Disability Services Research Articles

Examining the effectiveness, feasibility, and acceptability of an advocacy program for Latinx families of transition-aged autistic youth.

To support Latinx families of autistic youth navigate school-based transition services and adult disability services, we provided a family advocacy program entitled, ASISTIR (Apoyando a nueStros hIjo/as con autiSmo obTener servIcios de tRansición; Supporting our Children with Autism to Obtain Transition Services). The ASISTIR program consisted of six, two-hour sessions and included the following topics: school-based transition planning, person-centered planning, Supplemental Security Income, Vocational Rehabilitation, and Home and Community-Based Medicaid Waiver. Twenty-nine Latinx family members completed the cohort-based ASISTIR program. After participating family members demonstrated increased knowledge of school-based transition planning and adult disability services. Participants also demonstrated increased empowerment and advocacy.

Towards value‐based rehabilitation: an analysis of South African policies for people with disabilities

AbstractSouth Africa has progressively established good healthcare policies and actively promotes the rights of people with disabilities. However, as the healthcare sector is moving towards value‐based care to achieve universal health coverage, it remains unclear whether South African rehabilitation policies provide sufficient guidance for delivering value‐based rehabilitation services for people with disabilities. This article attempts to ascertain whether the content of South African rehabilitation policies is aligned with value‐based care. Rehabilitation policies were identified through a literature search (including grey literature) and discussions with stakeholders in the health policy field. A framework for value‐based care was created for deductive policy content analysis. A qualitative descriptive approach was used to describe the content that correlates with the framework's components. The National Rehabilitation Policy and the Framework and Strategy for Disability and Rehabilitation Services were included in this study. Both documents aligned with the value‐based framework, however, various barriers in South Africa challenge value‐based rehabilitation services. We conclude that South Africa's rehabilitation policies can guide value‐based rehabilitation services. However, these policies need to be operationalized and supported by empirical data on disability and rehabilitation services. A concerted effort is required from the government to ensure the allocation of resources for the implementation of policy.

Rehabilitation services for childrenwith disabilities during the COVID-19 pandemic in the United Arab Emirates: Experiences of parents

Introduction: The Covid -19 pandemic brought changes in professional practice across the globe. Children with disabilities received rehabilitation services remotely throughout the lockdown periods to contain the virus in the United Arab Emirates. This paper explores the experiences of parents of children with disabilities who received remote rehabilitation services during the Covid-19 pandemic.Methods: A survey was developed by the study team in English and Arabic. Demographic data, characteristics of children, family circumstances, access to rehabilitation, use of assistive tools, financial and psychological implications on parents and children, and future use of remote therapy. It was deployed to the parents through the rehabilitation centers and was analyzed using descriptive statistics with frequencies and percentages.Results: The survey was completed by 239 parents whose children with disabilities received the rehabilitation services remotely mainly through telerehabilitation. The pressure and psychological impact on parents were high, reporting frustration (44.8%), and anxiety (59.8%), although (70.3%) recognized the importance of continued care for the child.Conclusion: Telerehabilitation was the means during the pandemic to ensure continued care in the UAE. In the future, remote rehabilitation will be appropriate in specific situations when there is limited or no access to the center. Future research should explore thecontinued use of telerehabilitation and its effectiveness.

Exploring the relevance of Universal Design for Learning implementation in the post-secondary landscape from the perspective of sustainability

