Local therapy facilitators working with children with developmental delay in rural and remote areas of western New South Wales,Australia: the ‘Outback’ service delivery model

Australia's dispersed population in rural areas contributes to poor access to therapy services and the inability of the existing rural therapy workforce to meet demand. As a result, rural children with a developmental delay wait a long time for therapy. This paper describes participant perceptions of a therapy facilitation service model that has worked to improve access to therapy for children in these circumstances. The model, given the pseudonym ‘Outback’, operates in rural and remote areas of western New South Wales. ‘Outback’ employs local people to work under the guidance of therapists based in larger centres to provide preschool children with developmental delays with access to therapy interventions they might not otherwise receive. A two‐stage case study design involving focus groups and interviews with the director, four therapy facilitators, nine therapists, and seven carers was used. Three themes were identified as central to the service model: 1) being part of the local community; 2) developing therapy facilitator knowledge and skills; 3) improving access to therapy intervention for children in rural and remote areas. The ‘Outback’ model demonstrates that appropriately supported, local therapy facilitators provide a flexible workforce adjunct that expands the reach of therapists into rural and remote communities and enhances service access for children and their families.     

What are the facilitators,inhibitors, and implications of birth positioning? A review of the literature

BackgroundFrom the historical literature it is apparent that birthing in an upright position was once common practice while today it appears that the majority of women within Western cultures give birth in a semi-recumbent position.AimTo undertake a review of the literature reporting the impact of birth positions on maternal and perinatal wellbeing, and the factors that facilitate or inhibit women adopting various birth positions throughout the first and second stages of labour.MethodsA search strategy was designed to identify the relevant literature, and the following databases were searched: CINAHL, CIAP, the Cochrane Database of Systematic Reviews, Medline, Biomed Central, OVID and Google Scholar. The search was limited to the last 15 years as current literature was sought. Over 40 papers were identified as relevant and included in this literature review.ResultsThe literature reports both the physical and psychological benefits for women when they are able to adopt physiological positions in labour, and birth in an upright position of their choice. Women who utilise upright positions during labour, have a shorter duration of the first and second stage of labour, experience less intervention, and report less severe pain and increased satisfaction with their childbirth experience than women in a semi recumbent or supine/lithotomy position. Increased blood loss during third stage is the only disadvantage identified but this may be due to increased perineal oedema associated with upright positions. There is a lack of research into factors and/or practices within the current health system that facilitate or inhibit women to adopt various positions during labour and birth. Upright birth positioning appears to occur more often within certain models of care, and birth settings, compared to others. The preferences for positions, and the philosophies of health professionals, are also reported to impact upon the position that women adopt during birth.ConclusionUnderstanding the facilitators and inhibitors of physiological birth positioning, the impact of birth settings and how midwives and women perceive physiological birth positions, and how beliefs are translated into practice needs to be researched.     

Do actions reduce perceived risk? A longitudinal analysis of the relationship between risk perception and actions in response to forest disturbance in Colorado

As residents living in hazard-prone areas face on-going environmental threats, the actions they take to mitigate such risks are likely motivated by various factors. Whereas risk perception has been considered a key determinant of related behavioral responses, little is known about how risk mitigation actions influence subsequent perceived risk. In other words, do actions to prevent or mitigate risk reduce risk perception? This longitudinal study considers the dynamic relationships between risk perception and risk-mitigating behavior in the context of forest disturbance in north-central Colorado. Based on panel survey data collected in 2007 and 2018, the results provide a first look at changes in perceived forest risks as they relate to individual and community actions in response to an extensive mountain pine beetle outbreak. Analysis revealed that the perception of direct forest risks (forest fire and falling trees) increased, whereas indirect forest risk perception (concern on broader threats to local community) decreased across the two study phases. Higher individual or community activeness (level of actions) was associated with subsequent reductions in perceived forest fire risk, smaller increases in direct risk perception, and larger decreases in indirect risk perception. These findings contribute insights into the complex risk reappraisal process in forest hazard contexts, with direct implications for risk communication and management strategies.     

