Ableism among children and youth with acquired brain injury and their caregivers: a systematic review.

PURPOSE: Children and youth with acquired brain injury (ABI) experience persistent discrimination and ableism. The purpose of this systematic review was to understand the experiences and impact of ableism among children and youth with ABI. METHOD: Six international databases were systematically searched for articles from 2002-2022. Studies were screened independently by four researchers who performed the data extraction. Study quality was appraised using the Standard quality assessment criteria for evaluating primary research. RESULTS: Of the 2085 studies identified in the search, 15 met the inclusion criteria, which involved 1442 children and youth with brain injuries or caregivers representing them. Studies in the review showed the following key trends: (1) incidence of ableism among children and youth with ABI; (2) experiences of ableism at the individual and institutional levels, (3) impact of ableism (i.e., mental health, social relationships, quality of life) and (4) coping strategies (i.e., resources, supports). CONCLUSIONS: Our findings reveal the alarming incidence of ableism among youth with ABI. Therefore, there is a critical need for more research to explore youth's lived experiences of ableism, especially from their perspectives along with the co-development of solutions to help enhance their social inclusion and well-being.

Ableism and Workplace Discrimination Among Youth and Young Adults with Disabilities: A Systematic Review.

PURPOSE: Young people with disabilities are persistently under-employed and experience concerning rates of discrimination and ableism in looking for work and within the workplace. Focusing on youth is salient because rates of ableism are often higher among younger ages compared to older. The objective of this systematic review was to explore the experiences and impact of workplace discrimination and ableism among youth and young adults with disabilities. METHODS: Systematic searches of seven databases from 2000 to 2021 were conducted. Four reviewers independently applied the inclusion criteria, extracted the data and rated the study quality. RESULTS: Of the 39 studies meeting our inclusion criteria, they represented 516,281 participants across eight countries over a 20-year period. The findings highlight the rates of workplace ableism, factors affecting workplace ableism (i.e., type of disability, gender, education level, lack of employers' knowledge about disability), ableism in job searching and anticipated ableism. The review also noted the impact of workplace ableism, which included pay discrimination, lack of job supports and social exclusion, job turnover and unemployment, and discrimination allegations and charges. CONCLUSIONS: Our findings reveal the stark prevalence of workplace ableism among youth and young adults with disabilities. There is an urgent need for further in-depth research to understand youth's lived experiences of ableism and the development of solutions to address it so they can be included in a meaningful and respectful way in the workplace.

A Scoping Review of the Benefits and Challenges of Using Service Dogs for Finding and Maintaining Employment.

Purpose Having a service dog can help increase the independence of people with disabilities and they are considered a reasonable accommodation within employment settings. The objective of this scoping review was to understand the benefits and challenges of using a service dog in gaining and maintaining employment. Methods Systematic searches of seven international databases led to 19 studies meeting our inclusion criteria. Using a narrative review approach, we analyzed these studies regarding their sample characteristics, methods, results and quality of evidence. Results Nineteen studies were included in the review, which spanned across 6 countries over a 24-year period. Our findings showed that the benefits of having a service dog included improvements in employment status, employers' recognition of service dogs as a workplace accommodation, lower absenteeism, ability to travel to work, and other career-related benefits. Challenges with having a service dog included discrimination and exclusion, and lack of employers' awareness of service dogs and people with disabilities. Conclusions Our findings highlight several benefits and challenges of having a service dog in the workplace. More research is needed to explore the impact of service dogs on employment, health and productivity in the workplace and how this may vary by type of disability and service dog.

Unravelling the Complexities of Workplace Disclosure Among Persons with Non-Visible Disabilities and Illnesses: A Qualitative Meta-Ethnography.

BACKGROUND: Deciding whether and how to disclose a disability at work for persons with non-visible disabilities and illnesses involve complex processes. Research has focused on antecedents and outcomes of disclosure. More research is needed to understand the lived experiences related to disclosure decision-making and actual navigation of disclosure and concealment at work. PURPOSE: To understand the experiences of persons with non-visible disabilities and illnesses regarding workplace disclosure decision-making, navigating disclosure and/or concealment, and experiential differences across disability and illness types, ages, geographic locations, and genders. METHODS: We conducted a qualitative meta-synthesis using Noblit and Hare's seven steps of meta-ethnography. Searches were conducted via six databases. Studies were analyzed to develop conceptual categories, third-order constructs (themes), and a line-of-argument with comparisons drawn from the disclosure decision making model, disclosure process model, and consideration of disability and illness types, genders, ages, and geographic locations. RESULTS: Twenty-four studies were included involving 489 participants, aged 16 to 81, from nine countries, focusing on one non-visible disability or illness, or multiple. We developed four themes for the disclosure decision-making process (self- and other-focused, experiential, and environmental/workplace factors) and two themes for the disclosure/concealment event (disclosure/concealment logistics and timing) and noted emerging trends across ages, genders, disability and illness types, and geographic locations. CONCLUSIONS: Knowledge obtained could be used among professionals who support persons with non-visible disabilities and illnesses to help them navigate disclosure at work, and to consider the role of age, genders, disability and illness types, and geographic locations on disclosure.

