Direct Service Providers Research Articles

Improving Special Education Service Delivery Through Interdisciplinary Collaboration

Central to positive learning outcomes for students with disabilities is the ability of the individualized education program (IEP) team to work collaboratively. Within the IEP team, effective service delivery involves direct and related service providers working in an interdisciplinary capacity as they share professional responsibilities to implement the student’s program and achieve the common goal of improved student outcomes. With support from the literature, this paper discusses the core components of Bronstein’s Interdisciplinary Collaboration Model (2003); and elucidates how professionals share their content knowledge and technical skills with each other, collaborate in instructional design, and gain a firm understanding of each other’s discipline in practice. Practical applications that promote interdisciplinary collaboration between adapted physical educators, special educators, related service providers, and parents to improve service delivery and learner outcomes are shared.

The capacity-building role of community liaison workers with refugee communities in Victoria, Australia

BackgroundA range of services within Australia and internationally have been developed that are focused on the engagement of individuals who are of refugee background to work as a liaison between their communities and mental health services. The Community Liaison Worker (CLW) role at the Victorian Foundation for Survivors of Torture (VFST) was developed in 2008 in order to engage in such capacity-building initiatives.AimsTo review and document the establishment, evolution and current status of the VFST CLW role, and examine the perspectives of CLWs on their role in trauma-informed community capacity-building.MethodsThe study comprised of two stages: a historical case study of the development of the CLW role, and a qualitative research study based on interviews with CLWs in order to identify key themes regarding various aspects of their role and understand the facilitators and barriers to their work of trauma-informed capacity-building with their respective communities.ResultsThe CLW role has evolved from the provision of direct services through joint work with Counsellor Advocates at VFST to a broader role that is focused on building the capacity of community members. Thematic analysis of interviews with the seven current CLWs identified the complexity of their dual role as members of their community and employees of VFST, their role in addressing short-term goals to meet community needs, and the long-term objective of empowering their community to become integrated and self-sufficient.ConclusionsCLWs at VFST demonstrate important work of liaison workers in facilitating trauma-informed capacity-building initiatives that are of benefit to members of their communities and also to service providers.

Moral Distress Among Oncology Social Workers.

Literature on moral distress among oncology social workers (OSWs) is sparse. The aim of the current study was to examine the prevalence of moral distress and its domains of influence, and to identify demographic and work-related characteristics associated with moral distress among OSWs. Data came from the Oncology Social Work Competencies, Opportunities, Roles, and Expertise survey, conducted from August to September 2020 (during the COVID-19 global pandemic). Data collected included demographic information (eg, age, sex, and race) and work-related characteristics (eg, job position, organization type, work setting, employment status, salary, years in the profession, and OSW-C certification). Moral distress was measured using the Measure of Moral Distress for Healthcare Professionals. Tests of association, including multivariate linear regression, were conducted to achieve the research aims. Total moral distress scores on the Measure of Moral Distress for Healthcare Professionals (range 0-432) for 745 OSWs ranged from 1 to 273, with an average score of 74.0. The three highest indicators of moral distress were observed in the patient or family experience domain. Higher levels of moral distress were associated with younger age, being a direct service provider, provision of inpatient cancer care, and more years in the profession. OSWs are experiencing moral distress. Institutional investments in professional education and support of OSWs are needed to mitigate and possibly prevent moral distress experienced by cancer care providers and thus ensure the delivery of quality psychosocial care for patients with cancer and their families.

Paid sick leave benefits among essential frontline workers serving people experiencing homelessness in Canada during the COVID-19 pandemic

ObjectivesThis study examined the prevalence and factors associated with paid sick leave benefits among direct service providers who work with people experiencing homelessness. Study designCross-sectional study using an online survey disseminated during the second wave of the COVID-19 pandemic in Canada. MethodsSurvey data from 572 direct service providers working in the homeless, supportive housing, and harm reduction service sectors were analyzed for this study. Univariate and multivariate logistic regression models were used to examine predictors of paid sick leave benefits. ResultsOne hundred one (17.7%) participants did not have any paid sick leave benefits. In the univariate models, paid sick leave was associated with older age, greater family income, full-time work, specific employment settings (supportive housing and not emergency shelters or harm reduction programs), having a regular medical doctor, and fewer occupational impacts of the COVID-19 pandemic. Older age, full-time work, and non-receipt of emergency financial benefits remained statistically significant predictors in the multivariate model. ConclusionsAlthough the majority of service providers working with people experiencing homelessness have some amount of paid sick leave benefits, there is a precariously employed subset of individuals who are younger and working part-time in the sector. Temporary expansion of paid sick leave and removal of waiting periods for new employees to qualify for benefits are recommended.

