Mode Of Service Delivery Research Articles

Health Care Professionals' Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study.

The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality.

The rise and fall of an NPM-style reform in China: a longitudinal case study of sanitation service delivery in Guangzhou

ABSTRACT This article explores how three types of logic of action – consequences, appropriateness, and power dynamics – configurate to shape the trajectory of an illustrative NPM-style reform in China, reflecting how the NPM paradigm has evolved through layering, displacement, and hybridization. Using a longitudinal case study in Guangzhou, we trace sanitation service delivery modalities from in-house delivery to contracting-out, to standardized contracting-out, to contracting-in, and finally, to public-private partnerships with state-owned enterprise. Our findings underscore the salience of the logic of power dynamics in an authoritarian context, suggesting NPM as a transitionary paradigm bridging traditional public administration and hybrid paradigms in China.

Internet-Based Cognitive Behavioral Therapy and Virtual Reality Exposure Therapy for Social Anxiety Disorder: Protocol for a Randomized Controlled Trial in Hong Kong.

Social anxiety disorder (SAD), also known as social phobia, is one of the most common mental disorders worldwide. In Hong Kong, the prevalence of SAD is high, but its treatment rate is low. SAD has immense impact on academic or work performance, social life, career development, and quality of life. One of the most effective treatments for SAD is cognitive behavioral therapy (CBT), with internet-based CBT (iCBT) and virtual reality exposure therapy (VRET) showing promise in treating SAD. However, internet interventions are underdeveloped in Chinese communities including Hong Kong. This study aims to develop an iCBT program that includes VRET, called "Ease Anxiety in Social Event Online" (Ease Online), for Hong Kong adults with SAD in a randomized controlled trial. The 14-week Ease Online program is a guided self-help iCBT program with a blended mode of service delivery. The program comprises 9 web-based modules and 5 individual counseling sessions (including 2 VRET sessions) conducted remotely or face-to-face with a therapist to provide therapist support, as guided iCBT shows superior effects than unguided iCBT. Other program components include therapist feedback on assignments, internal messages, forums, client portfolios, web-based questionnaires, reminders, and web-based bookings. The program can be accessed either through a mobile app or program website through a PC with an internet connection. The participants are openly recruited and screened using a questionnaire and through an intake interview. Eligible participants are randomized by placing them into a web-based iCBT group, app-based iCBT group, or a waitlist control (WLC) group. Participants in the WLC group are assigned to the app-based program upon completion of the service of the 2 experimental groups. Measurements of social anxiety, depression and anxiety symptoms, psychological distress, automatic thoughts, and quality of life are administered at pretest, posttest, and 3- and 6-month follow-ups. Multivariate ANOVA with repeated measures will be performed to determine the intervention effectiveness on the continuous variables over time. Participant recruitment commenced in January 2021. As of February 2023, a total of 1811 individuals applied for the Ease Online program. In total, 401 intake interviews have been completed, and 329 eligible participants have joined the program, among whom 166 have completed the service. Data collection is still ongoing, which is expected to be completed in March 2024. This study is the first of its kind in combining iCBT and VRET for the treatment of SAD in Hong Kong. At a theoretical level, this study contributes to the development and evaluation of internet-based psychological interventions in Hong Kong. At a practical level, the Ease Online program may serve as an alternative service option for SAD clients in Hong Kong if proven effective. ClinicalTrials.gov NCT04995913; https://clinicaltrials.gov/study/NCT04995913. DERR1-10.2196/48437.

A meta-analysis of the impact of customer mistreatment on service employees' affective, attitudinal and behavioral outcomes

