The lived experience of receiving services as a National Disability Insurance Scheme participant in a rural area: Challenges of choice and control.

OBJECTIVE: To explore the lived experience of people with a physical disability residing in a rural area and receiving services under the NDIS. SETTING: Rural areas of New South Wales classified as Modified Monash Categories 3-7. PARTICIPANTS: Semistructured interviews were conducted with seven purposively sampled participants who self-identified as having a physical disability, were receiving NDIS funding and lived in a rural area of NSW. DESIGN: Data collection and analysis were guided by hermeneutic phenomenology. FINDINGS: We interpreted three interrelated themes; Uncertainty of Access, Battling Bureaucracy and Improving Relationships and Independence. The themes articulate the essence of this phenomenon, Challenges to choice and control. DISCUSSION: The findings of this study suggest that while people with a physical disability living in rural NSW acknowledged positive changes to their everyday lives through the NDIS, there remains a sense of confusion, frustration and disconnection with the system. Burdensome, inconsistent and untimely communication with NDIS staff caused uncertainty with the process and required negotiation to resolve issues such as delays in funding, essential services or equipment modifications. The essence of Challenges to choice and control articulates what the person had to negotiate within their lifeworld. Further guidance and clarity for people with disabilities to access the NDIS system would ensure confidence to navigate the system and receive the essential supports they need.

Lived experience of parents and carers of people receiving services in rural areas under the National Disability Insurance Scheme.

OBJECTIVE: The purpose of this study was to investigate the lived experience of parenting or caring for a person with a disability receiving services under the National Disability Insurance Scheme in rural Australia. DESIGN: Qualitative study guided by the phenomenology of practice. SETTING: Rural areas of New South Wales (MM 3-7). PARTICIPANTS: Participants were 5 parents and one carer of people receiving National Disability Insurance Scheme services who resided in rural New South Wales. DESIGN: Participants engaged in a semi-structured interview about their lived experiences caring for someone accessing services under the National Disability Insurance Scheme in rural New South Wales. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Three themes emerged from the data analysis. 'More than a disability' described the absence of understanding of family and carer challenges when National Disability Insurance Scheme plans were designed and implemented. 'Fighting for funding and services' described that while the National Disability Insurance Scheme increased funding support, parents and carers experienced limited support navigating the National Disability Insurance Scheme. 'Cold as Ice' encompassed parents' and carers' descriptions of their relationship with National Disability Insurance Scheme staff. These challenges were further impacted by the limited choice and availability of health service providers in rural areas. CONCLUSION: Participants felt that the National Disability Insurance Scheme had created additional stress and confusion in their lives and at times had hindered the achievement of the goals of their family member with a disability. The voices of parents and carers is a critical one, and it is essential that rural parents' and carers' needs are considered and supported in future planning of the National Disability Insurance Scheme.

Sharing Experiences in Infancy: From Primary Intersubjectivity to Shared Intentionality.

We contrast two theses that make different assumptions about the developmental onset of human-unique sociality. The primary intersubjectivity thesis (PIT) argues that humans relate to each other in distinct ways from the beginning of life, as is shown by newborns' participation in face-to-face encounters or "primary intersubjectivity." According to this thesis, humans' innate relational capacity is the seedbed from which all subsequent social-emotional and social-cognitive developments continuously emerge. The shared intentionality thesis (SIT) states that human-unique forms of interaction develop at 9-12 months of age, when infants put their heads together with others in acts of object-focused joint attention and simple collaborative activities. According to this thesis, human-unique cognition emerges rapidly with the advent of mind-reading capacities that evolved specifically for the purpose of coordination. In this paper, we first contrast the two theses and then sketch the outlines of an account that unifies their strengths. This unified account endorses the PIT's recognition of the fundamental importance of primary intersubjectivity. Any act of sharing experiences is founded on the communicative capacity that is already displayed by young infants in primary intersubjectivity. At the same time, we question the PIT's interpretation that dyadic encounters have the triadic structure of joint attention. Lastly, we draw on empirical work on the development of joint attention, imitation, and social referencing that serves as evidence that primary intersubjectivity continuously unfolds into the capacity for triadic joint attention.

