This cross-sectional study evaluates the prevalence of hearing loss among specific patient populations in Alberta and explores participant perceptions about patient-health care worker communication and potential solutions.

Autism exists across all populations, including among Indigenous Peoples, yet the experiences of First Nations caregivers of Autistic children remain significantly under-researched. This study explores the lived realities of caregivers in two First Nations communities: Maskwacîs (Alberta) and Six Nations of the Grand River (Ontario). Guided by a Community-Based Participatory Research (CBPR) approach and grounded in the nêhiyaw concept of wâhkôtowin (relationality), this research was co-led by the Autism Community Research Circle, which included Elders, Autistic individuals, caregivers, and professionals. Fourteen caregivers participated in semi-structured interviews, and thematic analysis revealed eight key themes: lack of understanding and recognition; caregiver burnout; challenges with diagnosis and clinical navigation; school experiences; advocacy; stigma and ableism; culture and ceremony; and acceptance and transformation. Caregivers identified barriers including jurisdictional divides, racism, and lack of culturally appropriate services, but also emphasized the importance of kinship, cultural identity, and community acceptance. Autism was often reframed through Indigenous worldviews as a gift from the Creator, highlighting a strength-based perspective rooted in relationality. This study addresses a critical gap in the literature and calls for culturally grounded, community-led autism supports that align with Indigenous knowledge systems. Findings offer essential insights to inform more responsive policy, programming, and future research.Lay AbstractAutism exists in every community, including among First Nations Peoples in Canada, yet very little research has explored the experiences of Indigenous families raising Autistic children. This study looked at what life is like for First Nations caregivers of Autistic children in two communities, Maskwacîs in Alberta and Six Nations of the Grand River in Ontario. The project was led in partnership with community members, including Autistic people, Elders, caregivers, and professionals, through the Autism Community Research Circle. Together, we used a community-based approach that followed local teachings and values, especially the Cree concept of wâhkôtowin, which means kinship and relationship. Fourteen caregivers took part in interviews where they shared their stories and perspectives. We learned that caregivers often face major challenges in getting autism diagnoses and finding appropriate supports and services. Many spoke about burnout, stigma, and racism, as well as frustration with school systems and health care providers. Despite these barriers, caregivers described the strength they draw from family, culture, and community. Cultural teachings, ceremonies, and language helped caregivers and their children feel proud, connected, and supported. Some families described autism as a gift from the Creator, showing how Indigenous ways of understanding autism can promote acceptance and belonging. This research shows the need for autism programs, services, and policies that are guided by Indigenous knowledge, community leadership, and cultural safety. It also highlights the importance of seeing autism through a strengths-based lens that values family relationships, community, and identity. By listening to First Nations caregivers, we can build more inclusive and culturally grounded supports for Autistic children and their families.

Background: People with hearing loss may have difficulty communicating with health care providers if not properly supported. Hearing loss is common among people with kidney failure. Outpatient hemodialysis centers may present communication barriers due to noisy machines and overlapping conversations. Tools, such as assistive listening devices, exist to help people with hearing loss communicate. If and how they should be used in the outpatient hemodialysis setting is unclear. Understanding the patient perspective is an important first step before implementing such solutions. Objective: Describe the communication-related experiences of patients with hearing loss when conversing with health care providers during hemodialysis treatment, focusing on perceptions about communication tools. Design: Qualitative descriptive. Setting: Outpatient hemodialysis centers in Calgary and Edmonton, Alberta, Canada. Participants: Adults with kidney failure receiving maintenance hemodialysis with self-reported hearing loss. Methods: Semi-structured individual interviews. Interviews were audio-recorded, transcribed, and abductively coded using a validated communication framework, a strategy to guide communication access in practice, and participants’ experiences. Results: Fourteen patients participated between October 2023 and January 2024. Patient perceptions about communication tools varied. We identified three themes that describe these differences: (1) communication tools may be needed in transitional or clinically complex situations, (2) patients with their own resources may rely less on center-provided tools, and (3) awareness and self-advocacy for support varies across patients. Limitations: The major limitation of this study is the lack of representation from patients with language barriers and those belonging to the Deaf community or with overlooked hearing difficulties. Consequently, results may not be transferable to all patients with hearing loss in Alberta or elsewhere. Conclusions: Communication support needs are both person-specific and context-dependent, varying across and within patients. Not all patients that may benefit from communication tools will be comfortable asking or accepting help. Clinicians should routinely check in with patients about their communication needs and offer a variety of tools to accommodate as needed.

