Disability Service Providers Research Articles

Building and Applying a Human Rights-Based Model for Migrant Integration Policy

AbstractThe approach of public bodies towards migrant populations is often framed in terms of ‘migrant integration’. However, domestic integration policy and practice often come up short in terms of ensuring equal access to rights such as education, employment and housing for migrants. In this article, we discuss a variety of approaches to defining and measuring integration and, drawing on the concluding observations of a number of UN human rights treaty monitoring bodies, argue in favour of a model of integration based on international human rights law. Indicators derived from this model are used to assess the extent to which policymaking in the public sector in Ireland is informed by human rights. Finally, it is suggested that the methodology used in this study could be applied outside the sphere of immigration and integration to other areas of public policy which directly affect individuals’ human rights—from housing policy, to the provision of disability services, to early education and other important domains.

The Contribution of Religious to Irish Healthcare

The Contribution of Religious to Irish Healthcare Tim O’Sullivan A recent Studies special issue, ‘The Nuns’ Story: Writing the Record’, included a comment by Deirdre Raftery that ‘Irish women religious have left a vast, and largely undocumented, legacy to healthcare and education’.1 This comment could be extended to male religious as well in healthcare, in areas such as intellectual disability and mental health services. Growing appreciation of the neglect of the contribution of religious has led to significant work on religious congregations in recent years, such as that reported on in Studies by Raftery and others. In the field of social policy, there has been considerable analysis of the historical importance of Catholic health care providers in Irish social services, but relatively little coverage ‘from within’ of Catholic non-profit providers in Ireland – partly perhaps because of their own reticence or their pragmatic focus on progressing the job at hand rather than in theorising about it.2 Many analyses set out statecentred narratives that view the involvement in social provision of non-profit providers, and particularly those with a religious motivation, as anomalous and distracting from the responsibility of the State to provide basic social services.3 . Interest in the perspectives of religious has also clearly suffered because of their declining numbers and relative importance in Irish social services and because of grave concerns about the historical abuses in residential child care services run by religious orders.4 As a result, although Catholic providers have been a very significant stakeholder in Irish social services, their perspectives on these services have arguably received limited coverage in the social policy literature. Nevertheless, as the Studies authors suggested, there is a strong case today for a more balanced reflection on the contribution of the religious. This contribution is not just an historical one, even if the religious orders delivering healthcare are in significant decline in Ireland. An important recent report chaired by Catherine Day on the role of voluntary organisations in publicly funded health and personal social services made it clear that the Tim O’Sullivan Studies • volume 108 • number 431 288 Studies_layout_AUTUMN-2019.indd 56 21/08/2019 09:14 faith-based contribution to Irish healthcare remains substantial.5 This article seeks to reflect on the contribution of the religious in healthcare, while taking account of their own perspectives. It offers some thoughts on the Day report and draws on a 2013 study of my own, which incorporated interviews with representatives of significant Catholic healthcare providers.6 Substantial presence of religious in Irish healthcare The Day report listed seven Catholic hospitals that are still under religious ownership: the Mater Misericordiae University Hospital, St Vincent’s University Hospital and Temple Street Children’s University Hospital in Dublin; Mercy University Hospital, Cork; Cappagh National Orthopaedic Hospital, Dublin; St Michael’s Hospital, Dun Laoghaire and St John’s Hospital, Limerick. It also noted that there was a faith-based element in the governance arrangements of several additional hospitals. It referred to the planned withdrawal of the Sisters of Charity from St Vincent’s and added that the number of voluntary acute hospitals owned by religious orders may be reduced to four in the coming years: Cappagh, the Mater, the Mercy and St John’s (par. 3.3). In the same paragraph, the report stated that two thirds of all disability services are still provided directly by the voluntary sector, including eighty per cent of residential places. A number of large disability service providers are faith-based, for example: Brothers of Charity Services Ireland, Carriglea Cairde Services, Daughters of Charity Disability Support Services, Saint John of God Community Services. These organisations, the review group stated, account for approximately fifty-eight per cent of the funding allocated to disability service providers under the ‘Section 38’ funding system. A somewhat State-centred distinction is drawn at times in the Irish policy literature between large non-profit bodies that provide services ‘on behalf of’ a statutory body and community and voluntary organizations that provide other services and undertake developmental activities to meet social need without being delivery agencies on behalf of a statutory agency.7 . In legal terms, this distinction is reflected in the 2004 Health Act...

