Training Of Service Providers Research Articles

Identifying enablers and barriers to the control of multidrug-resistant tuberculosis in Abia State, Nigeria: A qualitative study

ObjectiveDrug-resistant tuberculosis (TB) is a significant public health threat in high-burden TB countries, including Nigeria, constraining the achievement of End TB targets. Nonetheless, Nigeria's health system factors shaping the care of patients with multidrug-resistant tuberculosis (MDR-TB) are understudied. The study assessed the enablers and barriers to implementing MDR-TB care and treatment in Abia State, Nigeria. MethodsThis is a qualitative interview study adopting a phenomenological approach. We interviewed twelve participants comprising health workers and TB policymakers with roles in MDR-TB patient management at the national (n = 2) and state (n = 10) levels in May 2022. We used maximum variation sampling to purposively select participants based on their roles, availability, and consent. The data were analysed thematically. ResultsThe factors enhancing care for patients with MDR-TB include using a certificate of readiness, community involvement, donor financing, availability of treatment centre, effective facility-community linkage, treatment support, multidisciplinary care team, training service providers, availability of oral drugs, expansion of diagnostic facilities, data tool availability, review meetings, and data-focused supervision. In contrast, the factors constraining MDR-TB management are poor implementation of infection control policy, donor dependence, delayed initiation of treatment, poorly motivated health workers, health worker stigma, shortage of personal protective equipment, and role conflict in data management. ConclusionThe findings highlight critical health systems strengths and weaknesses in MDR-TB control. MDR-TB care policies must build on the enablers and address the barriers to strengthen the care for patients with MDR-TB.

Feasibility and acceptability of a digital parent group chat intervention to prevent child and adolescent maltreatment in the Philippines.

This study examined the feasibility, acceptability, and preliminary outcomes of MaPaChat, a parent support intervention delivered using Viber group chat to caregivers in the Philippines during the COVID-19 pandemic. Forty caregivers of children aged 4-17 from predominantly low-income households participated in a culturally adapted version of the Parenting for Lifelong Health ParentChat programme. Feasibility was assessed by enrolment, attendance, and dropout rates. Semi-structured interviews with caregivers and programme facilitators explored programme acceptability. A single-group pre-post design was used to explore changes in child maltreatment, positive parenting, parenting stress, and other secondary outcomes. The mean attendance rate was 82% and the dropout rate was 10%. Caregivers and facilitators found the programme helpful in enhancing parenting knowledge and skills and were satisfied with the programme delivery using Viber group chat but also reported experiencing technological challenges. Pre-post comparisons suggested that the intervention has potential in reducing physical and emotional abuse and associated risk factors. The findings suggest that a parenting intervention delivered over digital group chat by trained community service providers may be a feasible and acceptable way to support caregivers in low-resource settings.

Motivation-opportunity-ability-behaviour of community members and program implementers towards mass drug administration for lymphatic filariasis elimination in India: a systematic review and implementation priority.

Lymphatic filariasis (LF) is a significant public health issue in India. Despite 10-15 rounds of mass drug administration (MDA) in India, the global LF elimination target of 2030 appears challenging. To strengthen the program, community and provider perspectives on ways to bridge a gap in MDA are needed. Through the motivation-opportunity-ability-behaviour (MOAB) lens, we systematically reviewed the facilitators and barriers encountered in LF elimination in India. We followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched PubMed, Embase, ProQuest and Google Scholar databases to explore factors related to MDA program implementation in India through 30 June 2021. We analysed the data using a thematic framework. We identified 576 studies; of these, 20 studies were included. This review revealed that the public health system for distributing MDA drugs in India created a better enabling environment, including zero out-of-pocket expenditure, door-step distribution of medicines and ample capacity-building training and follow-up. However, community members were unaware of the rationale for drug consumption, leading to a gap in drug distribution and consumption. Motivation is required among community members, which suggests capacity-building training for service providers to counsel the community.

