Postcode Lottery in Healthcare? Findings from the Scottish National Comprehensive Geriatric Assessment in Secondary Care Audit 2019

Comprehensive Geriatric Assessment (CGA) is provided differently across Scotland. The Scottish Care of Older People (SCoOP) CGA Audit was a national audit conducted in 2019 to assess this variation in acute hospitals. Two versions of audit questionnaires about the provision of CGA were developed (one each for larger hospitals and remote/rural areas) and piloted. The questionnaires were sent to representatives from all hospitals in Scotland using the REDCap (Research Electronic Data Capture) system. The survey asked each service to provide information on CGA service delivery at the ‘front door’. The questionnaire was open for completion between February and July 2019. Of the 28 Scottish hospitals which receive acute admissions, we received information from 26 (92.9% response rate). Reporting sites included seven hospitals from remote and rural locations in the Scottish Highlands and Islands. Significant variations were observed across participating sites for all key aspects studied: dedicated frailty units, routes of admission, staffing, liaison with other services and rehabilitation provision. The 2019 SCoOP CGA audit highlights areas of CGA services that could be improved and variation in specialist CGA service access, structure and staffing at the front door across Scotland. Whether this variation has an impact on the outcomes of older people requires further evaluation.

LGBTQI + Migrants: A Systematic Review and Conceptual Framework of Health, Safety and Wellbeing during Migration

The health and safety of LGBTQI+ migrants or migrants who are of diverse sexual orientation, gender identity or expression (SOGIE) remains an under-studied area, particularly for the period during transit from their place of origin to destination. This systematic review aims to describe the literature on the health risks and consequences among SOGIE migrants during transit and examine their access and use of services. Six peer-reviewed databases and websites of nine large migration organisations were searched to identify the literature on forced migrants and sexual and gender minorities. Twenty English-language studies from 2000–2021 were included and analysed drawing on a conceptual framework. Studies emerged from six regions and the majority of research participants identified as gay men. In general, quality appraisal demonstrated studies as either medium or high quality. Findings suggested five common themes associated with SOGIE health and well-being, including: daily exposure to discrimination, harassment and violence; coping, social support and resilience; access to services; mental health; and physical and sexual health. Depression, anxiety and post-traumatic stress disorder (PTSD) were prevalent amongst SOGIE migrants, particularly when associated with detention or camp environments, and were exacerbated by social isolation. Barriers to accessing healthcare were identified and specific sexual health services were often found lacking, especially for trans persons. Unsurprisingly, during transit, SOGIE migrants are very likely to experience the double marginalisation of their migrant or minority status and their gender identity. Results indicate that services for SOGIE migrants need to tailor service access and support approaches to respond to the particular health and protection needs of SOGIE individuals in each setting.

Realizing the potential of routinely collected data for monitoring eye health services to help achieve universal health coverage

In the recent World Report on Vision, the World Health Organization (WHO) highlighted the need to strengthen health information systems (HIS) for eye health, including data from population-based surveys and facility-based sources such as service and resource data. The report also outlined the importance of strengthening eye health to enable Universal Health Coverage. In high-income countries, facility-based data are increasingly used to monitor eye services and answer research questions, including under the banner of big data. While there are some examples of comprehensive and robust information systems for eye care in low- and middle-income countries (LMICs), the potential of facility-based data is yet to be realized in many LMICs. Here, we discuss the potential of strengthening the collection and use of facility-based data for eye health in LMICs to monitor Universal Health Coverage relevant aspects of service access, quality, and equity.