BACKGROUND:Patients and families who use a language other than English (LOE) for health care communication face heightened risks for poor outcomes due to structural language barriers. Although interpreter services are increasingly available, considerable variability remains in how language access is operationalized. This study aimed to examine interpreter service infrastructure, processes for identifying language needs, and barriers to equitable care for hospitalized pediatric patients who use LOEs in Canada. METHODS:We conducted a cross-sectional survey of clinical leaders from pediatric inpatient units across Canada. The survey explored interpreter service availability, language identification processes, staff training, and perceived barriers to effective communication. Quantitative data were analyzed descriptively, and open-ended responses were examined qualitatively using thematic analysis. RESULTS:Thirty-six tertiary academic and community hospitals participated. Only 40% of respondent hospitals reported a formal process for identifying language needs at admission, and most lacked standardized documentation in electronic medical records. Key identified barriers to optimal language support for patients and families, identified from both quantitative and open-ended responses, included time constraints, inconsistent service availability, and situations in which families declined interpreter support, potentially due to previous experiences of stigma or mistrust. Participants recommended improvements, including improved identification and documentation of patients needing interpreters, increased interpreter availability, and expanded staff training. CONCLUSIONS:There are persistent gaps in the equitable provision of interpreter services and supports for families who use LOEs in Canadian pediatric hospitals. To ensure that language access becomes a foundational component of safe family-centered care, interpreter services must be embedded into clinical workflows, supported by institutional infrastructure, and implemented in ways that foster trust and relational safety.

Family caregivers provide most daily care for people living with chronic illness or frailty, yet they remain under-recognized in health and social care systems. To address this gap, we co-designed the Caregiver-Centered Care Champions Education Program, which equips frontline providers with the competencies needed to lead caregiver-inclusive change. Guided by the Kirkpatrick-Barr Health Workforce Education Framework, we conducted a mixed methods interpretive description evaluation of learner satisfaction, knowledge and confidence gains, and self-reported behaviour change. Sixty-seven interdisciplinary participants completed three online modules. Quantitative results from pre/post surveys (Wilcoxon signed rank tests) showed significant improvements across all competencies (p < 0.001; large effect sizes) alongside high satisfaction (means 6.56–6.96/7). Qualitative findings revealed that 94% of participants applied program content within three months, and 61% implemented five or more distinct behaviour changes (e.g., collaborative care planning, system navigation support). The analysis illuminated how learners integrated caregiver-centred principles with change leadership strategies. Time constraints and staffing shortages emerged as key barriers. Our co-designed, theory-informed approach effectively bridged individual learning and system change, demonstrating the potential to transform caregiver inclusion practices when supported by organizational policies.