Employment Interventions for People With Intellectual and Developmental Disabilities: A Delphi Study of Stakeholder Perspectives.

The purpose of this study was to examine the social validity of five different evidence-based and emerging pathways to employment (i.e., supported employment, customized employment, internships, apprenticeships, and postsecondary education) from the perspective of multiple stakeholders. A Delphi method was used to determine whether stakeholders are in consensus regarding the accessibility, affordability, acceptability, efficacy, and the cost-benefit ratio of these interventions. Findings indicated that all pathways were deemed socially valid via stakeholder consensus except for apprenticeships, which could not be determined as a result of limited stakeholder knowledge and experience with the pathway. Future efforts to improve employment outcomes for people with intellectual and developmental disabilities (IDD) should focus on better training for service providers and increased access to services.

Universal mental health training for frontline professionals: evaluation of pilot trial in Ukraine

Background Increasing accessibility of mental health services and expanding universal health coverage is possible worldwide by using a task-shifting approach and delegating elements of mental health support to trained non-mental health service providers. The Universal Mental Health Training (UMHT), dedicated to this aim, was developed and piloted in Ukraine. The UMHT is a specialised program for training frontline professionals on high-quality and evidence-based responses to the mental health needs of the population they serve. Methods The controlled pilot trial of UMHTs’ efficacy was conducted with 307 frontline professionals divided into 24 training groups. The control group included 211 persons with the same occupation background who participated in training later (waiting list). All the groups took part in eight-hour training which includes one introductory module that introduces the mental health topic alongside a five-step model, two disorders-focused modules with the steps adjusted to work with specific disorders and the final module that considers possible difficulties and ways of their solving. Three efficacy measurements were used in the outcome assessment: Readiness to interact with people with mental health issues at work, mental health awareness and mental health proficiency. Results Analysis of the outcome data revealed middle-level effect size related to the knowledge of mental health conditions, mental health awareness, and increasing the readiness to interact with people with mental health issues at work in first-line professionals that underwent the UMHT. Conclusions High-level utilisation of the UMHT at work by trained professionals confirms our hypothesis on the efficacy and feasibility of the developed intervention. Results obtained favour the continuation of the development of the UMHT and future implementation research in this field in Ukraine and potentially in other low- and middle-income countries.

Outpatient Service Provision In Tertiary Hospital During Covid-19 Pandemic

Background: The COVID-19 pandemic was a challenge for healthcare professionals globally. The outpatient department is an important part of the hospital. Service providers were facing tremendous difficulties and challenges due to sudden thrust of the pandemic. Despite these challenges service providers had to give service during COVID-19 pandemic. The purpose of this study to assess the state of outpatient service in tertiary hospital during COVID-19 pandemic.
 Methods: This cross-sectional study was conducted among conveniently selected 203 service providers including 156 doctors and 47 nurses. Data were collected through face-to-face interview using semi-structured questionnaire and observation checklist. The study was conducted at medicine, surgery, paediatric and family planning outpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka Medical College Hospital, and Bangabandhu Sheikh Mujib Medical University during the period from January to December 2021.
 Results: Among 203 service providers, 76.8% were doctors and 23.2% were nurses. All health services were available during COVID-19 pandemic in outpatient departments (OPDs) of the selected hospitals. At outpatient department there was separate entry-exit door, thermal scan was available at entry point, Patients and visitors are restricted. Number of patients were decrease in outpatient department. Among the three hospitals facility of flu-corner and triage in the OPD of ShSMCH. For the DMCH and BSMMU, flu-corner and triage center were situated at other premises of the hospitals. Outdoor surgery, vaccination service and shishu bikash kendro were open during COVID-19 pandemic. About 80.8% respondents mentioned about availability of adequate amount of personal protective equipment, 42.9% respondents mentioned about proper ventilation, 57.1% respondents said had not. About 32.5% respondent said about availability of N-95 mask and 57.6% said had not. Among the respondents 67.0% said they maintained physical distance during consult with the patients. 57.6% respondents said about lack of manpower. 61.6% respondents said about felt anxiety and high-risk during service.
 Conclusion: For more improvement of outpatient service during COVID-19 pandemic, the authority should pay special attention, to increase manpower, arrange frequent training for service providers.
 JOPSOM 2021; 41(2):20-27

