowledge and current use of AAC modalities. A binomial logistic regression predicted the probability of one or more independent variables for barriers to AAC service delivery and learning preferences for AAC-related professional development. The factors impacting SLPs' knowledge and barriers to practice are related to clinical practicum experiences. Engagement in AAC-related continuing education (CE) is the primary contributor to the use of AAC service provision. Predictors for barriers to AAC clinical provision are associated with clinical practicum experiences, the average number of patients seen weekly, and geographic region. Preference for CE topics and frequency depend on the work setting. Hands-on clinical practicum experience addresses opportunity barriers in AAC service provision, contributing explicitly to the value of collaboration in AAC service delivery and highlights the importance of evidence-based professional development content. The findings from this study are reassuring in that clinicians are using AAC and suggest that high-quality professional development is an effective means to address the gap between knowledge generation and translation in the field. https://doi.org/10.23641/asha.23202170.

Scaling-up integrated type-2 diabetes and hypertension care in Cambodia: what are the barriers to health system performance?

Non-communicable diseases (NCDs) such as type-2 diabetes (T2D) and hypertension (HTN) pose a massive burden on health systems, especially in low- and middle-income countries. In Cambodia, to tackle this issue, the government and partners have introduced several limited interventions to ensure service availability. However, scaling-up these health system interventions is needed to ensure universal supply and access to NCDs care for Cambodians. This study aims to explore the macro-level barriers of the health system that have impeded the scaling-up of integrated T2D and HTN care in Cambodia. Using qualitative research design comprised an articulation between (i) semi-structured interviews (33 key informant interviews and 14 focus group discussions), (ii) a review of the National Strategic Plan and policy documents related to NCD/T2D/HTN care using qualitative document analysis, and (iii) direct field observation to gain an overview into health system factors. We used a health system dynamic framework to map macro-level barriers to the health system elements in thematic content analysis. Scaling-up the T2D and HTN care was impeded by the major macro-level barriers of the health system including weak leadership and governance, resource constraints (dominantly financial resources), and poor arrangement of the current health service delivery. These were the result of the complex interaction of the health system elements including the absence of a roadmap as a strategic plan for the NCD approach in health service delivery, limited government investment in NCDs, lack of collaboration between key actors, limited competency of healthcare workers due to insufficient training and lack of supporting resources, mis-match the demand and supply of medicine, and absence of local data to generate evidence-based for the decision-making. The health system plays a vital role in responding to the disease burden through the implementation and scale-up of health system interventions. To respond to barriers across the entire health system and the inter-relatedness of each element, and to gear toward the outcome and goals of the health system for a (cost-)effective scale-up of integrated T2D and HTN care, key strategic priorities are: (1) Cultivating leadership and governance, (2) Revitalizing the health service delivery, (3) Addressing resource constraints, and (4) Renovating the social protection schemes.

P298 Gastroenterology services for patients with cystic fibrosis across Australia and New Zealand: a multi-stakeholder assessment of patients’ and professionals’ perspectives

Gastrointestinal symptoms are common in individuals with Cystic Fibrosis (CF) and can be a barrier to achieving optimal nutritional status. International research has highlighted that gastrointestinal care for this group of patients is lacking. However, gastroenterology services to CF clinics across Australasia are yet to be examined. This study aimed to describe the current service delivery model and to identify areas for improvement.

