Mainstream Service Providers Research Articles

Implementing 'Closing the Gap' policy through mainstream service provision: A South Australian case study.

The Australian government's 'Closing the Gap' (CTG) strategy has been implemented via multiple strategies. We examined CTG policy in early childhood within Southern Adelaide during the first decade of implementation (2008-2018) and critiqued the complexity and challenges of policy that is designed to promote health and well-being of Aboriginal and Torres Strait Islander children but lacked Aboriginal control. A qualitative case study was conducted in Southern Adelaide, and we interviewed 16 policy actors from health and early childhood education sectors. Thematic analysis revealed key themes to show how policy had been implemented through mainstream structures. The rapid roll out of the CTG strategy, the limitations of short-term funding, cuts to Aboriginal health services, tokenistic consultation, and the mainstreaming of service provision were key features of policy implementation. The influence of Aboriginal leaders varied across implementation contexts. Participants advocated for services in health and education that are culturally safe to improve health of children, families, and communities. The implementation of the CTG strategy in Southern Adelaide was rushed, complex, and lacking Aboriginal control. This contributed to the marginalisation of Aboriginal leaders, and disengagement of families and communities. A more collaborative and Aboriginal led process for policy implementation is essential to reform policy implementation and address health inequity. SO WHAT?: Findings from this study suggest that policy has continued to be implemented I ways that reflect colonial power imbalances. Alternative processes that promote the recognition of Indigenous rights must be considered if we are to achieve the targets set within the CTG strategy.

What is Financial Exclusion? A Review

The Central Bureau of Statistics (BPS) recorded that the Indonesian population living below the poverty line as of March 2016 reached 28.01 million people. Although Indonesia's poverty tended to decline in 2016, the World Bank considers that Indonesia's economic inequality has widened in the last 15 years. Poverty in Indonesia is motivated by financial exclusion. Financial exclusion is the lack of access, faced by those most in need, to cheap, fair and safe financial services from mainstream service providers. This study aims to determine the development of Financial Exclusion research trends published by leading journals on Islamic financial economics. The data analyzed consisted of 597 indexed research publications. The data is then processed and analyzed using the VoSviewer application to determine the bibliometric map of Financial Exclusion research development.

Developing self-report disability questions for a voluntary patient registration form for general practice in Australia

ObjectiveThis article reports on research undertaken to develop self-report disability questions for a patient registration form that may be implemented in general practices across Australia as part of a voluntary patient registration program. MethodsThere were four research components: rapid review of approaches for capturing disability information; expert informant interviews (n=19); stakeholder consultation via virtual focus groups (n=65); and online survey (n=35). Findings from each component informed development of materials for subsequent components in an iterative research process. ResultsThree disability questions were developed: two alternative questions for identifying disability, conceptually aligned with the operational definition of disability in Australia’s national disability survey; one question to determine the patient’s disability group/s. ConclusionsKnowledge and perspectives from a variety of sources informed the development of self-report questions to identify patients with disability. Implementing these questions represents an opportunity to test new ways of capturing disability information suited to mainstream service provision contexts. It will be essential to evaluate the quality of the data produced during the initial period of implementation. Implications for Public HealthThe collection of self-report patient disability information within general practice, using standard and conceptually-sound questions, has the potential to support improved provision of health care to patients with disability.

Twelve Tips for Inclusive Practice in Healthcare Settings

This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association's diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.

A case study approach to understanding the pathway to individualised funded supports under the National Disability Insurance Scheme for community-dwelling individuals with acquired brain injury.