Development and Evaluation of the Stoplight Healthy Living Program

Abstract To address health disparities of adults with intellectual disability (ID), the Kansas Disability and Health Program developed the Stoplight Healthy Living program to promote good nutrition and increased physical activity. The program is based in part on the Stoplight Diet, which uses a color-coded system to teach healthy food choices. The Stoplight Healthy Living program was tested with two groups recruited through a local disability service provider in Kansas. Evaluation results suggested increases in daily fruit and vegetable consumption after participation in the program as well as increased purchases of healthy foods, reduction in soda consumption, and increased knowledge of healthier fast food meal choices. The program was well-received by participants, and shows promise in supporting good nutrition and health of adults with ID.

Spotlight on Siblings: Considering Social Context in Home Modification Practice

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) recognizes the role of Assistive Technologies (AT) in enabling independent living and inclusion of people with disabilities. Research into the provision of AT and disability services in general has highlighted the importance of social context and its influence on individual outcomes. However, there is little recognition of sibling roles, relationships and rights in the guidance available for practitioners. This paper explores the socio-technical context of home modification practice and the importance of involving siblings. The international context and concepts behind AT provision, including home modifications, and issues emerging from practice in Australia’s new National Disability Insurance Scheme (NDIS) are discussed. Based on extensive practical experience and peer review, the “5 S’s for Siblings” is presented as a practice approach for involving siblings in the home modification process. Policy and practice implications are presented, including communication strategies for working in partnership with individuals and their families, and alignment with national standards and human rights principles. Involving siblings in the home modification process recognizes the important role they play in the lives of people with disabilities, both now and in the future.

Achieving Inclusive Field-based Education: Results and Recommendations from an Accessible Geoscience Field Trip

Learners with disabilities are often denied field-based learning experiences in naturalistic disciplines. Geology can present substantial barriers due to rugged terrain in difficult-to-reach locations. In 2014, a field trip was executed with the dual purpose of 1) designing inclusion in field learning and 2) demonstrating to college faculty an accessible field experience. Direct observations of participants on the trip, as well as pre- and post-trip focus groups, illuminate the student and faculty field learning experience. Geoscience faculty have little guidance or support in understanding what disability is, how to reconcile accommodation with field-geology learning goals, and they cited instances where disability service providers acted as gatekeepers. The net effect of these ontologies is to reduce faculty empathy with, and thus their ability to be inclusive of, students with disabilities in field settings. Recommendations for teachers include taking campus disability-services administrators on field trips, opening and maintaining communications with disability service providers, and designing pedagogically sound field trips that align as much as possible to principles of universal design. An advocacy approach is described, which focuses on the students and the educational process, instead of on institutional compliance. Finally, geoscience faculty should conceptualize disability service providers as accessibility service providers.

Needle placement approach to subacromial injection in patients with subacromial impingement syndrome: A systematic review.

Subacromial impingement syndrome (SAIS) is the most common cause of shoulder pain and is costly, in terms of disability and health service provision. Research evidence suggests that, generally, the anterior, lateral and posterior approaches are used by clinicians for subacromial injection. However, it is uncertain which of these approaches is more effective than the other in the management of SAIS. The aim of the present study was to determine the effectiveness of the anterior, lateral approach to subacromial injection compared with the posterior approach for the treatment of SAIS. A comprehensive search was undertaken of CINAHL, MEDLINE, Cochrane, PEDro and the E-Journals databases using full texts, from 1980 to April 2014 and updated in December 2016 via the Chartered Society of Physiotherapy (EBSCOhost). Studies of SAIS patients receiving cortisone injections which investigated needle placement through the lateral, posterior or anterior routes were included. Study selection, data extraction and appraisal of the study were undertaken by the researcher and his supervisor. Quality criteria were selected from PEDro, to form a checklist of 10 items. A total of 4265 citations were retrieved and screened for eligibility; 39 articles were assessed as full text and 8 met the inclusion criteria. They include four randomized controlled trials and four controlled trials. Due to the varying methodological quality, and clinical and statistical heterogeneity of these studies, they were analysed qualitatively, as a meta-analysis was not possible. The evidence establishing the superiority of any one method of subacromial injection approach over the other is unclear in clinical practice. This calls for further research into this area.

