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Objective: To examine parents’ perceptions of stigma regarding mental health services for their child, consider stigma in the context of novel service delivery settings (e.g., telehealth, primary care, and schools), and evaluate stigma with other factors known to influence service access. Methods: 347 caregivers of children with psychosocial concerns completed surveys regarding their perceptions of stigma, service delivery settings, and barriers to care. Results:Parents endorsed low levels of stigma around services. Greater perceived stigma was related to less willingness to seek services in a mental/behavioral health center or schools but not in other settings, even when other barriers were considered. Having a younger child and a history of prior services was associated with greater willingness to seek services. Conclusions: Stigma does appear to present as a barrier, but only for some parents. Providing mental health services to young children and their parents in some nontraditional settings may increase access.

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Indiana University-Purdue University Indianapolis (IUPUI) / Access to healthcare services is important for improving health outcomes, preventing and managing illness, and achieving health equity. The geographic maldistribution of physicians has a negative impact on rural areas compared to urban, particularly as it relates to access to healthcare. Rural hospitals have been closing or converting to another form of healthcare service at an increasing rate, adding another element to the existing complexities in rural access to care. Although a hospital closure in any location may have a considerable impact on the community, the closure of a rural hospital may have disproportionately more substantial implications for the economy and employment, health outcomes, and access to care. The contributing factors preceding rural hospital closures have been studied, but less is known about the full impact of rural hospital closures on the community. There is some evidence of shortages in healthcare providers and services, and therefore communities may employ multiple strategies to mitigate the shortages and provide services, including utilizing telehealth/virtual services. This dissertation proposes to examine the effects of rural hospital closures on the community, healthcare services, access to care, and provide a qualitative assessment of telehealth as a strategy to bridge gaps in provider access. This dissertation includes three studies: 1) a systematic review of the literature to examine the impact of rural hospital closures on the community; 2) an empirical study that utilizes a generalized difference in difference design with county and year fixed effects to estimate the relationship between rural hospital closures and nursing homes; and 3) a qualitative study exploring the perceptions and experiences of the nurses that piloted a virtual care support project, providing insights into crucial elements important to the implementation of similar models and the role of telehealth in bridging healthcare workforce gaps.

This policy paper reviews the history, use and significance of telehealth in primary care. The emergence of telehealth as a primary strategy to continue to deliver value based, timely primary care during COVID-19 is discussed with recommendations for future applications, payment and preparation of providers to continue to provide quality care of clients in the future using telehealth.

Increasing number of special needs students in mainstream school has imposed great challenge on educators as they are compelled to provide an inclusive classroom (Lim, 2016). However, limited knowledge on the broad scope of special needs and accessibility barrier to reach out to professionals such as occupational therapists (OT) results in delayed identification or provision of appropriate support for students with special needs (Kaur, 2013; Teng, 2017). As such, this doctoral project proposes an innovative tele-health service delivery model that utilizes the Teachable (2019) online software to create a 3-tiered intervention program. The intervention consists of 1) e-learning modules on the broad perspectives of classroom attention and participation, 2) e-consultation to seek OT support and, 3) discussion forum for educators and OT to discuss on scenarios and cases. This project is also a cost-effective service delivery model as the subscription plan and time-based e-consultation fees is aimed to cover the cost of running the online platform. Grant approval from Singapore Association of Occupational Therapists (SAOT) would be utilized for the start-up cost. Evaluation of the program content and service delivery model would be carried out as online survey using the Teachable platform. The evaluation outcome and dissemination activities to promote the program would aid in expanding the program as a teacher education curriculum for inclusive practice. The long-term impact of this program is to change the inclusive practice paradigm to a student-centered, holistic, performance-based paradigm!

According to the Macro, Meso, and Micro levels (3Ms), the 3Ms of Occupational Engagement: Awareness of Entitlement and Support Programs for People with Disabilities (People of Determination) in the United Arab Emirates (AESPPD) is an educational program focused on educational programs designed to increase awareness of policies, regulations, and entitlements in the United Arab Emirates (UAE). Promoting occupational justice, social justice, and improving employment are ways to break down social stigmas for people with disabilities (people of determination). Using a hybrid model of in-person and telehealth, the 24-week program proposed in this doctoral program will provide education on and facilitate access to entitlement and support programs for clients, caregivers, and occupational therapy students in the UAE and globally. The author aims to reduce the environmental barriers, including the lack of accessible community locations and transportation, as well as limited access to rehabilitation programs (WHO, 2001; WHO, 2006; Zhou et al., 2020). Reduced limitation to often necessary services results in success with paid employment (Andersen & Olsen, 2019; Bondia, 2019; Haza, 2019; Silva et al., 2019). Environmental barriers result in challenges in an individual's ability to support themselves financially, maintain healthy social participation, and engage in meaningful occupations (Adams et al., 2012; Marshall, 2009; Sheppard & Frost, 2016; WHO, 2011; WHO RCWP, 2018). The program will promote access, independence, opportunity, and change for this target population through awareness of occupational injustice and barriers to engagement (Hammell, 2008); collective occupations for change (Frank & Santos, 2020); awareness of cultural norms (Frank & Santos, 2020); policies and civil rights act change (WHO, 2011); developing intentional attendance using telehealth (Fogelberg & Frauwirth, 2010; Frank & Muriithi, 2015). Consequently, corresponding to the 3Ms telehealth program, the author can engage in employment and social participation for people with disabilities (people of determination) in the UAE and globally.