PurposeAlthough service researchers have long suggested that customer mistreatment adversely impacts service employees' outcomes, statistical integration of current empirical findings has been lacking. This meta-analysis aims to review and statistically synthesize the state of research on the relationship between customer mistreatment and service employees' affective, attitudinal and behavioral outcomes.Design/methodology/approachThe authors included 221 effect sizes of 135 independent samples from 119 primary studies (N = 47,964). The authors used a meta-analytic approach to quantitatively review the relationship between customer mistreatment and service employees' affective, attitudinal and behavioral outcomes. Meta-analysis structural equation modeling was used to explore the mediation mechanism of service employees' affective outcomes on the relationships between customer mistreatment and employees' attitudinal and behavioral outcomes. Meta-regression was applied to explore the impact of contextual-level moderators (i.e. service provider type and service delivery mode) on these relationships. Furthermore, we compared the effects of customer mistreatment with the effects of other organizational-related factors on some commonly measured employee outcomes.FindingsThe results show that customer mistreatment has a significant negative impact on service employees' affective outcomes (i.e. negative emotions), attitudinal outcomes (i.e. job satisfaction, organizational commitment, work engagement and turnover intention) and behavioral outcomes (i.e. job performance, surface acting and emotional labor). Additionally, service employees' negative emotions mediate the association between customer mistreatment and employees' job satisfaction, turnover intention, surface acting and emotional labor. Furthermore, the relationships between customer mistreatment and service employees' negative emotions and job performance are influenced by a contextual-level moderator (i.e. service delivery mode).Originality/valueThe authors contribute to the literature by providing robust meta-analytic estimates of the effects of customer mistreatment on a variety of service employees' affective, attitudinal and behavioral outcomes, as well as the different magnitudes of the effect sizes between customer mistreatment and other job-related and personality-related factors by quantifying the true variability of the effect sizes. The authors draw on current theories underpinning customer mistreatment to test a theoretical model of the mediation mechanism of service employees' affective outcomes (i.e. service employees' negative emotions) on the relationships between customer mistreatment and employees' attitudinal and behavioral outcomes. The authors explore the effects of two contextual-level factors (i.e. service provider types and service delivery mode) related to the service delivery context that may account for the variability of effect sizes across empirical studies.

Embracing videoconferencing interview applications beyond COVID-19: scoping review-guided implications for family centered services in South Africa

BackgroundPreventative measures at the height of the COVID-19 pandemic rendered in-person interviews unfeasible and unsafe for both research and healthcare service provision. Thus, viable alternatives became imperative, and videoconferencing bridged the gap between service delivery, community need and community safety, and increased utilization and integration of telehealth into the healthcare environment.AimThe aim of this scoping review was to review practices of videoconferencing in healthcare and how these can be applied to family-centered EHDI within the South African context.MethodsElectronic bibliographic databases including Sage, Science Direct, PubMed and Google Scholar were searched to identify peer-reviewed publications, published in English between April 2017 and April 2021; focusing on patients and healthcare professionals’ perceptions, attitudes, and experience of videoconferencing use in healthcare.ResultsFindings from this review are discussed under five themes: videoconferencing use; need for videoconferencing training; videoconferencing benefits; videoconferencing challenges; and recommendations for successful videoconferencing. Generally, there is sufficient evidence of videoconferencing use across various disciplines in healthcare and satisfaction with this service delivery mode and its benefits from both healthcare professionals and patients. However, patients and healthcare professionals require training on videoconferencing use to participate fully during videoconferencing consultations and mitigate some of the challenges associated with this service delivery mode.ConclusionsThese findings provided solid evidence-based guidance for the main study’s methodology; and raised significant implications for effective and contextually relevant Family-centered-EHDI programs within the South African context.

Modes and models of care delivery in municipal long-term care services: a cross-sectional study from Norway

