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.

Predictors of Custodial Grandparents’ Perceived Barriers to the Use of Services

Getting timely access to help, information, and a variety of services is paramount among the challenges of raising a grandchild, and grandparents face a variety of internal and external barriers in getting such help. The present pilot exploratory study focused on caregiving-related and personal resource variables best predicting grandparent caregivers’ perceptions of barriers to receiving services. Fifty-two grandparents (M age = 59.1) raising their grandchildren completed measures assessing caregiver strain, social support, resilience, self-care, psychosocial adequacy, health, depression, and grandchild relationship quality. They also completed measures of the extent to which they faced personal and caregiving-related difficulties giving rise to the need for services (e.g. health, grandchild well-being, support from others) as well as the extent to which they had experienced barriers to service (health/financial limitations, isolation, transportation, respite care, lack of knowledge of services) in the past 3 months. Correlations (p < .05) suggested that psychosocial adequacy (r = -.32), depression (r = .27), caregiver strain (r = .42) and difficulties (r = .48) were all related to greater perceived barriers. Regression analyses (F7, 40 = 2.81, p < .02) indicated that caregiver strain (Beta = .33, p < .05) and difficulties giving rise to the need for services (Beta = .32, p < .04) emerged as most salient in predicting barriers. These findings underscore the fact that personal, caregiving-related, and interpersonal factors exacerbate the barriers associated with grandparents’ accessing needed services and reinforce such factors’ impact on grandparents as targets for overcoming impediments to accessing services among them.

Role of small private drug shops in malaria and tuberculosis programs in Myanmar: a cross-sectional study

Background The role of community drug shops in providing primary care has been recognized as important in Myanmar as in other countries. The contribution by private community drug shops to National Tuberculosis case notifications and National Malaria testing and positive cases is significant. Population Services International Myanmar (PSI/Myanmar) has been successfully training and engaging community drug shops to screen presumptive Tuberculosis to make referrals to public health clinics and perform malaria rapid diagnostic tests (mRDT) to malaria fever cases and provide management accordingly. Objectives The study aims to identify barriers to service provision of the trained providers at the drug shops that are currently engaged in PSI/Myanmar Tuberculosis and malaria programs. Exploring their needs enabled us to identify and address barriers, to provide evidence for better linkage with the primary care system. Method A mixed method study was conducted with the service providers at the drug shops. A quantitative follow up survey was done with 177 trained Tuberculosis service providers and 65 trained malaria service providers. A total of 32 qualitative in-depth interviews were completed. Seventeen Tuberculosis trained providers and 15 malaria trained providers participated in individual interviews. Content analysis approach was used to generate themes for the data analysis. Results From the survey, the majority of drug shops reported that they performed appropriate first steps, particularly referring symptomatic Tuberculosis cases and offering mRDT testing to fever cases. Nevertheless, in-depth interviews with them revealed they did not adhere to the national guidelines for every client. There was a need to emphasize the importance of following the national guidelines for referring patients with prolonged cough and fever cases management. For those who were trained in Tuberculosis case referral, support from program staff was needed to make smooth referrals. Those who were trained in malaria often considered differential diagnosis of fever other than malaria and did not test with malaria rapid diagnostic test due to declining numbers of malaria cases. Conclusion The study findings highlighted that the drug shops trained in Tuberculosis referral seemed to have the potential to fully engage into the primary care health system if provided with suitable support and supervision. On the other hand, those trained in malaria case management might be less motivated to engage in the era of declining malaria endemicity.

Exploring challenges in mental health service provisions for school-going adolescents in Sri Lanka

Schools provide an ideal setting for early, accessible intervention according to research conducted in developed countries for adolescents experiencing adverse mental health (MH). Many schools in South Asia, however, lack structured and standardized school counselling services. Research indicates that where services do exist, students are reluctant to access them due to perceived high risks and low benefits in MH help seeking. This paper explores the challenges experienced in MH provision from the perspective of school counsellors. A qualitative approach was chosen, and three main themes emerged from the data using the thematic analysis: negative perceptions of MH and counselling, the unwillingness to invest in MH services, and the challenges inherent in the system itself. The findings reveal cultural implications behind these challenges and suggest grassroots level initiatives that can be implemented within schools to reduce the barriers to service provision without the need for legislative changes at a national level.