This presentation showcases findings from a Canadian study which was carried out through 2023-24. This project explores an innovative facet of the momentum around sustainability within higher education, one that goes beyond the focus on environmental and operational preoccupations and concentrates on social and pedagogical sustainability. It examines the way the introduction of Universal Design for Learning (UDL) to a campus, through the creation of a cross-discipline community of practice, can (i) empower faculty to develop sustainable accessible practices within their own classroom, (ii) significantly reduce the reliance of the campus on accessibility services and reduce the pressure felt by these services, (iii) successfully integrate accessibility and inclusion within institutional strategic thinking around sustainability. The presentation synthesizes findings from a qualitative action-research project which examined perceptions and experiences of 14 stakeholders with different status and toles across the campus. The study adopted a phenomenological approach to data collection and analysis (Holland, 2014) and explored the participants’ own constructs in relation to the overlap between UDL and sustainability. Accessibility in the higher education has thus far been addressed through a medical model approach focused on retrofitting. In a nutshell, teaching and learning is designed for the ‘traditional learner’ and support services take on the task of supporting students who experience barriers in this design, with remedial, targeted services outside the classroom. The demographics of higher education, however, have changed widely over the last two decades, and retrofitting approaches are no longer sustainable. The volume of demand is growing exponentially, wait times increase, and the cost of Accessibility Services increases in a way that becomes unmanageable within most post-secondary campuses (NEADS, 2018). Universal Design for Learning (UDL) can address many of these strains on resources. Indeed, UDL is an emerging model for the management of diversity in the classroom which equips instructors to remove the majority of barriers to access to learning and support the needs of most diverse learners within the classroom itself (Al-Azawei et al., 2016). The literature highlights that most of the needs of diverse learners can be addressed with ease within the classroom itself once inclusive design and UDL are adopted and integrated as a mindset, across institutions (Baumann & Melle, 2019; Dalton et al., 2019). UDL can therefore address some of the concerns over the sustainability of current disability service provision models. The need for a sustainable lens in this area is therefore tangible and pressing. Accessibility services, student services personnel, and faculty are all painfully feeling first-hand the inability of the current structure to meet the needs of diverse learners and to address the volume of service requests. UDL has the potential to address this strain on support services and to re-empower faculty to create inclusive provisions within the classroom space. A practical example of this would be the considerable pressure placed on accessibility services to digitalize printed material or to seek alternate versions of PDFs that are shared in class but are not accessible with reading software. This is an example of costly, repetitive use of resources that can be solved sustainably by empowering instructors to use the UDL principles in their class design and not rely on print only or on non-accessible digital documents. This has immediate resource and funding implications. UDL integration represents a clear example of sustainable transformation: an initial focus on professional development with faculty leads to a reduction in spending and resources that are non-renewable (Fovet, 2017). The presentation showcases the wider implications for UDL development across the sector.

The two ends of the tertiary education spectrum

Tertiary education over the past ten years has seen a significant increase in learner diversity and the variability. Learners today are not a homogeneous group, instead they bring a variety of rich cultures, abilities, multiple and intersectional identities, varied lived experiences, and educational backgrounds. What was once known as the non-traditional or under-represented learner, today it is more common experience with the increase in international learners, refugees, asylum seekers, neurodiverse learners, carers, vulnerable learners, widening participation and access learners. We know this variability exists with the increase in learners registered with the disability or wellbeing services, a targeted approach to recruiting international learners and the widening access and participation efforts. While variability and diversity should be celebrated it does require adequate resources and funding, inclusive support structures and systems to be put in place, as well providing staff professional development. With this change there is an opportunity through enhancement that involves ‘doing new things or doing established things in different ways’ (QAA Scotland 2022, p.6). Inclusive education, “understood as equal access and opportunities, has become a guiding principle of higher education agendas” (Timus et al. 2024, 473). Across institutions there is a plethora of inclusion allies, advocates, initiatives, strategies, polices and professional development supports, so why are so many learners leaving courses, not engaging, not attending and certainly not seeing the value of education. Is it the pendulum shift toward marketisation, commercialisation and privatisation that learners are not seeing institutions as spaces and places of equity and justice but factories where money needs to cross hands? Where on this spectrum is the balance for enhancement and could universal design and universal design for learning be at least the starting point?

Housing Australian Children: A Snapshot of Health Inequities in the First 2000 Days.

Housing is a critical social determinant of children's health. While individual pathways between housing and health are well evidenced, there has been less attention on the co-occurrence of housing disadvantages. We aim to identify typologies of children's housing disadvantage and describe the health inequities they generate. A cross-sectional latent class analysis (LCA) was conducted on 4355 Australian children aged 4 to 5years who participated in the Longitudinal Study of Australian Children. Nine binary indicators-dwelling tenure, external condition, affordability, stability, crowding, cleanliness, fuel poverty, and noise exposure-were used to generate latent housing typologies. Generalized linear models with robust standard errors described disparities in quality of life, injury, disability, and health service use across these housing typologies. Four distinct housing typologies were identified in this cohort: "good condition, affordable, and secure" (60%); "insecure" (11%); "crowded" (24%); and "unsuitable" (5%). Unsuitable housing, characterized by crowding, poor external conditions, and noise exposure, was more likely to be occupied by single-parent families, low-income households, and be headed by parents with low levels of education. Children in unsuitable housing lagged on quality of life indicators at preschool age (e.g., by 8.0 points on emotional functioning, 95% CI - 10.6, - 5.5), and underutilized primary healthcare services (e.g., prevalence ratio 0.76 for GP services, 95% CI 0.67, 0.87), compared to children in good quality housing. This finding supports the case for early intervention strategies that account for children's housing circumstances.

