Utilizing an Environmental Framework to Explore the Acceptability of a Health Promotion Program for Youth with Disabilities.

This study explored the acceptability of Children and Teens in Charge of their Health (CATCH), a program for children with spina bifida or cerebral palsy to enhance their physical activity and diet. Qualitative interviews were conducted with children (n = 6) and their parents (n = 6) who participated in CATCH. Analysis used an environmental systems framework. Microsystem factors impacting acceptability of the program were: Children's motivations for change, their age, and their physical health. Mesosystem factors were: Use of virtual coaching and the relationship between coach and child. Macrosystem factors (e.g. Covid-19), did not impact acceptability, but affected some goal attainment strategies. CATCH was broadly acceptable to children and parents and shows promise as a health promotion program tailored to children with disabilities. An environmental systems framework can potentially help other health promotion programs enhance their acceptability and success.

Resiliency to adversity in military personnel: The role of self-regulation.

Military service can include numerous adverse events. As such, resiliency has been considered as a means of potentially helping active-duty personnel face adversity and be better prepared for the demands of military service. However, research in military contexts has been hindered by use of disparate conceptualizations, definitions, and measures of resiliency. To provide some resolution to these inconsistencies, we use a comprehensive, theoretically based model of resiliency to explore how self-regulation processes contributed to Soldiers' negative affect and self-perceived effectiveness. We hypothesized that self-regulation (comprising distinct affective, behavioral, and cognitive processes) increments prediction of Soldiers' outcomes over and above trait-based resiliency protective factors. Using a sample of active-duty military personnel, cognitive self-regulation and affective self-regulation incremented the prediction of negative affect and self-perceived Soldier effectiveness, respectively, over and above trait-based protective factors. These results support the use of a comprehensive model and measure of resiliency, which may enable greater consistency across future research endeavors. As these results validated the links between self-regulation and post-adversity outcomes, this study provides a basis for developing new resiliency training programs. Additional implications for theory and continued research on resiliency in military contexts are discussed.

Community General Pediatricians' Perspectives on Providing Autism Diagnoses in Ontario, Canada: A Qualitative Study.

OBJECTIVE: Community general pediatricians (CGPs) are a potential resource to increase capacity for autism spectrum disorder (ASD) diagnostic assessments. The objective of this study was to explore factors influencing CGPs' perspectives on and practices of providing ASD diagnoses. METHODS: This qualitative study used a constructivist modified grounded theory approach. Participants included CGPs who had attended ASD educational events or had referred a child with suspected ASD to a tertiary rehabilitation center. Individual in-depth interviews with CGPs were recorded, transcribed, and coded. An explanatory framework was developed from the data. A summary of the framework was sent to participants, and responses indicated that no changes were needed. RESULTS: Eleven CGPs participated. Assessment for ASD consists of 3 stages: (1) determining the diagnosis; (2) communicating the diagnosis; and (3) managing next steps after diagnosis. Each of these stages of ASD diagnostic assessment exists within an ecological context of child/family factors, personal CGP factors, and contextual/systems factors that all influence diagnostic decision making. CONCLUSION: Community general pediatrician ASD diagnostic capacity must be considered within the larger context of ASD care. Suggestions to improve diagnostic capacity include preparing families for the diagnosis, changing CGP perceptions of ASD, providing community-based training, improving financial remuneration, and providing service navigation. Further study is needed to ensure that CGPs are providing accurate, high-quality assessments.

Validation of the Chinese version of the Assessment of Preschool Children's Participation for children with physical disabilities.

PURPOSE: To examine the psychometric properties of the Chinese version of the Assessment of Preschool Children's Participation (APCP-C). METHOD: The APCP, a measure of participation in play, skill development, active physical, and social activities of preschool children, was translated into Traditional Chinese. Data on 94 Taiwanese children with physical disabilities aged 2 to 6 years were analyzed. RESULTS: Internal consistency (Cronbach's α = 0.85 and 0.86) and test-retest reliability (ICCs = 0.79) were excellent for total scores, and varied from excellent to poor for activity type scores. Items were generally relevant to the Taiwanese culture. Correlations between scores for the APCP-C and the Chinese version of the Pediatric Evaluation of Disability Inventory Mobility and Social Functioning scales in general supported convergent validity (r = 0.33-0.68) but less support for discriminant validity. CONCLUSIONS: The results provide evidence of reliability, cross-cultural validity, and limited support for construct validity of the APCP-C in measuring participation of children with physical disabilities.

The cultural brokerage work of occupational therapists in providing culturally sensitive care.