The role of eye contact in young children's judgments of others' visibility: A comparison of preschoolers with and without autism spectrum disorder.

Typically-developing (TD) children under age 5 often deny that they can see a person whose eyes are covered (e.g., Moll & Khalulyan, 2017). This has been interpreted as a manifestation of their preference for reciprocal interactions. We investigated how 3- to 4-year-old children with autism spectrum disorder (ASD, n = 12) respond in this situation. Because a lack of interpersonal connectedness and reciprocal communication are core features of this disorder, we predicted that young children with ASD will not make mutual regard a condition for seeing another person and therefore acknowledge being able to see her. Against this prediction, children with ASD gave the same negative answers as a group of TD (n = 36) age-mates. Various interpretations are discussed, including the possibility that some children with ASD are capable of relating to others as second persons.

Taking ACTion: 18 Simple Strategies for Supporting Children With Autism During the COVID-19 Pandemic.

The COVID-19 pandemic has dramatically uprooted the lives of families around the world. Families living with children with autism spectrum disorder (ASD) may be particularly affected due to being abruptly deprived of their usual in-person support from applied behavior analysis (ABA) service providers. This article gives how-to instructions on 18 simple acceptance and commitment training (ACT) programs that can be used as supplements to ongoing ABA services to support children with ASD whose verbal repertoires may play a part in the challenges they are facing during the current crisis. We describe several challenges that have been frequently reported by families and ABA practitioners during the pandemic. For each behavioral challenge, we provide a brief practical description, brief behavioral conceptual description, and how-to guidance on implementing ACT procedures that address each behavioral challenge at a functional level. The Appendix contains child-friendly worksheets for practitioners to use as visual supports while implementing the intervention procedures.

Immersive placement experiences promote rural intent in allied health students of urban and rural origin.

INTRODUCTION: Pre-vocational placement experiences are known to considerably influence the career preferences of health graduates and are a key factor in growing the rural allied health workforce. This paper explores the rural placement experiences and future work intentions of students who attended a placement with the University of Newcastle Department of Rural Health. METHODS: Part of a larger longitudinal mixed methods study of students' placement experiences and subsequent career choices, this study explored students' placement evaluations responses. Following each placement, students were invited to complete an online survey which asked about their placement experiences and future work intentions. Counts and proportion tests were performed for frequencies of quantitative variables. Wilcoxon signed rank tests were conducted on the paired pre- and post-rural intent scores to determine any perceived differences in intent before and after placement for students both with and without a rural background. Qualitative data from short answer questions were analyzed thematically guided by qualitative content analysis. Data were comparatively analyzed for students of a rural or urban background. RESULTS: Four hundred and forty end of placement surveys were completed by 275 students (response rate 69.8%). There was a positive shift in intention to work rurally for students of both rural and urban background post-placement, but this was only statistically significant in the group from an urban background (p≤0.001). From the qualitative analysis three themes emerged: immersed rural supported placement experience, immersed interaction in rural life with other students, and immersed interaction in the rural community. Students from both rural and urban backgrounds indicated similar benefits and challenges. CONCLUSION: While the positive impact of rural placement experiences and rural background on future rural practice is well known, this study highlights the importance of positive supported placement experience for students from both rural and urban backgrounds.

Powerless facing the wave of change: the lived experience of providing services in rural areas under the National Disability Insurance Scheme.

