Research protocol of a multifaceted prospective mixed-method longitudinal study: Navigating Through Life - Western Australian study of transitions from out-of-home care.

BACKGROUND: Developing robust evidence is a challenge for researchers working with disadvantaged or vulnerable populations. For example, research shows that young people who have transitioned from out-of-home care (OOHC) to independent adulthood often experience poor long-term outcomes. However, evidence for the aetiology of those outcomes is weak due to methodological limitations such as small sample sizes and a lack of longitudinal data. This paper details the protocol for Navigating Through Life, a study that utilises novel research methods to better understand the pathways and outcomes of young people as they leave OOHC in Western Australia (WA). METHODS: Navigating Through Life is a longitudinal, mixed methods, population-based study. A prospective longitudinal study of young people aged 15-25 years will follow participants' experiences and outcomes over a two-year period. Quantitative and qualitative data is being collected from participants five times over 2 years, using standardised outcome measures and individual interviews. Outcome measures focus on key dimensions of young people's lives (e.g., social inclusion, well-being, resilience, self-determination). Interviews examine important influences and the variable contexts into which young people have transitioned from care. In addition, retrospective population-level data for young people transitioning from OOHC will be obtained from linked Western Australian government administrative records. Using a multitude of data sources, analysis will map pathways and outcomes of young people with care experience, and comparisons will be made with other population groups within WA. DISCUSSION: Navigating Through Life exemplifies a novel utilisation of multiple data sources to research outcomes for vulnerable and difficult to reach populations, and offers insights for other complex mixed-methods longitudinal studies. Results will provide new and more comprehensive data about specific pathways that may be influential to a range of post-care outcomes. Findings will extend evidence to inform better service-delivery models that improve outcomes and reduce disparities for vulnerable young people.

A snapshot of intellectual disabilities in Lao PDR: Challenges for the development of services.

Lao People's Democratic Republic (PDR) has experienced significant economic growth in the last two decades. While access to education, health, and employment for people with disabilities has also improved markedly, people with intellectual disabilities are still among the most vulnerable in society. This article presents findings from a screening survey of 2469 participants, a focus group discussion with key stakeholders in intellectual disabilities, and a case study of the Association for Autism. The screening survey suggests 1.9% of working age participants (18-59) and 0.7% of children (6-17) have intellectual disabilities. The qualitative data illustrate poor understanding and stigmatization of people with intellectual disabilities, lack of services, and development of a parent association to improve the life prospects for children with autism and intellectual disabilities. People with intellectual disabilities in Lao PDR remain particularly vulnerable. Parents and other disability advocates are raising awareness and demonstrating the effectiveness of specialized services.

Examples of individual supported living for adults with intellectual disability.

BACKGROUND: This article provides a qualitative account of four models of support for adults with intellectual disability in individual supported living (ISL) arrangements. MATERIALS AND METHODS: Completion of the first 50 evaluations of 150 arrangements for the third phase of the ISL project provided the examples. RESULTS: Four approaches are described: living alone, co-residency, relationship and host family. Within each type, wide variations occur particularly based on security of tenure, formal and informal support and management variations. CONCLUSION: Fifty evaluations so far illustrated a wide range of approaches to ISL, providing evidence of the critical importance of the formal and informal support environment and reinforcing the contention that ISL is appropriate for people with high support needs.

Inequitable distribution of human resources for health: perceptions among Thai healthcare professionals.

BACKGROUND: Effective delivery of health care is dependent on health manpower. In Thailand, an insufficiency of human resources relates to an inequitable distribution of healthcare professionals rather than to insufficiencies overall. Both internal and external factors influence healthcare professionals' choice of where to work, although perceptions rather than actual circumstances are more influential in their decision-making process. This inequitable distribution of healthcare professionals in Thailand affects rural areas and the provision of primary health care. OBJECTIVES: To understand the subjective perceptions, attitudes and dynamics among healthcare professionals regarding where they seek employment and the impact on the provision of primary care. DESIGN: Questionnaire survey among Thai healthcare students and professionals and semi-structured interviews with healthcare professionals investigating attitudes and perceptions. SETTING: Thai rural, urban and metropolitan areas. RESULTS: An interesting mix of factors influences healthcare professionals with regard to where they seek employment, or continue their employment. Family and community commitments, social status and a sense of belonging were associated with healthcare professionals seeking employment in their province of origin. Tensions are also emerging between preventative and curative health. These tensions, together with financial remuneration and professional development opportunities and promotions, as perceived by healthcare professionals themselves, have implications for current and future healthcare policy. CONCLUSION: The scaling up of human resources for health in Thailand will not, based on past experiences and attitudes outlined in this research, ensure an equitable distribution of healthcare professionals. Further consideration of these professionals' expectations of being able to work in areas close to their families and of sufficient financial remuneration is required. It is likely that rural regions and the delivery of primary care will be negatively affected by continued inequities. It was also found that current healthcare policies are creating new tensions.

Universal health care in Thailand: concerns among the health care workforce.

OBJECTIVE: To investigate the impact of the universal health care policy from the perspective of Thai health care professionals. METHODS: Semi-structured interviews with purposively selected health care professionals and key informants. RESULTS: Health care professionals at public hospitals, particularly in rural areas, have experienced up to a doubling in the number of daily out-patients; many with superficial symptoms. While the improved access to health care provisions was welcomed, questions regarding the appropriateness of seeking medical advice were raised. Concern regarding equity: between the universal health care policy and two parallel public health cover schemes; rural and urban areas; and the public and private sector also emerged. There are potentials for health care professionals to congregate in the private sector and urban areas where workloads are perceived to be less demanding. CONCLUSIONS: The general perception of the health care professionals interviewed suggests that although increased access and health equity was welcomed, this policy has had undesired effects and exacerbated rural-urban and public-private tensions. Universal coverage increased access to health care. However, equity may be further enhanced by consolidating the three public health covers into a single scheme and develop a parallel private income protection insurance scheme.