Article

“It All Goes Back to the Services”: A Rural/Urban Comparison of Service Providers’ Perceptions of Challenges and Facilitators to Disability Services

Authors:
  • Georgia Southern University (College of Public Health)
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Abstract

Purpose: The purpose of this qualitative study was to explore rural/urban differences in service providers’ perceptions of challenges and facilitators to services for children with special health care needs (CSHN) and their families in southeast Georgia. Methodology: A total of 23 individual interviews were conducted with service providers in one rural county in southeast Georgia (N = 12) and in one urban county in north central Georgia (N = 11). Interviews were based on the National Survey of Children with Special Health Care Needs 2009-2010 survey. All interviews were audio recorded, transcribed and coded with the intent of identifying themes and illustrative quotes. Findings: Service providers discussed a variety of challenges to accessing services related to socioeconomic status and the transition out of the school system. Urban and rural service providers’ perceptions were similar overall, with the exception of lack of transportation and access to a variety of services in rural area. Service providers overcome challenges through identifying parents’ needs and limitations and adapting service provision. Some of the facilitators mentioned by both urban and rural service providers are availability of transportation and resources. Practical Implications: The results of this study provide public health practice and policy implications that could guide the pathways of targeted interventions to improve the access and availability of variety of services for CSHCN. Originality/value of paper: This paper represents an in-depth exploration of service provider’s perceptions of challenges and facilitators related to service provision for children with special healthcare needs.

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... Approximately half of individuals with disabilities cannot afford health care (3). Families have noted that access to many health care services is hindered by cost (6). Many services available to families are not covered by insurance plans, which leaves the burden of cost on family members or requires families to attempt to provide some services at home (5). ...
... An unfortunate reality is that most CSHCN require variety of services to achieve and maintain an acceptable health-related quality of life, but few have access to all of the services that are needed (6). While offering community-based services (including all community stakeholders, medical care, educational resources, and community life) to those with limited access to coordinated, comprehensive care in a medical home may improve overall well-being and increase ability to participate in the community (3), this requires capacity building at the community level. ...
Article
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The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN). The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN) employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3%) met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.
... Na zona rural os maiores entraves se dão pela falta de transporte para acessar os serviços e pela baixa escolaridade dos acompanhantes. Na zona urbana, os maiores problemas são relacionados à renda baixa, ao fato dos responsáveis trabalharem e haver a necessidade de pedir para terceiros acompanharem a pessoa com deficiência até o serviço 24 . ...
... O acesso das pessoas com deficiência aos serviços de assistência é influenciado por fatores ambientais, estruturais, socioeconômicos, transporte, disponibilidade de acompanhante e escolaridade do cuidador 24 . ...
Article
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Este estudo buscou descrever e analisar o perfil sociodemográfico das pessoas com deficiência residentes nos trinta e dois municípios de abrangência da 4ª Coordenadoria Regional de Saúde (4ª CRS). A pesquisa é descritiva, de caráter quantitativo. Foram analisados dados secundários do último censo do Instituto Brasileiro de Geografia e Estatística (IBGE) - edição de 2010, por deficiência: Visual, Motora, Intelectual/Mental, Auditiva e por dois graus de complexidade correspondentes: grau não consegue de modo algum e grau grande dificuldade. Os itens analisados foram: frequência por deficiência, alfabetização, renda, zona/moradia, faixa etária, gênero e raça/etnia. Os dados revelam maior freqüência de pessoas com deficiência visual, que possuem 70 anos ou mais, de cor branca, residentes de zona urbana e que apresentam demandas quanto à ampliação do acesso a renda, alfabetização e serviços que contemplem o cuidado às pessoas com deficiência na rede de atenção à saúde.Descritores: Perfil de Saúde; Pessoas com Deficiência; Características da População.
... Rural areas possess unique challenges to physical activity, as environmental factors such as county sprawl serve as a barrier to positive health behaviors [28]. In rural areas, young people with disabilities and their families face disparities in the availability of and access to competent service providers [29,30]. ...