Understanding mental health stigma and discrimination in Ethiopia: A qualitative study

Abstract Background Stigma is significantly impacted by cultural and contextual value systems. People with mental health conditions frequently have to deal with the condition itself and the associated stigma and discrimination. Contextual understanding is essential to design measures and interventions. Objective This study aimed to explore the experiences and perceptions of people with mental health conditions, their families and key stakeholders. Method A qualitative method used to understand mental health-related stigma and its local contexts. Sixteen participants, including service users, caregivers, service providers and health service administrators, were interviewed. Result People with mental health conditions and their caregivers experienced various forms of stigmatization which is linked to attributions about the causality of the illness, overt manifestations of mental health condition leading to easy identification and functional impairments that adversely affect participation. Social contact, lived experiences sharing and training of service providers are relevant intervention strategy to address stigma. Implication Stigma and exclusion are prominent in the experiences of people with mental health conditions and their caregivers in this rural Ethiopian setting. Measurement of stigma and the development of interventions should consider how stigma is socially constructed. Anti-stigma interventions need to be implemented alongside expanded local access to mental healthcare.

Factors Associated with Sexual Victimization Among Transgender Emerging Adults.

This cross-sectional study documented between-group differences in risk factors associated with sexual victimization histories in an ethnically and racially diverse sample of transgender emerging adults (N = 248, ageM = 22.61 years). The sample was recruited using the Internet-based CloudResearch platform to answer questionnaires assessing predictors for recent experiences of intimate partner violence (IPV). Participants were categorized into four groups based on cross-classified self-reports of child sexual abuse (CSA) and recent sexual IPV, prior to the use of multivariate analysis of variance to evaluate mean score differences for past-year substance use, minority stressor, and relationship functioning variables. Participants reporting sexual IPV reported higher scores for all substance use variables, while transfeminine participants reported significantly higher scores for alcohol use problems and negative consequences related to substance use. Participants reporting both CSA and sexual IPV also reported the highest scores for everyday discrimination. Participants who experienced sexual IPV also reported the highest scores for internalized sexual stigma. Sexual revictimization among transgender adults occurs in the context of harmful patterns of substance use and several minority stressors. Our findings have implications for healthcare or counseling services for transgender emerging adults who have experienced multiple forms of victimization, substance use problems, and minority stressors, including the importance of trauma-informed and integrated intervention services, and specialized training for service providers.

Five key learnings from a court-based crossover youth program

Crossover youth (COY), those dually involved in both the child welfare and youth justice systems, face systemic barriers within the justice system, including harsher sentences and greater likelihood of detention as compared to non-crossover youth. The Crossover Youth Project (COYP) was formed to ameliorate these systemic issues. We conducted in-depth interviews with 22 stakeholders, predominantly from youth justice and child welfare, to examine the processes and outcomes of the program implementation. Interviews with the stakeholders revealed five key learnings for uptake and success: 1) A full-time case coordinator is key to increasing intersectoral collaboration; 2) Education and training for service providers must be ongoing and repeated; 3) A systematic COY identification and referral process is necessary for appropriate service provision; 4) Clear marketing of the program is needed to ensure service provider buy-in; and 5) Voices of the youth must be centered (Nothing about us, without us). These lessons serve to inform the formation and implementation of future interventions for crossover youth.