Recovery in the context of post-stroke aphasia: A concept analysis

BACKGROUND: The term ‘recovery’ frequents the literature relating to aphasia, however there has been limited research directly investigating the concept (or meaning) the term represents. OBJECTIVE: To present a concept analysis of ‘recovery’ in the context of post-stroke aphasia and investigate the consistency in meaning, use and interpretation of the concept, in relation the International Classification of Functioning, Disability and Health (ICF) and the Life Participation Approach to Aphasia (LPAA). METHODS: Rodgers’ evolutionary method of concept analysis was used to analyse the studies retrieved through a systematic search of PubMed and CINAHL bibliographic databases and a journal search of Aphasiology. The International Classification of Functioning, Disability and Health (ICF) and the Life Participation Approach to Aphasia (LPAA) were used as frameworks to explore the correspondence of the concept of ‘recovery’ with current speech and language therapy service delivery approaches. RESULTS: Seventy-one papers were retrieved and analysis revealed six core attributes of the concept; recovery as (1) a process (2) variable dependant (3) existing on a spectrum (4) facilitated (5) quantifiable (6) subject to deceleration. The concept of recovery was found to be impairment-oriented, demonstrating a poor overall correspondence with current frameworks underpinning service delivery. CONCLUSIONS: Facilitating recovery in the context of post-stroke aphasia is a widely discussed therapeutic priority, yet the concept of recovery itself remains ambiguous. Clarification of the current conceptual status of recovery is necessary to ensure consistency in meaning, use and interpretation of the concept, in recognition of its potential implications on research and service delivery.

Exploring the current and future osteoarthritis health service delivery needs in Aotearoa New Zealand.

Osteoarthritis (OA) affects the wellbeing of one in 10 people in Aotearoa New Zealand, yet current healthcare delivery for these people is fragmented, un-coordinated and inconsistent. How current and future needs should be addressed has not been systematically explored. This study aimed to describe the views of interested people from the health sector regarding current and future OA health service delivery in the public health system in Aotearoa New Zealand. Data were collected via a co-design approach within an interprofessional workshop at the Taupuni Hao Huatau Kaikōiwi: Osteoarthritis Aotearoa New Zealand Basecamp symposium and analysed using direct qualitative content analysis. The results highlighted several promising current healthcare delivery initiatives. Health literacy and obesity prevention policies featured in the thematic analysis suggesting a lifespan or systemwide approach is needed. Data highlighted a need for reformed systems that enhances hauora/wellbeing, promotes physical activity, facilitates interprofessional service delivery and collaborates across care settings. Participants identified several promising healthcare delivery initiatives for people with OA in Aotearoa New Zealand. Public health policy initiatives are needed to reduce osteoarthritis risk factors. Developing future care pathways should support the diverse needs within Aotearoa New Zealand, coordinate and stratify care, value interprofessional collaboration and practice, and improve health literacy and self-management.

A pilot survey on factors limiting veterinary service delivery systems at animal health facilities in Hawassa, Shashemene, and Negele Arsi, Ethiopia

A pilot questionnaire survey was carried out from December 2021 to June 2022 at animal health facilities in Hawassa city and Shashemene and Negele Arsi towns in Ethiopia. The objective of the survey was to determine what factors in the study area limited the provision of veterinary services at animal health facilities like veterinary clinics, veterinary pharmacies, and veterinary administrative offices. Government veterinary staff, clinical veterinarians, and private veterinary pharmacists were purposefully chosen based on their availability at each study area, whereas livestock owners (clients) were chosen at random at the point of service. A semi-structured questionnaire with multiple-choice and open-ended questions was administered to 100 study participants. It was discovered that the public sector was generally preferred by 74% of livestock owners and the private sector was preferred by 26%. In terms of infrastructurecoverage, the current animal health service delivery system was found to be deficient (35.7%). Drug shortages were a major problem for most public veterinary service providers (66.7%), while expensive drug prices were a problem for private veterinary service providers (34.0%). Additionally, it was determined that poor management (57.1%), a lack of funding (14.3%), a lack of commitment (28.6%), and a lack of attention to the veterinary sector (78.6%) were among the factors that hindered the provision of proper veterinary services in these areas. To carry out efficient veterinary clinical activities, the existing public veterinary institutions should be given sufficient financial resources,qualified personnel, and physical resources.

The role of midwives in implementing reproductive health services in Islamic Republic of Iran.

