Objective Current evidence highlights that women with disabilities experience challenges in accessing maternity care. Improving access requires an understanding of the factors influencing the capacity of healthcare providers to provide disability-inclusive care. Although providing maternity care services for women with disabilities has been reported to be a rewarding experience, numerous factors may impact health care providers’ capacity to do so. Limited evidence, especially from low and middle-income countries (LMICs), undermines our understanding of this issue and how to respond. This scoping review, therefore, aims to synthesise the current published literature examining factors influencing the capacity of healthcare providers to deliver disability-inclusive maternity care services. Design This scoping review used the Arksey and O'Malley framework in accordance with the PRISMA extension for Scoping Reviews. A systemic search of six electronic databases, including MEDLINE (Ovid), CINAHL Complete, Scopus, Eric Ebsco, Web of Science Core Collection, and EMBASE (Ovid), was undertaken to identify relevant studies. Snowball searching of reference lists and citations was also performed. The Quality of Care Framework for Maternal and Newborn Health, developed by the World Health Organization, was employed to guide the analysis and synthesis of the findings of this review. Findings Twenty-four studies published between 2000 and 2023 met the inclusion criteria. Factors influencing the capacity of healthcare providers to provide disability-inclusive maternity care were identified and categorised into six domains aligning with the Quality of Care framework: 1) Evidence-based practices for routine care and management of complications; 2) Actionable information systems; 3) Effective communication; 4) Respect and dignity; 5) Competent and motivated human resources; and 6) Essential physical resources available. Key conclusions and implications for practice This scoping review synthesised evidence on six key factors affecting the capacity of healthcare providers to provide disability-inclusive maternity care. It highlights the need to address the limited application of a ‘disability lens’ to evidence-based guidelines and health information. The review also highlights the need to better enable healthcare providers at all stages of their training and clinical practice to develop their knowledge and skills in providing respectful, disability-inclusive maternity care, in addition to ensuring essential physical resources are available. Very few studies examine the capacity of healthcare providers in low- and middle-income countries. Future research should focus on developing context-specific evidence from such countries, particularly given that this is where the majority of women with disabilities live.

People with disability are an 'at-risk' group in a pandemic context for various clinical and structural reasons. However, in the early stages of the COVID-19 pandemic, people with disability were not identified as a priority group, which exacerbated this risk, particularly for those living in congregate settings. This paper examines inter-organisational issues during the second wave of the COVID-19 pandemic in disability residential settings gathered from senior managers, team leaders, and disability support workers. We use Victoria as a case study since several Victorian disability residential settings were in mid-transition from state provision to non-profit organisations. We argue that residential settings in mid-transition had clearer lines of organisational accountability and communication, which was thought to reduce the impact of outbreaks compared to residential settings in other States and Territories with multiple lines of communication and blurred accountability. The paper contributes to the literature on inter-organisational collaboration by reinforcing the necessity of clear lines of accountability and leadership in collaborative governance during emergencies. The evidence suggests how government and disability residential settings could better support residents and staff in future COVID-19 outbreaks or other pandemics. Points for practitionersPeople with disability, particularly those living in congregate settings, are often at heightened risk during public health emergencies.Clearer lines of responsibility, administrative, and communication arrangements across organisations and governments, alongside tailored responses within residential settings, are required to keep 'at-risk' individuals safe.Emergency management block funding could be designed to alleviate the financial pressures identified in this study for residential disability services in future pandemic responses.

PURPOSE:Very little is known about the subjective well-being (SWB) of adults with a congenital corpus callosum disorder (CCD), the extent to which they feel satisfied with their lives, and what might be helpful in improving their SWB and quality of life. This study measured SWB among Australian adults with a CCD and compared the results with normative data for the wider Australian adult population. METHODS:Online surveys were completed independently by 53 Australian adults with a CCD. Data included demographic profiles and answers to questions about satisfaction with life, employing the Personal Wellbeing Index (PWI) and one open ended question. Domains measured included life as a whole, standard of living, health, achieving in life, personal relationships, safety, community connectedness and future security. The PWI results were statistically analysed and means compared with Australian normative data. The qualitative data were analysed using deductive thematic analysis. RESULTS:Australian adults with a CCD responded with ratings significantly below what might be expected of the adult Australian population in all domains except for standard of living and safety. Quantitative analysis results were supported by qualitative thematic analysis, expressing particular challenges and barriers to feeling satisfaction with life as a whole, personal relationships, achieving in life, health and future security. CONCLUSION:Evidence from the PWI and accompanying qualitative responses indicate that SWB of Australian adults with CCD is significantly reduced compared with the general population. Further research is needed to examine the lived experience and explore solutions for support of this community.