Compassionate, respectful care and associated factors among radiology clients at public hospitals in Addis Ababa, Ethiopia

BackgroundCompassionate and Respectful Care (CRC) is the basic radiology professional practice. Even though it is an essential component for all health practitioners, limited evidence was available in the study area, especially focusing on radiology services. Identifying levels of compassionate and respectful care and associated factors help in recommendations for improvement for radiology professionals to deliver service with a good habit of compassion and respect to their clients. Therefore, this study aimed to assess the level of compassionate and respectful care and associated factors among radiology clients. MethodsFacility-based cross-sectional study design was conducted from July 6 –27, 2022 in public hospitals in Addis Ababa, Ethiopia. Those hospitals were Tikur Anbessa Specialized Hospital, Armed Force Comprehensive Specialized Hospital, and St. Paulos Hospital. A systematic random sampling technique was used to select patients visited radiology departments and radiographers. Epi-Data version 6 and SPSS version 26 were used for data entry and analysis, respectively. Bi-variable and multivariable logistic regression analysis models are used to identify associated factors. Statistical significance was determined using a P-value of less than 0.05 and an adjusted odds ratio with a 95% confidence level. ResultsA total of 333 respondents were involved in the study with a response rate of 99.1%. Overall, compassionate and respectful care of radiology service providers were 66.7% and 70.9% respectively. Mode of transport (AOR (Adjusted Odd Ratio) =2.2, 95% CI (Confidence Interval): 1.00–4.81), waiting time (AOR= 4.10, 95% CI; 1.92–8.76), CRC training (AOR= 2.35, 95% CI; 1.34–4.12) and workload (AOR= 4.02, 95% CI; 1.9–8.51,) were significantly associated with compassionate care. Distance (AOR=2.98, 95% CI: 1.34–6.61), mode of transport (AOR=4.9, 95% CI; 2.09–11.5), number of service providers (AOR=0.52, 95% CI; 0.27–0.98), CRC training (AOR=2.15, 95% CI; 1.18–3.93) and workload (AOR=7.04, 95% CI; 3.13–15.8) were significantly associated with respectful care provision among radiology clients. ConclusionCompassionate and respectful care radiology service provision in Addis Ababa public hospitals was similar as compared with other studies. Waiting time, transportation, the number of service providers, Compassionate and respectful care training, and workload were significantly associated with compassionate and respectful care service provision. Providing adequate compassionate and respectful care training for service providers, reducing waiting time, and balancing the service provider-to-client ratio should enhance compassionate and respectful care service provision.

Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana.

Eliminating Tuberculosis is one of the targets of Sustainable Development Goal Three. Decentralizing TB care beyond health facilities by leveraging community involvement is crucial for safeguarding effective tuberculosis care. In this study, we explored potential facilitators and inhibitors of the implementation and sustainability of community-based interventions for the prevention and treatment of TB in the Moshupa district, Botswana. This study adopted a qualitative approach using a collective case design. An interpretive paradigm based on relativist ontology and subjectivist epistemology along with abductive research logic was used. The study enrolled treatment supporters of tuberculosis patients diagnosed with drug-susceptible tuberculosis between January 2019 and December 2019 in Moshupa Village for semi-structured interviews, Health care professionals for in-depth interviews, and e community leaders for focus group discussions. Clinic-based observations in Mma-Seetsele clinic were also conducted to corroborate the participants' views. The data collected was analyzed using the NVivo version 12 software package, and statements of the participants were presented as quotes to substantiate the issues discussed. This study highlighted effective partnerships between health services and external stakeholders, community empowerment, and the availability of policies and standard operating procedures as facilitators of community TB implementation and sustainability. However, Insufficient funding, low service provider training, policies not embracing age and educational eligibility for treatment supporters, shortage of equipment, medicines, and supplies, inadequate transport availability and incentives to meet clients' basic needs, paper-based systems, inadequate supervision, incomplete data reporting, and low service quality affected the Community TB program efficacy and sustainability in Moshupa. We also found that there was low service provider motivation and retention and that clients had low trust in treatment supporters. The findings of this study imply that the operational effectiveness of the community TB care approach to disease elimination is compromised; therefore, initiatives addressing the key components, including the availability of resources, governance arrangements and supportive systems for community health workers, are required for successful community TB implementation and sustainability.