Resiliency tactics during financial crisis: The nonprofit resiliency framework

AbstractThe ability of nonprofits to weather hard times is a popular theme in the literature, yet most of the research is spent on predicting organizational closure. Unfortunately, this offers little guidance to nonprofits attempting to both survive and deliver services during crises. We use the lived experiences of 31 nonprofits—a mix of umbrella groups and direct human service providers—during the Illinois state budget impasse to understand nonprofit organization resilience in times of crisis. We establish the Nonprofit Resiliency Framework using qualitative analysis, mapping tactics in five areas: financial, human resources, outreach, program and services, and management and leadership. This study not only provides further empirical investigation of organizational resilience, but also useful advice for nonprofits on how to weather a complex financial crisis.

Mental Health and Wellness of Service Providers Working with People Experiencing Homelessness in Canada: A National Survey from the Second Wave of the COVID-19 Pandemic.

Objective:This study examined the scope of common mental health problems and perceived impacts of the COVID-19 pandemic among direct service providers working with people experiencing homelessness in Canada.Method:This cross-sectional study used an online survey that was disseminated to homeless service, supportive housing, and harm reduction organizations and networks. Data were collected on depression, anxiety, stress, post-traumatic stress, compassion satisfaction and fatigue, and substance use problems as well as pandemic-related changes in mental health and wellness. A total of 701 service providers completed the survey and were included in data analysis. Descriptive statistics were used to examine the primary research questions, with hierarchical multiple regression models also being fit to explore mental health and wellness differences by occupational service setting.Results:Most direct service providers (79.5%) working with people experiencing homelessness reported a decline in their mental health during the pandemic. There were high rates of common mental health problems within the sample that are largely consistent with those found among health-care workers during the pandemic. Occupational service settings were not associated with the severity of mental health problems, indicating pervasive issues across the workforce, though providers who were younger and spent more time in direct service roles were at greater risk.Conclusions:The common mental health problems and negative impacts of the pandemic among service providers working with people experiencing homelessness highlight a highly vulnerable workforce that could benefit from improved access to supports. Given the similarities between our findings and other studies examining essential workforces, it is recommended that initiatives that provide accessible mental health care to the health-care workforce during the pandemic be expanded to include homeless and social service providers.

Barriers to Accessing Treatment Services: Child Victims of Youths with Problematic Sexual Behavior.

Child sexual abuse (CSA) remains a significant public health problem. Although the deleterious effects on the child victims could be mitigated through evidence-based interventions, victims often fail to be identified and receive clinical assessment and therapy services, particularly when they have been victimized by another youth. Given that at least a third of CSA cases are committed by another youth, understanding the process of identifying and addressing the needs of CSA victims of youth is the focus of the present study. Factors impacting services for child victims of youths with problematic sexual behavior (PSB) were examined through qualitative interviews (N = 226) with mental health agency administrators, direct service providers, and community stakeholders from eight geographically diverse communities across the United States. Responses focused on macro and micro level barriers to the identification and service provision for child victims of PSB of youths. Implications for clinicians and policymakers are discussed, along with strategies to enhance access and provision of services to meet the needs of the child victims.

Reasons for HOPE.

Reasons for HOPE.

Influences of Inner and Outer Settings on Wraparound Implementation Outcomes

In recent years, implementation researchers have focused on associations among organizational characteristics (inner settings), policy and funding drivers (outer setting), and implementation outcomes. The current study evaluated the influence of outer setting drivers on implementation of Wraparound care coordination for youth with complex behavioral health needs. Data were drawn from two sources. First, we examined the impact of outer setting drivers on Wraparound implementation by comparing Wraparound implementation in states that used Community Mental Health Centers (CMHCs) versus Care Management Entities (CMEs). Wraparound fidelity data were compiled for a sample of 1174 direct service providers within 9 states. Second, we compared workforce development efforts across CMHCs and CMEs within a separate sample of 813 administrators and practitioners. Results of multilevel models found that CMEs were associated with higher overall fidelity scores than CMHCs [b = .219, t(5.47) = 3.26, p = .020] even after accounting for state-level covariates and the clustering of individual practitioners within organizations. Furthermore, compared with CMHC staff, those employed by CMEs reported higher competence with the Wraparound model and attended more Wraparound-related trainings. Staff employed by CMHCs were more likely to change practices than their CME counterparts. These findings suggest possible influences of outer settings on Wraparound implementation. The unique policies and procedures associated with CMEs may have helped facilitate practice fidelity among staff, promoted competence, and required fewer practice changes to implement Wraparound. Such findings underscore the importance of policy and fiscal factors in implementation of Wraparound and other evidence-based strategies.

A Measure for Supporting Implementation of Telehealth Direct Therapy With Treatment Integrity.