The life experiences of Aboriginal and Torres Strait Islander people who are Deaf or Hard of Hearing are often more complex than for Aboriginal and Torres Strait Islander people who are hearing, or non-Aboriginal Australians who are Deaf or Hard of Hearing. In turn, this can make engaging with and benefiting from policies and programs such as Australia’s National Disability Insurance Scheme (NDIS) more complex, particularly for individuals living in remote settings. To understand more about these complexities, yarnings were held with 15 Aboriginal and Torres Strait Islander NDIS participants who are Deaf or Hard of Hearing living in rural and remote communities in the Northern Territory. Alongside analysis of the emerging narratives, we analysed NDIS quantitative data to examine how NDIS plan budgets were being utilised by this group in comparison to the wider NDIS population. This paper’s focus is on yarning participants’ experiences navigating the NDIS to gain supports that meet their interwoven socio-cultural, health and disability-related needs and aspirations. We highlight that with sufficient cultural and communication supports, some yarning participants were able to effectively utilise their NDIS plan to attain supports to achieve positive socio-cultural, health and disability-related outcomes. However, the NDIS must enhance collaboration with participants, local communities and Aboriginal Community Controlled Organisations, disability service providers, and interfacing systems such as the health system, to develop more locally led solutions that empower Aboriginal and Torres Strait Islander Deaf or Hard of Hearing participants to achieve better outcomes.

Sharing disability-related information with an employer to gain workplace adjustments is a complex process for young people with intellectual and/or psychosocial disabilities. We examined the disclosure experiences of young Australians with intellectual and psychosocial disabilities, their subsequent access to workplace adjustments, and their employment outcomes. Using narrative inquiry, we analysed qualitative data collected from 24 interviews with participants with an intellectual (n = 10) and psychosocial disability (n = 14) between 18 and 25 years old recruited as part of an Australian Government-funded Youth Employment Study. Four main narratives emerged among the participants responses. Positions ranged from their having no control over disclosure experiences to a high level of control resulting in access to workplace adjustments. These positions were impingent on their knowledge of rights and adjustments, previous experiences, workplace context, and self-advocacy capacity. Our study provides unique insights into the employment experiences of young people with intellectual and psychosocial disabilities. The findings may inform initiatives aimed at building their capabilities for disclosure to gain workplace adjustments that can improve their employment outcomes in turn.

People with disability continue to experience considerable employment discrimination, potentially hampering the success of the Australian government's Disability Employment Services (DES) program and contributing to the large inequalities in employment rates. Yet, discrimination experiences specifically among DES participants are underexamined in the literature. We therefore investigated perceived discrimination amongst people with disability accessing DES in relation to their experiences looking for work or during employment and explored differences for people with psychosocial and physical disabilities. Data for this study was drawn from the Improving Disability Employment Study (IDES) which aimed to gather evidence on factors influencing employment outcomes for Australians with disability accessing DES. Descriptive analysis of IDES survey data from 299 participants with physical and/or psychosocial disability was used to describe DES participant experiences of employment discrimination and how this differs for people with physical and psychosocial disability. Employment discrimination was a common experience for IDES respondents. Over a third (38.7%) of IDES participants reported one or more experiences of discrimination whilst seeking employment (which was higher for people with physical disability compared with psychosocial disability) and over half (59.1%) reported one or more experiences of discrimination whilst in the workplace (which was higher for people with psychosocial disability compared to physical disability). These findings reiterate that mitigating employment discrimination is paramount to improving employment success for people with disability accessing DES and different approaches may be required for people with different types of disability.

