Experiences Of Service Providers Research Articles

Experiences of Gender-Based Violence Among Disabled Women: A Qualitative Systematic Review and Meta-Synthesis Protocol

Background Gender-based violence (GBV) is a major public health concern and a human rights issue disproportionately affecting disabled women. Disabled women are twice as likely to experience GBV than nondisabled women, yet there has been a lack of attention to this issue. This review aims to gain a greater understanding of the experiences of GBV of disabled women through a systematic and qualitative meta-synthesis. The qualitative meta-synthesis will be conducted by a research team of academic and community members and students with varying lived and service provider experiences with disabilities and GBV. The study findings aim to promote best practices by offering solutions to increase accessible and inclusive resources and services responsive to disabled women. Methods A systematic review of qualitative studies will be performed based on searches of 12 academic databases, including MEDLINE (Ovid), APA PsycINFO (EBSCO), Sociological Abstracts (ProQuest), Social Services Abstracts (ProQuest), and SocINDEX (EBSCO). A search of the gray literature will be performed by searching the Google search engine, Google Scholar, the Community Health Online Digital Archive and Research Resource (CHODARR), and the Global Database on Violence Against Women. In addition to the database and gray literature searching, we will complete backward and forward citation tracing. Two research team members will be involved in all screening, review, data extraction, and quality assessment of studies. A third reviewer will resolve any disagreements and consult with the research team. Thematic synthesis steps will include becoming familiar with the data, developing a thematic framework, indexing the data to identify themes and codes, charting the data, and mapping and interpreting the data. The Critical Appraisal Skills Programme checklist will be used to appraise the quality of included studies. Confidence in the meta-synthesis findings will be assessed by applying the GRADECERQual approach. Review Registration This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42023400410.

The Compassionate Communities Connectors programme: experiences of supported families and referring healthcare providers.

Comprehensive evaluations that include the experience of patients and service providers are vital if interventions are to be translated into the standard practice of health services and allow formal networks to work as partners with informal community networks. However, published evaluations are limited in the palliative care volunteering literature. The objective of the study is to explore the experiences and views of both patients and their family carers who received support and their referring healthcare providers concerning their participation in the Compassionate Communities Connectors programme, in the south-west region of Western Australia. Connectors identified and addressed gaps in community and healthcare provision by accessing resources and mobilising social networks of people with life-limiting illnesses. The perspectives of patients, carers and service providers concerning the feasibility and acceptability of the intervention were sought. Semistructured interviews were undertaken with 28 patients/families and 12 healthcare providers, resulting in 47 interviews in total (March 2021-April 2022). An inductive content analysis was used in analysing interview transcripts to identify key themes. Families greatly appreciated the support and enablement received from the Connectors. Healthcare providers were impressed with the high level of resourcefulness exhibited by the Connectors and perceived a great need for the programme, particularly for those socially isolated. Three themes captured the patients'/families' perspectives: connector as an advocate, increasing social connectedness and taking the pressure off families. Healthcare providers' perspectives were captured in three themes: reducing social isolation, filling a gap in service provision and building the capacity of the service. Perspectives of patients/families and healthcare providers demonstrated the mediating role of Connectors. Each group saw the Connectors' contribution through the lens of their particular interests or needs. However, there were indications that the connection was shifting the way each group understood and practised care, encouraging or restoring agency to families and reminding healthcare providers that collaborating beyond the boundaries of their roles actually enhances the whole ecology of care. Using a Compassionate Communities approach to mobilise health and community sectors has the potential to develop a more holistic approach that addresses the social, practical and emotional domains of care.

The Benefits and Challenges of Shifting to Telehealth During COVID-19: Qualitative Feedback from Kentucky's Sexual Violence Resource Centers and Children's Advocacy Centers.