BackgroundNumerous forces drive the evolution and need for transformation of long-term care services. Decision-makers across the globe are searching for models to redesign long-term care to become more responsive to changing health and care needs. Yet, knowledge of different care models unfolding in the long-term care service landscape is limited. The objective of this article is twofold: 1) to identify and characterise models of care in Norwegian municipal long-term care services based on four different modes of service delivery: Specialised municipal services, Assistive technology, Planning and coordination, and Health Promotion and Activity, and 2) to analyse whether the identified care models vary with regard to municipal characteristics, more specifically ‘population size’ and ‘income’.MethodsWe adopted a cross-sectional approach and used data from a web-based survey conducted in 2019 to identify and characterize models of care in Norwegian long-term care services, based on four modes of service delivery. The questionnaire was developed through a comprehensive review of national healthcare policy documents and previous research and amended in collaboration with a user panel. A set of questions from the questionnaire were used to create four modes of service delivery. Hierarchical cluster analysis was used to cluster the municipalities based on the mean scores of the modes to identify care models.ResultsIn total, 277 municipalities (response rate 66%) completed the survey. The four modes made it possible to identify four care models that differ on the level of Specialised municipal services, Assistive technology, Planning and coordination, and Health Promotion and Activity. Additionally, the models differed regarding municipal population size (p < 0.001) and income (p = 0.006).ConclusionsWe put forward a theoretical description of the variety of ways long-term care services are provided, offering a way of simplifying complex information which can assist care providers and policymakers in analysing and monitoring their own service provision and making informed decisions. This is important to the development of services for current and future care needs.

Collective versus individual interests: The varying effects of public goods and services on tax attitudes in Africa

AbstractObjectiveTaxation is crucial for revenue, political participation, and the demand for accountability in Africa. Most existing theories do not predict tax attitudes in informal economies with weak institutional capacity nor do they demonstrate how service delivery translates to stronger tax regimes. This article examines the fiscal exchange theory— how government's expenditure affects voluntary compliance—across Africa, showing mechanisms through which service delivery affects tax morale.MethodsThe study uses a public opinion survey of over 41,000 respondents from 29 countries in sub‐Saharan Africa. The statistical analysis employs an ordered logit model and linear probability model to test the hypotheses.ResultsThe study finds that service delivery determines tax attitudes. In addition, the study examines aspects of service delivery that are of most concern to citizens and finds that services that cater to individual needs are stronger in inducing tax morale than those that address collective needs. The article also finds that citizens’ acknowledgement of receipt of goods is not an indication of inherent incumbent support.ConclusionThis study sought to understand the relationship between different modes of service delivery and the likelihood of having tax morale among African citizens and ultimately sheds light upon citizen–state relationships, effective governance, and voluntary compliance.

Volunteers as a resource for asset mapping and maintaining a living resource directory: lessons from an academic-community partnership.

Health and social services are fundamental to public and population health, and disruptions can have devastating effects on individuals of all ages. During the first wave of the COVID-19 pandemic, the availability of health and social services rapidly changed. Existing resources experienced changes in operation and mode of service delivery, while new resources emerged to address escalating needs. Both the general public and service providers lacked access to accurate information on availability and access, and existing service directories became obsolete or unreliable. To address this gap, a committee of university students expanded its volunteer base, partnered with a local non-profit organization, and invested in maintaining a centralized, up-to-date resource directory for the region. Student volunteers sourced and consolidated existing county-level directories to curate more than 370 resources across 12 healthcare and social care domains in a Google Sheets platform. This directory was publicly accessible, available in English and Spanish, adjustable to community feedback and needs, disseminated through the local health system intranet, synthesized into paper handouts for food pantries, and utilized to curate a directory aimed toward older adult needs. Students worked in a tiered leadership model and mobilized quickly to respond to immediate community needs. This academic-community partnership engaging student volunteers can be a low-cost, high-value resource to support public health systems meet the information needs of their community, particularly during periods of crisis or rapid changes in service availability.

Irreconcilability of heritage missions: Personalized and general tourism audiences

This paper explores the tensions between access to heritage as a social good, its commercialization and the subsequent impact this has on service delivery. Drawing on the context of ancestral tourism, a growing heritage tourism segment requiring a high level of personalization, it develops arguments about the structural irreconcilability implicit in contemporary museum service delivery when staff resources do not meet the individualized demands of specialist markets. Its findings reveal how challenges with delivering bespoke services drive tensions surrounding aspirations for greater public access and the commercialization of public heritage. Our focus contributes to debates around heritage missions and public heritage management, illuminating the importance of understanding provider perspectives as museums adapt to more visitor-centered service delivery modes.

