Veitch Craig, Dew Angela, Bulkeley Kim, Lincoln Michelle, Bundy Anita, Gallego Gisselle, Griffiths Scott
Faculty of Health Sciences, The University of Sydney, New South Wales, Australia.
Rural Remote Health. 2012;12:1903. Epub 2012 Jun 11.
The disability sector encompasses a broad range of conditions and needs, including children and adults with intellectual and developmental disabilities, people with acquired disabilities, and irreversible physical injuries. Allied health professionals (therapists), in the disability sector, work within government and funded or charitable non-government agencies, schools, communities, and private practice. This article reports the findings of a qualitative study of therapist workforce and service delivery in the disability sector in rural and remote New South Wales (NSW), Australia. The aim was to investigate issues of importance to policy-makers, managers and therapists providing services to people with disabilities in rural and remote areas.
The project gathered information via semi-structured interviews with individuals and small groups. Head office and regional office policy-makers, along with managers and senior therapists in western NSW were invited to participate. Participants included 12 policy-makers, 28 managers and 10 senior therapists from NSW government agencies and non-government organisations (NGOs) involved in providing services and support to people with disabilities in the region. Information was synthesised prior to using constant comparative analysis within and across data sets to identify issues.
Five broad themes resonated across participants' roles, locations and service settings: (1) challenges to implementing policy in rural and remote NSW; (2) the impact of geographic distribution of workforce and clients; (3) workforce issues - recruitment, support, workloads, retention; (4) equity and access issues for rural clients; and (5) the important role of the NGO sector in rural service delivery and support.
Although commitment to providing best practice services was universal, policy-related information transfer between organisations and employees was inconsistent. Participants raised some workforce and service delivery issues that are similar to those reported in the rural health literature but rarely in the context of allied health and disability services. Relatively recent innovations such as therapy assistants, information technology, and trans-disciplinary approaches, were raised as important service delivery considerations within the region. These and other innovations were expected to extend the coverage provided by therapists. Non-government organisations played a significant role in service delivery and support in the region. Participants recognised the need for therapists working for different organisations, in rural areas, to collaborate both in terms of peer support and service delivery to clients.
残疾领域涵盖了广泛的状况和需求，包括患有智力和发育障碍的儿童与成人、后天致残者以及不可逆转的身体损伤者。残疾领域的专职医疗专业人员（治疗师）在政府部门、有资金支持的或慈善性质的非政府机构、学校、社区以及私人诊所工作。本文报告了一项针对澳大利亚新南威尔士州（NSW）农村和偏远地区残疾领域治疗师劳动力及服务提供情况的定性研究结果。目的是调查对为农村和偏远地区残疾人提供服务的政策制定者、管理人员和治疗师而言重要的问题。
该项目通过对个人和小组进行半结构化访谈来收集信息。邀请了总部和地区办公室的政策制定者，以及新南威尔士州西部的管理人员和资深治疗师参与。参与者包括来自新南威尔士州政府机构和非政府组织（NGO）的12名政策制定者、28名管理人员和10名资深治疗师，这些机构参与为该地区的残疾人提供服务和支持。在对数据集内部和数据集之间进行持续比较分析以确定问题之前，先对信息进行了综合整理。
五个广泛的主题在参与者的角色、地点和服务环境中引起了共鸣：（1）在新南威尔士州农村和偏远地区实施政策面临的挑战；（2）劳动力和客户地理分布的影响；（3）劳动力问题——招聘、支持、工作量、留用；（4）农村客户的公平和获取问题；（5）非政府组织部门在农村服务提供和支持中的重要作用。
尽管普遍致力于提供最佳实践服务，但组织与员工之间与政策相关的信息传递并不一致。参与者提出了一些劳动力和服务提供问题，这些问题与农村卫生文献中报道的问题类似，但在专职医疗和残疾服务背景下很少见。诸如治疗助理、信息技术和跨学科方法等相对较新的创新，被视为该地区重要的服务提供考虑因素。这些以及其他创新有望扩大治疗师提供的服务范围。非政府组织在该地区的服务提供和支持中发挥了重要作用。参与者认识到，在农村地区为不同组织工作的治疗师需要在同伴支持和为客户提供服务方面进行合作。