It is essential to study the availability of reproductive health services and the capacities of providers, to provide evidence for improving service quality. To identify the role of midwives in the provision of reproductive health services and recommend improvements. A national review of government health resources in the Islamic Republic of Iran was conducted to explore available reproductive health services. Through semi-structured interviews with 30 midwives, information was collected about the compatibility of services with the capacity and scope of the activities of midwives. A panel of 12 experts was assembled to develop a proposed service package. The content analysis method was applied to data analysis and interpretation. The service package developed covered 82 services that midwives can offer at the 8 healthcare facility groups. Although midwives were trained to manage a range of primary and gynaecological care services, certain essential aspects of reproductive health services were not being delivered on the frontline. These include sexually transmitted diseases and human papilloma virus management, diagnosis and treatment of common gynaecological problems, sexual education and counselling, and childbirth services. Midwives were not adequately engaged to provide reproductive health care at the secondary level. There are drawbacks to the current reproductive health service delivery in the Islamic Republic of Iran. The service package designed and proposed in this study aims to strengthen reproductive health care services and planning and better integration of midwife-led programmes.

Core Values in the Traditional Provision of Hearing Health Care.

Untreated hearing loss is a significant public health issue affecting the quality of life of millions of Americans. Barriers to treatment invite novel and innovation solutions, but as these solutions create new treatment delivery models, they also may-purposefully or accidentally-challenge the values of the field. Value-sensitive design methodology is used in this study to identify the values in current hearing health care service delivery. We performed qualitative content analysis of questionnaires, clinical practice guidelines, and professional ethics documents that represent the intended and enacted values in audiology. The result is a comprehensive list of values that can be used as a structured codebook for systematic textual analysis of materials representing current best practices in the provision of hearing health care services. A secondary result is an analysis of the relative importance of values in audiology, inferred from the frequency of references to each value. Subjective benefit, professional duties, and self-efficacy were the core values identified in the current provision of audiologic care, and these values should be central to considerations for new hearing health care models and technologies.

Applications and Implications of Service Robots in Hospitality Sector: A Case Study

Purpose–Previous research has emphasized that service robots cause radically change current service production and delivery practices and, consequently, service management and marketing strategies. This research explores the use of current state-of-the-art service robotics in the hospitality industry and aims to better understand how this technology can transform service operations. Design/Methodology/Approach–An exploratory qualitative approach was adopted for this study. Case study pattern and holistic single case pattern were preferred from qualitative research patterns as the method of inquiry. This qualitative study was conducted using a thematic analysis approach.The criterion sampling method was performed to collect data with one participant through in-depth, semi-structured individual interview. Data were analyzed using a thematic approach that built on a priori themes or categories were adopted for data analysis. Findings –Analysis of participant’s perspectives and experiences showed the 8 themes of the roles of service robotics in service encounters including substitute, support, supporting new business models, improve, differentiate, creative experiences & competition, upskill, and data collection. Unlike the previous research, supporting new business models, creative experiences & competition, and data collection were also found as new technology roles specific to service robots. By developing a new conceptual DRiTE Model (Development of Robotics in Tourism Ecosystem), the research not only contributes theoretical implications to the literature but also offers business strategies (management, marketing, etc.) for hospitality firms to manage innovative, automated service offerings. Discussion –Despite previous research having extensively discussed the use of technology in services, it can be interpreted that the current global tourism industry on the use of robotics in service encounters is still in its infancy. Over time, these micro-scale changes will evolve to form a global ecosystem. This means that the way they do business will change on a global scale through various diffusion areas such as brand, service type or stakeholder network. The paper’s novelty and uniqueness lie in suggesting a new conceptual DRiTE of addressing the implications ofthis research and offering insight for hospitality services-related managers into how to effectively research implications can be implemented.

Public expectations of good primary health care in China: a national qualitative study.