Understanding what really helps to ensure access to diagnostic services in the Indian Public Health System: a realist synthesis of the Common Review Mission reports (2007-2021)

Background In India, the National Health Mission (NHM) has been supporting the states in building an integrated public healthcare network across the levels of care. This effort has improved access to, and utilization of, diagnostic services at public healthcare facilities. To continually enhance citizens’ ability to seek and avail quality and affordable services, it is imperative to take stock of various components of the diagnostic ecosystem that may be common or unique to states and understand their influence on equipping the health system. The objective of the study was to understand key health system factors augmenting or limiting access to diagnostic services and outcomes. Methods Common Review Mission (CRM) reports between 2007 and 2021 were selected for the study. Data relevant to diagnostic services were retrieved using defined search terms. The data were segregated for each Indian state and categorized under the pre-determined themes: state-specific practices, key findings, and challenges. Analysis of the data was done iteratively to identify the themes emerging from the reports over the years. Each theme was analysed further to deduce context-specific enablers and barriers influencing access to diagnostic service delivery. Results The major themes that emerged include (i) the approach to health systems strengthening, (ii) efficiency of procurement and distribution systems, (iii) infrastructure, (iv) modes of service delivery, (v) implementation of Free Diagnostic Service Initiative, Comprehensive Primary Health Care and Biomedical Equipment Management and Maintenance Program, and (vi) quality of care , and (vii) diagnostic service outcomes. Conclusions In a complex adaptive system, access to diagnostic services depends on the concurrent strengthening of various health system components across the levels of care. The nation has strategized accessible, affordable and acceptable diagnostic services to achieve universal health coverage and care-continuum pathways. States need to leverage the existing mechanisms, assess their implementation, and arrive at feasible and sustainable solutions to strengthen access to diagnostic services.

Strategies Adopted by Commercial Banks to Enhance Customer Retention in Kenya

Customer retention is increasingly being seen as an important managerial issue, especially in the context of a saturated market or lower growth of the number of new customers. The purpose of the study will be to assess the influence of strategic responses by commercial banks on customer retention in Kenya, the case of Kenya Commercial Bank Kisii branches. The data was coded to enable the responses to be grouped into various categories. Data collected in this study was quantitative. The quantitative data was analysed descriptively using Statistical Package for Social Statistics. The findings were presented by the use of frequency distribution tables. The study sought to establish the strategic responses adopted by commercial banks in Kenya to enhance customer retention. The study deduced that the level of service quality in the bank was high. The study established that technology adoption affected customer retention to a moderate extent. To a moderate extent, the bank had adopted new technologies on time, adoption of new technologies had improved the task completion rate among staff, adoption of information technologies had improved the bank’s agency banking management, adoption of information technology had increased the modes of service delivery in the bank and adoption of information technology had improved the portability of the bank’s services internationally. The study further established that product differentiation had been adopted by the banks to a moderate extent. To a moderate extent, the Banks had well-differentiated financial products from other banks; the bank had a well-differentiated market segment from other banks; The Banks had unique financial products for their customers and financial product differentiation has allowed the bank to position itself better on the market. The study concluded that customer relationship management strategy had affected customer retention. Commercial banks had created a platform to manage interactions; the interaction system with customers had improved customer satisfaction levels; the interaction system with customers had reduced the number of customer complaints; and the interaction system with customers had enabled the banks to learn the expectations and needs of its customers. From the findings, it was evident that customer relationship management had affected customer retention; thus, the study recommends that commercial banks should improve customer satisfaction, interaction with customers and systems to know their needs. Technology adoption, commercial banks should adopt new information technologies which would meet customer needs and improve efficiency in the banking industry in Kenya.

Public perception of hospital-based nursing care: a study of the Tamale Metropolis in Ghana

Background: A key contributor for the improvement of patients’ health outcomes and their holistic well-being after hospital stay is the quality of nursing care received in hospitals of which may also be influenced by the perceptions the public precisely patients have about nursing care. This study assessed the public perception of hospital-based nursing care in the Tamale metropolis. Methods: The study was conducted at the Tamale Central Hospital in Ghana and employed a qualitative approach with an in-depth interview guide in collecting primary data from 30 participants. The interviews were transcribed and analysed using thematic analysis and the common themes identified were presented in line with the objectives of the study. Results: With respect to the experiences the patients had, it was revealed that they had both negative and positive experiences. While the positive experiences were related to the quality of care, the negative experiences on the other hand were on the attitude of nurses. The study also revealed that nurses’ attitudes, mode of service delivery and professional ethics which include respect for patient and communication were the major factors that influence patients’ satisfaction. Conclusions: The study revealed that the public have negative perception towards nursing care resulting from unmet expectations. Policies should be formulated to ensure effective communication, empathy, and respect which will help ensure patients satisfaction with healthcare delivery at the hospitals since these appear to be the best predictors of patients’ satisfaction.