Background: Autistic adults have a high incidence of mental health challenges, including suicidal thoughts and behavior (STB). Our objective was to gain a nuanced understanding of autistic adults' experiences in seeking and receiving support for their mental health, including STB, presented in a format that could be operationalized to improve service provision for autistic adults.Methods: We applied an integrated codesign approach involving autistic adults at every stage of the research, acknowledging them as experts on their own lives. Thirty-three autistic adults with a history of STB participated in semi-structured narrative interviews, discussing their experiences seeking and receiving support for their mental health. We analyzed data using reflexive thematic analysis.Results: We constructed an overarching theme, "We Don't Know What We Don't Know," representing the bidirectional misunderstandings that occur between health care providers and autistic people. Within the overarching theme were four central themes: (1) Communicate with Me (understanding the uniqueness of autistic communication); (2) Understand Me (developing a nuanced understanding of autism and being autistic); (3) Help Me to Understand Myself (developing self-understanding); and (4) Support Me (empowerment when supported). We constructed an underpinning theme, "Trust and Safety," representing the need for psychological safety in all domains of mental health care. We centered the lived experiences of autistic adults to acknowledge the need for autistic people to feel safe and for service providers to build trust to effectively support the mental health of autistic adults.Conclusions: Our analysis demonstrates the need to facilitate access to mental health care and improve the quality and effectiveness of service utilization for autistic adults. Recommendations include improving understanding of and communication with autistic people, embedding education, cultural humility, and psychological safety, acknowledging power imbalances, adapting interventions, and validating autistic experience. Our thematic map serves as a framework to inform and improve health care services for autistic people. Community Brief Why is this an important issue? Autistic adults often experience great difficulty accessing services for their mental health. They may also not benefit from health care services as much as nonautistic people if the services are not suited to their needs. This is important because autistic adults can experience more mental health challenges than nonautistic people. Compared with the general population, autistic adults also experience more suicidal thoughts and behavior. This includes higher rates of suicide death. Improving mental health services for autistic adults may improve their quality of life and prevent suicide. What was the purpose of this study? We wanted to understand the experiences of autistic adults when they looked for support for their mental health, including experiences of suicidal thoughts and behavior. We wanted to find out how to improve support for autistic adults with mental health challenges. What did the researchers do? We asked 33 autistic adults who had previously experienced suicidal thoughts or behavior about their experiences seeking support for their mental health. We asked them who they reached out to for support, what the experience was like, and what could be improved. An autistic researcher analyzed these conversations to identify common themes between the research participants. We looked for problems with health care services that might make it difficult for autistic adults with mental health challenges to access and receive appropriate support. What were the results of the study? We found that challenges accessing health care services included: (1) communication between autistic adults and service providers, (2) (mis)understanding of autism and autistic people, (3) difficulties autistic adults experience in understanding themselves and their support needs, and (4) finding appropriate services and supports. We found that misunderstanding between autistic adults and health care service providers was common, and that autistic people may not feel safe when using mental health care services. This made it very difficult for autistic adults to receive the support they needed for their mental health. What do these findings add to what was already known? Our findings build on previous research through our development of a new framework. This framework can be used to identify gaps between what is provided by health care services and the unmet needs of autistic adults. We suggest that health care providers can use this framework to critically assess their service offerings from the perspective of people with lived experience. What are potential weaknesses in the study? We excluded autistic adults with intellectual disability and complex communication needs from our study. Our results might not apply to autistic people who have those challenges. We also excluded self-identified autistic adults, even though this group also experiences more mental health challenges than nonautistic people. How will these findings help autistic adults now or in the future? Our findings can be used to help health care service providers to better understand and meet the needs of autistic adults.

BACKGROUND/OBJECTIVES:Patients who use a language other than English (LOE) for health care communication are at increased risk of experiencing adverse events and worse outcomes. The objectives of this research are (1) to understand the lived experience of families who speak LOEs around the hospitalization of their child and (2) to understand the perspectives of patients and families who speak LOEs on opportunities to improve their experiences during hospitalization. METHODS:This study is grounded in patient- and family-informed research. We designed a qualitative study involving children hospitalized in the general pediatric inpatient unit at a Canadian children's hospital. We conducted semistructured individual interviews with children and families with a medical interpreter. We used thematic analysis, and all interviews were coded by 2 reviewers. RESULTS:A total 20 families of 16 different languages participated in the interviews. Themes important to understanding their lived experience were the following: (1) communication uncertainty-families experienced inconsistent interpreter use and availability, which affected in-the-moment communication and families' ability to understand the overall clinical context, leading to increased uncertainty; (2) lack of belonging-despite communicating that they had positive experiences in the hospital, families described a lack of belonging and felt that they were "other" during hospitalization; (3) altered trust-in addition to language, each patient/family's unique and complex social contexts contribute to developing an altered trust relationship with the health system that impacts their engagement in care processes. Families described opportunities for improvement such as supporting patient-initiated interpretation, increasing workforce diversity, and tailoring concepts such as shared decision making to their realities. CONCLUSIONS:Patients and families also revealed that they experience communication uncertainty, altered trust, and a lack of belonging within the hospital setting. Our research builds on the current literature and serves to advance our efforts to address health inequities experienced by this population.