Cerebral palsy in Australia: birth prevalence, 1995-2016, and differences by residential remoteness: a population-based register study.

To examine recent changes in the birth prevalence of cerebral palsy in Australia; to examine the functional mobility of children with cerebral palsy by residential remoteness. Population-based register study; analysis of Australian Cerebral Palsy Register (ACPR) data. Children with cerebral palsy born in Australia, 1995-2016, and included in the ACPR at the time of the most recent state/territory data provision (31 July 2022). Change in birth prevalence of cerebral palsy, of cerebral palsy acquired pre- or perinatally (in utero to day 28 after birth), both overall and by gestational age group (less than 28, 28-31, 32-36, 37 or more weeks), and of cerebral palsy acquired post-neonatally (day 29 to two years of age); gross motor function classification by residential remoteness. Data for 10 855 children with cerebral palsy born during 1995-2016 were available, 6258 of whom were boys (57.7%). The birth prevalence of cerebral palsy in the three states with complete case ascertainment (South Australia, Victoria, Western Australia) declined from 2.1 (95% confidence interval [CI], 1.9-2.4) cases per 1000 live births in 1995-1996 to 1.5 (95% CI, 1.3-1.7) cases per 1000 live births in 2015-2016. The birth prevalence of pre- or perinatally acquired cerebral palsy declined from 2.0 (95% CI, 1.7-2.3) to 1.4 (95% CI, 1.2-1.6) cases per 1000 live births; statistically significant declines were noted for all gestational ages except 32-36 weeks. The decline in birth prevalence of post-neonatally acquired cerebral palsy, from 0.15 (95% CI, 0.11-0.21) to 0.08 (95% CI, 0.05-0.12) cases per 1000 live births, was not statistically significant. Overall, 3.4% of children with cerebral palsy (307 children) lived in remote or very remote areas, a larger proportion than for all Australians (2.0%); the proportion of children in these areas who required wheelchairs for mobility was larger (31.3%) than that of children with cerebral palsy in major cities or regional areas (each 26.1%). The birth prevalence of cerebral palsy declined markedly in Australia during 1995-2016, reflecting the effects of advances in maternal and perinatal care. Our findings highlight the need to provide equitable, culturally safe access to antenatal services for women, and to health and disability services for people with cerebral palsy, across Australia.

Adult decision-making capacity and health research in Aotearoa New Zealand.

The Code of Health and Disability Services Consumers' Rights (the Code)1 and the Health and Disability Commissioner Act (the Act)2 are up for review. The Code currently applies to clinical care, teaching and research. When it was introduced, there were no national mechanisms to govern research, but since then the National Ethics Advisory Committee (NEAC) has developed detailed guidelines and established a network of ethics committees at various institutional levels. As currently written, the Code prohibits research on a patient who lacks capacity unless it is in their "best interests." This precludes some important research. The NEAC guidelines are more nuanced and measured, designed to balance the risks to the patient with the benefits to the community. We argue that the Code and the Act should be amended to allow decisions about research proposals on people who lack capacity to be made by an ethics committee set up by NEAC.

Exploring practice leadership in intellectual disability services: a concept analysis

Exploring practice leadership in intellectual disability services: a concept analysis

Help your students transition to the world of work

With everything disability services offices must do, helping with students’ job transitions may seem like one more responsibility you may not wish to take on. But connecting with career services can not only benefit students in their pursuit of a job after graduation, but also during their time at college. I spoke to Amanda Feaster of Kent State, Christy Oslund of Michigan Technological University, Joan Rachmel of Nevada State, and Gabe Wright of the University of Tampa about this process.