Individualised funding and its implications for the skills and competencies required by disability support workers in Australia

ABSTRACT Within Australia, the National Disability Insurance Scheme (NDIS) has been heralded as one of the most significant social policy initiatives of recent times. The introduction of the NDIS follows similar moves towards individualised funding and consumer-directed care in the aged care sector. International evidence provides examples of the implications of individualised funding for workers within the social care sector; however, little attention has been paid to how the shift to individualised funding impacts on the skills and competencies required by disability support workers and in an Australian context. Our study aims to provide such an examination. We use qualitative data from in-depth interviews with key stakeholders including disability support workers; people with disability, and their families and carers; disability service providers; and training providers to investigate the impact of the NDIS on the skills and competencies required by disability support workers. Findings suggest that disability support workers require new skills to support choice and control, to be more customer-orientated and, to move from task-focused to person-centred care. As a consequence of these changes, the training of disability support workers is adapting to take account of these new skills and competencies.

A ‘Tripadvisor’ for disability? Social enterprise and ‘digital disruption’ in Australia

ABSTRACTWe explore how social enterprises can use platform technologies to plug ‘informational gaps’ in the provision of disability services. Such gaps are made more apparent by policies promoting self-directed care as a means of giving service users more choice and control. We use a case study of a start-up social enterprise seeking to provide a TripAdvisor style service to examine the potential for social innovation to ‘disrupt’ current models of service. The case study suggests that any disruptive effects of such changes are not due to new digital technology per se, nor to novel platform business models, but rather rest in the manner in which the moral orders which justify current patterns of social disablement can be challenged by social innovation.

Pass the parcel: Service provider views on bridging gaps for youth with dual diagnosis of intellectual disability and mental health disorders in regional areas.

Youth with both intellectual disability (ID) and mental health (MH) disorders (dual diagnosis) have complex physical and MH needs that can make providing integrated care for this complex group challenging. We conducted a mixed methods needs assessment to identify gaps and challenges in care delivery, identify bridges for these and identify what works well in existing services. Our research team recruited service providers (n = 126) caring for youth aged 14-24 years with a dual diagnosis in the Illawarra Shoalhaven region of New South Wales, Australia, to participate in focus group interviews. Data were transcribed and analysed thematically. We identified six themes related to caring for youth with dual diagnosis in regional areas: access to services and information about services, communication between service providers and with clients and carers, the divide between MH and ID, early intervention and health promotion, capacity building of service providers and capacity building of clients and carers. Across these themes, service providers highlighted the transition from child to adult services as a particularly challenging time for clients, families and carers. Our data suggest several approaches to break down silos and to facilitate collaboration between current services for youth with a dual diagnosis, including increasing specialised ID/MH services and building the capacity of current disability and MH service providers. Our results provide important information to provide quality and integrated care for youth with complex health needs.

Mixed accountability within new public governance: The case of a personalized welfare scheme in early implementation

AbstractWe explore personalized funding schemes and associated changes for accountability within new welfare governance reforms. Using the case of the Australian National Disability Insurance Scheme as hybrid institution, requiring mixed accountability arrangements, we examine the implications for broader discussions of accountability in personalized welfare arrangements. Methods used were semistructured interviews with government actors and disability service providers in Australia. In describing how accountability structures emerge, we argue that the way that layers fit together during implementation are often imperfect because of the conditions under which they arise. As a result, critical gaps can emerge in layered systems, which can put end users at risk. We demonstrate that theories on accountability in new public governance welfare reforms must also be informed by context and history informed qualitative analysis of case studies.

Choosing the harder road: Naming the challenges for families in person-centred planning.