China is currently making efforts to transform the current hospital-centric service delivery system to people-centred primary health care (PHC)-based delivery system, with service delivery organized around the health needs and expectations of people. To help direct China's PHC reform efforts, a profile of high-quality PHC from the public's perspective is required. To profile high-quality PHC from the perspective of the Chinese public. Semistructured interviews were conducted in 6 provinces (Henan, Shandong, Zhejiang, Shaanxi, Shanxi, and Heilongjiang) in China. In total, 58 interviewees completed the recorded interview. For transcription, trained research assistant listened to the recording of the interviews, summarizing each 30-s segment in English. Next, thematic analysis was performed on the narrative summaries to identify thematic families. Seven themes and 16 subthemes were generated from the analysis of our interview data. In order of their frequency, the interviewees expressed a high expectation for interpersonal communication and technical quality; followed by access, comprehensive care, cost, continuity, and coordination. Using qualitative data from 6 provinces in China, knowledge was generated to reveal the public's views and expectations for high-quality PHC. Our results confirm the urgent need for quality improvement efforts to improve patient experience and technical quality. The government also needs to further improve the delivery system and medical training programme to better meet public expectation in these areas, especially in establishing an innovative integrated primary care model, and strengthening interpersonal and clinical competency training for family doctors.

Providing Leadership Through Patients as Partners: Improving Australian Colorectal Survivorship Care Through Perspectives from a Nurse Who Became a Cancer Patient

ObjectiveTo provide contemporary real-world, real-life insights into gaps in supportive care experiences for people affected by colorectal cancer. For the first time, this article includes a patient as a coauthor, with the aim to identify future priorities to improve care and recovery in colorectal cancer survivorship. Data SourcesElectronic databases, peer-reviewed literature, and real-life professional and personal experiences were used. ConclusionThere are several problematic areas in providing supportive care for people affected by colorectal cancer that could be improved by wider access to colorectal specialist nurses, coordinated multidisciplinary teams, patient collaboration, linking survivorship care outcomes to national standards, and developing supported self-management care plans. Implications for Nursing PracticeA patient-led insight has underscored some fundamental failings in current service delivery among people affected by colorectal cancer. Partnering with consumers in research and service redesign is essential to stratify future priorities to optimize care and person-centered recovery.

Algorithmic modeling of public recommender systems: insights from selected cities

PurposeIn the context of digital public governance of the 21st century, recommender systems serve as a digital tool to support decision-making and shift toward proactive public services delivery. This paper aims to synthesize an algorithm for public recommender systems deployment coherent with the digital transformation of public services in three Russian regions: the City of Moscow, Moscow region and Astrakhan region.Design/methodology/approachThe studied regions serve as an adequate representation of the country’s population coverage carrying, at the same time, diversity of public governance structures in qualitative and quantitative terms. Thus, the authors were able to retrieve both commonalities and particularities in locally applied policies to create an algorithm model for governance high-tech decision support systems (DSS) deployment in management terms. Therefore, the authors use structural and functional analysis to derive the matters for further induction into our algorithmic model.FindingsThe proposed algorithmic model is developed under the framework of automated verification of current public service delivery mechanisms. The practical application of recommendation systems as a special case of DSS is shown in the example of public service delivery. It is assumed that following the developed algorithm leads to the “digital maturity” of a particular sector of public governance.Originality/valueThe paper holds a novel look at public services digital transformation through the application of recommender systems, which is evidenced by the algorithmic model approbation on the theoretical level.

Identifying best-practice features of diabetic retinopathy treatment models for Aboriginal and Torres Strait Islander Australians.