The onset of the COVID-19 pandemic presented novel challenges for service providers addressing mental health issues with a large shift to the utilization of telehealth. While previous research has examined the benefits and challenges of providing mental health and crisis services remotely through telehealth, little research exists examining the use of telehealth in children's advocacy centers (CACs) and sexual violence resource centers (SVRCs). CACs and SVRCs are multi-disciplinary agencies taking a holistic approach to addressing interpersonal violence, making them unique in that they provide a range of direct services beyond mental health counseling (e.g., legal advocacy, medical exams, and prevention education) but all geared toward public health and safety. The current study explored the experiences of direct service providers in Kentucky CACs and SVRCs and their opinions about the most significant challenges and benefits of adapting their practices at the onset of the COVID-19 pandemic. A total of 118 providers participated in the study, and 88 reported using telehealth (defined as communicating with clients via technology such as videoconferencing, phone calls, or email) since the onset of COVID-19. Qualitative data from those 88 respondents regarding the challenges and benefits of using telehealth were collected and coded using a thematic content analysis. 78.6% of the sample indicated that they served primarily rural areas. Benefits noted included increasing treatment access, increasing treatment flexibility, and advancing continuity of care, while challenges included difficulties with technology, client engagement, privacy, and logistical challenges. Responses highlighted that telehealth presented both a number of advantages and difficulties and that more formal guidance for providers at CACs and SVRCs was desired.

“Systems trauma”: A qualitative study of work-related distress among service providers to people experiencing homelessness in Canada

Service provision to people experiencing homelessness is challenging and stressful work. Yet, there is a dearth of evidence on how the work experiences of service providers contribute to mental health distress and wellness. This qualitative study examined the contributing factors to workplace mental health among service providers to people experiencing homelessness in Canada, with the aim of establishing a causal theory for how work-related challenges cause distress. In-depth interviews were conducted with 40 service providers working in the homeless service, supportive housing, and harm reduction sectors across Canada. Data were analyzed using a grounded theory-informed approach. The workplace mental health of service providers was centred on the concept of “systems trauma,” which refers to the structural and systemic factors that exacerbate the difficulty of service providers’ work, putting them at-risk of work-related mental health distress. “Systems trauma” had multifaceted causes and consequences, as did the organizational- and individual-level factors that protected service providers against its impacts. Overall, the findings highlight how the same sociopolitical context that negatively affects people experiencing homelessness also shapes the workplace mental health of service providers. Supports for managing moral distress, policy and public initiatives to improve the valuation of work with people experiencing homelessness, dedicated funding for workforce development, and further investment in primary and secondary prevention of homelessness are recommended to promote workplace mental health.

Improve Autism Rehabilitation Services by Providing Solutions Based on the Perception and Experience of Parents and Providers: A Qualitative Study

Background: Children with autism spectrum disorder (ASD) need a variety of services. One of the most essential needs of these children with ASD is the use of rehabilitation services. However, these services pose many challenges for these individuals. Providing strategies to solve these barriers is essential. Objectives: The purpose of this study was to identify strategies to overcome barriers to using rehabilitation services and improve them based on the perceptions and experiences of rehabilitation service providers and parents of children with ASD. Methods: This study was conducted with a conventional qualitative approach. Twenty-seven participants were selected from rehabilitation service providers and parents of children with ASD based on purposive sampling with maximum diversity. Data were collected through semi-structured face-to-face interviews. The interviews lasted from July to December 2020 for 20 to 60 minutes and continued until the data was saturated. Data were analyzed with MAXQDA 10 software. Results: After the interviews, 1057 initial codes were extracted by deleting similar codes. Strategies for using rehabilitation services for these children with ASD were classified into 5 main categories and 20 subcategories, which are: Improving the level of knowledge and attitude, creating and strengthening a systematic support system, systematic rehabilitation policies, developing a comprehensive autism rehabilitation management program and facilitating access. Conclusions: In previous studies, many challenges have been identified for all services for children with ASD. The findings of this study showed that considering facilitators to solve the existing challenges in order to use of rehabilitation services for these children with ASD and their families. Therefore, policy makers, service providers and managers need to be aware of the strategies collected and pay special attention to these issues. To achieve a more favorable situation, they should adopt and implement the necessary mechanism in the field of policy and planning, so that finally lead to fundamental steps to improve the rehabilitation services needed by children with ASD.