Person-centred planning (PCP) has underpinned disability service provision in many Western countries for the past 30 years. For many people with an intellectual disability, family members are central to this process and are important allies in facilitating positive change. This article presents findings from an evaluation of a family resourcing and capacity building project in New South Wales (NSW), Australia. Accounts from families show the merits of such work, but family efforts can be undermined by apathy and discrimination to disability from extended family, community and service providers. Asking families to be the primary support in PCP initiatives may potentially ignore the impacts of structural and psycho-emotional disablism on all family members. For families to support people with intellectual disability in PCP, there is a need to acknowledge and respond to the material, cultural and personal challenges for all family members in planning processes.

Increasing the participation of women with intellectual disabilities in women's health screening: a role for disability support services

ABSTRACTNew Zealand women with intellectual disabilities do not participate in population-based breast and cervical screening programs to the same extent as other women. This article reports on one component of a study that was designed to (a) explore the knowledge and experiences of women with intellectual disabilities in relation to breast and cervical screening, and (b) to identify factors that health practitioners and disability service providers perceived as either facilitating or impeding the participation of women with intellectual disabilities in generic health screening. Findings related to the second aim are reported here. Three disability support service health advisors and two clinicians contributed data through in-depth qualitative interviews. Braun and Clarke's approach to inductive data analysis was implemented, with coding aligned to the purpose of the study. Three themes were identified: perceived influences on screening; informing women about screening; and supporting women during and after screening. The findings suggest that disability support services can assist women to access screening, and support them throughout the process. Strategies might include challenging attitudes of others regarding a woman's eligibility for screening; assisting women to access information that is meaningful; ensuring that women are supported to engage with screening by disability support service staff they are comfortable with; and developing relationships with primary health providers to facilitate increased participation in screening.

Care-giving dynamics and futures planning among ageing parents of adult offspring with intellectual disability

ABSTRACTThe number of older parents ageing in tandem with their adult children with intellectual disability (ID) is increasing. This unique situation calls for greater research that investigates how older parents experience this extended care-giving role, including the extent to which they are engaging in futures planning. Participants were recruited via disability service providers in South Australia. Using the theoretical perspective of hermeneutic phenomenology to understand lived experiences, semi-structured in-depth interviews were carried out with older parents (N = 17, mean age 70 years). Six offspring were living in the family home while the remainder were in supported accommodation. Main themes to emerge from the data were: (a) perpetual parenting, (b) costs and rewards and (c) planning to plan. Parents were providing care across a range of areas, regardless of whether their offspring lived at home or in supported accommodation. While aware of the need to plan for the future, most did not have a firm plan in place. Parents are providing a high level of support to their adult children with ID regardless of whether they live in supported accommodation or the family home. While some have started to think about future care arrangements, most appear unclear over what the future holds.

Integrated Care for NDIS Participants with Complex Needs

This presentation reviews the results of five recent Australian studies we have been involved with addressing the question of health and economic outcomes and the optimal model of service for this population. Through these studies the authors propose an integrated model of care and are developing a service for roll out with the NDIS to adress these critical issues. Health professionals in hospitals are poorly prepared to work effectively with individuals with disability who present with health needs. Their primary focus on acute care means there is a lesser degree of experience and familiarity with the disability support needs of patients. Some of the consequences of this poor understanding include communication difficulties leading to misdiagnosis, poor access to services, variable treatment outcomes and negative quality of life for individuals. Increased costs for the health system can also result from poor interactions with health professionals and increased use of health resources. The use of Integrated Care Principles assures the best possible clinical outcomes for this population. Nonetheless these priciples are rarely utilised and these individuals fall in the chasm between disabiltiy services and health services. Integrated Care involves partnering with a patient’s service provider, primary care provider, specialists, and both private and public hospitals as well as dental, allied health and disability care providers to enable disability and health workers to continue providing support to patients with disability alongside hospital healthcare professionals. This model promises to deliver the following benefits Attending to the patient’s disability needs supports his/her health improvement and recovery while in hospital. Maintenance of improved health and well being outcomes post discharge from acute care to the community including Improved coordination and delivery of health responses in the acute setting. Improved health outcomes at discharge. Enhanced capacity in the disability sector workforce to manage the complex health needs of individuals in community settings. Improved understanding and management of the health needs of individuals with disability. Improved health service practice for people with complex needs within the acute care setting. Improved inpatient health outcomes. Through input of disability support workers, reduced demand on scarce health resources to manage disability needs of inpatients. Reduced hospital readmission rates through improved health outcomes at discharge and in community settings. Improved collaboration with Disability Services/NDIS regarding discharge planning, discharge options and transition arrangements to community care for individuals with di Development of a disability workforce with skills and capacity to successfully manage More effective use of health resources to manage the complex health needs of individuals with disability. Reduced hospital readmission rates through improved health outcomes at discharge and in community settings. Identification and implementation of integrated services pathways that maintain established health and well being outcomes in community and residential settings post discharge. Improved management of complex health needs by disability service providers. Improved collaboration and partnership between health and disability/NDIS services including contribution of expertise and services as needed. Shorten hospital length of stay.