Exploring Direct and Indirect Associations of Exercise and Sport Participation with Employment among Individuals with Disabilities: A Scoping Review.

Purpose Exercise and sports have many positive benefits for persons with or without a disability. Despite this, the contribution of exercise and sport participation to employment is less documented. The purpose of this scoping review was to provide insight into the direct and indirect associations of exercise and sport participation with employment among persons with disabilities. Methods Six databases were searched (MEDLINE, Embase, Scopus, PsychINFO, CINAHL, and HealthStar) from their inception date to March 20, 2020. Peer-reviewed English and French articles were included if at least one outcome measure on employment or work-related outcomes as a result of participation in, or benefits of exercise and sport participation was the focus of the study. Results The research identified 2796 hits. Of which, 23 published between 1992 and 2019 met eligibility criteria. Seven studies identified a direct association between exercise and sport participation with employment and full-time positions. Sixteen studies reported on improved health/work-related outcomes such as occupational performance (i.e., self-care, functional independence), physical fitness (i.e., upper extremity strength, endurance) and psychological well-being (i.e., self-efficacy). Conclusions This scoping review highlights that exercise and sport participation have associations with employment and work-related outcomes. Benefits of exercise and sports may be considered to a greater extent, than in the past, in programs that facilitate employment for persons with disabilities. Additional research using longitudinal design should be conducted to further understand the strength of these associations and evaluate whether exercise and sport participation should be incorporated more intensely in vocational programs.

The training needs for gender-sensitive care in a pediatric rehabilitation hospital: a qualitative study.

BACKGROUND: Gender is an important social determinant of health; however, clinicians often lack training in how to provide gender-sensitive care. Offering appropriate and relevant training could help to address some gender-based health inequalities. Our objective was to identify and describe the training needs for gender-sensitive care among pediatric rehabilitation healthcare providers. METHODS: This study used an interpretive descriptive qualitative design to conduct interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man), from a pediatric rehabilitation hospital in a large urban center, in Ontario, Canada from a range of disciplines. Interviews were transcribed verbatim and analyzed using an open-coding inductive thematic analysis. RESULTS: Our analysis revealed the following themes: [1] lack of knowledge about gender-sensitive care and the need for more training; [2] content of the desired training (i.e., gender differences, effective communication and how to practice gender-sensitive care) and [3] delivery method of the training. CONCLUSIONS: Enhanced gender-sensitive training for healthcare providers is required for optimizing patient outcomes and addressing gender-based health inequalities. Educators in pediatric rehabilitation should consider developing gender-sensitive care training that is embedded within post-graduate education and also continuing education within hospitals and community care centers.

Measures of Workplace Inclusion: A Systematic Review Using the COSMIN Methodology.

Purpose To systematically assess the measurement properties and the quality of the evidence for measures of inclusion or exclusion at work. Methods Comprehensive searches of five electronic databases were conducted up to February 2019. Eligible studies aimed to develop a measure of workplace inclusion or exclusion or assessed at least one measurement property. Pairs of reviewers independently screened articles and assessed risk of bias. Methodological quality was appraised with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best-evidence synthesis approach guided the analysis. For each measurement property, evidence quality was rated as high, moderate, low, or very low and results were classified as sufficient, insufficient, or inconsistent. Results The titles and abstracts of 14,380 articles were screened, with 151 full-text articles reviewed for eligibility. Of these, 27 studies were identified, 10 of which were measure development studies. Included measures were the Workplace Ostracism Scale, Ostracism Interventionary Behaviour Scale, Workplace Culture Survey, Workplace Exclusion Scale, Perceived Group Inclusion Scale, Organizational Cultural Intelligence Scale, Inclusion-Exclusion Scale, Climate for Inclusion Scale, Workplace Social Inclusion Scale and the Inclusion-Diversity Scale. Most workplace inclusion instruments were not examined for some form of validity or reliability and evidence for responsiveness was absent. The quality of the evidence for content validity was low for 30% of studies and very low for 70% of studies. Conclusion Future research should focus on comprehensive evaluations of the psychometric properties of existing measures, with an emphasis on content validity, measurement error, reliability and responsiveness.