Building Equity Into Transition Practice and Service Delivery: A Call for Systemic Changes in the Field of Transition

There is a common narrative in the field of transition: students with disabilities continue to experience poorer post-school outcomes compared with their peers without disabilities. After decades of research and practice, scholars and practitioners have impacted countless numbers of students. However, disparate outcomes for diverse youth still exist. The Division on Career Development and Transition takes the position that if we are to begin reducing persistent differential outcomes for diverse youth, we must examine our current practices and apply anti-oppressive practices to transition planning to ensure we do not continue to perpetuate White cultural norms and ableist approaches to transition. We applied four equity frameworks to transition planning and provided recommendations for transition practice and service delivery.

Patient, Provider, and Organizational Considerations for Implementing Rehabilitation Telehealth.

Introduction: While telehealth services (THS) have been around for some time, for many in the rehabilitation services, it is a new mode of service delivery. THS can be as effective as face-to-face care and are valued by patients and clinicians. However, THS present considerable challenges and may not be appropriate for everyone. Clinicians and organizations must be prepared to triage and manage patients in this environment. Aims of this study were to capture clinician perceptions of the implementation of THS in rehabilitation and use the insights gained to provide strategies for overcoming implementation challenges. Methods: An electronic survey was emailed to 234 rehabilitation clinicians in a large urban hospital. Completion was voluntary and anonymous. Qualitative analysis of the open-ended responses consisted of an iterative consensus-driven interpretivist approach. Multiple strategies were used to minimize bias and optimize trustworthiness. Results: From the 48 responses received, four themes were identified: (1) THS provide unique benefits for patients, providers, and organizations; (2) challenges arose in multiple domains (clinical, technological, environmental, and regulatory); (3) clinicians require specific personal, clinical, and technological knowledge, skills, and attributes to be effective; and (4) individual characteristics, session type, home environment, and needs must be considered in patient selection. Discussion and Conclusion: From the themes identified, a conceptual framework illustrating the keys to effective implementation of THS was developed. Recommendations addressing challenges across multiple domains (clinical, technological, environmental, and regulatory), and at all levels of care delivery (patient, provider, and organization) are provided. Insights gained from this study can be used by clinicians in advocating for and designing effective THS programs. Educators would also gain from using these recommendations to train students and clinicians to recognize and address the challenges they may encounter in providing THS in rehabilitation.

Exploring the impact of the COVID-19 pandemic on healthcare and substance use service access among women who inject drugs: a qualitative study

BackgroundThe COVID-19 pandemic disrupted healthcare and substance use services engagement, including primary and mental health services as well as residential and outpatient drug treatment. Women who inject drugs (WWID) face known barriers to healthcare and substance use service engagement, which pre-date the COVID-19 pandemic. The impact of COVID-19 on WWID’s engagement with healthcare and substance use services, however, remains understudied.MethodsTo explore the impact of the COVID-19 pandemic on service-seeking and utilization, we conducted in-depth interviews with 27 cisgender WWID in Baltimore, Maryland, in April–September 2021. Iterative, team-based thematic analysis of interview transcripts identified disruptions and adaptations to healthcare and substance use services during the COVID-19 pandemic.ResultsThe COVID-19 pandemic disrupted service engagement for WWID through service closures, pandemic safety measures restricting in-person service provision, and concerns related to contracting COVID-19 at service sites. However, participants also described various service adaptations, including telehealth, multi-month prescriptions, and expanded service delivery modalities (e.g., mobile and home delivery of harm reduction services), which overwhelmingly increased service engagement.ConclusionTo build upon service adaptations occurring during the pandemic and maximize expanded access for WWID, it is vital for healthcare and substance use service providers to continue prioritizing expansion of service delivery modality options, like telehealth and the provision of existing harm reduction services through alternative platforms (e.g., mobile services), that facilitate care continuity and increase coverage.

