Mode Of Service Delivery Research Articles

“We adapted because we had to”: how domestic violence perpetrator programmes adapted to work under COVID-19 in the UK, the USA and Australia

PurposeThis study explores responses by domestic violence perpetrator programme (DVPP) providers of three Western countries (UK, USA and Australia) to the COVID-19 pandemic and population movement control measures on their practice. The purpose of this paper was to offer an evidence base for changes to programme and intervention delivery around domestic violence to sustain integrity of safe, effective working practices with perpetrators, survivors and staff.Design/methodology/approachBased on 36 semi-structured qualitative interviews conducted from July to September 2020, the authors mapped the experiences of changes in service with frontline staff, managers and sector-wide representatives.FindingsThe findings focus on how providers of DVPPs adapted to the increase in referrals and workload that had a positive impact on service delivery innovation but an adverse impact on staff wellbeing. Digital services were reported to be adopted into mainstream approaches but introduced new barriers to service access and group dynamics. Integrated safety support for survivors, if not adequately connected to programmes pre-pandemic, risked being disconnected from DVPP that may undermine positive programme outcomes.Originality/valueThe paper provides a documentation of changes in DVPPs, and a cross-comparison of services across three Western countries during the first wave of COVID-19. The work offers implications of the development of digital modes of service delivery for DVPPs and highlights the need for focus on resource management and integration of safety services for survivors in DVPP services.

Using an intensive interdisciplinary telehealth model to treat pediatric feeding disorders.

The necessity of treatment using telehealth was apparent during the novel coronavirus (COVID-19) pandemic, as many practitioners were forced to use telehealth as a primary mode of service delivery. Although the telehealth model has been studied for different populations, little is known about its success when applied with children with feeding disorders and complex medical histories. The purpose of this study was to evaluate the efficacy of using a telehealth model from the onset of treatment. All 5 children who participated engaged in low levels of acceptance and high levels of inappropriate mealtime behavior during baseline. Caregivers were taught to implement the treatment with high integrity using behavioral skills training. Procedural integrity increased posttraining, and as a result acceptance increased and inappropriate mealtime behavior decreased. Treatment gains maintained during follow up at 1 month and 1 year. These data are discussed in relation to alternative ways of providing treatment in locations where intensive feeding programs are not available.

Transition to a virtual model of physiotherapy and exercise physiology in response to COVID-19 for people in a rural Australia: Is it a viable solution to increase access to allied health for rural populations?

Virtual healthcare has the potential to increase access to allied health for people living in rural areas, but challenges in delivery of such models have been reported. The COVID-19 pandemic provided an opportunity for a rural practice of physiotherapists and exercise physiologists to transition service delivery to a virtual model of care which utilised a combination of phone, video, an exercise app and/or paper handouts. This study aimed to evaluate the uptake and outcomes from virtual delivery of allied health services, and to describe patient and clinician experiences of the virtual model of care. A parallel convergent mixed methods study was conducted. De-identified data from patients who were offered the virtual service between 15 March 2020 and 30 September 2020 were extracted from the database of the rural practice, as were data from patients attending the practice in-person during the same time in 2019 to serve as a historical comparison. De-identified data from a monthly survey tracking clinician experiences of delivering care virtually was also obtained from the practice. Quantitative data were presented descriptively. Between-group differences were compared using independent samples t-tests, and within-group longitudinal changes compared using paired t-tests. Semi-structured interviews were conducted among a purposive sample of patients using the virtual service, and focus groups conducted among clinicians providing this model of care. Qualitative data were recorded and transcribed verbatim, then thematic analysis conducted. During the study period, the practice delivered 4% (n = 242) consultations virtually. Thirty-seven of the 60 patients (62%) using the virtual service were new referrals. Patients attended fewer sessional appointments virtually and a smaller proportion of patients reported high satisfaction with virtual care, compared to those who received in-person care the previous year (p < .05). Clinician confidence in delivering virtual care did not change significantly over time (p>.05), though clinicians not providing virtual care in a given month perceived their lower confidence than those who did provide virtual care (p < .05). Five themes influencing the success of virtual allied health provision emerged from patient interviews and clinician focus groups: adaptation of program elements for virtual delivery, conduct of virtual treatment, clinician flexibility, patient complexity and communication. The theme of communication influenced all the other themes. Virtual healthcare is a potential solution to address lack of access to allied health practitioners in rural areas, but may not suit all patients. Establishing a therapeutic relationship and ensuring people have access to adequate resources prior to virtual care delivery will optimise successful adoption of virtual care models. A hybrid model incorporating limited in-person consultations with virtual consultations appears a more viable option.