BACKGROUND:Good communication is essential for high quality healthcare. People with hearing loss face communication challenges during health encounters, which may compromise their experience with care and outcomes, especially in noisy or stressful acute care facilities. Tools and strategies to facilitate two-way communication with these patients and other members of their healthcare team may help address this gap. This study describes the communication-related experiences of patients with hearing loss in Alberta hospitals, which can help inform future strategies in this setting. METHODS:Drawing on qualitative description, we conducted focus groups and individual interviews with people with hearing loss who had a recent hospital experience in Alberta, Canada. Focus group and interview transcripts were abductively coded and analyzed, guided by established communication frameworks to explore experiences and opportunities for change. RESULTS:Fourteen people participated in 3 focus groups and 3 interviews. Overall, participants perceived hospitals as not meeting their communication needs. We identified 3 themes: 1) Hearing loss is an invisible disability; 2) Communication is a team effort; 3) Every patient has different needs in different situations. CONCLUSIONS:Patients with hearing loss experience communication gaps while in hospital, possibly related to the invisibility and stigma of hearing loss, the lack of awareness about how to identify and accommodate different communication needs, and systemic barriers. Strategies to identify patients' communication needs, train healthcare providers, and increase the uptake of communication tools may help improve communication in this population.

Families of individuals with neurodevelopmental disabilities or differences (NDDs) often struggle to find reliable health information on the web. NDDs encompass various conditions affecting up to 14% of children in high-income countries, and most individuals present with complex phenotypes and related conditions. It is challenging for their families to develop literacy solely by searching information on the internet. While in-person coaching can enhance care, it is only available to a minority of those with NDDs. Chatbots, or computer programs that simulate conversation, have emerged in the commercial sector as useful tools for answering questions, but their use in health care remains limited. To address this challenge, the researchers developed a chatbot named CAMI (Coaching Assistant for Medical/Health Information) that can provide information about trusted resources covering core knowledge and services relevant to families of individuals with NDDs. The chatbot was developed, in collaboration with individuals with lived experience, to provide information about trusted resources covering core knowledge and services that may be of interest. The developers used the Django framework (Django Software Foundation) for the development and used a knowledge graph to depict the key entities in NDDs and their relationships to allow the chatbot to suggest web resources that may be related to the user queries. To identify NDD domain–specific entities from user input, a combination of standard sources (the Unified Medical Language System) and other entities were used which were identified by health professionals as well as collaborators. Although most entities were identified in the text, some were not captured in the system and therefore went undetected. Nonetheless, the chatbot was able to provide resources addressing most user queries related to NDDs. The researchers found that enriching the vocabulary with synonyms and lay language terms for specific subdomains enhanced entity detection. By using a data set of numerous individuals with NDDs, the researchers developed a knowledge graph that established meaningful connections between entities, allowing the chatbot to present related symptoms, diagnoses, and resources. To the researchers’ knowledge, CAMI is the first chatbot to provide resources related to NDDs. Our work highlighted the importance of engaging end users to supplement standard generic ontologies to named entities for language recognition. It also demonstrates that complex medical and health-related information can be integrated using knowledge graphs and leveraging existing large datasets. This has multiple implications: generalizability to other health domains as well as reducing the need for experts and optimizing their input while keeping health care professionals in the loop. The researchers' work also shows how health and computer science domains need to collaborate to achieve the granularity needed to make chatbots truly useful and impactful.