Housing Provision for Women Experiencing Domestic and Family Violence in NSW during COVID-19

ABSTRACT Domestic and family violence (DFV) increased in complexity during the COVID-19 pandemic, creating further opportunities to help women escape DFV. Governments responded by injecting ad-hoc funding into temporary housing options and homelessness services. This paper provides an integrated discussion between the COVID-driven responses (policy analysis) and the experiences of DFV service providers in NSW, Australia (empirical data), which showed that existing policies are often limited in scope and out of touch with the DFV survivors’ long-term housing and support needs. A more holistic approach with DFV targeted housing responses and policies is needed to more effectively help women leaving DFV.

Does place matter in the implementation of an evidence-based program policy in an Australian place-based initiative for children?

Policy-mandated requirements for use of evidence-based programs (EBP) in place-based initiatives are becoming more common. Little attention has been paid to the geographic aspects of uneven market development and urbanicity in implementing EBPs in large place-based initiatives. The aim of this study was to explore geographic variation in knowledge, attitudes, and experiences of service providers who implemented an EBP policy in Australia's largest place-based initiative for children, Communities for Children. A cross-sectional online survey of Communities for Children service providers was conducted in 2018-2019, yielding 197 participants from all of Australia's eight states and territories. Relationships between two measures of 'place' (thick and thin market states; urbanicity: urban, regional and remote) and study-designed measures of knowledge, attitudes, and implementation experiences were analyzed using adjusted logistic and multinomial regressions. Participants from thin market states (outside the Eastern Seaboard) were more resistant to the policy and experienced greater implementation challenges than those from thick market states (Eastern Seaboard). Regional participants reported greater knowledge about EBPs but experienced greater dissatisfaction and implementation challenges with the policy than both urban and remote participants. Our study found that place does matter when implementing EBPs in a place-based initiative.

Gains and losses within the homeless service, supportive housing, and harm reduction sectors during the COVID-19 pandemic: A qualitative study of what matters to the workforce.

The COVID‐19 pandemic has had deleterious effects on individuals experiencing homelessness; yet, less is known about how this global health crisis is impacting service providers that support the homeless population. This qualitative study examined the perceived impacts of the COVID‐19 pandemic on the lives and work experiences of service providers in the homeless service, supportive housing, and harm reduction sectors in Canada. Further analyses were conducted to identify the occupational values that were represented in the work‐related changes experienced by providers. A stratified purposive sample of 40 participants (30 direct service providers and 10 providers in leadership roles) were drawn from a pan‐Canadian study of the mental health of service providers working with individuals experiencing homelessness. Reflexive thematic analysis was used to identify five themes of the work‐related changes experienced by service providers during the pandemic: [1] “Everything was changing every day”: Work role and responsibility instability; [2] “How on Earth do we do our job?”: Challenges to working relationships with service users; [3] “It used to be a social environment”: Transitions to impersonal and isolating workspaces; [4] “It all comes down the chute”: Lack of organisational support and hierarchical conflict; and [5] “We've been supported as well as we could have”: Positive organisational support and communication. The findings underscored how many of the occupational changes during the pandemic did not align with service providers' occupational values for collaboration, control, effective and safe service provision, and the importance of human relationships, among other values. As pre‐existing sectoral problems were exacerbated by the pandemic, recovery efforts need to address these long‐standing issues in ways that are aligned with service providers' values. Future research is warranted on how organisational approaches can promote supportive workplaces for service providers and improve outcomes for individuals experiencing homelessness.

