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Theoretically, individualised funding schemes empower people with disability (PWD) to choose high quality support services in line with their needs and preferences. Given the importance of support, the aim of this scoping review was to understand the factors that influence the quality of paid disability support for adults with acquired neurological disability. A comprehensive scoping review of the published literature from 2009–2019 was conducted on five databases: Medline, CINAHL, Embase, PsycINFO and Scopus. Of the 3391 records retrieved, 16 qualitative articles were eligible for review. Thematic synthesis of the findings revealed six key interrelated themes: (1) choice and control, (2) individualised support, (3) disability support worker (DSW) qualities, (4) DSW competence, (5) PWD – DSW relationship, and (6) accessing consistent support. The themes depict factors influencing the quality of paid disability support from the perspective of PWD, close others and DSWs. Although the evidence base is sparse, the factors identified were in line with international rights legislation and policy ideals. The findings can provide insights to PWD hiring and managing support, and facilitate the delivery of quality disability support. Further research is required to understand the interactions between the factors and how to optimise support in practice. The quality of paid disability support is determined by a multitude of interrelated factors influenced by the disability support worker's qualities and competencies, the interaction between the person with disability and the disability support worker, as well as external contextual factors. Optimising choice and control for adults with acquired neurological disability and providing individualised support should be a significant focus for disability support workers. Training modules for disability support workers can be informed by five of the identified themes: (1) choice and control, (2) individualised support, (3) DSW qualities, (4) DSW competence and (5) the relationship between PWD and DSWs. [ABSTRACT FROM AUTHOR]

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Background: Patient Reported Experience Measures are promoted to be used as an integrated measurement approach in which outcomes are used to improve individual care (micro level), organisational quality (meso level) and external justification (macro level). However, a deeper understanding of implementation issues of these measures is necessary. The narrative Patient Reported Experience Measure "Dit vind ik ervan!" (English "How I feel about it!") is used in the Dutch disability care sector, but insight into its' current use is lacking. We aimed to provide insight into experiences with the implementation and current ways of working with "Dit vind ik ervan!" as an integrated measurement strategy. A descriptive qualitative study was done at a disability care organisation. Data were collected by nine documentations, seven observations, 11 interviews and three focus groups. We applied deductive content analysis using the Consolidated Framework for Implementation Research as a framework. Results: Our analysis revealed facilitators and barriers for the implementation of "Dit vind ik ervan!". We found most barriers at the micro level. Professionals and clients appreciated the measure's narrative approach, but struggled to perform it with communication vulnerable clients. Some clients, professionals and team leaders were unfamiliar with the measure's aim and benefit. On the meso level, implementation was done top-down, and the management's vision using the measure as an integrated measurement approach was insufficiently shared throughout the organisation. Conclusions: Our study shows that Patient Reported Experience Measures have the potential to be used as an integrated measurement strategy. Yet, we found barriers at the micro level, which might have influenced using the measurement outcomes at the meso and macro level. Tailored implementation strategies, mostly focusing on designing and preparing the implementation on the micro level, need to be developed in co-creation with all stakeholders. [ABSTRACT FROM AUTHOR]

This qualitative analysis of survey data explores service and care experiences reported by Medicaid enrollees with disabilities newly transitioned to managed care. Consumer surveys were distributed to a random sample of adult program enrollees with disabilities in an independent evaluation of one state's Medicaid managed care (MMC) rollout. Researchers performed conventional content analysis to code comments submitted by enrollee participants (N=402) in response to two open-ended survey items. Six key themes were observed in the data: (1) unmet medical, long-term services and supports (LTSS), and informational needs; (2) ineffective care coordination; (3) barriers in accessing providers; (4) limitations in benefit coverage; (5) unreliable transportation; and (6) variable provider care experiences. The results revealed salient managed care performance issues for the disabled Medicaid population. Enrollee experiences can inform recommendations for service access, provision capacity, and the integrated care of people with disabilities in the state MMC program. [ABSTRACT FROM AUTHOR]

PurposeTo identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services.MethodsQualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9.ResultsThe main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation.ConclusionThe numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors.Implications for rehabilitationTraffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities.The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care.A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients.Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs. [ABSTRACT FROM PUBLISHER]

• The problem of voluntarily abandonment free health services among children with disabilities is caused by asymmetry between the ideology of egalitarianism and developmentalism. • Disability policy implementation from developmentalism produces the result of voluntarily abandonment through the governance methods and parents' attitudes approach. • The Governance methods produce invisible institutional exclusion in the form of non-client-centered tasks, constraints surrounding service costs, competitive welfare development models, and "good" performance chasing. • Parents treat children with disabilities as abnormal, unprofitable, burdensome, and tragic, which encourages the voluntarily abandonment of healthcare services. • The results of this study call for critical reflections to protect health and rehabilitation rights for children with disabilities. In terms of protecting children with disabilities, healthcare rights are a crucial issue that cannot be ignored. In China, although the government provides generous health services, children with disabilities abandoning those services is a common phenomenon. Few scholars have directly and systematically studied this important issue. Using a qualitative method, we investigated the experiences and feelings of six service providers and twelve primary caregivers. From an ideological conflict perspective, we have found that China is a social context in which the state-led ideology of egalitarianism and the ideology of developmentalism co-exist but clash at the level of local governments and organizations. We produced two themes: (a) Governance methods arising from developmentalism produce invisible institutional exclusion in the form of non-client-centered tasks, constraints surrounding service costs, competitive welfare development models, and "good" performance chasing; (b) parents operating under developmentalism treat children with disabilities as abnormal, unprofitable, burdensome, and tragic, which encourages the voluntarily abandonment of healthcare services. The interaction of these two themes strengthens the ideological split occurring between them, leading to the widespread deprivation of health rights among children with disabilities. The results of this study call for critical reflections on disability policy implementation under this current conflicting ideology. [ABSTRACT FROM AUTHOR]