Accessibility

An overview of the key topics faced by disability services providers with citations to noteworthy cases, statutes, regulations, and additional sources.

Help coordinate employment assistance and support for students with disabilities

October is National Disability Employment Awareness Month, and throughout the month, many disability services offices have highlighted employment for those with disabilities. But why not maintain these activities? In conjunction with your institution's career services and related offices, you can continue the emphasis on targeted employment skills and available assistance for students with disabilities.

Healthcare for People With Intellectual Disabilities: An Exploration of Intellectual Disability Service Providers' Experiences of Joint Working With Acute Service Providers When People With Intellectual Disabilities Access Healthcare in Acute Services

Healthcare for People With Intellectual Disabilities: An Exploration of Intellectual Disability Service Providers' Experiences of Joint Working With Acute Service Providers When People With Intellectual Disabilities Access Healthcare in Acute Services

Evaluation of an Australian community‐based model of care for adults with intellectual and developmental disabilities undergoing procedures under sedation

AbstractBackgroundAdults with intellectual and developmental disabilities (IDDs) have higher healthcare needs, but experience difficulties accessing preventative healthcare. Despite this inequity, models of care that address barriers and provide customized treatment are limited, exacerbating vulnerabilities and poorer health outcomes. This study describes the development of a procedural model of care (PMOC) for adults with intellectual and developmental disabilities, and evaluates the sedation tier, exploring procedure and sedation outcomes.MethodsDevelopment of the PMOC was informed by current evidence and themes identified in stakeholder consultation and literature. A retrospective cohort study evaluated the sedation option within the model, conducted at a community‐based disability service in Melbourne, Australia. All records over a 14‐month period were included. Descriptive statistics and univariate logistic regression analysis were used to analyze data.ResultsThe PMOC includes assessment, intervention, and evaluation tiers. Intervention options range from least to most invasive, culminating in the sedation level (mild; oral psychoactive, moderate; midazolam and nitrous oxide, high; general anesthetic). A total of 127 adults with IDDs received procedures under sedation; median age was 26 years, 61% lived with family, and 81% had multiple disabilities. A total of 197 procedures were referred to CDDH, including immunization (61%) and oral health reviews (23%), and resulted in 98% completion rate. Mild (n = 36) and moderate (n = 95) sedation were used for 67% of procedures. The PMOC correctly predicted 91% of sedation requirements. Living with family (OR 2.211, 95% CI 1.001–4.885, p = 0.05); immunization (OR 7.935, 95% CI 4.025–15.644, p <0.001); and multiple disabilities (OR 3.064, 95% CI 1.123–8.362, p = 0.029) were associated with mild, moderate and high sedation options, respectively.ConclusionsModels of care offering individualized interventions can support adults with IDDs to receive preventative procedures. Demographic variables may be able to predict sedation requirements. Wider application of this model may reduce health inequity within this vulnerable population.

Learning from innovative staff practices that led to virtual disability services using the lens of Complex Adaptive Systems

This paper draws on a Complex Adaptive Systems lens to develop an understanding of the staff practices that supported the development of Virtual Disability Services in Ireland amid the COVID-19 pandemic. The study involved twelve interviews with service providers, which were analysed using Reflexive Thematic Analysis, leading to two overarching themes. The first theme focuses on the logistics of constructing the response. This includes dynamic adaptiveness, technological readiness, a positive attitude towards technology, resource availability, digital skills, and the level of take-up. The second theme centres on the enacted response, which encompasses sensemaking, developing technological expertise, managing upward, fostering creative innovation, cultivating a systems sensibility, and creating conditions for psychological safety and authentic engagement. We conclude that staff practices are key for creating conditions conducive to safe spaces, sustaining well-being, and reshaping power dynamics and emphasise the importance of embracing technology as a tool for innovation within complex operating environments. POINTS OF INTEREST Virtual Services offered a good alternative to face-to-face services for some disabled people during COVID-19: they supported people to stay connected while self-isolating. Even though some staff and disabled people did not have many technology skills before COVID-19, they learned in real-time, using the resources available to them. Online relationships were seen as more equal as everyone was learning as they went. People with disabilities developed new skills and sometimes co-facilitated sessions. This gave them greater choice and control over how they interacted with services and changed power relationships within services. Having choices about how to access services is in line with enhancing rights and choice under the Convention of the Rights of People with Disabilities. Promoting digital inclusion may protect people against future societal disruptions.