Five Approaches to Qualitative Comparison Groups in Health Research: A Scoping Review.

Qualitative researchers have much to gain by using comparison groups. Although their use within qualitative health research is increasing, the guidelines surrounding them are lacking. The purpose of this article is to explore the extent to which qualitative comparison groups are being used within health research and to outline the lessons learned in using this type of methodology. Through conducting a scoping review, 31 articles were identified that demonstrated five different types of qualitative comparison groups. I highlight the key benefits and challenges in using this approach.

A Systematic Review of the Role of Gender in Securing and Maintaining Employment Among Youth and Young Adults with Disabilities.

Purpose There is a critical need for gender-specific vocational supports for young adults with disabilities as they transition to employment. We conducted a systematic review to explore the role of gender in securing and maintaining employment. Methods Systematic searches of seven databases identified 48 studies meeting our inclusion criteria. Using a narrative synthesis approach, these studies were analyzed in terms of the characteristics of the participants, methodology, results, and quality of the evidence. Results Among the 48 studies, 112,473 participants (56% male), mean age (of the total sample) was 21, represented across ten countries. Twenty-one studies reported that young men with disabilities had better employment outcomes than women with disabilities. Eight studies showed that females with disabilities had better employment outcomes than males. Five studies reported that there were no gender differences in employment outcomes for youth with various disabilities. With regards to maintaining employment, men with disabilities often work more hours and have better wages compared to women with disabilities. There are several gender-related barriers and facilitators to maintaining employment including social supports and gender role expectations. Conclusions Our findings highlight that there is a critical need for gender-specific vocational supports for young adults with disabilities.

A Systematic Review of the Benefits of Hiring People with Disabilities.

Purpose We reviewed literature on the benefits of hiring people with disabilities. Increasing attention is being paid to the role of people with disabilities in the workplace. Although most research focuses on employers' concerns, many companies are now beginning to share their successes. However, there is no synthesis of the peer-reviewed literature on the benefits of hiring people with disabilities. Methods Our team conducted a systematic review, completing comprehensive searches of seven databases from 1997 to May 2017. We selected articles for inclusion that were peer-reviewed publications, had a sample involving people with disabilities, conducted an empirical study with at least one outcome focusing on the benefits of hiring people with disabilities, and focused on competitive employment. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality. Results Of the 6176 studies identified in our search, 39 articles met our inclusion criteria. Findings show that benefits of hiring people with disabilities included improvements in profitability (e.g., profits and cost-effectiveness, turnover and retention, reliability and punctuality, employee loyalty, company image), competitive advantage (e.g., diverse customers, customer loyalty and satisfaction, innovation, productivity, work ethic, safety), inclusive work culture, and ability awareness. Secondary benefits for people with disabilities included improved quality of life and income, enhanced self-confidence, expanded social network, and a sense of community. Conclusions There are several benefits to hiring people with disabilities. Further research is needed to explore how benefits may vary by type of disability, industry, and job type.

A systematic review of factors affecting driving and public transportation among youth and young adults with acquired brain injury.

PURPOSE: Although many people with an acquired brain injury (ABI) encounter difficulties with executive functioning and memory which could negatively affect driving, few people are assessed for fitness to drive after injury. The purpose of this systematic review was to synthesize the literature on factors affecting driving and public transportation among youth and young adults with ABI, post injury. METHOD: Seven databases were systematically searched for articles from 1980 to 2016. Studies were screened independently by two researchers who performed the data extraction. Study quality was appraised using the Standard Quality Assessment Criteria (Kmet) for evaluating primary research from a variety of fields. RESULTS: Of the 6577 studies identified in the search, 25 met the inclusion criteria, which involved 1527 participants with ABI (mean age = 25.1) across eight countries. Six studies focused on driving assessment and fitness to drive, ten on driving performance or risk of accidents and nine studies explored issues related to accessing or navigating public transportation. Quality assessment of the included studies ranged from 0.60 to 0.95. CONCLUSIONS: Our findings highlight several gaps in clinical practice and research along with a critical need for enhanced fitness to drive assessments and transportation-related training for young people with ABI.