“Well, that’s like night and day, being homeless, having nothing.” A qualitative exploration of the experiences of residents and service providers of permanent supportive housing

ABSTRACT A body of research documents the empirical benefits of permanent supportive housing (PSH) at the individual and societal levels. This study aimed to understand how formerly homeless adults experience living in PSH and how service providers experience working with residents of PSH. Semi-structured interviews were conducted with 13 residents and 12 service providers across three PSH sites in Northern California. Using thematic analysis, we constructed four themes that highlight the complexities of housing chronically homeless adults with severe mental illness and co-occurring substance use disorders. Interviewees discussed the ways in which housing provided a foundation for residents to make positive life changes, including achieving housing stability, improving physical and mental health, finding a sense of purpose, and (re)building relationships. Interviewees also discussed challenges with project-based PSH, such as appropriateness of fit between new and existing residents, and provision of services. Residents and service providers alike highlighted substance use as the primary threat to housing stability for both the person using and those who have minimized use or stopped using. These findings provide support for the Housing First principles underlying PSH, but also highlight the need for considering individual consumers’ needs in the development of housing programs and implementation of supportive services.

The Tommy’s Clinical Decision Tool, a device for reducing the clinical impact of placental dysfunction and preterm birth: protocol for a mixed-methods early implementation evaluation study

BackgroundDisparities in stillbirth and preterm birth persist even after correction for ethnicity and social deprivation, demonstrating that there is wide geographical variation in the quality of care. To address this inequity, Tommy’s National Centre for Maternity Improvement developed the Tommy’s Clinical Decision Tool, which aims to support the provision of “the right care at the right time”, personalising risk assessment and care according to best evidence. This web-based clinical decision tool assesses the risk of preterm birth and placental dysfunction more accurately than current methods, and recommends best evidenced-based care pathways in a format accessible to both women and healthcare professionals. It also provides links to reliable sources of pregnancy information for women. The aim of this study is to evaluate implementation of Tommy’s Clinical Decision Tool in four early-adopter UK maternity services, to inform wider scale-up.MethodsThe Tommy’s Clinical Decision Tool has been developed involving maternity service users and healthcare professionals in partnership. This mixed-methods study will evaluate: maternity service user and provider acceptability and experience; barriers and facilitators to implementation; reach (whether particular groups are excluded and why), fidelity (degree to which the intervention is delivered as intended), and unintended consequences. Data will be gathered over 25 months through interviews, focus groups, questionnaires and through the Tommy’s Clinical Decision Tool itself. The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability) will inform data analysis.DiscussionThis paper describes the intervention, Tommy’s Clinical Decision Tool, according to TiDIER guidelines, and the protocol for the early adopter implementation evaluation study. Findings will inform future scale up.Trial registrationThis study was prospectively registered on the ISRCTN registry no. 13498237, on 31st January 2022.

Median regression models for clustered, interval-censored survival data - An application to prostate surgery study.

Genitourinary surgeons and oncologists are particularly interested in whether a robotic surgery improves times to Prostate Specific Antigen (PSA) recurrence compared to a non-robotic surgery for removing the cancerous prostate. Time to PSA recurrence is an example of a survival time that is typically interval-censored between two consecutive clinical inspections with opposite test results. In addition, success of medical devices and technologies often depends on factors such as experience and skill level of the medical service providers, thus leading to clustering of these survival times. For analyzing the effects of surgery types and other covariates on median of clustered interval-censored time to post-surgery PSA recurrence, we present three competing novel models and associated frequentist and Bayesian analyses. The first model is based on a transform-both-sides of survival time with Gaussian random effects to account for the within-cluster association. Our second model assumes an approximate marginal Laplace distribution for the transformed log-survival times with a Gaussian copula to accommodate clustering. Our third model is a special case of the second model with Laplace distribution for the marginal log-survival times and Gaussian copula for the within-cluster association. Simulation studies establish the second model to be highly robust against extreme observations while estimating median regression coefficients. We provide a comprehensive comparison among these three competing models based on the model properties and the computational ease of their Frequentist and Bayesian analysis. We also illustrate the practical implementations and uses of these methods via analysis of a simulated clustered interval-censored data-set similar in design to a post-surgery PSA recurrence study.

Experiences of service providers in the expedited delivery of ABA therapy via telehealth during the COVID-19 pandemic: Reflections and considerations for the future.

Experiences of service providers in the expedited delivery of ABA therapy via telehealth during the COVID-19 pandemic: Reflections and considerations for the future.