Experiences of Young People and Their Carers with a Rural Mobile Mental Health Support Service: A Qualitative Study.

Mental health difficulties during teenage years are common. They are also a risk factor for later mental and physical health problems. Rural young people are at a greater risk for mental health difficulties and have less access to services than their urban counterparts. The purpose of this study was to explore the experiences of young people and their carers with mental health support provided by a rural mobile service, and to identify access enablers from the perspective of the service users. A qualitative descriptive approach was used to analyse twelve interviews with current service users and eight interviews with family members of young people who had accessed the service. Three main themes were identified: (a) access and flexibility, (b) the qualities and strategies of the clinicians, and (c) experiences of change. The mobile service was perceived to be effective in producing a positive change in mental health, relationships, and the attainment of life goals. Key enablers to access included the flexibility of the mobile service, the variety of service delivery modes and therapeutic methods offered, the ease of access facilitated by the location in schools, and the autonomy of young people in how they chose to utilise the service. This study provides information about what is important to rural young people and their families in the provision of mental health services. The findings have implications for changing the way services are organized and operated. Healthcare policies and services could support a user-led model design that incorporates access and use-enablers and removes barriers to rural mental health support.

Patient satisfaction with a virtual multidisciplinary team balance clinic: a pilot study

Background/Aims The COVID-19 pandemic led to many services being conducted remotely, including ear, nose and throat services. Although much in-person activity has now resumed, some services are still being provided remotely. This pilot study explored patients' satisfaction with the virtual multidisciplinary team balance clinics established at the authors' practice, looking at the feasibility of continuing this model of service delivery in the future. Methods Self-administered questionnaires were posted to the 56 patients who had received a virtual consultation with the service between March and September 2020, of which 22 were returned. The questionnaire presented respondents with 14 items, with which they rated their agreement on a 6-point Likert scale. Correlations between the final item (which measured overall satisfaction) and the other items were analysed using Spearman's rho. Results Overall, respondents were satisfied with the virtual consultations. Respondents either agreed or strongly agreed with 13 of the 14 items; the only exception was ‘I obtained better access to healthcare services by use of telemedicine’. Most respondents were happy with the quality of communication and valued the time saved on travel, although one pointed out that this may not be an appropriate mode of service delivery for patients who are deaf. Conclusions Virtual clinics can be an acceptable adjunct to traditional clinical consultations in an ear, nose and throat outpatient department for balance disorders and should be continued in future.

Service delivery through e-governance: The case of highly urbanized cities in northern Mindanao, Philippines

This study explored the new digital opportunity for realizing democracy in public administration. This is a descriptive-evaluative type of research, utilizing a cross sectional survey which aimed to describe and assess the service delivery through e-governance of the two (2) highly urbanized cities in Northern Mindanao, Philippines. Utilizing the mixed methods of qualitative and quantitative research designs, this paper endeavoured to examine the delivery models of e-governance applications did the Local Government Units of Iligan and Cagayan de Oro provide to their constituents in terms of; G2C (Government-to-Citizens), G2B (Government-to-Business), G2E (Government-to-Employees), and G2G (Government-to-Government) Q2. Utilizing a survey questionnaire with a 5-point Likert scale, a total of 234 survey respondents categorized as citizens, business sectors and city hall employees of the locales evaluated the efficiency, effectiveness, responsiveness, and satisfaction of e-governance implementation with regards to the delivery of the following services; administrative services, economic services, health services, and infrastructure services. Moreover, the qualitative data were obtained from the 4 key informants using an interview guide whose responses were analyzed thematically. Analyses of the findings were drawn from the delivery models of E-governance, technology, organization and environment (TOE) framework, and the role of IT in good governance. Data revealed that both LGUs had provided the four delivery models of e-governance. It is also implicit in the findings that the similar provisions and modes of service delivery by the two cities facilitated the furtherance of e-governance in their respective areas of responsibilities.