Perspectives of the National Disability Insurance Scheme: participants’ knowledge and expectations of the scheme

Limited research investigates future participants’ perspectives of the National Disability Insurance Scheme (NDIS) – Australia’s first national attempt towards self-directed disability service provision. To identify future participants’ perspectives, seventy people with disability in South-East Queensland participated in an interview. Over half the participants demonstrated having little to no knowledge of the NDIS. Participants’ expected that: (i) they would make decisions around organising and paying support and (ii) that their current service provider would provide the support. Participants also indicated that training around budgeting and hiring would be essential to ensure their successfully engagement with the NDIS. The findings are timely and provide a first-hand account of how people with disability intend to engage with self-directed support programs. Findings also imply that targeted information dissemination and participant training and support are necessary to ensure their successful participation within self-directed programs.

Barriers and facilitators in supporting people with intellectual disability to report sexual violence: perspectives of Australian disability and mainstream support providers

PurposeEvidence from Australia and worldwide has highlighted the ongoing marginalisation, discrimination, abuse, violence and neglect of people with disability. One of the main areas of concern is that despite such evidence there remain fundamental barriers for people with disability to report violence and/or access supports. Significantly few studies have canvased the perspectives of people with intellectual disability (ID), family members or disability service providers. Accordingly as a first step, the purpose of this paper is to explore the perceptions of disability and violence-response professionals’ regarding the barriers and facilitators of effective support for people with ID reporting sexual violence and accessing mainstream supports.Design/methodology/approachA qualitative research design informed the basis of this study. Semi-structured interviews were conducted with seven participants who held roles within disability services and mainstream violence response. Interviews were recorded and transcribed. These transcripts were then analysed individually using a combination of thematic analysis and discourse analysis to bring to light the social and material structures within service systems in terms of how they disempower or empower supports for people with ID.FindingsParticipants from both services reported that professionals (particularly those outside the disability sector) lacked awareness of practical ways in which they could support people with ID to report and access services outside of disability-specific services. Participants also felt the capacity for people with ID to have a voice about what happens in the “aftermath” of reporting sexual violence was rarely acknowledged. Participants called for education and development of resources which could guide professional practice across disability and wider violence-response services. Participants saw investment in building interagency relationships across sectors as key to supporting the citizenship of people with ID.Originality/valueThis study suggests that there is a strong need for better community engagement and understanding of the multi-faceted issues surrounding responses to violence concerning people with ID. The findings of this study also outline implications for practice and policy which may be of interest to professionals both within disability and wider violence-response sectors in Australia and internationally.

A quantitative study of attitudes toward the research participation of adults with intellectual disability: Do stakeholders agree?

BackgroundAttitudes toward the research participation of adults with intellectual disability inform research policy and practice, impact interest in and support for research participation, and promote or discourage the generation of new knowledge to promote health among adults with intellectual disability. Yet we know little about these beliefs among the public and the scientific community. Objective/HypothesisWe quantitatively studied attitudes among adults with intellectual disability, family and friends, disability service providers, researchers, and Institutional Review Board (IRB) members. We predicted that adults with intellectual disability, and researchers would espouse views most consistent with disability rights, whereas IRB members, and to a lesser degree family, friends, and service providers, would espouse more protective views. MethodsWe surveyed five hundred and twelve members of the five participant stakeholder groups on their attitudes toward the research participation of adults with intellectual disability. ResultsWe found broad support for research about people with intellectual disability, though slightly more tempered support for their direct participation therein. In general, IRB members and to some extent adults with intellectual disability endorsed direct participation less than others. We also found that adults with intellectual disability strongly believed in their consent capacity. ConclusionsResources should be directed toward health-related research with adults with intellectual disability, and interventions should be pursued to address ethical challenges and promote beliefs consistent with human rights.