Indigenous Australians are nearly three times more likely to have diabetes than non-Indigenous Australians. The prevalence of diabetes-related vision impairment for Indigenous Australians is 5.5% compared to 1.5% for non-Indigenous Australians, and treatment rates are lower for Indigenous Australians. Despite this situation, there is limited evidence on effective service delivery models for diabetic retinopathy care and treatment. This study seeks to identify best-practice features of diabetic retinopathy care that could be used to inform current and future service delivery models for Indigenous Australians with diabetic retinopathy. All states, territories and geographic remoteness categories in Australia. Eight ophthalmologists engaged in providing eye healthcare to Indigenous Australians. Semi-structured interviews were conducted. The Framework Approach was used to conduct a thematic analysis of the interviews to facilitate identification of key themes and issues that emerged from these discussions. Seven best-practice features for service delivery of diabetic retinopathy treatment for Indigenous Australians were identified. These were: cultural safety, affordability and accessibility, partnerships with key stakeholders, timeliness, integration with primary care, clarity of guidelines, and clinician attitude and motivation. The findings from this study identified seven best-practice features for diabetic retinopathy treatment. These have the potential to inform and influence how care is delivered to Indigenous Australians. Although further research is warranted to capture other service provider inputs and Indigenous end-user perspectives, these features in the meantime can begin to inform the decisions of the Indigenous eyecare sector on policy reforms and best-practice diabetic retinopathy treatment approaches.

Practice of It-Based Discharge Communication in General Surgery Wards at The Kenyatta National Hospital

Purpose: The current study sought to investigate the practice of IT-based discharge communication in general surgery wards at the Kenyatta National Hospital.
 Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely General surgery ward, Urology ward and Neurology ward. A semi structured questionnaire was used to collect both qualitative and quantitative data with the use of SPSS version 25.
 Results: The findings revealed that there is a significant difference between the mean responses of the patients in General surgery ward and Neurology ward (-.299*, P= 0.001). Likewise, there is a significant difference between the mean responses of the patients in Urology ward and General surgery ward (-.417*, P= 0.000). The correlation findings indicated that there is a positive and significant association between IT-based discharge communication practices and patient health outcomes at KNH (r=0.533**, p=0.000). This was supported by the regression findings that indicated that IT-based discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β = 0.305, p=0.000). This implies that improvement in 1 unit of IT-based discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.305 units (vice versa is also true).
 Unique contributions to theory, policy and practice: Since, well-designed and implemented IT systems increase communication, coordination, and knowledge retention, resulting in better results for discharged patients, their families, caregivers, and primary healthcare professionals, Kenyan hospitals are encouraged to pursue the IT direction and put into practice the best IT-based communication infrastructure for current and future quality service delivery

Evidence and methods required to evaluate the impact for patients who use social prescribing: a rapid systematic review and qualitative interviews

Background Social prescribing encourages health-care and other professionals to refer patients to a link worker, who will develop a personalised plan to improve the patient’s health and well-being. We explore the feasibility of evaluating the service. Objective The objective was to answer the following research questions. (1) What are the most important evaluation questions that an impact study could investigate? (2) What data are already available at a local or national level and what else would be needed? (3) Are there sites delivering at a large enough scale and in a position to take part in an impact study? (4) How could the known challenges to evaluation (e.g. information governance and identifying a control group) be addressed? Data sources Data sources included MEDLINE ALL (via Ovid), searched from inception to 14 February 2019, and the first 100 hits of a Google (Google Inc., Mountain View, CA, USA) search. Review methods Rapid systematic review – electronic searches up to February 2019. Studies included any study design or outcomes. Screening was conducted by one reviewer; eligibility assessment and data extraction were undertaken by two reviewers. Data were synthesised narratively. Qualitative interviews – data from 25 participants in different regions of England were analysed using a pragmatic framework approach across 12 areas including prior data collection, delivery sites, scale and processes of current service delivery, and known challenges to evaluation. Views of key stakeholders (i.e. patients and academics) were captured. Results Rapid systematic review – 27 out of 124 studies were included. We identified outcomes and highlighted research challenges. Important evaluation questions included identification of the most appropriate (1) outcomes and (2) methods for dealing with heterogeneity. Qualitative interviews – social prescribing programmes are holistic in nature, covering domains such as social isolation and finance. Service provision is heterogeneous. The follow-on services that patients access are often underfunded or short term. Available data – there was significant heterogeneity in data availability, format and follow-up. Data were collected using a range of tools in ad hoc databases across sites. Non-attendance data were frequently not captured. Service users are more deprived and vulnerable than the overall practice population. Feasibility and potential limitations of an evaluation – current data collection is limited in determining the effectiveness of the link worker social prescribing model; therefore, uniform data collection across sites is needed. Standardised outcomes and process measures are required. Cost–utility analysis could provide comparative values for assessment alongside other NHS interventions. Limitations This was a rapid systematic review that did not include a systematic quality assessment of studies. COVID-19 had an impact on the shape of the service. We were not able to examine the potential causal mechanisms in any detail. Conclusions We describe possible future research approaches to determine effectiveness and cost-effectiveness evaluations; all are limited in their application. (1) Evaluation using currently available, routinely collected health-care, costing and outcomes data. (2) Evaluative mixed-methods research to capture the complexity of social prescribing through understanding heterogeneous service delivery across comparative settings. Cost-effectiveness evaluation using routinely available costing and outcomes data to supplement qualitative data. (3) Interventional evaluative research, such as a cluster randomised controlled trial focused on the link worker model. Cost-effectiveness data collected as part of the trial. Future work Mature data are currently not available. There needs to be an agreement across schemes on the key outcomes that need to be measured, harmonisation of data collection, and follow-up referrals (how and when). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 29. See the NIHR Journals Library website for further project information.