Article
Purpose: The purpose of this study was to use a qualitative, community-based participatory action research method – Photovoice – to identify perceived facilitators and barriers to physical activity among adolescents with cerebral palsy (CP) in a rural community. Materials and methods: Fifteen participants including adolescents with CP (n = 7) and parents (n = 8) were included in this study. The researchers followed the nine-step methodology recommended for Photovoice. During the training session, participants completed versions of the Barriers to Physical Activity Questionnaire for People with Mobility Impairments. This questionnaire was used to generate descriptive information about participant barriers and facilitators. Participants were given 14 days to take photographs after which researchers used in-depth and focus group interviews structured by the SHOWeD method. Content analysis of transcripts was used to identify common themes. Results and conclusions: Photographs and accompanying text were presented to local stakeholders and an action plan to increase physical activity for adolescents with CP was created. Perceived barriers included lack of inclusiveness, family isolation, and limited accessibility of equipment and resources. Facilitators included support services for families and adaptive sport leagues. Photovoice serves as a powerful tool to initiate change to promote physical activity among rural adolescents with CP. • Implications for rehabilitation • Adolescents with cerebral palsy living in rural areas face unique barriers to physical activity. • Accessibility of equipment and the structural environment can serve as barriers to participation. • Lack of accessibility can lead to feelings of isolation. • Families need support services outside of rehabilitation settings to support physical activity for their children and overcome potential barriers.
... When we consider the benefits yielded when special education teams pull together and demonstrate effective interprofessional collaboration, the vast distances that exist between special education teachers and service providers who travel between rural schools to supports students and teams can be made less challenging (e.g., Alfonso, Walker, Gupta, Telfair, & Colquitt, 2015). For example, Billy's service providers and family worked to be consistent on vocabulary instruction and on how each goal and activity tied together. ...
Article
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The roles of teachers and related service providers (e.g., speech-language pathologists, occupational therapists, physical therapists) are vital to skill acquisition and meaningful access to the general education curriculum for students who have been identified as having significant or extensive support needs. However, often delivery of instruction can become fragmented and disjointed as time for service providers to collaborate with team members is limited in rural schools. As a result, students with more extensive support needs may not receive adequate access to systemic and meaningful literacy instruction. This article will identify the obstacles as well as three strategies special education teams can use to improve communication and collaboration.
... Although some families do have access to specialized medical care, some of these providers do not accept any form of insurance and are private pay only (Walker, Alfonso, Colquitt, Weeks, & Telfair, 2016). When families have difficulty accessing appropriate care for their child, they are often forced to attempt to provide care at home (Alfonso, Walker, Gupta, Telfair, & Colquit, 2015;Miller et al., 2015). Put another way, families caring for CSHCN lose an average of $3,200 in wages due to providing care for their child (Romley et al., 2017). ...
... However, it is also possible that families in rural areas without adequate coverage feel powerless when making decisions related to their child's health because of limited options. This is also consistent with previous research on the perceptions of both parents of CSHCN and their service providers in rural areas (Alfonso, Walker, Gupta, Telfair, & Colquitt, 2015;Walker, Alfonso, Colquitt, Weeks, & Telfair, 2016). Better communication between these doctors/specialists and family members will lead to better health decisions for the child which may lead to more adequate insurance coverage overall. ...
Article
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Background: The purpose of this study was to examine urban vs. rural differences on the relationship between family contextual variables and adequacy of insurance coverage and impact on employment for among families with a child with Cerebral Palsy from a nationally representative sample. Methods: A retrospective, observational study was carried out using data from the National Survey of Children with Special Healthcare Needs. Results: A total of 744 participants reported as having a child with a diagnosis of Cerebral Palsy and were included in the sample. Logistic regression analyses, adjusting for urban and rural setting revealed different predictors of adequacy of insurance coverage and impact on employment. Among urban respondents, three variables with odds ratios ranging from 1.33 to 1.58 served as protective factors, increasing the likelihood of adequate insurance coverage. Four variables with odds ratios ranging from 1.41 to 1.79 decreased the likelihood of negatively impacting employment. Among rural families, there was only one significant protective factor for adequacy of insurance coverage (odds ratio 1.80) and one for decreasing the chances of impact on employment (odds ratio 2.53). Conclusion: Families in rural areas caring for a child with CP have few protective factors for adequate insurance coverage and impact on familial employment.
Article
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The efficacy of special education is often measured by employment, independent living and social outcomes. Therefore, the purpose of this review was to synthesize articles concerning outcomes of young adults who have transitioned from secondary school to adult life in rural areas. Articles on transition of young adults with disabilities in rural areas published in numerous refereed journals between 1990 and 1998 were reviewed to determine the rates of employment and independent living. Additional variables included demographics, job types, wages, and benefits. Results indicated that few empirical studies examined special education outcomes for young adults living in rural areas. Studies that did examine employment outcomes indicated that, overall, fewer than 70% of young adults with disabilities in the studies' samples were employed. However, employment outcomes seem to have improved from 1990 to 1997. The synthesis also indicated that, overall, fewer than 40% of young adults with disabilities in rural areas live independently. More research on additional outcomes of employment, independence, and social well-being is called for as well as research on effective transition programs and processes in rural areas.