Advanced Intuitive Model for Digital Forensics Collection Methods in the Context of Cloud Computing and IoT

Abstract: With the wide scale adoption of cloud computing paradigms and Internet of Things implementations, the arena of service delivery has changed significantly for the world of technology-oriented services. While these new modes of service delivery have provided innovations that were not fathomable earlier, they not only create new non-traditional pathways for evidence generation, nevertheless, they have also been seen to carry a potential of creating and exposing a whole new set of security vulnerabilities that malicious actors can exploit. Traditional forensic investigation process falls short in many ways including the way it aims to identify and link crucial pieces of evidence in these scenarios due to a myriad of internal and external factors. Challenges and inadequacies have been identified in the community in relation to these specific sets of advancing technologies that hinder the efficient identification, extraction and processing of evidence generated in crimes involving them. In this paper we wish to surmise the current forensic collection methods, how they pose challenges when put together with the latest cloud and IoT technologies and then attempt to propose an advanced, more intuitive, and theoretically validated digital forensic collection process guided by zero trust principle and enforced with artificial intelligence and machine learning methodologies with the aim to fill the gaps and provide a more reliable, robust and intuitive model to perform digital evidence collection in the given context.

A therapist-guided internet-based cognitive behavioral therapy program for Hong Kong university students with psychological distress: A study protocol for a randomized controlled trial

BackgroundUniversity students are at high risk of various mental health problems due to high levels of psychological distress. However, university counseling services are often inadequate to meet their mental health needs due to shortage of mental health professionals, especially in Hong Kong. Internet-based cognitive behavioral therapy (iCBT) has shown similar effects as those of face-to-face CBT in addressing these mental health concerns, but few iCBT programs have been developed for Hong Kong university students. ObjectiveThis study protocol aims to develop and evaluate a culturally and linguistically appropriate iCBT program called “REST Online” to reduce the psychological distress and improve the mental health of Chinese university students in Hong Kong in a randomized controlled trial (RCT). MethodThe contents and functionality of the “REST Online” program which includes both web- and app-based versions, are described. A blended mode of service delivery is adopted, with 8 online modules and 2 counseling sessions. Therapist support will be provided by a CBT therapist. A total of 338 Chinese university students with mild to moderate levels of psychological distress will be openly recruited and randomized to three groups: the (1) web-based and (2) app-based “REST Online” groups, and (3) waitlist control group. The program effectiveness is evaluated in psychological distress, depression and anxiety symptoms, and positive and negative emotions and positive and negative thoughts at pre-, post- and 3-month follow-up tests. Linear mixed effect models will be conducted for data analysis. DiscussionThe “REST Online” program is among the first of its kind to address the mental health needs of Hong Kong university students by an internet intervention. Theoretically, this study will provide some empirical evidence for the effectiveness of this iCBT program in the Hong Kong context for Chinese clients. Practically, if proven effective, this program can be provided to local university counselors as an option for service delivery. Strengths and limitations are also discussed.

IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England.

In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research.

Toward Participation-Focused School-Based Occupational Therapy: Current Profile and Possible Directions

ABSTRACT Enabling inclusive participation is an overarching goal of Occupational Therapy services in the school setting; however, evidence is scarce on practices addressing it. This study conducts an in-depth examination of actual Occupational Therapy practices with students with physical disabilities in mainstream schools and explores possible directions toward facilitation of successful participation. Eight Occupational Therapists representing different practice settings and regions of a large Canadian province were recruited, each providing two distinct charts of students with physical disabilities integrated in regular classrooms. Data extracted from charts was analyzed and coded based on the International Classification of Function, Disability, and Health. Chart-stimulated recall interviews were conducted with each therapist and analyzed thematically. Services focused predominantly on academic rather than social activities. Two overarching themes emerged describing the clinical reality including resources (e.g. time and teams) and the impact of occupational therapy (e.g. service delivery and promotion of the profession). Subthemes suggest expansion of practice scope and diversification of service delivery modalities as promising directions. Facilitation of fuller inclusion and participation of students with physical disabilities in the school setting by Occupational Therapy services may require additional resources including knowledge translation initiatives relating to collaboration and facilitation of social participation in schools.