The National Disability Insurance Scheme (NDIS) offers opportunity against a historical background of underfunded and fragmented services for people with disability. For people with acquired brain injury (ABI), concerns have been raised about how they access NDIS individualised funded supports. The aim of this research was to explore how community-dwelling individuals with ABI in Queensland navigate the NDIS participant pathway to individualised funded supports. This study used a multiple case study design within a policy implementation framework. Twelve people with ABI, nine family members and eight NDIS funded and mainstream service providers participated. Data was collected from relevant NDIS documentation, health records and semi-structured interviews with individuals with ABI, family members, and service providers. The current study highlighted the complexity of navigating the NDIS participant pathway of access, planning, implementation and review for people with ABI, their family and service providers. The NDIS pathway was impacted by the insurance and market based NDIS model itself, time, communication, and the requirement for external supports. Equally, the process was affected by environmental factors, individual person and injury factors as well as service providers, with a range of outcomes evident at the individual, family and system level. Findings suggest that the NDIS has struggled to make specific allowance for people with ABI and the complexity of their disabilities. Providing people with ABI access to the NDIS Complex Support Needs Pathway may redress many of the difficulties people with ABI experience accessing and using NDIS funded supports.

Rising to the challenge: disability organisations in the COVID-19 pandemic

This paper examines the impact of COVID-19 on disabled people from the perspective of disability organisations located in the Global South. Drawing on the findings of an online survey, which received responses from 20 representatives of disability organisations located in 13 countries, this study builds on a growing body of recent research highlighting the disproportionate impact of COVID-19 on disabled people, many of whom have experienced greater levels of discrimination and deeper levels of isolation and poverty as the result of inadequate state responses to the pandemic. The study also highlights the crucial role played by many disability organisations in supporting disabled people during the crisis, often filling in the gaps in mainstream service provision, and argues that they should be enabled to play a much more prominent role in the long-term recovery process in order to ensure a more disability-inclusive post-pandemic world.

‘The disparity is evident’: COVID-19, violence against women and support for Black and minoritised survivors

The disproportionate impact of COVID-19 on women and on Black and minoritised groups has highlighted the gendered and intersectional nature of the pandemic where structural inequality has reproduced disproportionately and exacerbated existing gendered and racialised inequalities. The pandemic and subsequent lockdowns led to an increase in domestic violence and abuse; noted to be disproportionately affected at multiple interlocking levels, home and the wider structural context constituted sites of violence for Black and minoritised survivors. Not only were women being subjected to heightened levels of violence and expanded coercive control but they faced greater constraints in seeking help. The decommissioning and closure of Black and minoritised organisations at a disproportionate level under austerity, inequitable funding structures and the simultaneous reinforcement of a hostile immigration environment have closed the door to safety for many survivors. Reporting on research conducted during 2020 with Black and minoritised organisations about the challenges encountered during the pandemic highlights how they rapidly adapted and reshaped survivor-centred support provision, the ways in which survivors experienced and responded to expanded forms of abuse, and the responses they and women received from mainstream service providers and the greater intersectional advocacy this required.

Machine Learning-based Orchestration of Containers: A Taxonomy and Future Directions

Containerization is a lightweight application virtualization technology, providing high environmental consistency, operating system distribution portability, and resource isolation. Existing mainstream cloud service providers have prevalently adopted container technologies in their distributed system infrastructures for automated application management. To handle the automation of deployment, maintenance, autoscaling, and networking of containerized applications, container orchestration is proposed as an essential research problem. However, the highly dynamic and diverse feature of cloud workloads and environments considerably raises the complexity of orchestration mechanisms. Machine learning algorithms are accordingly employed by container orchestration systems for behavior modeling and prediction of multi-dimensional performance metrics. Such insights could further improve the quality of resource provisioning decisions in response to the changing workloads under complex environments. In this article, we present a comprehensive literature review of existing machine learning-based container orchestration approaches. Detailed taxonomies are proposed to classify the current researches by their common features. Moreover, the evolution of machine learning-based container orchestration technologies from the year 2016 to 2021 has been designed based on objectives and metrics. A comparative analysis of the reviewed techniques is conducted according to the proposed taxonomies, with emphasis on their key characteristics. Finally, various open research challenges and potential future directions are highlighted.