Intimate Partner Violence Among Transitional-Aged Women With and Without Disabilities: Implications for Social Work Practice

ABSTRACTAlthough women with disabilities are at increased risk for intimate partner violence (IPV), little is known about how this phenomenon impacts transitional-aged young women with disabilities who are still trying to master the developmental challenges of adolescence. This study explores risk factors for and prevalence of IPV by drawing on a population-based sample of women ages 18–21 with (N = 1,616,207) and without (N = 7,554,064) self-reported disabilities. Findings suggest that risk factors for IPV were more prevalent among sample members, as was past year experience of IPV. This study has implications for school social workers and disability service providers who interact with this population.

Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study.

BackgroundImproved understanding of the quality of survival of patients is crucial in evaluating trauma care, understanding recovery patterns and timeframes, and informing healthcare, social, and disability service provision. We aimed to describe the longer-term health status of seriously injured patients, identify predictors of outcome, and establish recovery trajectories by population characteristics.Methods and findingsA population-based, prospective cohort study using the Victorian State Trauma Registry (VSTR) was undertaken. We followed up 2,757 adult patients, injured between July 2011 and June 2012, through deaths registry linkage and telephone interview at 6-, 12-, 24-, and 36-months postinjury. The 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3L) was collected, and mixed-effects regression modelling was used to identify predictors of outcome, and recovery trajectories, for the EQ-5D-3L items and summary score. Mean (SD) age of participants was 50.8 (21.6) years, and 72% were male. Twelve percent (n = 333) died during their hospital stay, 8.1% (n = 222) of patients died postdischarge, and 155 (7.0%) were known to have survived to 36-months postinjury but were lost to follow-up at all time points. The prevalence of reporting problems at 36-months postinjury was 37% for mobility, 21% for self-care, 47% for usual activities, 50% for pain/discomfort, and 41% for anxiety/depression. Continued improvement to 36-months postinjury was only present for the usual activities item; the adjusted relative risk (ARR) of reporting problems decreased from 6 to 12 (ARR 0.87, 95% CI: 0.83–0.90), 12 to 24 (ARR 0.94, 95% CI: 0.90–0.98), and 24 to 36 months (ARR 0.95, 95% CI: 0.95–0.99). The risk of reporting problems with pain or discomfort increased from 24- to 36-months postinjury (ARR 1.06, 95% CI: 1.01, 1.12). While loss to follow-up was low, there was responder bias with patients injured in intentional events, younger, and less seriously injured patients less likely to participate; therefore, these patient subgroups were underrepresented in the study findings.ConclusionsThe prevalence of ongoing problems at 3-years postinjury is high, confirming that serious injury is frequently a chronic disorder. These findings have implications for trauma system design. Investment in interventions to reduce the longer-term impact of injuries is needed, and greater investment in primary prevention is needed.

The Impact of Public Policy on Support Services for Indigenous Families with Children with Special Education Needs

In Australia and Europe, government agencies and not-for-profit organisations (NFPOs) have had long involvement in the funding and provision of community disability services. Significant change has occurred in Australia over the past two decades in the way government funds are expended, with marketplace mechanisms increasingly being used. As a consequence of economic and governance imperatives, funding of services via NFPOs has changed significantly with a move away from the provision of grants to the contracting of these organisations for the provision of services. In 2013, a new national policy, the National Disability Insurance Scheme (NDIS), was introduced that has impacts for the provision of disability services for children and their families. In particular, Indigenous families are likely to experience barriers in accessing services. This paper reviews the impact of international changes in policy and associated funding models and considers the impacts and research implications of Australia's initial experience of implementation of the NDIS.