A scoping review of virtual synchronous intervention studies in preschool rehabilitation

Purpose To summarize the available evidence for the delivery of synchronous virtual rehabilitation intervention services for preschoolers and to identify key factors associated with virtual intervention. Methods Five databases were searched to identify peer-reviewed articles that assessed virtual interventions for preschoolers delivered by rehabilitation health professionals including physical therapists, occupational therapists, speech-language pathologists, audiologists, and their associated assistants. Relevant data regarding demographics, technology, mode of service delivery, timing, engagement, and measurement data were extracted, and charted. Data were then summarized quantitatively using frequency counts, and qualitatively using descriptive summaries. Results Sixteen studies were identified. Virtual interventions primarily targeted language difficulties or disorders, therefore most services were delivered by a speech-language pathologist or audiologist. Most interventions were delivered using Skype or Zoom on a weekly basis. Various technological features (e.g., phonology software, ‘e-helpers’) were included, and multiple activities (e.g., playdough, bubbles) and strategies were used to support engagement. Conclusion This scoping review provides current knowledge about the delivery of virtual rehabilitation interventions for preschoolers to help guide best practices for clinicians. Future research could assess the validity of existing outcome measures in the virtual environment, and outline optimal session length and frequency for virtual preschool interventions.

Evaluating Transition Readiness: Is Self-Report Valid as the Gold Standard?

Determination of transitional readiness is an essential component of delivery of transition services to adolescents and young adults with chronic diseases, including those with inflammatory bowel disease (IBD). To date, this has been performed using the transition checklist (TC). However, clinical experience suggests the validity of the checklist may not be ideal. We sought to evaluate the validity of the TC among adolescents and young adults with IBD (AYA IBD). We evaluated the validity of the TC compared with a skills-based practicum (TKSP) in a cross-sectional study using a real-world clinical cohort of AYA IBD. Extent of concordance between TC and TKSP was assessed using confusion matrices and calculation of Matthews correlation coefficients. Concordance between self-reported TC answers and TKSP performance varied based on skill/knowledge base assessed, ranging from 81.3% for mastery of knowing one's medical condition to 39.2% for mastery of knowing one's medication schedule and 29.3% for mastery of knowing how to refill medications. Matthews correlation coefficients were closer to random prediction than perfect correlation for all skills/knowledge tested. Self-reported TC answers lack sufficient concordance with TKSP performance. Our findings suggest that a TKSP should be performed to assess for transition readiness and to identify individual AYA IBD patient needs during the transition process.

Efficiency of TB service provision in the public and private health sectors in Ethiopia.

BACKGROUND: The Ethiopian Government has identified efficiency of TB services as a key priority in planning and budgeting. Understanding the magnitude and sources of inefficiencies is key to ensuring value for money and improved service provision, and a requirement from donors to justify resource needs. This study identifies the cost of providing a wide range of TB services in public and private facilities in Ethiopia.METHODS: Financial and economic unit costs were estimated from a health provider´s perspective, and collected retrospectively in 26 health facilities using both top-down (TD) and bottom-up (BU) costing approaches for each TB service output. Capacity inefficiency was assessed by investigating the variation between TD and BU unit costs where the factor was 2.0 or more.RESULTS: Overall, TD unit costs were two times higher than BU unit costs. There was some variation across facility ownership and level of care. Unit costs in urban facilities were on average 3.8 times higher than in rural facilities.CONCLUSION: We identified some substantial inefficiencies in staff, consumable and capital inputs. Addressing these inefficiencies and rearranging the TB service delivery modality would be important in ensuring the achievement of the country´s End TB strategy.

Postsecondary transition barriers for students with disabilities in two neighboring school regions in Botswana

Successful delivery of transition services for students with disabilities remains a significant challenge in the developed and developing countries like Botswana as students continue to experience poor post-school outcomes. This study examined teachers’ perceptions about barriers concerning the effective implementation of transition practices and principles in Botswana senior secondary schools. The researchers adopted a quantitative research approach using paper surveys to collect data from 258 participants. Teachers reported several challenges in the transition process and showed significant differences on transition barriers by teacher position and school region. Challenges noted among others included inadequate training of teachers and shortage of resources to support transition. Recommendations for practice include the formulation of a transition legal framework and provision of clear guidelines in the delivery of transition services.