BACKGROUND: The important place of culture within occupational therapy is widely recognized, and there is increasing emphasis on addressing the diversity of clients. PURPOSE: This study explores how occupational therapists perform cultural brokerage when providing culturally sensitive care to immigrant families. METHOD: A descriptive qualitative methodology was used for this study. A purposive sample of 17 occupational therapists from two Canadian paediatric rehabilitation centres were interviewed. FINDINGS: Participants encountered several cultural and structural constraints in providing culturally sensitive care. To overcome these constraints, clinicians used four strategies: (a) translating between health systems for clients, (b) bridging different meanings of occupational therapy to make it relevant for clients, (c) establishing long-term relationships by building trust and rapport, and (d) working with clients' relational networks to help them navigate the health system. IMPLICATIONS: Occupational therapists should advocate for both the individual needs of immigrant families and for institutional level resources to better meet the needs of diverse clients.

A multidimensional model of optimal participation of children with physical disabilities.

PURPOSE: To present a conceptual model of optimal participation in recreational and leisure activities for children with physical disabilities. METHODS: The conceptualization of the model was based on review of contemporary theories and frameworks, empirical research and the authors' practice knowledge. A case scenario is used to illustrate application to practice. RESULTS: The model proposes that optimal participation in recreational and leisure activities involves the dynamic interaction of multiple dimensions and determinants of participation. The three dimensions of participation are physical, social and self-engagement. Determinants of participation encompass attributes of the child, family and environment. Experiences of optimal participation are hypothesized to result in long-term benefits including better quality of life, a healthier lifestyle and emotional and psychosocial well-being. CONCLUSION: Consideration of relevant child, family and environment determinants of dimensions of optimal participation should assist children, families and health care professionals to identify meaningful goals and outcomes and guide the selection and implementation of innovative therapy approaches and methods of service delivery. Implications for Rehabilitation Optimal participation is proposed to involve the dynamic interaction of physical, social and self-engagement and attributes of the child, family and environment. The model emphasizes the importance of self-perceptions and participation experiences of children with physical disabilities. Optimal participation may have a positive influence on quality of life, a healthy lifestyle and emotional and psychosocial well-being. Knowledge of child, family, and environment determinants of physical, social and self-engagement should assist children, families and professionals in identifying meaningful goals and guiding innovative therapy approaches.

Assessment of Interprofessional Team Collaboration Scale (AITCS): development and testing of the instrument.

INTRODUCTION: Many health professionals believe they practice collaboratively. Providing insight into their actual level of collaboration requires a means to assess practice within health settings. This chapter reports on the development, testing, and refinement process for the Assessment of Interprofessional Team Collaboration Scale (AITCS). There is a paucity of literature and measurement tools addressing interprofessional collaborative team performance and the nature of effective teamwork processes and patient roles within collaborative teams. These gaps limit our knowledge about how health care teams form and function. Instruments are therefore needed to assess collaborative relationships. METHODS: The AITCS, with its 47 items within 4 subscales (partnership, cooperation, coordination, and shared decision making) and assessed on a 5-point Likert scale, was administered to a total of 125 practitioners from 7 health care teams practicing within a variety of settings, in 2 provinces in Canada. RESULTS: Principal components and factor analysis of data resulted in 37 items loading onto 3 factors, explaining 61.02% of the variance. The internal consistency estimates for reliability of each subscale ranged from 0.80 to 0.97, with an overall reliability of 0.98. Thus, the AITCS is a reliable and valid instrument. DISCUSSION: The psychometric analysis of this instrument supports its value in measuring collaboration within teams and when patients are included as team members. The AITCS can be applied to continuing professional education interventions to determine change over time. It has limitations to the Canadian context and within the settings where participants practiced. Further test and retest reliability and longitudinal study application is needed.

Development of a measure to assess effective listening and interactive communication skills in the delivery of children's rehabilitation services.

PURPOSE: Therapists' listening and communication skills are fundamental to the delivery of children's rehabilitation services but few measures comprehensively assess these skills. The 24-item Effective Listening and Interactive Communication Scale (ELICS) was developed to reflect a multifaceted conceptualization based on evidence in the literature. METHOD: Data from 41 pediatric rehabilitation therapists (occupational, physical, speech-language, recreation, and behavioural therapists; psychologists and social workers) were used to determine the factor structure, internal consistency, and construct validity of the subscales. RESULTS: The measure contains four subscales with very good to excellent reliability: Consensus-oriented, Exploratory, Receptive, and Action-oriented Listening. Content validity was ensured by the development process. CONCLUSIONS: The ELICS portrays listening as a purposeful, goal-oriented, and relational activity. The measure allows clinicians to assess and reflect on their listening/communication skills, and can be used to evaluate professional development activities and interventions geared to improving these skills.

Participation-based therapy for children with physical disabilities.