Tackling LGBTQ+ youth mental health inequality: Mapping mental health support across the UK

Young people who identify as lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) experience higher rates of mental health distress than reported in the general population, yet are far less likely to seek support services. Factors such as homophobia, biphiobia and transphobia, cis-heteronormativity, fear of judgement and lack of staff awareness of LGBTQ+ identities are barriers to help seeking. This paper reports on the first stage of a study that investigated and mapped current LGBTQ+ youth specific mental health service provision across the UK. An online and offline service mapping exercise was undertaken to identify services. 111 services were identified across the search strategies, the majority in urban settings in England. There were three significant characteristics of LGBTQ+ child and adolescent mental health UK provision. Firstly, there was an absence of mainstream NHS support that specifically addressed the needs of LGBTQ+ young people. Secondly, the majority of LGBTQ+ youth mental health support was provided by voluntary/community organisations. Thirdly, there was a new emerging model of service that is based on collaborative working between NHS trusts and community/voluntary organisations. The results of this mapping exercise suggest that there is a reliance on the voluntary/community sector to provide mental health provision for LGBTQ+ young people. Furthermore, there was a distinct divergence in the approaches of the support provided by the voluntary/community sector and those from within the NHS. The affirmation of LGBTQ+ identities that is pivotal to the support provided by voluntary/community services contrasted with the ‘treating everyone the same’ approach prevalent in mainstream service provision. NHS mental health services must recognise that to tackle LGBTQ+ youth mental health inequality, statutory mental health support must address specifically the mental health needs of LGBTQ+ young people.

NHS commissioning in probation in England - Still on a wing and a prayer.

Policy reforms in England and Wales mean that all individuals released from prison will have some contact with probation services, either serving a community sentence, or being on licence post-release. Despite often having complex health needs, including a higher prevalence of mental health problems, substance misuse problems and physical health problems than the general population, this socially excluded group of people often do not access healthcare until crisis point. This is partly due to service-level barriers such as a lack of appropriate and accessible healthcare provision. We conducted a national survey of all Clinical Commissioning Groups (CCGs, n=210) and Mental Health Trusts (MHTs, n=56) in England to systematically map healthcare provision for this group. We compared findings with similar surveys conducted in 2013 and 2014. We had excellent response rates, with the data analysed here representing responses from 75% of CCGs and 52% of MHTs in England. We found that just 4.5% (n=7) of CCG responses described commissioning a service specifically for probation service clients, and 7.6% (n=12) described probation-specific elements within their mainstream service provision. Responses from 19.7% of CCGs providing data (n=31) incorrectly suggested that NHS England are responsible for commissioning healthcare for probation clients rather than CCGs. Responses from 69% (n=20) of MHTs described providing services specifically for probation service clients, and 17.2% (n=5) described probation-specific elements within their mainstream service provision. This points to a need for an overarching health and justice strategy that emphasises organisational responsibilities in relation to commissioning healthcare for people in contact with probation services to ensure that there is appropriate healthcare provision for this group.

The role, practice and training of unregulated birth workers in Australia: A mixed methods study

BackgroundIn Australia, the provision of homebirth services by unregulated birthworkers (doulas, ex-registered midwives, traditional midwives and lay workers) has increased. Accessing a homebirth with a registered midwife via mainstream services is limited. Concern is growing that new legislation aimed at prohibiting unregulated birthworkers practice may result in homebirth going underground. AimTo explore the role, practice and training of unregulated birthworkers in Australian and establish what they would do if legislation prohibited their practice. MethodsThis study used a mixed methods sequential exploratory design to explore the practice, training and role of unregulated birthworkers in Australia. In phase one, four unregulated birthworkers were interviewed in-depth and the findings informed the development of a survey in phase two. This was distributed nationally through two consumer websites, social media, Facebook and email. Data from both phases were integrated. FindingsUnregulated birthworkers in Australia provide homebirth services to women with high and low-risk pregnancies when this choice is unavailable or unacceptable within mainstream services. They operate covertly to protect their practice and avoid the scrutiny of authorities. Unregulated birthworkers can be experienced and trained in childbirth care and practice, much like a midwife working within a holistic paradigm of care. ConclusionUnregulated birthworkers believe they provide women with the homebirth service they want but cannot access. Mainstream service providers need to listen to consumer criticisms, as women seek answers outside the system. Change is needed to improve and align services with women’s expectations of homebirth.