Changes in telepractice use and perspectives among speech and language therapists in Singapore through the COVID-19 pandemic.

Much has been written about the changes in use and perspectives of telepractice among speech and language therapists (SLTs) during the global COVID-19 pandemic. However, no long-term study has been done to examine whether there is a permanent shift in attitudes towards telepractice as the world adjusts to new norms and endemic COVID-19. To compare the speech telepractice use and perspectives of SLTs at two time points of the pandemic: during and after the height of the pandemic. Two online surveys were distributed a year apart among SLTs in Singapore. The first survey was disseminated during an initial lockdown period in 2020 and the second survey was done in 2021 when Singapore was starting to reduce strict quarantine and safe-distancing regulations. These surveys were distributed via communication channels of the local speech therapy association. A total of 115 and 71 responses to the survey were collected in 2020 and 2021, respectively. Responses were captured and analysed using descriptive statistics and statistical analysis while qualitative content analysis was used to derive key themes from open-ended questions. Telepractice use across all age groups and client types peaked at the height of the pandemic. Even as lockdown measures were eased, telepractice utilization was still higher than what it was before the pandemic. Dysphagia management was the only area where SLTs reduced their use of telepractice during the stabilization phase. After more experience with telepractice during the height of the pandemic, SLTs acknowledged the benefit of being able to use a wide range of media through telepractice and were less worried about not having the resources or knowledge to set up telepractice. SLTs also reported increased confidence in providing telepractice, which was reflected in their willingness to continue to provide telepractice even after the pandemic ends. The increase in use of telepractice during this pandemic is likely to be sustained as a majority of respondents believed they would continue to provide this mode of service delivery even after the pandemic ends. However, clinicians will still have to assess for client suitability, as clients with more complex medical or behavioural issues may still require in-person therapy. Additionally, dysphagia management via telepractice will still be limited given that swallow presentations may be more variable. Lastly, although generic resources are helpful for clinicians, the long-term sustainability of telepractice can be boosted by the sharing of resources that are suitable for the local context. What is already known on this subject Current studies have examined telepractice use and perspectives of SLTs before and during the COVID-19 pandemic. Despite the evidence for the efficacy of telepractice, uptake was low due to perceived lack of training and resources. Although more clinicians provided telepractice during the pandemic, many still doubted its efficacy over in-person therapy and most studies concluded that longer term studies are required to ascertain if SLTs will continuing providing telepractice after the pandemic. What this paper adds to existing knowledge This study shows that there is a definitive shift in perspectives in favour of telepractice after the pandemic, as clinicians continued to provide telepractice across most service areas even without lockdown restrictions. The previous challenges of insufficient resources, knowledge and privacy concerns were reduced with more experience in providing telepractice. Although client suitability remained a major barrier, more clinicians saw benefits of easy access to therapy and range of resources used as benefits that they could harness from telepractice. What are the potential or actual clinical implications of this work? A majority of respondents stated that they are more confident in providing telepractice and would want to continue providing this service delivery mode after the pandemic, so more training and resources suitable for the local contexts can be provided by national associations to sustain this. More research and resources can be gathered to make telepractice more efficacious for dysphagia management and clients who may be deemed unsuitable for telepractice.

Older Adults' Demand for Community-Based Adult Services (CBAS) Integrated with Medical Care and Its Influencing Factors: A Pilot Qualitative Study in China.