Context: Children with medical complexity have substantial medical needs and their caregivers must make many challenging decisions about their care. Caregivers often become more involved in decisions over time, but it is unclear what skills they develop that facilitate this engagement.Objectives: To describe the skills that caregivers developed as they gained experience making medical decisions.Methods: Eligible caregivers had a child who met referral criteria for their centre's Complex Care program for >1 year, were adults responsible for their child's medical decisions, and spoke English or a language with an available interpreter. We followed a semi-structured interview guide to ask caregivers to describe and reflect on two challenging medical decisions that they made for their child—one early and one recent. Guided by interpretive description, we identified and refined themes in an iterative process.Results: We conducted 15 interviews with 16 parents (14 [88%] women, 2 [13%] men) of a child with medical complexity (aged 1-17 years). Parents described (1) becoming more adept at managing decisional information, (2) recognizing the influence of the decision's context, (3) building stronger relationships with providers, and (4) becoming more effective at guiding their child's care as a decision-maker. As parents built these skills, they developed a greater sense of agency and confidence as decision-makers.Conclusion: Parents of children with medical complexity change how they approach decision making over time as they acquire relevant skills. These findings can inform the development of interventions to support skill-building among new caregivers.

Background Patients who use Languages other than English (LOE) for healthcare communication in an English-dominant region are at increased risk for experiencing adverse events and worse health outcomes in healthcare settings, including in pediatric hospitals. Despite the knowledge that individuals who speak LOE have worse health outcomes, they are often excluded from research studies on the basis of language and there is a paucity of data on ways to address these known disparities. Our work aims to address this gap by generating knowledge to improve health outcomes for children with illness and their families with LEP. Body We describe an approach to developing a study with individuals marginalized due to using LOE for healthcare communication, specifically using semi-structured qualitative interviews. The premise of this study is participatory research—our overall goal with this systematic inquiry is to, in collaboration with patients and families with LOE, set an agenda for creating actionable change to address the health information disparities these patients and families experience. In this paper we describe our overarching study design principles, a collaboration framework in working with different stakeholders and note important considerations for study design and execution. Conclusions We have a significant opportunity to improve our engagement with marginalized populations. We also need to develop approaches to including patients and families with LOE in our research given the health disparities they experience. Further, understanding lived experience is critical to advancing efforts to address these well-known health disparities. Our process to develop a qualitative study protocol can serve as an example for engaging this patient population and can serve as a starting point for other groups who wish to develop similar research in this area. Plain English Summary Providing high-quality care that meets the needs of marginalized and vulnerable populations is important to achieving an equitable, high-quality health care system. Children and families who use a Language other than English (LOE) in English dominant regions for healthcare have worse health outcomes including a significantly increased risk of experiencing adverse events, longer lengths of stay in hospital settings, and receiving more unnecessary tests and investigations. Despite this, these individuals are often excluded from research studies and the field of participatory research has yet to meaningfully involve them. This paper aims to describe an approach to conducting research with a marginalized population of children and families due to using a LOE. We detail protocol development for a qualitative study exploring the lived experiences of patients and families who use a LOE during hospitalization. We aim to share considerations when conducting research within this population of families with LOE. We highlight learning applied from the field of patient-partner and child and family-centred research and note specific considerations for those with LOE. Developing strong partnerships and adopting a common set of research principles and collaborative framework underlies our approach and initial learnings, which we hope spark additional work in this area.

BACKGROUND:At present, little is known about the factors that contribute to the relatively low uptake of government-funded disability programs in Canada.AIM:Understand how parents/caregivers of Canadian youth with neurodevelopmental disability (NDD) experience the process of applying for and accessing disability programs.METHODS AND PROCEDURES:This mixed methods sequential explanatory study utilized two phases: an online survey (quantitative), followed by semi-structured interviews (qualitative). The quantitative phase gathered sociodemographic information and preliminary information about participant experiences applying for and accessing programs. The qualitative phase provided greater depth by asking participants to describe barriers and facilitators to program access.OUTCOMES AND RESULTS:499 participants completed the online survey and 81 participants completed an interview. Analysis of survey data revealed that many participants are not accessing disability programs and experience difficulty when applying. Regression analyses revealed that factors relating to the process of applying and applicant/family attributes are significantly associated with program access. Inductive thematic analysis of interview data revealed four barriers and three facilitators to access. Integration of findings provided an overview of the multi-faceted journey to program access.CONCLUSIONS AND IMPLICATIONS:The results of this study highlight policy changes that are needed to ensure disability programs adequately support Canadian families.