EXPLANATORY FACTORS OF LOCAL WASTE MANAGEMENT IN MOROCCO: A TERRITORIAL AND ORGANIZATIONAL APPROACH

Purpose – The aim of this article is to specify the determining factors behind the decision to adopt either an internal or external means of the household waste management service in Moroccan local authorities (LAs), particularly in the “communes”. Research methodology – The methodology applied is quantitative, based on a questionnaire addressed by e-mail to 115 “Communes”. The SPSS 25 software was used to analyze the result of the logistic regression. Results – Our findings show that socio-territorial factors do not have a significant influence upon the choice of a local waste management service delivery mode, while organizational and institutional factors, particularly financial resources, do influence this choice. Local authorities with better financial resources tend to rely less on in-house solid waste management services. Research limitations – Methodological limitations such as sample size and a lack of reliable data on public service delivery, may be overcome in an exploratory study by using a qualitative method (interviews, case studies). Practical implications – Our study sheds light on the factors explaining the development of public service management methods as well as testing proposals favoring the effective use of management techniques in the local context. Originality/Value – The originality of our study lies in its quantitative investigation of waste management service delivery mode in Moroccan local authorities emphasizing the role of financial resources and distinguishing itself from previous research by finding that socio-territorial factors do not significantly affect this choice.

Testing a relationship between special districts and nonprofits: Do they substitute or complement?

ObjectiveAs similar modes of public service delivery on behalf of general‐purpose governments, a relationship between special districts(SD) and nonprofit organization are empirically tested.MethodsUsing U.S. data from the Census of Government Finance and the National Center for Charitable Statistics databases between 1997 and 2017, this study regress counts and spending level of SDs on the nonprofits’ counterparts.ResultsFor both counts and spending level, there are positive association between SDs and nonprofit organizations.ConclusionSDs and nonprofit organizations complement each other even when their service domains overlap.

The Use of Telehealth Among People Living With Dementia-Caregiver Dyads During the COVID-19 Pandemic: Scoping Review.

Telehealth has gained substantial attention during the COVID-19 pandemic, and reimbursement policies in health care settings have increased access to remote modes of care delivery. Telehealth has the potential to mitigate care concerns for people living with dementia and their family caregivers. There is a paucity of knowledge on the performance of telehealth services and user experiences, especially among caregiving dyads during the pandemic. This study aims to describe the implementation, effectiveness, user experience, and barriers to accessing and using telehealth services for people living with dementia and their caregivers during the COVID-19 pandemic. Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, we searched 7 databases (PubMed, PsycINFO, AgeLine, CINAHL, Social Services Abstracts, Web of Science, and Scopus) and a web-based search engine (Google Scholar). The inclusion criteria for peer-reviewed English publications from March 2020 to August 2022 consisted of studies related to telehealth services for people living with dementia and their family caregivers and studies conducted during the COVID-19 pandemic. A total of 24 articles (10 quantitative and 14 qualitative studies) from 10 different countries were included. The major findings of the reviewed articles were extracted and organized into the following 4 themes: study design characteristics-strategies were adopted to improve the accessibility and experience of people living with dementia-caregiver dyads; efficacy outcomes of telehealth services-robust evidence is lacking on the comparative effectiveness of in-person services; perceived experiences of people living with dementia and caregivers-most reviewed studies reported positive experiences of using telehealth services and perceived personal and social benefits from their participants; and barriers to accessing and using telehealth services-several barriers related to individuals, infrastructure, and telehealth environments were identified. Although evidence of its effectiveness is still limited, telehealth is widely accepted as a viable alternative to in-person care for high-risk groups, such as people living with dementia and their caregivers. Future research should include expanding digital access for those with limited resources and low technology literacy, adopting randomized controlled trial designs to establish the comparative effectiveness of different modes of service delivery, and increasing the sample diversity.