The number of older people in China who require formal care is increasing. In response, China is creating a service delivery mode of health and social care combination for older people-community-based adult services (CBAS) integrated with medical care-in some provincial capital cities, such as Changsha. However, the needs of most older people for this service delivery mode are not well understood. To assess older people's awareness of and demand for CBAS integrated with medical care and to determine influencing factors. Semi-structured guideline interviews were conducted with 20 older people (aged 65+ years) from two communities at different economic development levels and from a nursing home in Changsha, China. Interviews were analyzed using qualitative content analysis. The specific needs that older adults expect from CBAS integrated with medical care involve daily care, primary care, self-management guidance, rehabilitation therapy services, and mental health services. Contrary to expectations, most interviewees showed low awareness of and demand for CBAS integrated with medical care. Individual, family, and community factors influence older people's demand, as do exogenous variables such as gender and number of children. The influencing mechanism of older people's demand for CBAS integrated with medical care is complex and multifaceted. To implement and promote CBAS integrated with medical care, attention should be given to older people's individual needs, family backgrounds and community environment improvement. Furthermore, improving awareness of integrated care and increasing ageing-in-place opportunities for more older adults is essential and urgent.

Exploring Special Education and Center for Independent Living Professional Beliefs on Collaboration and the Value-Based Principles That Drive Secondary Transition Service Delivery

The importance of interagency collaboration to support the postschool outcomes of youth with disabilities is underscored in many ways. Perhaps one of the most important among them is the place of interagency collaboration as an evidence-based predictor of postschool success. Although Centers for Independent Living (CILs) receive U.S. federal funding to serve people with disabilities across the lifespan, little research exists to map the nature of their collaboration with local education agencies (LEAs) to this end. The current survey-based study examined perceptions of professionals in both settings (i.e., LEAs and CILs) on their current level of collaboration with one another and the value-based principles they believe influence their work as they support transition-age youth with disabilities ( n = 581). Findings indicate a widespread belief in the importance of CILs in youth transition service delivery, a stark contrast between CIL and school-based transition professional perceptions of current collaboration, and a dynamic landscape of shared and divergent ratings of importance across value-based principles of transition practice. Practical implications are outlined to inform CIL and LEA collaboration to support youth with disabilities alongside directions for future research.

Adaptation among aged care and disability service providers in response to the COVID-19 pandemic: Lessons for the future.

Aged care and disability service organizations are critical infrastructure. However, in 2020, restrictions were introduced to reduce the infection risk of the coronavirus disease 2019 (COVID-19), and these organizations needed to quickly devise COVID-safe ways of working to continue to meet the needs of their clients. To investigate how these organizations adapted their service delivery and which innovations they felt were worthwhile for sustaining beyond the COVID-19 pandemic, interviews were undertaken with representatives from 26 aged care and disability service organizations across three states in Australia (Western Australia, New South Wales, and Victoria). Findings revealed that organizations adapted their practices across three key innovation areas: (1) developing new approaches or expanding existing services, particularly around food provision, social connection, information dissemination, and technology support; (2) modifying the mode of service delivery, through safe in-person contact or offering alternative online services; and (3) reducing bureaucracy and introducing remote working. A common theme across all service innovations was the strong focus on providing clients and staff with choice and control. Moving forward, many organizations wanted to integrate and maintain these innovations, as they were associated with additional benefits such as increased client health and safety, service flexibility, and sufficient human resources to serve clients. However, continued maintenance of some initiatives require additional resourcing. The continuation of COVID-19 pandemic adaptations and, indeed, ongoing innovation, would therefore be facilitated by greater flexibility of funding to allow organizations and their clients to determine the service types and modes that best meet their needs. Further, these innovations have implications for sector-wide best practice.

Intangible trade: Understanding the relationship between trade barriers and mode of supply in services sectors

AbstractIn recent years, increased availability of services trade data and measures of non‐tariff barriers has enabled more detailed analysis of trade patterns, including the relationship between different modes of service delivery across international borders. This paper uses a detailed, sector‐level structural gravity model to shed light on the question of whether services trade via foreign affiliate sales (also known as mode 3 trade) is a complement or substitute for cross‐border services trade (modes 1, 2, and 4) in 13 services sectors. In 9 of the 13 sectors considered, there is a negative and significant relationship between trade policies that limit foreign affiliate sales and cross‐border trade, indicating a complementary relationship between the two types of trade flows. This suggests that when services firms export, they rely on multiple modes of supply to deliver their products, considering factors such as the degree of service tradability over the internet, levels of customer interaction, and complexity of particular tasks.

Opportunities for Increasing Access to Effective Contraception in Australia.

Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.