The journey from pain to power: A meta-ethnography on women’s experiences of vaginal birth after caesarean

Background

Vaginal birth after caesarean can be a safe and satisfying option for many women who have had a previous caesarean, yet rates of vaginal birth after caesarean remain low in the majority of countries. Exploring women’s experiences of vaginal birth after caesarean can improve health practitioners’ understanding of the factors that facilitate or hinder women in the journey to have a vaginal birth after caesarean.

The experiences of carers in using shared activities to communicate with looked‐after young people about alcohol,tobacco, and drug use

Parental conversations with their teenage children about alcohol, tobacco, and drugs are associated with lower rates of use. Looked‐after young people are at greater risk of early initiation, higher rates of use, and more problematic use. However, there is no evidence regarding whether these conversations occur in settings where the parental role is assumed by someone other than the biological parent. The aim of the study was to examine how carers communicate with looked‐after young people about alcohol, tobacco, and drug use. In‐depth interviews were conducted with 16 residential care staff and foster carers in Scotland. Data were analysed using a thematic analysis approach. Participants talked about “shared doing” as a way of building relationships and communicating about substance use. Shared doing encompassed particular activities that carers and young people would do together, such as driving in the car, cooking, watching TV, and going for a walk. Shared doing provided an opportunity to spend time together and to create an environment in which communication could be facilitated. These environments were shaped by space, time, and context. Carers should be encouraged to take advantage of the time‐limited occasions they are with young people to have conversations about substance use.     

US foreign aid and economic policy concessions*

Why do donors continue to provide foreign aid despite its failure to help poor countries over the past several decades? While some scholars argue that foreign aid is purely for humanitarian purposes, others assert that such aid serves as a tool to pressure recipient countries into accepting policy concessions. In this study, we subject these arguments to empirical testing using a dataset that integrates the amount of US aid and economic policies of recipient countries for 1995–2012. The findings suggest that aid decisions correspond to the interests of the United States, such as policy concessions in economic and business liberalization. However, an increase in US aid is not directly associated with further economic reforms in recipient countries. We conclude that US foreign aid programmes are strategic in nature and successful not in alleviating economic problems in recipient countries but, at the very least, in buying their policy compliance.     

The Intersection of Multiple Minority Identities: Perspectives of White Lesbian Couples Adopting Racial/Ethnic Minority Children

In order to analyse the salience of race/ethnicity, sexual orientation, and adoptive status for lesbian adoptive parents, this study examined the challenges and strengths described by 20 White lesbian couples (40 women) who were adopting racial/ethnic minority children from within the United States. Data from two time points (pre‐ and post‐adoptive placement) were analysed qualitatively. Results indicated that the majority of women voiced concerns about raising racial/ethnic minority children in a ‘White privileged’ society. Many women reported facing a lack of understanding from others and were aware of multiple layers of stigma. However, having faced discrimination themselves as sexual minorities, many also perceived themselves as possessing unique strengths (e.g., experience coping with stigma). Many women expressed feeling that by drawing on support from their communities as well as their own awareness of and experience with diversity issues, they could prepare their children for the challenges they might face.     

Hierarchy of Gambling Choices: A Framework for Examining EGM Gambling Environment Preferences

This paper presents the Hierarchy of Gambling Choices (HGC), which is a consumer-oriented framework for understanding the key environmental and contextual features that influence peoples’ selections of online and venue-based electronic gaming machines (EGMs). The HGC framework proposes that EGM gamblers make choices in selection of EGM gambling experiences utilising Tversky’s (Psychol Rev 79(4):281–299, 1972). Elimination-by-Aspects model, and organise their choice in a hierarchical manner by virtue of EGMs being an “experience good” (Nelson in J Polit Econ 78(2):311–329, 1970). EGM features are divided into three levels: the platform—including, online, mobile or land-based; the provider or specific venue in which the gambling occurs; and the game or machine characteristics, such as graphical themes and bonus features. This framework will contribute to the gambling field by providing a manner in which to systematically explore the environment surrounding EGM gambling and how it affects behaviour.