‘That was all over the shop': Exploring the COVID-19 response in disability residential settings

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 practitioners: People 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. © 2023 Institute of Public Administration Australia.

Political legitimacy and vaccine hesitancy: Disability support workers in Australia

People with disability are an at-risk group in the COVID-19 pandemic for a range of clinical and socioeconomic reasons. In recognition of this, Australians with disability and those who work with them were prioritized in access to vaccination, but the vaccination targets were not met. In this paper, we analyze qualitative data generated from a survey with 368 disability support workers to identify drivers of COVID-19 vaccination hesitancy and why the implementation of this policy may have experienced challenges. We identify a range of themes within these data but ultimately argue that a major driver of vaccine hesitancy in this group is a mistrust of government and an erosion of employment terms and conditions. Drawing on the policy capacity literature, we argue that the "Achilles' heel" for the Australian government in this case is the critical policy capacity of political legitimacy. This finding has important implications for where the government needs to increase/build policy capacity, strengthening its efforts and better relating to organizations that can be helpful in terms of developing public health messaging for disability support workers.

Vaccine hesitancy among working-age adults with/without disability in the UK.

OBJECTIVES: To estimate levels of COVID-19 vaccine hesitancy among working-age adults with disabilities in the United Kingdom. STUDY DESIGN: Cross-sectional survey. METHODS: Secondary analysis of data collected on a nationally representative sample of 10,114 respondents aged 16-64 years. RESULTS: The adjusted relative risk for hesitancy among respondents with a disability was 0.92 (95% CI 0.67-1.27). There were stronger associations between gender and hesitancy and ethnic status and hesitancy among participants with a disability. The most common reasons cited by people with disabilities who were hesitant were: concern about the future effects of the vaccine, not trusting vaccines and concern about the side effects of vaccination. CONCLUSIONS: The higher rates of vaccine hesitancy among women with disabilities and among people from minority ethnic groups with disabilities are concerning.

How do employment conditions and psychosocial workplace exposures impact the mental health of young workers? A systematic review.

PURPOSE: To assess the quality of the research about how employment conditions and psychosocial workplace exposures impact the mental health of young workers, and to summarize the available evidence. METHODS: We undertook a systematic search of three databases using a tiered search strategy. Studies were included if they: (a) assessed employment conditions such as working hours, precarious employment, contract type, insecurity, and flexible work, or psychosocial workplace exposures such as violence, harassment and bullying, social support, job demand and control, effort-reward imbalance, and organizational justice; (b) included a validated mental health measure; and (c) presented results specific to young people aged ≤ 30 years or were stratified by age group to provide an estimate for young people aged ≤ 30 years. The quality of included studies was assessed using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool. RESULTS: Nine studies were included in the review. Four were related to employment conditions, capturing contract type and working hours. Five studies captured concepts relevant to psychosocial workplace exposures including workplace sexual harassment, psychosocial job quality, work stressors, and job control. The quality of the included studies was generally low, with six of the nine at serious risk of bias. Three studies at moderate risk of bias were included in the qualitative synthesis, and results of these showed contemporaneous exposure to sexual harassment and poor psychosocial job quality was associated with poorer mental health outcomes among young workers. Longitudinal evidence showed that exposure to low job control was associated with incident depression diagnosis among young workers. CONCLUSIONS: The findings of this review illustrate that even better studies are at moderate risk of bias. Addressing issues related to confounding, selection of participants, measurement of exposures and outcomes, and missing data will improve the quality of future research in this area and lead to a clearer understanding of how employment conditions and psychosocial workplace exposures impact the mental health of young people. Generating high-quality evidence is particularly critical given the disproportionate impact of COVID-19 on young people's employment. In preparing for a post-pandemic world where poor-quality employment conditions and exposure to psychosocial workplace exposures may become more prevalent, rigorous research must exist to inform policy to protect the mental health of young workers.