BACKGROUND:Chatbots have been increasingly considered for applications in the health care field. However, it remains unclear how a chatbot can assist users with complex health needs, such as parents of children with neurodevelopmental disorders (NDDs) who need ongoing support. Often, this population must deal with complex and overwhelming health information, which can make parents less likely to use a software that may be very helpful. An approach to enhance user engagement is incorporating game elements in nongame contexts, known as gamification. Gamification needs to be tailored to users; however, there has been no previous assessment of gamification use in chatbots for NDDs. OBJECTIVE:We sought to examine how gamification elements are perceived and whether their implementation in chatbots will be well received among parents of children with NDDs. We have discussed some elements in detail as the initial step of the project. METHODS:We performed a narrative literature review of gamification elements, specifically those used in health and education. Among the elements identified in the literature, our health and social science experts in NDDs prioritized five elements for in-depth discussion: goal setting, customization, rewards, social networking, and unlockable content. We used a qualitative approach, which included focus groups and interviews with parents of children with NDDs (N=21), to assess the acceptability of the potential implementation of these elements in an NDD-focused chatbot. Parents were asked about their opinions on the 5 elements and to rate them. Video and audio recordings were transcribed and summarized for emerging themes, using deductive and inductive thematic approaches. RESULTS:From the responses obtained from 21 participants, we identified three main themes: parents of children with NDDs were familiar with and had positive experiences with gamification; a specific element (goal setting) was important to all parents, whereas others (customization, rewards, and unlockable content) received mixed opinions; and the social networking element received positive feedback, but concerns about information accuracy were raised. CONCLUSIONS:We showed for the first time that parents of children with NDDs support gamification use in a chatbot for NDDs. Our study illustrates the need for a user-centered design in the medical domain and provides a foundation for researchers interested in developing chatbots for populations that are medically vulnerable. Future studies exploring wide range of gamification elements with large number of potential users are needed to understand the impact of gamification elements in enhancing knowledge mobilization.

Supervisors of human service organizations can support violence prevention or contribute to experiences of workplace violence. This qualitative study sought to explore the ways in which supervisors prevent opportunities for workplace violence through their relationships with workers. Interviews with 81 workers in publicly administered human services in a Canadian province were analyzed using qualitative techniques. Results show that supervisor attentiveness, supervisor support, involvement by one's supervisor, and treating workers equally all contributed to workplace violence prevention. Findings provide important practical considerations that detail how supervisors play a critical role in supporting health and safety in human service workplace environments.

OBJECTIVES:Parents of children with medical complexity are often expected to implement complicated plans of care, such as enteral tube feeding, to support the health of their child. Enteral feeding can have psychosocial implications for the parent, child, and family. Blenderized tube feeding (BTF) refers to the administration of pureed food and drinks through a feeding tube. Little is known regarding parents' experiences with BTF. Therefore, the purpose of this qualitative study was to understand the lived experience of BTF from the parent's perspective.METHODS:This qualitative study was a grounded theory analysis utilizing semi-structured interviews of parents who provided at least 50% of their child's diet through BTF. Participants were recruited using purposive sampling from the Complex Care Program at a tertiary care paediatric centre. Interviews were conducted until thematic saturation was achieved. Themes were identified using constant comparative analysis of transcribed interviews.RESULTS:Parents (n=10) felt that BTF positively affected the experience of tube feeding and enhanced their child's health and wellbeing. Parents described BTF as a means of self-empowerment and a mechanism to normalize feeding and care for the entire family. Despite reporting BTF as more time consuming than formula feeding, all parents were satisfied with having made the change, and planned on continuing the diet.CONCLUSION:BTFs can improve the experience of tube feeding and positively address some of the negative psychosocial implications of enteral tube feeding, providing a sense of normalcy and control for parents caring for a child with medical complexity.