Objectives Support for adults with congenital corpus callosum disorders (CCDs) is impeded by poor understanding of the impacts of a CCD on day-to-day functioning and quality of life. This scoping review examines existing literature to establish the evidence-based impacts of congenital CCDs in adults and identify gaps to inform future research, policy development, and service delivery. Methods We conducted searches in Scopus, Medline Ovid, PsycInfo, Discovery, and ERIC. Studies meeting selection criteria were peer-reviewed, in English, published from 1980 to 2021, reported predominantly on participants 16 years or older who were diagnosed with a CCD by magnetic resonance imaging (MRI). Results The thirty-eight included articles comprised 14 single/dual participant case studies and 24 group studies, comparing adults with a CCD with normative data or matched controls. Although most participants were of average IQ, CCDs affected day-to-day executive functioning, social interaction, and meeting expectations of adulthood. Cognitive impacts included difficulties with learning and memory, linguistic and emotional processing, and complex reasoning, with functional capacity typically decreasing as tasks and situations increased in complexity. Psychological impacts pertaining to feelings, emotions, and social awareness were reported in addition to associated mental health, psychiatric mood, and developmental and psychotic disorders including autism, anxiety, depression, and schizophrenia. Conclusions Impacts were extremely heterogenous, presenting interwoven challenges to learning, executive functioning, social interaction, and mental health. Knowledge of these circumstances is vital for adults with CCDs, professionals, and family members to ensure appropriate services and support are available to promote good quality, inclusive lives for all adults with a CCD.

Introduction: Difficulty accessing services and supports during critical life transitions are recognised as contributing to unacceptably poor life outcomes for Autistic Australians. The National Disability Insurance Scheme (NDIS) provides funding for eligible individuals with permanent and significant disability to purchase services and supports to meet their needs and aspirations, holding the potential to improve transition support for the third of all NDIS participants with a primary diagnosis of autism. Aim: This paper reports on research to better understand the NDIS policy and practice environment supporting Autistic youth during transition to life-after-school. Methodology: Using a qualitative approach, individual interviews were completed with four Autistic NDIS participants aged 18–21 in 2019. Separate interviews were conducted with four family members nominated by each of the youth interview participants. Thematic analysis explored how Autistic youth and those who support them, experienced NDIS facilitated transition to life-after-school. Results: Two key themes emerged: 1) Transition journeys: aspirations and experiences, and 2) Navigating the NDIS in pursuit of better transition experiences. Conclusion: The research highlights a cross-sector, person and family-centred approach is needed to address barriers and build systems literacy for the NDIS to better meet the transition requirements of Autistic Australian youth.

The persistent disadvantage Australians with disability face in the labour market is troubling from both an economic and a human rights standpoint, and it has significant public and private costs. This chapter explores Australia’s efforts to boost employment for people with disability in the years leading up to the COVID-19 pandemic and in its early stages, and new health and economic challenges faced by jobseekers with disability, with a view to addressing what lies ahead. It examines trends in disability employment; shifts in related policy over time; the actors involved; the focus on employment in the economic case for reform of disability services; governance challenges in ensuring people with disability can find and sustain meaningful employment in the current environment; and opportunities to reframe how we examine and address this issue in the emerging labour market. Concerted policy effort is needed to ensure people with disability are not excluded from the post-pandemic labour force.

Employment is an important social determinant of health and wellbeing. People with disability experience labour market disadvantage and have low labour force participation rates, high unemployment rates, and poor work conditions. Environmental factors are crucial as facilitators of or barriers to participation for people with disability. Understanding how the physical, social, and economic characteristics of local areas influence employment for people with disability can potentially inform interventions to reduce employment inequalities. We conducted a scoping review of research investigating associations between area-level environmental factors and employment for people with disability. Eighteen articles published between 2000 and 2020 met the inclusion criteria, and data were extracted to map the current evidence. Area-level factors were categorised into six domains relating to different aspects of environmental context: socioeconomic environment, services, physical environment, social environment, governance, and urbanicity. The urbanicity and socioeconomic environment domains were the most frequently represented (15 and 8 studies, respectively). The studies were heterogeneous in terms of methods and data sources, scale and type of geographic units used for analysis, disability study population, and examined employment outcomes. We conclude that the current evidence base is insufficient to inform the design of interventions. Priorities for future research are identified, which include further theorising the mechanisms by which area-level factors may influence employment outcomes, quantifying the contribution of specific factors, and interrogating specific factors underlying the association between urbanicity and employment outcomes for people with disability.

