Chronic conditions and related functional disabilities are highly prevalent among resettled refugees in the United States. There is a need to explore this population's access to appropriate healthcare services in order to identify service disparities and improve interventions. Using a community-based participatory research approach, semi-structured interviews were conducted with key informants to identify healthcare access barriers affecting disabled and chronically ill refugees. Eighteen participants were interviewed, revealing three main barriers: (1) inadequate health insurance, (2) language and communication barriers, and (3) a complex maze of service systems. These barriers were found to operate at systems, provider, and individual levels. Broad-based policy and practice interventions are required to address barriers including: an expanded pool of medical interpreters, peer navigators, innovative health information technologies, and greater collaboration and information-sharing between service systems. Further research is needed to monitor the impact the Affordable Care Act on service access of refugees with disabilities and chronic conditions.

BackgroundDeafblindness, also known as dual sensory loss, is a varying combination of visual and hearing impairment in the same individual. Interest in this topic has increased recently due to evidence suggesting an increase in prevalence of this condition among older adults. Persons with deafblindness frequently experience participation barriers and social isolation. Developing an understanding of their experiences can inform the design of programs and policies to enhance participation of people with deafblindness in society.ObjectiveTo identify and summarize available research literature on participation experiences of people with deafblindness or dual sensory loss.MethodsA comprehensive literature search of eight databases (CINAHL/EBSCO, Embase, ERIC, Global Health, MEDLINE, ProQuest, PsycINFO, PubMed) was performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) during January 2017 and last updated in June 2017. In addition, non-peer reviewed (grey) literature was also retrieved in the form of online published reports of research projects by 16 deafblind-specific organizations across the globe. To be included, sources had to be published after 1990, had persons with deafblindness as the focal population, and focused on their participation experiences.ResultsA total 1172 sources were identified of which 54 studies were included. The findings reveal that persons with deafblindness, regardless of origin of their impairment, experience difficulty in communication, mobility, daily living functioning, and social interactions. While these experiences may vary between individuals with congenital versus acquired conditions, they generally feel socially isolated, insecure and uncertain about their future.ConclusionParticipation experiences of persons with deafblindness are shaped by dynamic interactions between personal factors (such as onset and type of impairments) and environmental influences (such as attitude, technology, and supports). A better understanding of participation experiences may help professionals in placing emphasis on affected participation domains to design services to enhance participation of people with deafblindness.

Objective To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery. Data sources Discharge registry including all non-federal hospitals in Washington State from 2004–2007. Study Design We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identified whether or not each patient had a subsequent complication within 90 days. Logistic regression models with hospital and surgeon random-effects were used to examine complications, controlling for patient characteristics and comorbidity. Principal findings Complications within 90 days of a fusion occurred in 4.8% of patients, and 2.2% had a reoperation. Hospital effects accounted for 8.8% of the total variability, and surgeon effects account for 14.4%. Surgeon-factors account for 54.5% of the variation in hospital reoperation rates, and 47.2% of the variation in hospital complication rates. The discretionary use of operative features, such as the inclusion of Bone Morphogenetic Proteins, accounted for 30% and 50% of the variation in surgeons’ reoperation and complication rates, respectively. Conclusions To improve the safety of lumbar spinal fusion surgery, quality improvement efforts that focus on surgeons’ discretionary use of operative techniques, may be more effective than those that target hospitals.

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There is an emerging interest in issues of occupational justice and occupational deprivation within contemporary occupational therapy practice and theory. To inform this emerging agenda, research with populations at risk of occupational injustice is crucial. This study used a global ethnography framework to explore disabled refugees' access to occupational participation in the context of the U.S. refugee resettlement program. Narrative data from eight Cambodian and seven Somali refugees were combined with documentary analysis and information obtained from service providers. Data were analyzed using grounded theory techniques. Findings revealed a strong policy emphasis on employment and self-sufficiency within the U.S. refugee resettlement program. Consequently, resettlement service providers focused on the dichotomous options of work or welfare, overlooking the broader occupational needs of disabled refugees. Lacking supportive services for developing vocational skills or exploring occupational alternatives, the refugees struggled to find occupational avenues that would earn them social validity and integration into American society, leading to feelings of isolation and inadequacy. Research and practice initiatives with this population need to consider the role of institutional factors in shaping their occupational participation and evolving occupational needs.

This case study revealed complex interactions between accessibility, universal design, and sustainability. Two visual models were proposed to understand and analyze these complexities.

Background A consumer-directed service-delivery approach to assistive technology and environmental modification intervention was examined with people who were ageing with intellectual disabilities. Material and Methods The intervention was based on a collaborative approach involving consumers, their social supports and service deliverers. Thirty individuals were randomly selected to receive the intervention from a sample of 75 community-dwelling adults. Outcomes related to consumers' and significant others' perceptions of performance and satisfaction with goal attainment were assessed and the consumer-directed goal planning process examined. Results Participants in the intervention group reported significantly higher levels of performance and satisfaction related to goals identified at baseline than participants in the control group. Two broad categories of goals were addressed during the intervention -basic self-care goals and participation ⁄ environmental ⁄ systems level goals. A 98% direct agreement rate between consumer-identified goals and goals addressed by service deliverers was found during the intervention. Of the environmental strategies employed during the intervention, assistive devices and systems level advocacy and action were the two most frequently used across goals. Conclusion Results provide evidence in favour of a consumer-directed approach to assistive technology and environmental modification service delivery for consumers who are ageing with intellectual disabilities.

Disabled refugees resettled in the U.S.A. have many unmet needs associated with gaps in-service delivery stemming from disconnections between refugee and disability service systems.