Parent perceptions of a group telepractice communication intervention for autism

Background & Aims Estimates suggest that one in 59 children receive a diagnosis of autism and that early intervention can be effective if applied consistently and intensively. Parent implemented intervention can increase intervention consistency and intensity however, availability of providers, geographical factors, time constraints, and parental stress levels can all act as barriers to service access. Limitations in understanding elements that support family engagement can also impact participation in intervention. Telepractice can increase availability of intervention services and decrease the time and costs associated with face-to-face delivery. Research focused on children with autism has shown that telepractice is acceptable to parents. Despite positive findings for telepractice services with individual clients, limited research has been conducted on telepractice services for parent groups; parent perceptions and preferences regarding intervention; and service delivery methods. This research aimed to investigate parent perceptions of a group intervention programme for autism; the telepractice approach; parent and child outcomes; and parental stress. The purpose of the investigation was to build an understanding of parent's intervention preferences to inform future service offerings, increase choice, and support participation. Methods Eleven parents of preschool children with autism participated in a telepractice delivered group training programme called Hanen More Than Words (HMTW). The intervention is traditionally delivered face to face and teaches strategies to facilitate social-communication development in young children. Quantitative and qualitative measures were used to evaluate parent perceptions of the telepractice HMTW intervention. Data were collected via the Parenting Stress Index, HMTW programme evaluation forms, and online parent survey. Quantitative data was analysed using descriptive statistics. Pre- and post-intervention comparisons of parenting stress were conducted using paired T-Tests. Open comment field responses were analysed qualitatively using a directed content analysis. Results Parents reported high levels of satisfaction with telepractice delivered HMTW across intervention and post programme evaluations. Interactive learning opportunities, group participation, video coaching, individualisation of service, and programme facilitation were identified as key supports to learning. Parents perceived increased insight into the interaction, learning, and behaviour of themselves and their children. They reported positive changes in strategy implementation and confidence. Parents also perceived improvements in their children's communication, responsiveness, interaction, and play following intervention. Parental stress measurements from pre- to post intervention, were not significantly different. Conclusions Telepractice may reduce service barriers and improve access, particularly with the efficiency of a group delivery approach. Utilising technology to deliver group intervention was acceptable to parents and perceived to have positive outcomes for both parent and child. Further investigation into parent perceptions of intervention types and delivery approaches, could facilitate a broader understanding of family needs with respect to service access and engagement. Implications Expansion of telepractice offerings can increase efficiencies and service choice for families and providers. Limitations in service availability and barriers to service access and engagement, confirm the importance of pursuing ongoing service improvements and evaluating the preferences of service users. Development of standardised tools to measure and compare parent perceptions across intervention types and service delivery approaches would be beneficial.

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination tools

Introduction & importance Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child's complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. Methods A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. Results 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. Discussion Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI.

Child Neglect: Statutes, Rates, and a Neglect Diversion Model

Introduction: Poverty is a correlate if not a cause of child neglect in the US and worldwide (Slack, 2017; WHO & UNICEF,2021,UN 2021). Definitions of child neglect vary widely and include parental omissions and commissions. The purpose of this manuscript is to examine the extent to which poverty exemptions in state statutes (N=15) actually are correlated with “screened out” neglect cases. We then undertake a case study of Vermont, the state in the U.S. with the lowest rate of screened in neglect cases, to explore the extent that the state of Vermont can be seen as a “positive outlier.” Methods: Using a multi-phase analysis, this article examines US state statutes (2019). Focusing on the 14 states that use poverty and service access qualifiers in their neglect statutes, we compare their neglect rates with states that do not include such qualifiers. We hypothesized that states with poverty exemptions in their statutes would have proportionately fewer neglect cases. The second phase of analysis built off of key informant interviews to help explain findings from phase 1. Findings: The findings expose the wide variation in neglect percentages across the nation, ranging from 92.2% to 1.5%. Using Vermont as a case study, with the lowest reported neglect rate and only 18 cases screened in for investigation in 2019, we examine explanations for the wide discrepancies nationally. These include the use of an economic firewall with poverty related cases in Vermont being referred to economic support services instead of a CPS investigation, Family Resource Centers, and Differential Response Systems. Implications and Conclusions: Differentiating child neglect from poverty, creating a national if not a globally standardized definition of neglect could help to better contextualize neglect rates, create poverty related diversion programs, and address race equity agendas. Finally, we offer recommendations to create more innovative practices to address and divert neglect cases to other systems and services that can more appropriately aid children, parents, and whole families.

Adults on the Autism Spectrum Face Significant Challenges Accessing Health Care Services

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by difficulties with social skills, verbal and non-verbal communication, repetitive behaviours and atypical sensory processing. Individuals on the autism spectrum face a higher prevalence of health conditions and have a higher mortality rate than the general population. There is a critical need to understand adults’ experiences on the autism spectrum when accessing health care services to understand how to improve accessibility to health care for these individuals. The purpose of this scoping review was to investigate how adults on the autism spectrum access and experience health care services. Four databases, including Embase, MEDLINE, CINAHL, and PsycInfo, were systematically searched for literature exploring how individuals on the autism spectrum access and experience health care. Results were extracted and categorized into five determinants based on the accessibility framework described by Levesque et al. (2013). Results indicated adults on the autism spectrum experience numerous barriers when accessing health care services. The dimension of access most frequently cited was the appropriateness of care, followed by the acceptability of care. It is essential to explore access as it is often conceptualized as the availability and affordability of services; however, results of this study indicate the broader experience of quality care provision and acceptance of the individual are important in understanding the complex experience individuals on the autism spectrum face. Based on these findings, there is a need to provide comprehensive education and clinical practice guidelines for health care providers to help reduce barriers to providing appropriate care for adults on the autism spectrum. Efforts to destigmatize intrapersonal and extra-personal perceptions of individuals on the autism spectrum will help overcome the barriers that affect care acceptability. Further research must understand how to design and implement strategies to maximize health service access for adults on the autism spectrum.