As telehealth direct therapy sessions are being increasingly provided for safety reasons during the COVID-19 pandemic, it is critical to ensure that sessions are implemented with integrity by direct service providers. Although existing research addresses the efficacy of the telehealth model, there is no literature on integrity measures tied to this service model. Without a framework or point of reference, clinicians new to the field of telehealth direct therapy may not be able or willing to attempt to implement it. The Telehealth Therapy Treatment Integrity Measure is designed to delineate components of effective telehealth direct therapy, including aspects of both instruction that should be generalized from in-person sessions to telehealth direct therapy sessions and new elements that are unique to telehealth direct therapy. A description of how the measure can be used to support the training, both initial and ongoing, of direct service providers is included. This measure can support clinicians in ensuring that direct service providers are working within their scope of competence when providing telehealth direct therapy.

Outpatient clinical pharmacy practice in the face of COVID-19 at a cancer center in New York City.

With the rapid spread of COVID-19 in New York City since early March 2020, innovative measures were needed for clinical pharmacy specialists to provide direct clinical care safely to cancer patients. Allocating the workforce was necessary to meet the surging needs of the inpatient services due to the COVID-19 outbreak, which had the potential to compromise outpatient services. We present here our approach of restructuring clinical pharmacy services and providing direct patient care in outpatient clinics during the pandemic. We conducted a retrospective review of electronic clinical documentation involving clinical pharmacy specialist patient encounters in 9 outpatient clinics from March 1, 2020 to May 31, 2020. The analysis of the clinical pharmacy specialist interventions and the impact of the interventions was descriptive. As hospital services were modified to handle the surge due to COVID-19, select clinical pharmacy specialists were redeployed from the outpatient clinics or research blocks to COVID-19 inpatient teams. During these 3 months, clinical pharmacy specialists were involved in 2535 patient visits from 9 outpatient clinics and contributed a total of 4022 interventions, the majority of which utilized telemedicine. The interventions provided critical clinical pharmacy care during the pandemic and omitted 199 in-person visits for medical care. The swift transition to telemedicine allowed the provision of direct clinical pharmacy services to patients with cancer during the COVID-19 pandemic.

How does rural village in China achieve industry integration to reduce labour force surplus through farmers’ co-operatives?

Facing the difficulties in developing industries in rural regions in china, farmer’s co-operative is proposed as a valid solution to transform the excess labour force from agriculture to manufacture and service industries. The co-operative has two main advantages: centralised production and service provision that drive up the profitability and competitiveness of the production. However, the growth of co-operatives is obstructed by numerous barriers, namely, lack of funds and lack of collaboration. Targeting these two defects, this paper proposes two policy recommendations: first, direct government service provision and financial aid to expand co-operative service range and basic equipment; second, promote a shareholder based co-operative model to enhance the interest linkage between farmer members, thus reducing the transaction costs of production.

Factors that inhibit and promote resilience following childhood maltreatment: A qualitative exploration of practitioner perspectives

The negative impacts of childhood maltreatment are vast and span multiple domains. Recently, studies have examined the characteristics of maltreated children who exhibit a lack of negative outcomes; in other words, children who displayed resilience. Though resilience has become a more prevalent topic, the perspectives of practitioners working with children following maltreatment have been inadequately represented. The purpose of the current study was to explore the perspectives of practitioners working with maltreated children to better understand the factors that promote and inhibit resilience. Semi-structured qualitative interviews were completed with practitioners who provide services to maltreated children (N = 27). After audio-recording and professional transcription, the research team engaged in a process of thematic coding and analysis, with collaborative theme development. Study codes yielded two primary themes relating to factors that inhibit or promote resilience among maltreated children. Internal factors referred to characteristics of the individual child that could influence their likelihood of displaying resilience. External factors referred to context and circumstances outside of the child that can impact the development and display of resilience. Practitioners understood resilience as the interaction of internal and external factors which influence the degree to which children display resilience following maltreatment. The findings help to incorporate practitioner perspectives into current conceptualizations of resilience. This study carries implications for increased reliance on translational research in the resilience field, reflecting the perspectives and needs of direct service providers. Further, the results help us to better understand how practitioner perspectives shape the interventions they deliver to build resilience capacity.

Value-Based Health Care: Adjusting Speech-Language Pathology Practice to Fit the Model

Purpose The climate of health care is changing, and reimbursement is evolving into a value-based system. Facilities are pressed to be more fiscally responsible with their resources. The notion of “doing more with less” is becoming a predominant theme across settings, and speech-language pathologists (SLPs) must adjust practice models to prove their value to both payers and customers. The Centers for Medicare & Medicaid Services is moving away from a fee-for-service model, and reimbursement is being based on the quality and safety of services, not the quantity. This article will examine key components of value-based care, including how SLPs can provide their services effectively and efficiently and analyze the value-based reimbursement model in their setting to identify ways to demonstrate their value beyond direct service provision. Conclusions Effectiveness and efficiency are the key components of a value-based system. SLPs must stay abreast of evidence-based practice and use appropriate measures to determine the effectiveness of their interventions. They must provide the right service to the right patient with the right frequency and intensity. They must also ensure they are practicing at the top of the license to reduce/eliminate any activities that are not a skilled service, which decrease efficiency. A pivotal component is patient self-management, which places responsibility on patients and caregivers to work toward goals between sessions. SLPs can help promote the value of their services by working collaboratively with other disciplines to improve patient outcomes as well as the fiscal well-being of the facilities in which they serve.

Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions

With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs affect the quality of care provided. This study aimed to investigate the influential factors affecting NAs’ current competences. A total of 255 NAs’ valid questionnaires were collected from 20 long-term care institutions in Taiwan through convenience sampling. The questionnaire comprised dimensions of demographics and care competence. The study results indicated that NAs had the greatest care competence in the domain of recognition of patient rights (4.64 ± 0.54 points). The multiple regression indicated that age, religion, job category, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses significantly affected the level of care competence (p < 0.05). With the aforementioned findings, the results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities.

How a shared humanity model can improve provider well-being and client care: An evaluation of Fraser Health's Trauma and Resiliency Informed Practice (TRIP) training program.

Stress in the healthcare sector is an important concern, with worrying trends in provider burnout, secondary traumatic stress, and lower mental health. Importantly, provider stress is also connected to patient care, with recent research on Canada’s opioid crisis finding that compassion satisfaction and burnout are linked to the perpetuation of negative attitudes and behaviours towards people with opioid use problems. In 2017, the Fraser Health Authority developed a training program for direct service providers designed to address this important connection—a mental health and resiliency program based in the principles of trauma-informed practice and care. This article reports the results of an evaluation of this program. Findings suggest that embedding resiliency and self-compassion within trauma-informed training programs is a promising approach for cultural change in healthcare practice. Leaders are encouraged to explore how such a model may be implementable for their own organizations and departments.

Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice.

Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.

A Multilevel Intervention Framework for Supporting People Experiencing Homelessness with Pets.

Simple SummaryApproximately one in 10 people experiencing homelessness have pets. Despite pets having psychosocial benefits for their owners, pets can also present challenges for people experiencing homelessness related to meeting their basic needs and obtaining housing. This article proposes a framework of policy, public, and service interventions for improving the health and well-being of pet owners experiencing homelessness. At the policy level, the framework proposes an increase of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. At the service delivery level, direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support this vulnerable group.Approximately one in 10 people experiencing homelessness have pets. Despite the psychosocial benefits derived from pet ownership, systemic and structural barriers can prevent this group from meeting their basic needs and exiting homelessness. A multilevel framework is proposed for improving the health and well-being of pet owners experiencing homelessness. Informed by a One Health approach, the framework identifies interventions at the policy, public, and direct service delivery levels. Policy interventions are proposed to increase the supply of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. Direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support a group that is often overlooked or unaccommodated in efforts to end homelessness.

Governance models for rural accessible transportation: insights from Atlantic Canada

Insufficient or lack of accessible transportation options pose significant challenges for persons with disabilities living in small rural communities who need to travel within communities for day-to-day needs and between communities to access educational, employment, medical, and recreational services in urban areas. It is more than gaining the right to accessible transportation but one of how transportation services are to be provided. This article examines governance options for rural accessible transportation in Canada’s Atlantic provinces: New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador. Alternative governance options for accessible transit are identified including the direct provision of services, contracting out, co-operatives, not-for-profits, community boards and taxis. Insights gleaned from interviews with service providers tease out the advantages and disadvantages of the various options and reveal a struggle to balance accountability provisions with transaction costs. Points of interest Accessible public transit is enabling and necessary for people with disabilities to live full and independent lives. Many small towns and rural communities, like those found in Atlantic Canada, lack accessible public transit due to struggling economies and aging populations. Variability exists in how other small towns provide accessible public transit including direct provision, contracting out, co-operatives, not-for-profits, community boards to accessible taxis. Local officials struggle to balance oversight provisions while minimizing the expense of negotiations.

Transitioning Ambulatory Medicine from Pediatrics to Adult Care for Patients with Epilepsy and Intellectual Disability

AbstractConsensus statements and clinical reports exist to guide the transition of youth from pediatric to adult healthcare services. Across the range of youth with no chronic health conditions to those with the most complex disabilities, the standards of practice continue to vary broadly across the country and internationally. Youth and young adults with combined conditions of epilepsy with intellectual disability are a small subset of the total population of young adults who share common needs. These include a system of supports that supplement each person's limitations in autonomy and self-management. Caregivers play significant roles in their lives, whether they are family members or paid direct service providers. Medical decision making and treatment adherence require specific adaptations for patients whose independence due to disability is unlikely. Key issues related to tuberous sclerosis complex, neurofibromatosis, and Rett and Sturge–Weber syndromes will be highlighted.