PURPOSE: Optimizing home and community participation of children with physical disabilities is an important outcome of rehabilitation. METHOD: A review of literature identified research and theory on participation of children with physical disabilities. The authors' incorporated current knowledge to conceptualize the experience of optimal participation, formulate principles of participation-based physical and occupational therapy, and develop a five-step process for intervention. A case report was completed to illustrate application to practice. RESULTS: Optimal participation involves the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation. Real-life experiences enable children to learn new activities and develop skills that optimize their participation and self-determination. Interventions are: goal-oriented, family-centered, collaborative, strengths-based, ecological, and self-determined. A distinguishing feature of intervention is that the therapist's primary role is to support the child and family to identify challenges to participation and solutions to challenges. The therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity. CONCLUSION: The model may have utility for collaboration with families and community providers, determining goals for participation, and providing evidence-informed interventions.

Determinants of social participation--with friends and others who are not family members--for youths with cerebral palsy.

BACKGROUND: Social participation provides youths with opportunities to develop their self-concept, friendships, and meaning in life. Youths with cerebral palsy (CP) have been reported to participate more in home-based leisure activities and to have fewer social experiences with friends and others than youths without disabilities. OBJECTIVE: The objective of this study was to identify youth, family, and service determinants of the participation of youths with CP in leisure activities with friends and others who are not family members. DESIGN: The study design was a cross-sectional analysis. METHODS: The participants were 209 youths who were 13 to 21 years old (52% male), had CP, and were classified in Gross Motor Function Classification System (GMFCS) levels I to V as well as their parents. The participants were recruited from 7 children's hospitals in 6 different states. Youths completed the Children's Assessment of Participation and Enjoyment in structured interviews. Parents completed the Coping Inventory, Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Measure of Processes of Care, and demographic and service questionnaires. Researchers determined GMFCS levels. A sequential multiple regression analysis was used to determine the youth, family, and service variables that predicted participation with friends and with others who were not family members. RESULTS: Sports and physical function, communication or speech problems, educational program, and the extent to which the desired community recreational activities were obtained explained 45.8% of the variance in the number of activities engaged in with friends. A higher level of parental education explained 6.3% of the variance in the number of activities engaged in with others who were not family members. Limitations The youths' activity preferences and intensity of participation were not examined. CONCLUSIONS: /b> Youth and service characteristics were determinants of participation with friends but not others who were not family members. The findings have implications for the role of physical therapists in promoting sports and physical and communication abilities and enhancing community opportunities to optimize the social participation of youths with CP.

Bringing the Life Needs Model to life: implementing a service delivery model for pediatric rehabilitation.

This article describes the use and utility of the Life Needs Model of Pediatric Service Delivery at a regional children's rehabilitation center. The model is a transdisciplinary, evidence-based model that guides pediatric service delivery to meet the long-range goals of community participation and quality of life for children and youth with disabilities. The article describes the use of the model as a tool to assist with the development of organizational culture, strategic and operational planning, the development of therapists' expertise, and the development of community partnerships. The model also has influenced human resources practices, community relations activities, and research. The model provides needed direction to service planners about the types of services that are important to provide in a geographical region, and fills a gap in outlining the nature of services that can be encompassed in pediatric rehabilitation.

The meaning of life experiences: application of a meta-model to rehabilitation sciences and services.

A motivational, developmental meta-model of the meaning of everyday life experiences is presented. The model proposes that there are 3 fundamental ways in which people establish meaning across the life span: the paths of belonging (relationships), doing (meaningful engagement in activities), and understanding oneself and the world. The principles of the model include intertwined, fundamental meanings of human experience; the indeterminacy of cause and effect; individual differences in preferences for ways of attaining meaning; the importance of commitments in life; and life-long adaptation and changes in meaning. The model provides an organizing framework that clarifies the assumptions of various disciplinary frames of reference with respect to establishing meaning in everyday life. Implications of the model are discussed for the rehabilitation sciences and rehabilitation service delivery.

Development of hand function among children with cerebral palsy: growth curve analysis for ages 16 to 70 months.

This study documents the development of hand and upper-extremity function in young children who have cerebral palsy (CP) with upper-extremity involvement using longitudinal data. Assessments of hand function and the quality of upper-extremity movement were conducted on 29 males and 22 females (mean age 36.2 months, SD 10.6; age range 16 to 60 months at baseline) and on four other occasions over 10 months. Linear mixed effects modeling was used to estimate average developmental curves and the degree of individual differences in the patterns of development which were conditional on the body-site distribution of CP and severity of impairments. Results indicate that hand function in this clinical population develops differently from overall upper-extremity skills with declines in function in upper-extremity skills being more common and pronounced among older children. However, there is substantial interindividual variation. Distribution of CP and severity of impairments were significant predictors of development. Results are discussed in terms of their clinical implications.