Utilisation of budgets provides important insights into the effectiveness of individualised funding schemes. Significant under-utilisation by certain cohorts may indicate schemes are not working as intended. People with psychosocial disability have been identified as one such cohort experiencing barriers to effective budget utilisation within Australia's National Disability Insurance Scheme. Our mixed-methods research confirms that while this cohort receive sufficient budgets, their spending is lower in comparison to other participants. Addressing under-utilisation drivers arising from complex interactions between individual, systems, and contextual-level factors, requires intervention within individualised funding schemes and the broader policy environment.

Labour markets around the world are experiencing extraordinary disruption during the COVID-19 pandemic. The gap in the employment rate between Australians with and without disability is likely to widen, given the entrenched disadvantage of people with disability in the job market. For many, it will compound existing health and economic vulnerabilities. This scenario is troubling from both a human rights and an economic perspective. In this paper, we examine the interface of two policy instruments intended to improve the prospects of people with disability finding and keeping employment in Australia - Disability Employment Services and the National Disability Insurance Scheme - in the lead up to and in the early stages of the COVID-19 pandemic. Findings from three studies conducted between 2018 and 2020 reveal these instruments are not mutually reinforcing. With a 10-year National Disability Employment Strategy (NDES) in development under federal government oversight, we argue that more concerted and targeted effort from these services and broader public policies and programs is needed to ensure Australians with disability are not sidelined in the labour market in the wake of the pandemic.

Disability employment programs play a key role in supporting people with disability to overcome barriers to finding and maintaining work. Despite significant investment, ongoing reforms to Australia's Disability Employment Services (DES) are yet to lead to improved outcomes. This paper presents findings from the Improving Disability Employment Study (IDES): a two-wave survey of 197 DES participants that aims to understand their perspectives on factors that influence access to paid work. Analysis of employment status by type of barrier indicates many respondents experience multiple barriers across vocational (lack of qualifications), non-vocational (inaccessible transport) and structural (limited availability of jobs, insufficient resourcing) domains. The odds of gaining work decreased as the number of barriers across all domains increased with each unit of barrier reported (OR 1.22, 95% CI 1.07, 1.38). Unemployed respondents wanted more support from employment programs to navigate the welfare system and suggest suitable work, whereas employed respondents wanted support to maintain work, indicating the need to better tailor service provision according to the needs of job-seekers. Combined with our findings from the participant perspective, improving understanding of these relationships through in-depth analysis and reporting of DES program data would provide better evidence to support current DES reform and improve models of service delivery.

This chapter addresses the developing field of disability in public health. Disability is traditionally associated with morbidity and mortality as negative public health outcomes. Primary prevention activities addressing birth defects, developmental disabilities, injuries, and chronic illnesses associated with disabling conditions are the foundation of public health. Public health is developing rapidly in promoting the health and well-being of the population of people living with disabling conditions. This chapter outlines the essential public health functions of assessment, policy development, and assurance for this population across countries and age groups. The WHO’s International Classification of Functioning, Disability and Health (ICF) provides the framework for the conceptual and scientific issues. Finally, the chapter discusses directions for public health and disability to develop more closely. Recommendations are made for improving communication, cooperation, and coordination of activities between the public health and disability communities. The fundamental tenet of the chapter is that people with disabilities should be included in planning, development, and implementation of all public health activities.

Objective: To systematically review interventions aimed at improving employment participation of people with psychosocial disability, autism, and intellectual disability. Methods: We searched MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL, ERIC, and ERC for studies published from 2010 to July 2020. Randomized controlled trials (RCTs) of interventions aimed at increasing participation in open/competitive or non-competitive employment were eligible for inclusion. We included studies with adults with psychosocial disability autism and/or intellectual disability. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias II Tool. Data were qualitatively synthesized. Our review was registered with PROSPERO (CRD42020219192). Results: We included 26 RCTs: 23 targeted people with psychosocial disabilities (n = 2465), 3 included people with autism (n = 214), and none included people with intellectual disability. Risk of bias was high in 8 studies, moderate for 18, and low for none. There was evidence for a beneficial effect of Individual Placement and Support compared to control conditions in 10/11 studies. Among young adults with autism, there was some evidence for the benefit of Project SEARCH and ASD supports on open employment. Discussion: Gaps in the availability of high-quality evidence remain, undermining comparability and investment decisions in vocational interventions. Future studies should focus on improving quality and consistent measurement, especially for interventions targeting people with autism and/or intellectual disability.