Experiences of South African speech-language therapists providing telepractice during the COVID-19 pandemic: A qualitative survey.

The COVID-19 pandemic necessitated that speech-language therapists (SLTs) make a radical change to provide services to their clients safely via telepractice. For many practitioners, telepractice was an unfamiliar mode of practice that had to be implemented under emergency conditions. Limited literature on SLTs' experiences of implementing telepractice in the Global South during this time is available. To explore the experiences of South African SLTs (N = 45) who implemented telepractice services during the COVID-19 pandemic. SLTs across the country were invited via professional bodies to participate in an online qualitative survey distributed in 2021. Data were analysed using thematic analysis principles. We describe participants' reports of their current telepractices, discuss their perspectives on accessibility to telepractice for SLTs, clients and caregivers, and working with specific diagnoses, and consider the support needs of SLTs to enhance telepractice services. Most participants work in private practice or school settings with primarily paediatric caseloads. They reported telepractice as a positive experience and felt it was effective, although they judged that some clients were not well served by telepractice. SLTs felt underprepared for the rapid switch to telepractice and the flexibility required, especially given the limited availability of guidelines given the pandemic crisis. Greater preparation is required for telepractice sessions and more attention needs to be paid to supporting caregiver involvement online. Telepractice involves various barriers and facilitators, many of which seem common across Global North and South contexts. Support is required to enhance current telepractices in terms of computer literacy, technical education, different telepractice methods and caregiver coaching. Our findings have the potential to enable the development of support, training and guidelines to improve SLTs' confidence in providing telepractice whilst delivering quality services in an accessible and safe manner. What is already known on the subject Many SLTs had to transition quickly to telepractice service provision during COVID-19, with limited existing guidelines and support. Although there is some literature available on SLTs' experiences of implementing telepractice in the Global North, perspectives from the Global South during this time are limited. It is important to understand experiences, barriers and facilitators to telepractice provision to provide tailored support to practitioners. What this paper adds to existing knowledge Telepractice provides a viable alternative to in-person therapy for specific clients and contexts. Telepractice presents both benefits and barriers for effective clinical practice across Global North and South contexts. Greater preparation is required for telepractice sessions and more attention needs to be paid to enhancing caregiver involvement online, especially since many practitioners are likely to continue offering telepractice services post-pandemic. What are the potential or actual clinical implications of this work? Clinicians felt underprepared for the rapid switch from service delivery mode to telepractice. Greater support, training and guidelines for students and practitioners are required to enhance current practices and ensure practitioners are equipped to provide effective telepractice in the future. In particular, support should cover technological aspects, caregiver coaching and online assessment options, especially for paediatric clients.

Perspectives on the implementation of pre-ETS services: Identification of barriers and facilitators to early career planning for youth with disabilities

BACKGROUND: There are differences between and within states in the delivery of Pre-Employment Transition Services (Pre-ETS) for students with significant disabilities early in their career planning process. This complicates the delivery of services for these youth with disabilities (YWD) and leaves gaps in communication between families, educators, and vocational rehabilitation (VR) counselors. OBJECTIVE: To identify facilitators and barriers in the implementation of Pre-ETS to students with significant disabilities ages 14–16. Additionally, to gather data from rural, urban, and suburban areas spanning across two states to analyze the similarities and differences between these states. METHODS: Researchers from Virginia and Kentucky conducted semi-structured interviews with 56 participants representing VR counselors providing Pre-ETS, educators, and families. RESULTS: A majority of respondents stated that starting Pre-ETS with 14–16 year-olds provided numerous benefits. In both Virginia and Kentucky, educators and VR counselors expressed the need for more resources, particularly ongoing training for providing Pre-ETS to younger students in the transition process. Families recommended making activities meaningful and engaging by increasing job exploration and workplace readiness experiences. CONCLUSION: The results of the study provide insight on the implementation of Pre-ETS activities in local communities across two states. Implications are discussed for providing Pre-ETS to students with significant disabilities early in their career planning process.