Application of learning algorithms in smart home IoT system security

With the rapid development of Internet of Things (IoT) technologies, smart home systems are getting more and more popular in our daily life. Besides providing convenient functionality and tangible benefits, smart home systems also expose users to security risks. To enhance the functionality and the security, machine learning algorithms play an important role in a smart home ecosystem, e.g., ensuring biotechnology-based authentication and authorization, anomalous detection, etc. On the other side, attackers also treat learning algorithms as a tool, as well as a target, to exploit the security vulnerabilities in smart home systems. In this paper, we unify the system architectures suggested by the mainstream service providers, e.g., Samsung, Google, Apple, etc. Based on our proposed overall smart home system model, we investigate the application of learning algorithms in smart home IoT system security. Our study includes two angles. First, we discussed the functionality and security enhancing methods based on learning mechanisms; second, we described the security threats exposed by employing learning techniques. We also explored the potential solutions that may address the aforementioned security problems.

Use of UK health services by Gypsies, Roma, and Travellers: triangulation of two mixed methods studies

BackgroundGypsies, Roma, and Travellers (GRT) are less likely than the general population to access health services. The reasons are multiple, complex, and interlinked, and they exist at individual, provider, health system, and national levels. We report on two studies that explore GRT use of UK health services. Study 1 aimed to investigate barriers to, and facilitators of, immunisation, and identify interventions to promote uptake. Study 2 aimed to explore approaches that facilitate engagement and trust between GRT and health services, with maternity, early years, and child dental health services as exemplars. MethodsStudy 1, completed in 2016, involved in-depth interviews with 174 GRT from six communities and 39 service providers in Scotland and England, and intervention mapping and co-production workshops with 76 participants to prioritise interventions. Study 2, to be completed in 2017, involves systematic reviews and a realist synthesis; online consultation with 196 UK-based stakeholders; case studies involving interviews and focus groups with 44 GRT, 54 health-care professionals and 13 third sector staff in Scotland and England; and cross-sectoral workshops which will refine policy recommendations. Qualitative and quantitative analysis identified barriers and facilitators to receiving health care; and approaches to enhancing engagement and trust in health care. Ethics approval for study 1 was granted by National Research Ethics Service Committee Yorkshire and The Humber, Leeds East, and for study 2 by the NHS Health Research Authority East Midlands, Leicester Central Research Ethics Committee (16/EM/0028). FindingsBarriers to health care included discrimination, economic disadvantage, differences in cultural interpretations, language, and health literacy. Facilitators included trust in health professionals and intergenerational change towards valuing health services. Approaches to enhancing engagement included specialist workers and named professionals for GRT communities, cultural training for professionals, and tailored or flexible systems. Facilitating the research depended on collaborating with trusted gatekeepers, and both studies used co-production methods to ensure that study recommendations are grounded in practice realities and acceptable to stakeholders. InterpretationThe findings provide advice for practitioners and policy makers engaging with GRT people, as well as insight on supporting other marginalised populations. Exploring the experience of GRT, service provision, and policy offers a substantiated account enabling public health to reflect on success or otherwise of interventions aimed at tackling inequalities. FundingStudy 1 was funded by the National Institute for Health Research Health Technology Assessment Programme (12/17/05). Study 2 is funded by the Department of Health Policy Research Programme (Enhancing Gypsy/Travellers' trust: using maternity and early years' health services and dental health services as exemplars of mainstream service provision, PR-R8-0314-24002).

Evaluation of the health impact of an urban regeneration policy: Neighbourhood Renewal in Northern Ireland

BackgroundNeighbourhood Renewal (NR) was launched in Northern Ireland (NI) in 2003 to revive the social, economic and physical fabric of 36 deprived communities, characterised by a legacy of sectarian conflict....

Investigation of training and support needs in rural and remote disability and mainstream service providers: implications for an online training model.