A scoping review of early childhood support for Aboriginal and Torres Strait Islander children living with a disability in regional, rural and remote settings.

Many experts and communities have concerns about how National Disability Insurance Scheme services are provided to Aboriginal and Torres Strait children. This study was undertaken at the request of the NPY Women's Council in partnership with the researchers, to explore supports for Aboriginal and Torres Strait Islander children living with a disability in their remote areas. This scoping review aims to (a) explore the barriers and enablers to accessing disability support services for families of young Aboriginal and Torres Strait Islander children (0-8 years) living in regional, rural and remote settings, and (b) summarise best practice approaches for accessing support for young children in these settings. The search was run in three electronic databases, as well as grey literature sources. We assessed the quality of included publications using the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange tool. A narrative synthesis was supported by thematic analysis. From an initial search (557 citations), we identified 13 eligible documents. Most documents were peer-reviewed articles of qualitative studies. Key themes identified included the following: (1) Holistic approach, (2) Understanding disability, (3) Consistent relationships, (4), Flexibility, (5) Simplify system and (6) Enhance communication. This scoping review has revealed gaps in the provision of quality, culturally responsive disability services for families of Aboriginal and Torres Strait Islander children living in regional, rural and remote areas of Australia. A family-centred, flexible approach will help address their needs. Future research is required to design and evaluate models of care for Aboriginal and Torres Strait Islander children.

Role of Occupational Therapy Assessment and Office Ergonomics to Support Students with Accommodations in Higher Learning: A Narrative Review

Postsecondary students with disabilities (SWDs) face significant challenges to their academic and personal well-being. There is a demand for more supportive strategies to facilitate fulfilling and equitable academic experiences for SWDs. This review aimed to (1) determine the effectiveness of various interventions, programs, and accommodations for enhancing the overall well-being of postsecondary SWDs and (2) evaluate the implications of these support strategies for disability service providers at postsecondary institutions. A narrative review was conducted, examining 13 studies aimed at enhancing the well-being of postsecondary SWDs. Studies were classified using the International Classification of Functioning, Disability and Health (ICF) Model. Ergonomics, assistive technology, and counselling programs had positive improvements on the academic success of SWDs. In SWDs, health status was associated with higher community participation, and physical interventions were beneficial to reducing pain over time. Coaching and mentoring opportunities were beneficial for successful goal fulfilment. However, there remains a risk of digital eye strain when using technology to support postsecondary SWDs. The findings indicate that a range of support strategies can benefit several different components of SWDs experiences. This review identifies research gaps and opportunities to examine support strategies to improve the physical and mental well-being of SWDs.

What does trauma-informed care mean to people admitted to a forensic mental health and intellectual disability service? A reflexive thematic analysis.

What does trauma-informed care mean to people admitted to a forensic mental health and intellectual disability service? A reflexive thematic analysis.

The North Carolina Division of Mental Health's Strategic Plan for Limiting Substance Use Overdose Deaths.

The North Carolina Division of Mental Health, Developmental Disabilities, and Substance Use Services has implemented a strategic plan for limiting substance use overdose deaths, including increasing primary prevention and increasing public awareness of and access to evidence-based treatment options.

Improving access in medical physics residency programs for physicists with disabilities.

Within the landscape of medical physics education, residency programs are instrumental in imparting hands-on training and experiential knowledge to early-career physicists. Ensuring access to educational opportunities for physicists with disabilities is a legal, ethical, and pragmatic requirement for programs, considering that a significant proportion of the United States population has a disability. Grounded in conceptual frameworks of competency-based medical education and the social model of disability, this work provides an introduction to some practical recommendations for medical physics residency programs. Strategies include embracing universal design principles, fostering partnerships with disability service offices, using inclusive language, developing and publicizing clear procedures for disclosing disabilities and requesting accommodations, and maintaining an overall commitment to equitable access to education. This work urges medical physics residency leadership to proactively move towards training environments that support the needs of residents across the spectrum of disability, highlighting why disability inclusion fundamentally enriches diversity.