Provider Perspectives on HIV Pre-Exposure Prophylaxis Service Disruptions and Adaptations During the COVID-19 Pandemic in Baltimore, Maryland: A Qualitative Study.

The COVID-19 pandemic continues driving unprecedented disruptions to health care provision, including HIV pre-exposure prophylaxis (PrEP) services. We explored service provider experiences promoting and prescribing PrEP to marginalized populations during the COVID-19 pandemic in Baltimore, Maryland. In February to April 2021, we facilitated four virtual focus group discussions with 20 PrEP providers, representing various professional cadres and practice settings. Employing an iterative, team-based thematic analysis, we identified salient enablers and constraints to PrEP promotion, initiation, and maintenance in the COVID-19 era, along with innovative adaptations to PrEP service delivery. Discussants described attenuated demands for PrEP early in the pandemic, exemplified by high PrEP discontinuation rates. This was attributed to changes in clients' sexual behaviors and shifting priorities, including caregiving responsibilities, during the pandemic. Substantial systems-level disruptions impacting PrEP provision were identified, including outreach service suspension, personnel shortages, and facility restrictions on face-to-face visits. Providers emphasized that these disruptions, though occurring early in the pandemic, had protracted impacts on PrEP accessibility. The transition to telemedicine rendered health care services, including PrEP, more accessible/convenient to some clients and expeditious to providers. However, structural barriers to telehealth engagement (telephone/internet access), coupled with limitations of the virtual care environment (difficulty establishing rapport), impeded efforts to equitably promote and prescribe PrEP. Expanding the PrEP outreach workforce and availing alternatives to telemedicine (e.g., community-based PrEP provision, specimen self-collection) could facilitate PrEP care continuity, especially as COVID-19 transitions from an acute to a protracted health crisis.

LAST MILE TRIPS: Logistics distribution infrastructure in smart cities and the experiences of service provision in the Metropolitan Region of Recife - PE

The present research aims to explore the main technologies added in the last mile logistics distribution infrastructure models used in smart cities, as well as relate them to the experiences of companies that provide these services in the Metropolitan Region of Recife (MRR). In order to do so, a case study is presented on the logistics distribution system used by a company that performs last mile delivery in the MRR. The data were collected through the application of a questionnaire to the manager of the company in question. Considering the studies analyzed on the subject, the implementation of new models of last mile logistics distribution in smart cities around the world, such as pick-up points, lockers, crowdsourcing and crowdshipping, was evident. Regarding the logistics distribution infrastructure used in the MRR, the results obtained showed that the application of the new models is still limited. It is concluded that the existence of public/private partnerships is essential for the introduction and strengthening of new last mile logistics distribution systems used in cities, whether they are considered smart or not.

Child and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers

BackgroundCurrent work in the field point to the need to strengthen child and adolescent mental health services (CAMHS) globally, and especially in low- and middle-income countries (LMICs). Policy development, planning and service provision must be relevant to the needs of stakeholders at grassroots level, and should include their perspectives. This study set out to explore the perspectives and lived experiences of service providers, including their recommendations to strengthen CAMHS in South Africa.MethodsUsing focus group discussions (FGDs) and semi-structured individual interviews (SSIIs), qualitative data were collected from 46 purposefully selected multidisciplinary health service providers across the Western Cape, one of the nine provinces of South Africa. Audio-recorded data were entered into NVivo 11 (QSR), and thematic analysis was performed by two independent raters.ResultsResults highlighted a significant lack of CAMH resources, poor intersectoral collaboration, limited access to training, absence of consistency and uniformity in service delivery, weak support for staff, and high rates of negative attitudes of staff. External factors contributing to poor CAMHS identified by service providers included poor socioeconomic circumstances, high rates of HIV/AIDS, substance use and stigma. The eight recommendations to strengthen CAMHS included a need to (1) increase CAMH staffing, (2) provide dedicated CAMHS at secondary care and child-friendly infrastructure at primary care, (3) review current service focus on number of patients seen versus quality of care provided to children, (4) formalise intersectoral collaborations, (5) increase learning opportunities for trainees, (6) employ a lead professional for CAMHS in the province, (7) increase support for staff, and (8) acknowledge staff initiatives.ConclusionsFindings underlined the need for quality improvement, standardisation and scale-up of mental health services for children and adolescents in South Africa. Whilst we used the Western Cape as a ‘case study’, we propose that our findings may also be relevant to other LMICs. We recommend that the perspectives of service users, including children and adolescents, be sought to inform service transformation.

