‘Reasonable and necessary’ care: the challenge of operationalising the NDIS policy principle in allocating disability care in Australia

Disability reform in Australia centres on a National Disability Insurance Scheme (NDIS), which aims to provide lifelong, individualised support based on the principle of ‘reasonable and necessary’ care. As a universal rights‐based scheme it represents a historical shift in allocation principles in Australia's disability policy. Nonetheless, attention will be on determining who receives what care given the diversity of personal and family contexts. The aim of this paper is to discuss the operational complexities of a principle of reasonable and necessary care with reference to the findings of a three‐year study on the experiences and perspectives of disability care of 25 adults with acquired disability, their 22 nominated family members and 18 service providers. Evidence from this study suggests enacting the principle of reasonable and necessary care and support will be problematic, in particular as it relates to personalising the level and scope of services, balancing formal and informal care, and principles of equity. The paper contributes to the literature about allocation principles in social policy and the challenges of implementation. Further, it provides an empirically informed discussion of some of the specific policy implementation challenges concerning the NDIS.     

Input Variable Selection in Neural Network Models

One of the most important issues in using neural networks for the analysis of real-world problems is the input variable selection problem. This article connects input variable selection with multiple testing in the neural network regression models. In the proposed procedure, the number and the type of input neurons are selected by means of a testing scheme, based on appropriate measures of relevance of a given input variable to the model. In order to avoid the data snooping problem, family-wise error rate is controlled by using the StepM method proposed by Romano and Wolf (2005 Romano , J. P. , Wolf , M. ( 2005 ). Exact and approximate stepdown methods for multiple hypothesis testing . J. Amer. Statist. Assoc. 100 : 94 – 108 .[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). The testing procedure is calibrated by using the subsampling, which is shown to deliver consistent results under weak assumptions on the data generating process and on the structure of the neural network model.     

Models of disability support governance: a framework for assessing and reforming social policy

In many developed countries, the provision of disability services has undergone significant transformations, from institutional to community based care, and from oganisational to personalised funding. Yet delivering disability support remains an ongoing challenge for governments. Specifically, the relative success of different types of disability support governance is convoluted and problematic given the diversity and complexity of disability support systems and the people they serve. To enhance the systematic analysis and evaluation of disability support governance, this paper conceptually advances four distinct models based on the locus of control and coordination of such support: uncoordinated; casework governance; dwelling‐based governance; and user‐coordinated. Using illustrations from case studies of individuals receiving care, the identification of these ideal types enables their relative strengths, weaknesses, and the occasions of governance failure to be articulated. No one model is universally applicable to people, nor immune to failure. Furthermore, the paper presents a novel approach to visualising actual disability support arrangements as social networks. The utility of such visualisations for analysing individual and system‐ wide arrangements is outlined. In the context of Australia's developing National Disability Insurance Scheme, these conceptual and analytical developments are argued to be important tools for policy and service analysis and reform.     

Tucker3 Model for Compositional Data

For the exploratory analysis of three-way data, the Tucker3 is one of the most applied models to study three-way arrays when the data are quadrilinear. When the data consist of vectors of positive values summing to a unit, as in the case of compositional data, this model should consider the specific problems that compositional data analysis brings. The main purpose of this paper is to describe how to do a Tucker3 analysis of compositional data, and to show the relationships between the loading matrices when different preprocessing procedures are used.     

Practitioners preferences of care coordination for older people: A discrete choice experiment

These findings demonstrate the importance of organisations providing care coordination for older people receiving long-term funding. Further research is required to investigate the influence of service setting on practitioner preferences.

This study explored practitioner preferences about the relative value of attributes of care coordination services for older people. A Discrete Choice Experiment (DCE) survey was used to identify the views of 120 practitioners from 17 services in England in 2015. The survey design was informed by an analysis of standards of care coordination, a postal survey and a consultation with carers of older people. Results of the DCE survey were supplemented by a content analysis of qualitative comments and fieldwork notes. Most respondents were over 30 years of age, female and almost half worked part-time. Continuity of care (care provided by the same care coordinator) and the ability to access the range of services outlined in the care plan were the most important service attributes. Service setting influenced practitioner preferences. Those in specialist services for people with dementia identified the length of time a service was provided as another important attribute. The DCE methodology has provided the opportunity to systematically canvas practitioner preferences.     

Meaning of touch: The case of touch from a stranger or same sex person

Two hundred and eight respondents rated what it means to them if they are touched on various areas of their body by either a stranger or a close friend of the same or opposite sex. Male and female respondents agree that (a) touch from a close friend of the opposite sex is pleasant, and (b) touch from a same sex person is unpleasant. However, touch from an opposite-sex stranger, is considered to be unpleasant by women but quite pleasant by men. For women, the meaning of a touch is primarily influenced by how well they know the other person; for men, the meaning is primarily determined by the other person's sex. That the intrusiveness of touch depends on acquaintanceship supports the hypothesis that for psychological comfort the level of intimacy of a) nonverbal behavior and b) the social relationship of two people must be congruent.     

Addressing the impact of foster care on biological children and their families

This study explores from a dual perspective the impact of the fostering process on biological children in the home. Ten foster parents and their biological children were interviewed separately. The impact of foster care on the psychological, educational, and social well-being of biological children and their relationship with parents and siblings were examined. The exploration reveals a paradoxical and life-changing process as seen through the eyes of biological children and their parents.     

Lesbian, gay, bisexual, and transgender (LGBT) physicians' experiences in the workplace

Little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) physicians in the workplace. There is little formal education in medical school about LGBT issues, and some heterosexual physicians have negative attitudes about caring for LGBT patients or working with LGBT coworkers, setting the stage for an exclusive and unwelcoming workplace. The current study used an online survey to assess a convenience sample of 427 LGBT physicians from a database of a national LGBT healthcare organization, as well as a snowball sample generated from the members of the database. Although rates of discriminatory behaviors had decreased since earlier reports, 10% reported that they were denied referrals from heterosexual colleagues, 15% had been harassed by a colleague, 22% had been socially ostracized, 65% had heard derogatory comments about LGBT individuals, 34% had witnessed discriminatory care of an LGBT patient, 36% had witnessed disrespect toward an LGBT patient's partner, and 27% had witnessed discriminatory treatment of an LGBT coworker. Few had received any formal education on LGBT issues in medical school or residency. It appears that medical schools and health care workplaces continue to ignore LGBT issues and operate in discriminatory fashion far too often.