Remote access and care: A comparison of Queensland women's maternity care experience according to area of residence

BackgroundThis study fills a gap in the literature with a quantitative comparison of the maternity care experiences of women in different geographic locations in Queensland, Australia.MethodData from a large-scale survey were used to compare women's care experiences according to Australian Standard Geographical Classification (major city, inner regional, outer regional, remote and very remote).ResultsCompared to the other groups, women from remote or very remote areas were more likely to be younger, live in an area with poorer economic resources, identify as Aboriginal and/or Torres Strait Islander and give birth in a public facility. They were more likely to travel to another city, town or community for birth. In adjusted analyses women from remote areas were less likely to have interventions such as electronic fetal monitoring, but were more likely to give birth in an upright position and be able to move around during labour. Women from remote areas did not differ significantly from women from major cities in their satisfaction with interpersonal care. Antenatal and postpartum care was lacking for rural women. In adjusted analyses they were much less likely to have booked for maternity care by 18 weeks gestation, to be telephoned or visited by a care provider in the first 10 days after birth. Despite these differences, women from remote areas were more likely to be breastfeeding at 13 weeks and confident in caring for their baby at home.ConclusionsFindings support qualitative assertions that remote and rural women are disadvantaged in their access to antenatal and postnatal care by the need to travel for birth, however, other factors such as age were more likely to be significant barriers to high quality interpersonal care. Improvements to maternity services are needed in order to address inequalities in maternity care particularly in the postnatal period.     

Self-managed Supervision

The growth of professional supervision in social work has been accompanied by complex attempts to theorise key elements of supervisory practice and highlight the need to further examine what constitutes supervisory support in current regulatory environments. Changes in human service organisations resulting from new public management generate a need to theorise broader patterns of support available to human service workers. This article draws on an electronic, mixed-method self-reporting study of advice and support-seeking behaviours of 193 human service professionals in 3 South Australian organisations. The findings indicate the fluidity of current professional supervision practice, with workers seeking professional wisdom, identifying practice direction, and debriefing with a range of colleagues within and outside their organisation. Accordingly, the article confirms that supervisors should no longer be thought of as the sole providers of professional advice and support for human service workers and conceptualises the workers as active agents shaping their own learning.     

The personalisation agenda: the case of the Australian National Disability Insurance Scheme

As part of the international trend towards personalisation, in 2013 Australia launched a major disability scheme aiming to give participants greater choice and control over services. The scheme aims to cover a wide diversity of disabilities, services and significant geographical area – resulting in a highly complex system of local overlapping markets. At four years into implementation a range of challenges have emerged. In this paper we firstly describe the Australian National Disability Insurance Scheme, then explore a range of implementation challenges it currently faces as a large-scale personalisation scheme. Based on these experiences we pose a range of questions for similar schemes internationally.