Objectives It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle. Technology provides a possible solution not only for increasing access to these opportunities, but also in building community capacity to support children with autism. The aim of the present study was to investigate the current learning and support needs within rural and remote professionals prior to setting up a model of support. Methods An online survey was used to gather information from service providers in rural and remote communities on their demographics, current skills and confidence in working with clients on the autism spectrum, current supervision and professional development, identified learning and support needs, and the availability and uptake of technology for accessing professional development. Results Respondents reported below average levels of perceived confidence and skills when working with children with autism, most notably children with challenging behaviour. Half the respondents do not currently attend supervision sessions, with only 15% receiving regular supervision (fortnightly or more often), and 66% of respondents had travelled more than 3h to access professional development workshops. The majority of participants had access to technology and over half had already used this for online training. Conclusion Overall, service providers in rural and remote areas are generally not currently meeting their needs in terms of frequency of supervision and professional development. The present needs analysis identifies key areas for learning, the ideal frequency of support and the acceptability of using technology to deliver this support. This information will guide future researchers in the development of an evidence-based model that will be accessible and meaningful to its participants. What is known about the topic? It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle, which may be triggered by geographical isolation. Technology-delivered intervention and support, also known as eHealth or Telehealth, has been used successfully in the disability sector for medical rehabilitation, direct intervention, employment support and support groups, but there is little evidence as to how technology is received by and implemented with disability and mainstream service providers supporting children with autism living in remote regions. What does this paper add? This paper provides an insight into the current skills and confidence of a broad range of service providers, including educators, allied health therapists and therapy and community support workers, in working with children with autism. This paper also investigates the experience, feasibility and potential uptake of a technology-driven program of support and professional development in rural and remote Australia. Finally, this paper provides an insight into the desired frequency of training and support, as well as identified learning support needs. What are the implications for practitioners? These findings have and will continue to guide practitioners in the development of an evidence-based, technology-driven model of supporting rural and remote staff working with children with autism. Technology has the potential to provide practitioners in geographically isolated areas with access to more responsive, collaborative and individualised professional support and training. Such practice may improve the skills of practitioners and the level of support they can provide their clients with autism, with the added potential of increasing staff retention in rural and remote areas of Australia.

Communities, abandonment and ‘recognition’: The case of post-state funding community bodies

Communities have increasingly been internalised as subjects with responsibilities in the delivery of urban policy and involvement in broader urban governance. A prominent example is the English New Deal for Communities (NDC) programme that ran between 2001 and 2012. Towards the end of government funding, NDCs were required to develop succession strategies that would leave a ‘legacy’ for their communities. This involved the development of social enterprise bodies that would continue to support community involvement and regeneration efforts through ownership of capital assets, acquisition of public service contracts, and partnership working with mainstream service providers. This paper examines the influence of communities on post-NDC bodies, and the relationship between these organisations and local government, which was a critical agent in the management of the previous NDC bodies. The ‘recognition’ perspective of Honneth (1995), which is concerned with the self-actualisation of actors through inter-subjective relations based on forms of recognition (e.g. respect), is deployed in the analysis of post-NDC bodies. The paper concludes that long term community representatives’ have incorporated market values as a means in which to acquire ‘respect’ from social enterprise professionals, and that there is a lack of recognition by state agents of the role of post-NDC bodies in contemporary urban governance.

Addressing unresolved tensions to build effective partnerships: lessons from an Aboriginal cancer support network.

BackgroundCancer is the second leading cause of death among Aboriginal and Torres Strait Islander people and their survival once diagnosed with cancer is lower compared to that of other Australians. This highlights the need to improve cancer-related health services for Indigenous Australians although how to achieve this remains unclear. Cancer support groups provide emotional and practical support, foster a sense of community and belonging and can improve health outcomes. However, despite evidence on their positive effects on people affected by cancer, there is scarce information on the function and effectiveness of Indigenous-specific cancer peer-support programs in Australia.Using qualitative data from an evaluation study, this paper explores different understandings of how a cancer support group should operate and the impact of unresolved tensions following the establishment of an Indigenous women cancer peer-support network in a regional town in Western Australia.MethodsData were collected through semi-structured interviews with 24 participants purposively selected among Indigenous and mainstream healthcare service providers, and group members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. NVivo was used to manage the data and assist in the data analysis. Rigour was enhanced through team member checking, coding validation and peer debriefing.ResultsFlexibility and a resistance to formal structuring were at the core of how the group operated. It was acknowledged that the network partly owned its success to its fluid approach; however, most mainstream healthcare service providers believed that a more structured approach was needed for the group to be sustainable. This was seen as acting in opposition to the flexible, organic approach considered necessary to adequately respond to Indigenous women’s needs. At the core of these tensions were opposing perspectives on the constructs of ‘structure’ and ‘flexibility’ between Indigenous and non-Indigenous participants.ConclusionsDespite the group’s achievements, unresolved tensions between opposing perspectives on how a support group should operate negatively impacted on the working relationship between the group and mainstream service providers, and posed a threat to the Network’s sustainability. Our results support the need to acknowledge and address different perspectives and world views in order to build strong, effective partnerships between service providers and Indigenous communities.