Experiences of Reporting Family Violence Among LGBTQ + Adults in Australia: Findings from the Private Lives 3 National Survey

Abstract Purpose LGBTQ + people who have experienced intimate partner violence (IPV) and family of origin violence (FOV) are known to face significant barriers to reporting or seeking support for these experiences and may not always feel supported when do so. Method Data from 4,607 participants of a nationwide survey of LGBTQ + adults in Australia who indicated having ever experienced IPV or FOV was analysed. Multivariable logistic regression analyses were conducted to identify factors associated with reporting the most recent experience of IPV or FOV and with feeling supported when reporting. Results In total, 1,188 (25.9%) participants indicated that they reported their most recent experience of IPV or FOV and 1,112 (84.6%) of those felt supported. Participants’ sexual orientation, level of education, engagement with a regular general practitioner (GP), experience of homelessness and country of birth were associated with reporting their most recent experience of IPV or FOV. Of those who reported their experience, participants were most likely to feel supported if they had a regular GP and least likely to feel supported if they had ever experienced homelessness. Conclusion The findings of this study highlight inadequacies in family violence frameworks in promoting or facilitating access to services that could benefit this population. Encouraging LGBTQ + people to engage with a regular GP, establishing family violence services that cater to the specific needs of LGBTQ + people, and training family violence responders and service providers to recognise diverse relationship dynamics may improve support outcomes for LGBTQ + survivors of family violence.

요양시설의 기능회복훈련 서비스 제공에 관한 연구

Purpose : This study was conducted to investigate the functions of daily living, physical and cognitive functions, and functional recovery training services of elderly residents in long-term care facilities.
 Method : We sent surveys to representatives of the facilities and analyzed the data for 73 care facilities that we received via email. Each facility has selected one resident for each of the eight groups. The functions of daily living, cognitive function and physical function, and functional recovery training service providers of 453 selected residents were recorded on a checklist based on the past week.
 Results : The degree of assistance for activities such as bathing and shampoo increased proportionally from Group 1 to 8 in the eight categorized groups. The proportion of cognitive and physical impairments also increased. The analysis of the average time and frequency of functional recovery training conducted by residents in Group 1 to 8 over a one-week period revealed that the average time of physical activity training was 9.56 minutes with 3.34 sessions, movement and walking training had an average of 6 minutes with 4 sessions, and activities of daily life training had an average of 12.04 minutes with 4 sessions.
 Conclusion : The average time and frequency of functional recovery training conducted for the residents can be utilized for the development of standardized guidelines for functional recovery training. There is a need for activity-centered functional recovery training in conjunction with the daily activities of the residents.

Youth cannabis use in Canada post-legalization: service providers’ perceptions, practices, and recommendations

BackgroundIn 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16–24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers’ perceptions, practices, and recommendations on youth cannabis use.MethodsThis mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16–24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis.ResultsThe survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services.ConclusionYouth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.

SERVICE QUALITY AND BRAND LOYALTY: EVIDENCE FROM CHAIN FAST FOOD COMPANIES IN SOUTHS EAST NIGERIA

This study determined the influence of service quality on customer loyalty in chain fast food companies inSouth East Nigeria. It was a survey that was guided by three objectives and three research hypotheses.Consumers of chain fast food products and services served as respondents while the sample size was 323. A17-itemed questionnaire on a 4-point scale which reliability test produced a co-efficient of 0.79 served asresearch instrument and accessibility sampling technique was used in the administration of the instrument.Descriptive and inferential statistics on SPSS version 23 were used to analyze the data generated. Findingsrevealed that, reliability dimension has positive/significant relationship with brand loyalty(R = 0.504);responsiveness dimension has positive/significant relationship with brand loyalty (R = 0.245) whiletangibles dimension has a negative relationship with brand loyalty (R = -0.023). In view of the findings, thestudy concluded that reliability and responsiveness dimensions of service quality have positive /significantrelationships with brand loyalty while tangibles dimension has a negative relationship with brand loyalty inthe study area and therefore recommended that managers of fast food companies must among others ensurethat service promises are fulfilled, billings are properly done and training of service providers made toppriority in order to improve their speed and mitigate service defects and failures in service delivery