One of the basic assumptions underlying all traditional definitions is that diversity is a characteristic of an individual or a group, which is a problematic to groupwork. This paper explores Phases 1 and 2 of a multi-method research project exploring groupworkers’ understandings of diversity and how their perceptions impact their approach to group processes, with implications for group practice advancement. The project consists of sequential phases following a mixed-methods design. In the initial phase, in-depth semi-structured qualitative interviews were conducted individually with 24 groupworkers. While the second phase (phase two) consisted of 4 focus groups involving theoretical and criterion sampling strategies to interview experienced therapeutically-oriented groupworkers in Western and Eastern Canada. The analysis was guided by Glaser and Strauss’s (1967) constant comparative method involving open-coding, followed by axial coding, and concluded with selective coding. Groupworkers reported feeling overwhelmed and, in some cases, “paralyzed” by the complex diversity present in their groups. These findings suggest attention to group diversity renders it potentially more relevant and salient. We also found the levels and complexity of diversity increased as the reflection by groupworkers deepened. In keeping with the traditional aims of groupwork, attending to diversity goes beyond the group to include responses to diversity in the organizational and community contexts. Dialogue and change in organizational responses to diversity is important in the areas of organizational climate, allocation of resources, and agency policy and procedures. Accordingly, offering groupworkers and members tools to attend and navigate diversity in situ is a first step towards recognizing its presence and importance. A critical step in moving forward is to examine the nuances of diversity and move beyond thinking of diversity in terms of demographic variables.

This reflection article, which positions itself within an ecological systems approach, focuses on advancing the capacity for effective responses to autism spectrum disorder in Eswatini. Autism spectrum disorder is a neurodevelopmental disorder with impacts ranging from mild to severe. Knowledge about this condition in Africa is limited, as exemplified by a very small body of research conducted in African countries. This article presents the developmental work underway in the Kingdom of Eswatini to raise awareness and to build capacity in autism spectrum disorder. It focuses on (1) increased understanding and recognition of the need and direction for capacity-building, (2) collective learning for proactive change, (3) policy and practice advancement, and (4) disciplinary development in social work in the service of this advancement. Recommendations for ongoing advancement are offered.

Summary Worker experiences of workload is a poorly understood component of health and safety practice in the social services sector. Job Demands-Resources theory is applied to explore how workload contributes to health and safety, workplace violence, and violence prevention. Data from qualitative interviews ( n = 81) of workers in publicly administered social services in Western Canada were analyzed using analytic induction and constant comparison methods. Findings Qualitative themes highlight the role of Workload Management, Equal Distribution of Workload, Stress Management, and Flexibility on worker experiences with workplace violence prevention. These themes are further elaborated on and contextualized within a Job Demands-Resources framework. Finally, a conceptual model of workload management and health and safety is presented. Applications Findings highlight areas of workload development and innovation as a component of violence prevention interventions within social service workplaces.

Despite its historic prominence in group work, there is little empirical research to support our understanding of the professional use of self in group work. This paper reports the results of a SPARC endorsed study, which focused on group workers’ experience and struggle with their professional uses of self in groups in responding to diversity. Using focus groups, a semi-structured interview format, and Straussian grounded theory data analysis, two key themes emerged – grappling with professional uses of self and disengagement from professional uses of self. When grappling with professional uses of self, group workers employed intentional self-disclosure, opened space, and supported norms for the expression of diversity, humility, genuineness, and reflexivity. Disengagement occurred in response to fear and often resulted in an overemphasis on group tasks. Our results suggest that the effective professional use of self in the here and now of group dynamics creates a sense of safety for both the group workers and the group members when responding to diversity. The implications of this study highlight the need for a method that supports critical self-reflection in real-time in group and builds capacity for responsibly responding to diversity in groups.