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Partnering between families and their children's providers is a cornerstone of family-centered care. This study aimed to identify factors associated with family-provider partnership and determine the association between partnership and other outcome measures for children with special health care needs (CSHCN). Descriptive, bivariate, and multivariate analyses were conducted using data from the 2005-2006 National Survey of Children with Special Health Care Needs. Multivariate models showed that CSHCN who are White non-Hispanic, younger than 12, reside in households with incomes above 400% of the federal poverty level, and have a usual source of care were associated with family-provider partnership. Multivariate models showed that family-provider partnership was significantly associated with adequate insurance, early and continual screening, organized health care services, and transition preparedness. Family-provider partnership was associated with 20% fewer emergency department visits and 9% fewer school days missed. This study suggests that policies aimed at promoting family-provider partnership could increase health outcomes for CSHCN.
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To evaluate the role of health care providers in the transition from pediatric to adult health care for adolescents with disabilities and special health care needs (SHCN) from both the families' and providers' perspectives. A total of 753 parents of adolescents with SHCN (e.g. developmental, physical, behavioral/emotional, learning, or health-related disabilities) were surveyed by questionnaire to assess their perceptions of their health care provider's level of involvement in various transition activities and the extent to which they felt it was the provider's responsibility to assist in a particular activity. One hundred forty-one health care providers (primarily pediatricians) completed a parallel survey to assess their level of participation in the same transition activities and the extent to which they felt it was their responsibility to assist with each transition activity. The questionnaire listed 13 different transition activities health providers may engage in to help young people prepare for adulthood and also asked questions about areas such as employment and health insurance. To investigate whether parents and providers share the same views regarding the involvement and responsibility of providers across the 13 transition activities, two sets of Student's t-tests were calculated. There were significant differences between providers and parents concerning both the level of provider involvement and the extent to which it was the provider's responsibility to assist in various transition activities (e.g., health providers reported significantly more involvement than did parents for 11 of the 13 transition activities and, compared with parents, providers reported that it was more within their role to assist in these 11 transition activities). The findings suggest a need for health care providers and parents to have open discussions about the nature and extent to which providers assist families in key transition activities.
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A key issue, and one known to be highly problematic and challenging, concerns the transition of young disabled people from children's services to adult services, and from childhood to adulthood. To inform its recommendations on this issue, the Disabled Children's External Working Group (EWG) for the Children's NSF commissioned a review of research on young disabled people and transition. Given the preponderance of grey literature in this area, database searches were supplemented by hand searching of key journals and contacts with key individuals, research units, publishers and funding bodies in order to identify relevant literature on the experiences of transition from the perspectives of young people, parents and practitioners; the outcomes of transition; and evaluations of services provided during this life-stage. The evidence available with regard to transitions of young disabled people provides a clear and consistent picture of the way transitions are currently experienced by young disabled people and their families. There is limited evidence on what works to ensure smooth transitions between services and positive outcomes of transition for the young people themselves. Existing research is very persuasive on the need to improve transitions for young disabled people. It can also be used to provide clues as to the sorts of support and service configurations that need to be in place to ensure positive transitions. However, further research is needed both at the level of specific service/service model evaluation as well as holistic, longitudinal work to provide evidence on the long-term outcomes of young disabled people as they move into adulthood.
American Community Survey
United States Census Bureau (2013) American Community Survey. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?fpt=table
Factors That Affect Parent Perceptions of Provider-Family Part
  • C A Knapp
  • V L Madden
  • M I Marcu
Knapp, C.A., Madden, V.L. and Marcu, M.I. (2010) Factors That Affect Parent Perceptions of Provider-Family Part
2013 NCHS Urban Rural Classification Scheme for Counties
Centers for Disease Control and Prevention (2014) 2013 NCHS Urban Rural Classification Scheme for Counties. http://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf
The National Survey of Children with Special Health Care Needs: Chartbook
Health Resources and Services Administration. (2008) The National Survey of Children with Special Health Care Needs: Chartbook 2005-2006. http://mchb.hrsa.gov/cshcn05