Examining the Practice Patterns of School Based Occupational Therapy in Western New York

ABSTRACT There is no research available describing how school Occupational Therapy practitioners (OTPs) in Western New York (WNY) provide services. The purpose of this study was to determine OTP practice patterns in WNY schools, with a focus on delivery of contextual services and the contributing factors, consistent with American Occupational Therapy Association (AOTA) and special education guidelines. Forty school-based OTPs in WNY completed a 27-question online survey in an exploratory study that examined their practice patterns by type of setting (urban, suburban, rural). OTPs were asked to describe the type of services provided and the location of service provision To analyze our hypotheses we used a Kruskal-Wallis one-way ANOVA and chi-square analyses. All statistical analyses used SPSS 26.0. More students (77.0%) received services through special education then general education. There was no difference in setting type (urban, suburban, or rural). A higher number of students received out-of-context services (83.5%) with no difference by setting type. However, OTPs hired by the districts reported a higher percentage of in-context services than those not hired by the district. Most participants (90.0%) reported satisfaction with current service delivery models with no difference in setting type. WNY practices and special education laws and AOTA guidelines suggest that OTPs provide services to all students and they learn best in-context. Our study examined the factors that may influence this finding including type of setting, type of employer, years of experience, and type of practitioner. Our study found that although practitioners report preferring in-context services, the majority continue to use out-of-context services through special education. The factors that contributed to a preference for contextual service provision included type of employer and years of experience.

Meeting housing needs of child welfare-involved families: Policy insights from simulation modeling

BackgroundInadequate housing contributes to the risk of family separation in nearly one-quarter of child maltreatment investigations. Child welfare struggles to identify and address the demand for housing assistance. A range of housing interventions shows promise for stabilizing families. Still, aid remains difficult to access, and little evidence exists for prioritizing households to interventions. Inefficient decisions about who to serve with scarce housing resources threaten to diminish resources and unintentionally place children at greater risk. ObjectiveThe present study leverages computational modeling to simulate the complex dynamics of coordinated child welfare response to inadequate housing. Simulations address the lack of microdata on current service delivery to inform policy-making that protects children from family insecurity. Participants and settingsA series of simulated policy experiments test strategies for maximizing access to appropriate housing assistance and minimizing system-wide family separations using US estimates of housing insecurity and child welfare involvement. Models incorporate the feedback loops involved in seeking and waiting for needed services, using information on national rates of housing insecurity among child welfare-involved families. ResultsResults demonstrate population-level improvements in family stability from enhanced targeting of housing assistance to families most likely to benefit, plus expanded access to housing interventions. Neither improved screening procedures nor more housing supports alone improve child welfare outcomes. ConclusionsFindings emphasize the importance of data-driven upstream policies for protecting inadequately housed children at risk of maltreatment.