Self-Management Strategies for Problem Gambling in the Context of Poverty and Homelessness

Problem gambling and gambling disorder are serious public health issues that disproportionately affect persons experiencing poverty, homelessness, and multimorbidity. Several barriers to service access contribute to low rates of formal treatment-seeking for problem gambling compared with treatments for other addictions. Given these challenges to treatment and care, self-management may be a viable alternative or complement to formal problem gambling interventions. In this study, we described problem gambling self management strategies among persons experiencing poverty and homelessness. We conducted semi-structured interviews with 19 adults experiencing problem gambling and poverty/homelessness, and employed qualitative content analysis to code and analyze the data thematically. We identified five types of self-management strategies: (1) seeking information on problem gambling, (2) talking about gambling problems, (3) limiting money spent on gambling, (4) avoiding gambling providers, and (5) engaging in alternative activities. Although these strategies are consistent with previous research, the social, financial,housing, and health challenges of persons experiencing poverty and homelessness shaped their self-management experiences and approaches in distinct ways. Approaches to problem gambling treatment should attend to the broader context in which persons experience and attempt to self-manage problem gambling.

A Scoping Review Examining the Integration of Exercise Services in Clinical Oncology Settings

Background: Addressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and provided practical recommendations to inform evidence-based practice, policymaking, and further investigations. Methods: Studies that recruited cancer patients, assessed the co-location of exercise services and cancer treatment units and reported findings on service implementation were included. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis. Results: Exercise service implementation was relatively modest across the included studies. These services were delivered by physiotherapists, exercise physiologists, and kinesiologists and funded mainly through grants and private donations, with staff salaries accruing as the major expense. Service penetration, adoption, and acceptability were generally low. However, studies recorded high clinician/patient satisfaction. Major barriers to service integration were limited funding, lack of detailed implementation plan, and low organizational buy-in. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness, hospital readmission, disease progression, and adverse skeletal events. Conclusion: Implementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise medicine for individuals on cancer treatment. While this model appears feasible for patients/clinicians, calculated efforts are required to drive uptake. There is no one-size-fits-all approach; hence, sustainable service integration remains a product of many factors, including structures and strategies that reflect the organizational dynamics of the clinical service environment housing the exercise unit.

Overcoming the Barriers to Service Excellence

The seven barriers to be overcome on the way to successful implementation of servitization are as follows: customers; organizational structure and culture; knowledge and information; products and activities; competitors, suppliers, and partners; economic and finance; and society and environment. We will look at each of the barriers in more detail, based on the ranking described in Chap. 10.1007/978-3-030-80511-1_1. This chapter draws from the published and unpublished work of the authors using the survey data and the interview insights. This chapter will use cases to describe how others overcame the barriers (Fig. 2.1).

Policy and Administrative Barriers to IDPs Accessing Basic Services

Literature shows that IDPs struggle to access services, which has an impact on their ability to live healthy and fulfilling lives. In the field of health, IDPs frequently have worse outcomes than both host community and refugees. This rapid literature review finds evidence of a number of policy and administrative barriers to access of services for internally displaced persons (IDPs). IDPs remain citizens of the countries in which they are displaced, and the national authorities retain responsibility for meeting their basic rights. However, their displacement, loss of livelihoods and assets, lack of documentation, as well as discrimination against them, lack of protection under international law, lack of policy to address their needs, poor services and conflict or disaster conditions, can all make it more difficult for IDPs to access basic services than non-displaced citizens. There is relatively little literature systematically addressing the issue of administrative and policy barriers to service access among IDPs. Much of the literature discusses IDPs alongside refugees (who have a different legal status and access to different national and international support), or discusses the whole range of difficulties facing IDPs but does not focus on administrative or policy barriers. The literature frequently does not compare IDPs and other citizens and service users. Nevertheless, policy and administrative barriers are discussed, ranging from analysis of international instruments on IDPs to documentation procedures in particular countries. Much of the literature shows the prevalence of disease, lack of school attendance, limited provision of services etc. faced by IDPs, but does not discuss the policy and administrative barriers in detail.