'Connecting tracks': exploring the roles of an Aboriginal women's cancer support network.

Aboriginal Australians are at higher risk of developing certain types of cancer and, once diagnosed, they have poorer outcomes than their non-Aboriginal counterparts. Lower access to cancer screening programmes, deficiencies in treatment and cultural barriers contribute to poor outcomes. Additional logistical factors affecting those living in rural areas compound these barriers. Cancer support groups have positive effects on people affected by cancer; however, there is limited evidence on peer-support programmes for Aboriginal cancer patients in Australia. This paper explores the roles played by an Aboriginal women's cancer support network operating in a regional town in Western Australia. Data were collected through semi-structured interviews with 24 participants including Aboriginal and mainstream healthcare service providers, and network members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. Connecting and linking people and services was perceived as the main role of the network. This role had four distinct domains: (i) facilitating access to cancer services; (ii) fostering social interaction; (iii) providing a culturally safe space; and (iv) building relationships with other agencies. Other network roles included providing emotional and practical support, delivering health education and facilitating engagement in cancer screening initiatives. Despite the network's achievements, unresolved tensions around role definition negatively impacted on the working relationship between the network and mainstream service providers, and posed a threat to the network's sustainability. Different perspectives need to be acknowledged and addressed in order to build strong, effective partnerships between service providers and Aboriginal communities. Valuing and honouring the Aboriginal approaches and expertise, and adopting an intercultural approach are suggested as necessary to the way forward.

Contracts and commissioning: what’s happening to social care services for black and minority ethnic older people

Purpose – The purpose of this paper is to explore current provision of targeted social care services for the growing populations of Black and Minority Ethnic (BAME) older people in England and Wales. Design/methodology/approach – This was a mixed study. Following a review of the policy and research literature, 12 semi-structured interviews were undertaken in 2013/2014. Most participants were recruited from BAME policy and service provider organisations and organisations focusing on older people. Findings – There is some evidence that BAME voluntary organisations are experiencing disproportionately greater funding cuts than mainstream voluntary service providers: moreover some mainstream providers reported reducing services targeted at BAME older people, while others expressed the view that choices for BAME older people are likely to become more limited following recent health and equalities policy changes. Practical implications – Practitioners should contribute to data collection about protected characteristics, such as race/ethnicity to establish if BAME older people’s needs are being assessed equitably, whether access to care and support is easy; and how market-shaping at local levels can ensure a range of providers. Originality/value – This study provides an overview of voluntary sector provision for the growing numbers of BAME older people in need of care and support that should be useful to practitioners and service commissioners.

Diversity Within Family Caregiving: Extending Definitions of "Who Counts" to Include Marginalized Communities.

As researchers in the field of diversity and aging, we share Williams et al.'s call for policymakers to pay attention to the experiences of family caregivers across a wider spectrum than that which currently operates in health and social care. This paper addresses the particular issues at play in interactions between caregivers from marginalized 1communities and mainstream service providers. Using case studies from our work with ethnocultural minority (2) and LGBT (3) older adults, this commentary describes the unique realities faced by marginalized communities in their efforts to both provide care and gain access to a broad range of health and social care services. The assumptions addressed provide a basis for reconsidering how caregivers are perceived, experience services and demonstrate resilience in developing alternative forms of support.