This paper explores New Public Management-inspired reforms to Australia's Disability Employment Services (DES), which assume increasing participant choice and control within DES will enhance provider competition and effectiveness. However, capability for exercising choice within this context is multifaceted. This is particularly so for participants who experience significant barriers to employment, as highlighted in our narrative analysis of the perspectives of DES participants with psychosocial disability and their resistance to exercising control to change providers despite dissatisfaction with outcomes. This brings into question whether increased marketization of DES will indeed support its objective of improving employment outcomes for people with disability.

Abstract Background While classified as a rare condition, a congenital disorder of the corpus callosum (DCC) is one of the most commonly identified brain anomalies in newborns, occurring in 1:4000 live births. Advances in imaging techniques have improved early diagnosis for children, yet adults with a DCC—who may present with extreme heterogeneity in cause and impact—often experience challenges in receiving a definitive diagnosis and accessing appropriate services and supports. To date, the dearth of evidence documenting the lived experiences of adults with DCC has made it difficult to determine adequate policy and service responses. This exploratory research aims to address this gap by presenting the first qualitative examination of the experiences and impact of complete or partial agenesis of the corpus callosum among adults. Results Eight face-to-face interviews were conducted with Australian adults, aged 23–72 years, to explore their lived experience. Data was collected in four Australian states from June to August 2017. Thematic and interpretive analyses were employed to analyse data. Three emergent themes described difficulties related to: (1) reactions to the diagnosis; (2) access to supports and key life domains, and (3) identifying as an adult. Interview analysis described lived experiences typically outlining a lifetime of exclusion and misunderstanding from family, educators and disability and health support services. Conclusions This paper contributes to filling the knowledge gap around a rare congenital brain disorder affecting the lives of adults. Findings confirm a considerable lack of information and support for adults living with corpus callosum disorders. Greater professional and societal understanding is needed to improve access to the key life domains of education, employment and social inclusion for adults with a DCC. To instigate truly effective change, social research must tackle the issues of applicability and impact to alter the dominance of uninformed practices, hindered by prevailing myths. This research paves the way for further phenomenological studies in which participant narrative is vital. Further research will elicit stronger policy and service responses for all current and emerging adults with a DCC.

People with disabilities experience health disparities arising from social, environmental, and system-level factors. Evidence from a range of settings suggests women with disabilities have reduced access to health information and experience barriers to screening, prevention, and care services. This results in greater unmet health needs, particularly in relation to sexual and reproductive health. Women with disabilities are also more likely to experience physical and sexual violence than women without disabilities, further undermining their health. Community-based participatory research (CBPR) can generate knowledge and underpin action to address such health disparities and promote health equity. However, the potential and challenges of disability inclusion in CBPR, particularly in contexts of poverty and structural inequality such as those found in low- and middle-income countries, are not well documented. In this paper, we reflect on our experience of implementing and evaluating W-DARE, a three-year program of disability-inclusive CBPR aiming to increase access to sexual and reproductive health and violence-response services for women with disabilities in the Philippines. We discuss strategies for increasing disability inclusion in research and use a framework of reflexive solidarity to consider the uneven distribution of the benefits, costs, and responsibilities for action arising from the W-DARE program.

BACKGROUND: Continual reforms of the Australian Disability Employment Services (DES) program aim to improve employment outcomes for people with disabilities, including people with a psychosocial disability who experience high levels of unemployment. OBJECTIVE: To understand contextual factors in the lives of DES participants with a psychosocial disability that influence their engagement with and potential benefits from the DES program in the context of the 2018 reforms. METHODS: Thematic analysis of 30 qualitative interviews with DES participants with a psychosocial disability was conducted as part of the Improving Disability Employment Study between November 2017 to October 2018. RESULTS: Findings highlight diverse life challenges experienced by DES participants including disrupted education, inadequate access to mental and general health services, and financial and housing insecurity. CONCLUSIONS: The life circumstances of DES participants with a psychosocial disability are often complex and undermine their engagement with employment services and access to labour markets. Despite considerable investment in ongoing reforms, these circumstances continue to undermine the effectiveness of the DES program.