“Frantic online searches for help”: design considerations for an online early intervention service addressing harmful sexual behaviour

ABSTRACT Secondary prevention efforts, which target risk and protective factors associated with harmful sexual behaviour (HSB) and seek to intervene early in the trajectory of HSB, are underdeveloped in Australia. This study explored design considerations for an online early intervention service for children and young people worried about their sexual thoughts and behaviours. A trauma-informed child right’s framework underpinned the study, which involved 10 individual interviews with international experts in HSB, and one group interview (n = 3) with Australian practitioners. Analysis was carried out using thematic analysis. Results reflect design considerations in relation to: theoretical approaches; practice frameworks; service delivery components; and helpseeking challenges. Key tensions emerging from the results are discussed, including the need to move beyond binary constructions of victims and perpetrators. PRACTICE IMPACT STATEMENT: This paper has significant potential to influence practice in the field of harmful sexual behaviour prevention and response. The paper sets out the components of an early intervention online service for children and young people worried about their sexual thoughts and behaviours. The online service could be built and trialed for impact and efficacy in supporting children and young people not to sexually harm. It would be the first service of its kind in Australia and fill a gap in the current service delivery landscape.

Processes of assistive technology service delivery in Bangladesh, India and Nepal: a critical reflection

Purpose This paper critically reviews and reflects on the processes for providing Assistive Technology (AT) services to Persons with Disabilities (PWD) in Bangladesh, India and Nepal. The aim is to investigate the AT service delivery systems in these countries and suggest improvements where weaknesses are identified. Materials and methods We carried out a descriptive qualitative exploratory study in Bangladesh, India and Nepal by conducting key informant interviews with policymakers (5), AT service providers (22) and mobility and hearing related AT service users (21). We used a directed content analysis approach guided by a seven-point AT service delivery process model to thematically analyse the existing processes for AT service delivery, from first contact through to follow-up and maintenance. Results AT service delivery processes are sub-optimal in all three countries, and improvements are needed. No common AT service delivery process was found, although there are common features. In general, it is easier for PWDs in India and Nepal to access AT than for those in Bangladesh, but all three countries are failing to live up to their commitments to uphold the human rights of PWDs. Conclusions Although good elements of AT service delivery processes can be identified, the systems in all three countries are fragmented and generally weak. A more holistic approach of looking at the process of AT service delivery, from first contact right through to follow-up and device maintenance, with a single door service delivery system, free of cost at the point of service is recommended in these countries. IMPLICATIONS FOR REHABILITATION Although we found significant weaknesses in AT delivery in all three countries, there are some good AT service delivery practices and opportunities for these countries to learn from one another. A systematic and stepwise approach to assessing current AT service delivery processes in the three countries – examining the delivery system as a whole, from initiation to repair and management – can help identify opportunities to improve the process for (prospective) AT users. A more coherent single door system of AT service delivery will increase the quality and efficiency of the fragmented AT service delivery practices in Bangladesh, India and Nepal.

Maximizing Writing Interventions for Individuals Receiving Special Education Services Through Technological Applications in the Elementary Classroom

Since its inception, special education has historically been an underfunded federal mandate leaving states and school districts unable to offer more than a basic level of support for individuals with disabilities. The amount and frequency of time allotted for special services including Speech Therapy, Occupational Therapy, and Physical Therapy is not sufficient for making significant and lasting progress, and many parents have expressed dissatisfaction with the current service delivery model. In this paper, we explore the issue of accessibility and how technology may play a role in leveling the playing field for students who, prior to this COVID-19 pandemic, were receiving inadequate levels of intervention to make progress on goals outlined within their Individualized Education Program. We explore one teacher’s experience implementing a new application in her classroom aimed at increasing writing accuracy, while addressing the need for platforms that are engaging and promote parent participation.