Reducing the Burden of HIV and HCV among Sex Workers Who Use Drugs in France

Context:The far-reaching effects of the Covid-19 pandemic exacerbated the adverse working and living conditions of Sex Workers (SWs) in France. These consequences, coupled with illicit drug use, and reduced access to prevention measures raise concerns for the transmission of the Human Immunodeficiency virus (HIV) and Hepatitis C virus (HCV) among Sex Workers Who Use Drugs (SWWUD), creating an urgent call for targeted interventions. There is an acute need for accessible, ongoing care for SWWUD to prevent HIV and HCV infections and mitigate adverse health effects. Current French health services such as harm reduction and HIV/HCV prevention services often operate separately and seldom address SWs and People Who Use Drugs (PWUD) simultaneously. Given the compounding set of challenges that SWWUD face, a holistic approach to policy interventions must be considered.Policy Options:Firstly, integrated services are particularly effective in promoting harm reduction and improving the health of their users. When these services include substance use care and HIV services, uptake of these interventions and primary care utilisation increases due to enhanced accessibility. Secondly, pre-exposure prophylaxis (PrEP) and needle and syringe programs (NSP) are clinically effective prevention methods that, when coupled with point-of-care-testing (POCT), can reduce the prevalence of HIV and HCV and improve the monitoring of these viruses. Finally, willingness to engage with health services is impacted by the attitudes of healthcare staff. Sensitisation training can promote trauma-informed care, a non-judgemental approach in health workers, encouraging SWWUD to seek care and achieve better health outcomes.
 Recommendations:A three-pronged approach to implementing integrated services is recommended. First, facilitating access to care can be attained through the linkage of patients to treatment, primary care, sexual and reproductive health, and social services. Existing service providers can be supported with interdisciplinary teams and telemedicine to reduce care fragmentation. Additionally, prevention and testing measures can be enhanced through the coordinated provision of needle and syringe programs, point-of-care testing, PrEP, and harm reduction supplies. These services should be linked to established integrated service centres to ensure a continuum of care. Finally, peer leaders may deliver sensitisation training for service providers to reduce stigma and improve understanding of the unique health needs of SWWUD. Integrated service providers should further employ peer leaders as peer navigators to promote the vision of community empowerment and inclusion.

Disparities in readiness of health facilities to provide long-acting reversible contraceptives (LARCs) and permanent methods (PMs) in Bangladesh

The considerable success of Bangladesh's family planning programs Slowed in recent years due to the low utilization of long-acting reversible contraceptives (LARCs) and permanent methods (PMs). The low uptake persists despite the fact that these methods are proven to be highly effective in preventing unplanned pregnancies and lowering maternal deaths. This situation causes a daunting challenge for the country to attain sustainable development goals (SDGs) by 2030. The current study provides new insights into the status of LARCs and PMs availability in Bangladesh from the supply-side perspective. The main objective of this study was to assess the readiness of health facilities to provide all LARCs and all PMs in Bangladesh. To assess service readiness, we examined variations in facility types and regions, using data from the Bangladesh Health facility Survey (BHFS) 2017. Out of a total of 1054 health facilities assessed, government health facilities manifested higher availability of items of general service readiness for LARCs and PMs compared to private health facilities. Service readiness included domains including staff and guidelines, equipment, and medicine. Logistic regression models of readiness of LARCs, PMs, and combined LARCs-PMs showed significant variations by facility types and regions. Moreover, the findings of this study highlighted that, Bangladesh government facilities, irrespective of region, were more likely to be ready to provide combined LARCs-PMs, LARCs, and PMs individually than private health facilities. Looking more closely at the overall readiness within private health facilities, we found that it was better in rural areas than in urban areas. The findings of this study provide a basis to develop recommend strategic approaches to family planning programs, investment priorities in family planning services and, training for service providers to reduce regional inequality and disparities by facility types in Bangladesh.

Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults.

There is a growing population of autistic adults in need of supports from a service delivery system that, at present, fails to accommodate their needs adequately and equitably. Unfortunately, there is a shortage of trained behavioral health service providers to meet the needs of young autistic adults. Quality of life (QoL), or one's perception of, and satisfaction with, life in relation to held goals and expectations, has been identified as a key outcome of interest by autistic self-advocates. By supporting autistic clients to hone their strengths and interests, integrate various aspects of their identity, identify goals, and connect to appropriate resources, providers can promote clients' self-knowledge and self-determination, in the service of improving QoL. In this Perspectives article, we offer concrete recommendations to mental health providers, including those who do not specialize in autism, with the goal of supporting implementation of evidence-based strategies that improve QoL and promote self-determination among young autistic clients.

Organizational Challenges in Healthcare Services Providers for Individuals with Autism Spectrum Disorder (ASD) Considering Personnel Turnover Rate.

The organizational strategy and environment of the healthcare systems influence the turnover rate among healthcare provider personnel. These critical factors have received scant attention in the literature and particularly in the healthcare systems of the Kurdistan Region of Iraq (KRI) as one low-income country with a lack of infrastructural health provision foundations. In this cross-sectional study with qualitative synthesis, the turnover rate of a population consisting of 115 (85 "74%" rehabilitation and training personnel) members of a daycare center for individuals with autism spectrum disorder (ASD) during eight years in the city of Erbil was considered. The aim was to understand the organizational strategy and its impacts on the personnel turnover rate, particularly among healthcare providers. The analysis was conducted utilizing collective data over an eight-year period of service provisions. A qualitative methodological approach was adopted to understand the different aspects of turnover among the staff. The finding indicated a general turnover rate of 87% for the entire personnel and 72% for the rehabilitation and training service providers. This rate imposes considerable costs on the system. Interview analysis also yields supporting evidence for the desire of the staff to change jobs and the lack of understanding of the turnover among system authoritarians resulting in unpredictable changes and staff displacement. Further investigations are needed to understand different contributing factors to imposed or desired turnover rates among healthcare providers in KRI. The turnover over the years has imposed different challenges for the center where the data was collected and imposes unwanted negative impacts on healthcare organizations.

Need of Market-based Skills Training to Create Employment Opportunities for Returnee Migrants in Madhesh Province

A Rapid Market Appraisal (RMA) was conducted with the aim of exploring market prospects or the specific occupational skills in demand in the local markets of Madhesh Province so as to reintegrate the returnee migrant workers into the Nepalese economic system. In order to collect data for RMA, major key informants that are also the key labor market players of Madhesh Province like returnee migrant workers (RMWs), employers of major three occupational sectors (Construction, Agriculture and Tourism), training providers, entrepreneurs, and rural municipal representatives were identified from different seventeen municipalities of seven districts of Madhesh Province. While interacting with 87 returnee migrant workers (RMWs- 64 as FGD and 23 as KII), it was found that around 70% of the 87 respondents did not have any specific skills learned in their respective destination countries, and the general skills acquired by them in such countries were not applicable in the context of Nepal. Based on the collected data from 204 key informants of labor market, 24 different occupations were identified as highly demanding occupations in three occupational sectors, nine were in the construction sector, eight in the agriculture sector, and six in the tourism sector. It was also found that the province, having the largest area of cultivated land in Nepal, is very potential for employing a bigger number of youths and returnees in the agriculture sector. However, it was felt necessary to make the agriculture sector truly attractive in terms of technology, financial access like floating subsidized loans and value addition. Regarding the access to the training and employment service providers (T&Es), there is sufficient access of training but maintaining the quality of training is a challenging issue, for which a mechanism has been suggested.