A knowledge implementation model in health system management based on the PARIHS model

BackgroundThe gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran.MethodsThe present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software.Results The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model.Conclusion The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.

Examining the Impacts of the COVID-19 Pandemic on Service Providers Working with Children and Youth with Neuro-developmental Disabilities and their Families: Results of a Focus Group Study.

Background: The COVID-19 pandemic has imposed unprecedented service interruptions in many sectors including services for children and youth with neuro-developmental disabilities (NDD). Methods: We examined the experiences of service providers as they supported this population during the pandemic. Five focus groups were convened with 24 service providers offering support to children/youth with NDD and their families. Results: Results highlight substantial service changes and challenges, as observed by service providers. Service closures and program delivery modification resulted in the rapid adoption of virtual services and reduced program delivery. Service providers have faced heightened workloads, personal weariness and ‘burn out’, and new levels of conflict at work, yet with little opportunity and support for self-care. Beyond challenges, new learning and growth have emerged, with heightened collaboration amongst organizations. Conclusion: Strains in service delivery during the pandemic have exposed programming and systems gaps, for which proactive capacity building is warranted and recommended.

Family-centred care for children with traumatic brain injury and/or spinal cord injury: a qualitative study of service provider perspectives during the COVID-19 pandemic

ObjectivesCOVID-19 has led to rapid changes in rehabilitation service provision for young people living with traumatic brain and/or spinal cord injury. The aim of this project was to understand the...

“This Pandemic Has Opened Another Box of War”: COVID-19, Safeguarding, and Research on Human Trafficking and Modern Slavery in Kenya and Uganda

ABSTRACT There is growing evidence of the significant impacts of COVID-19 and government responses for those who experience human trafficking and modern slavery (HTMS). There is less known about experiences of service-providers, effects on international partnerships, and the implications of funder responses. This article uses the prism of safeguarding to explore the challenges faced during the pandemic for service-providers in Kenya and Uganda, paying attention to the power dynamics embedded within international development and knowledge production. The research included interviews conducted with a diverse set of organizations in 2020 and 2021. Our findings contribute to human rights approaches to HTMS, laying bare the effects of the pandemic on shared meanings around protection and harm prevention. The analysis identifies fresh challenges and additional risks that research on the effects of COVID-19 on HTMS places on local fieldworkers and research participants. The discussion emphasizes the dangers of opportunistic research, and the importance of addressing local needs as a focus and priority. The article concludes by arguing that the centering of safeguarding should be the basis for future strategy to address SDG8.7, with potential to provide a pathway for genuinely collaborative research that foregrounds equity in both partnership-building and knowledge production.

Transition to adulthood: experiences of service providers working with immigrant disabled adolescents and young adults in Norway

The demographic landscape of Norway is diversifying. These changes present challenges for frontline professionals working with immigrant parents raising children with disabilities. This article explored service providers’ perspectives on the challenges they face in delivering services to immigrant adolescents and young adults with disabilities aged 16–25. The study generated qualitative data from seven informants from different state institutions using semi-structured interviews. Our findings showed that service providers encountered personal and organisational challenges, including communicating and collaborating with immigrant parents. Service agencies experienced underfunding, making them unable to cope with growing demands. Additionally, service providers experienced inter-agency cooperation and collaboration difficulties such as a lack of information sharing, even when they served the same clients. Increasing funding, staff training, and strengthening formal and informal communication with immigrant parents of children with disabilities can provide opportunities to improve service delivery.