INTRODUCTION: Australia's National Disability Insurance Scheme (NDIS) is the catalyst for a significant shift in the delivery of disability services to people with a disability and their families, including those residing in rural and remote parts of Australia. Allied health services in rural areas of Australia are often limited, existing services are characterised as being of a generalist nature and demand for services often exceeds service capacity. This shift in the delivery of disability services with the rollout of NDIS could have a poignant impact on the rurally based allied health providers delivering these services. The aim of this study was to explore in depth the experiences of providing clinical services under the NDIS in a rural area. METHODS: Accessing the publicly available NDIS register, the authors purposively sampled service providers delivering services in rural or remote areas of the state of New South Wales (NSW). Participants consented by email to participate in a semi-structured interview during which they were asked about their lived experience providing services under the NDIS in rural NSW. Data collection and analysis were guided by phenomenology of practice. Interviews were audio-recorded and transcribed verbatim, and data were then thematically analysed. RESULTS: Eight service providers were interviewed, representing the disciplines of occupational therapy, nutrition and dietetics, speech pathology and physiotherapy. The locations of their service delivery varied across a range of rural and remote areas of NSW. Data analysis yielded three themes: (1) 'Beyond my depth', which described service providers' limited influence on the funding process their clients were now required to navigate as participants of the NDIS; (2) 'A sea of uncertainty', which described the inconsistencies demonstrated by the NDIS and its impact on service providers; and (3) 'Drowning in the wave', which described increases in service demand and changes to case mix as experienced by service providers. Additionally, the essence of providing services within the NDIS in a rural area was identified as 'Powerless facing the wave of change'. CONCLUSION: These findings offer insights into the particular challenges for rural clinicians in providing services under the NDIS. While there is improved funding support for people with a disability, this places additional pressure on rural clinicians who are already likely to be working at or beyond their workload capacity. Issues with recruitment and retention of new clinicians into rural and remote areas appear to be ongoing, which was identified as compounding the impact of the NDIS on existing service providers. Supporting the rural and remote workforce appears critical to avoid de-registration of existing NDIS service providers.

Developing and maintaining collaborative practice: Exploring perspectives from dietetics and speech pathology about 'what works well'.

AIM: The aim was to support rich collaborative practice between two professions who frequently work together across both ordered and organic modes of collaboration. METHODS: This study uses a qualitative research approach of collaborative dialogical inquiry to explore the question 'From the perspective of dietitians and speech pathologists, "what works well" for developing and maintaining collaborative practice?' We deliberately chose a context where collaborative practice is evident, University Department of Rural Health (UONDRH). Participants in the research were academics and clinicians from dietetics and speech pathology. Data were sourced from our research reflections and focus group transcriptions. Analysis was dialogical and iterative. RESULTS: Beyond shared purpose, knowledge of roles and good communication, the notions of curiosity, willingness and momentum were at the core of 'what works well' for collaborative practice between dietitians and speech pathologists. Participant perspectives related to collaborative practice between these professions and beyond to other professions, and involved collaborative practice within and across healthcare organisations and a university setting. CONCLUSIONS: Our interpreted themes of curiosity, willingness and momentum for developing and maintaining collaborative practice highlight the importance of paying attention to the less visible and difficult to measure aspects of patient-centred care. Questions for reflection are suggested to inform the ongoing process of developing and maintaining our and others' collaborative practice.

Longitudinal Tracking of Workplace Outcomes for Undergraduate Allied Health Students Undertaking Placements in Rural Australia.

Creating positive experiences in rural practice at the undergraduate level can influence allied health students' attitudes to working rurally. This study aimed to evaluate allied health students' experiences of their short-term, medium-term, or long-term rural placement and to follow their career outcomes. METHODS: The study used a mixed-methods design that utilised qualitative and quantitative data. Students from six allied health degree programs undertaking placements in Tamworth and Taree were invited to participate. Participation comprised of a series of surveys and an individual in-depth semi-structured interview. RESULTS: 198 students completed 257 end-of-placement surveys as of June 2014, with 72.7% reporting an intention to work rurally after placement. Fifty-five percent (n=51) of the 92 students who had never lived in a rural area had a more favourable attitude towards working rurally following placement. After 1 year, 50% of graduates were working in a rural or remote location, compared to 23.7% of all graduates from these disciplines. CONCLUSIONS: Preliminary findings indicated a positive perception of the rural placement experience and impact on intention to work rurally or in a rural location, particularly from those who had not previously spent time in a rural area. Future directions are to investigate longer-term workforce outcomes and the impact on the rural health workforce.