Gender and Transition From Pediatric to Adult Health Care Among Youth With Acquired Brain Injury: Experiences in a Transition Model.

OBJECTIVE: To explore gender and sex differences in experiences of transitioning to adult health care among young adults with acquired brain injury (ABI) who take part in a coordinated model of transitional care. DESIGN: Descriptive design using in-depth semistructured qualitative interviews. SETTING: Interviews over the phone and in person. PARTICIPANTS: Participants (N=18) included 10 young adults with a diagnosis of ABI (4 women, 6 men; age range, 19-21y) and 9 parents (8 women, 1 man) from the Greater Toronto Area, Ontario, Canada. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Semistructured interviews with participants. RESULTS: Our findings highlight several commonalities and differences relative to sex and gender among young adults with ABI who are transitioning from pediatric to adult care. Both young adult men and women experienced a similar transition process and similar organization, continuity, and availability of care. Sex differences were found in relational factors (eg, communication, family involvement, social support). Young adult men, and parents of the men, differed in their transition regarding relational factors (eg, communication, family involvement). CONCLUSIONS: Our findings show that young adult men and women with ABI who have taken part in a transition preparation program experience similarities in organization, continuity, and availability of care, but they experience differences in relational factors (eg, communication, family involvement).

Clinician and educator experiences of facilitating students' transition back to school following acquired brain injury: A qualitative systematic review.

OBJECTIVE: Transition back to school following paediatric acquired brain injury (ABI) is complex. It must be facilitated by healthcare and educational professionals, who need to work together to return affected students to learning. This qualitative systematic review synthesizes qualitative studies on clinicians' and educators' experiences of facilitating hospital-to-school transitions following ABI. METHODS: A search was conducted using seven electronic databases (CINAHL, Cochrane, EMBASE, ERIC, HealthSTAR, MEDLINE, PsycINFO) and key resources were manually reviewed. Publications selected for inclusion had a sample of clinicians and/or educators who worked with children/youth with ABI and focused on hospital-to-school transition processes from the professionals' perspectives. RESULTS: The initial search returned 4761 publications. Of those, 10 met the inclusion criteria. Six main themes emerged across those publications. Three related to transition barriers: (1) lack of training and education regarding transition processes; (2) lack of communication between stakeholders; and (3) lack of preparation for transition. The remaining three presented items that both facilitate and/or impede the transition process: (4) supports available; (5) linking agents; and (6) policies and procedures guiding transition. CONCLUSIONS: Clinicians and educators called for collaboration and communication to support students' transition back to school. Further inquiry into designated linking agents and policies that facilitate hospital-to-school transitions for students following ABI may address these lacking areas.

Parents' experiences of caring for a child with autism spectrum disorder.

Autism spectrum disorder (ASD) is a developmental disorder involving abnormal communication, repetitive and restrictive interests, and impaired social functioning. ASD can have a profound impact on family life, including the roles and responsibilities that parents assume. In this metasynthesis, we explore the experiences of parents who care for a child with ASD. We undertook a thematic synthesis to integrate qualitative evidence, searching 10 electronic databases and reviewing 4,148 abstracts. We selected 31 articles for inclusion (involving 160 fathers and 425 mothers) and examined the articles using a constant comparative approach. We identified six themes: prediagnosis, diagnosis, family life adjustment, navigating the system, parental empowerment, and moving forward. Our findings can inform the development of programs and services for families, provide insight for health care workers who advocate on behalf of parents, and provide valuable information to parents, particularly those of children newly diagnosed with ASD.

A qualitative synthesis of adolescents' experiences of living with spina bifida.

In this article, I explore the experiences and perspectives of youth living with spina bifida, the second most common congenital condition in North America, to inform the development of health programs. I undertook a thematic metasynthesis to integrate qualitative evidence across studies examining the experiences of youth with spina bifida. I used 10 electronic databases to search for and review 4,051 abstracts, and identified 12 articles meeting the inclusion criteria. I examined those articles using a constant comparative approach, drawing on concepts of normalcy and biographical disruption to inform understanding of three emergent themes: (a) the medical management of spina bifida; (b) the importance of peer and family relationships (i.e., social support, belonging, and challenges in peer connections); and (c) identity and self-concept (i.e., normalization). This metasynthesis provides insight for youth, parents, and clinicians on areas of life in which youth could use further support.

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.

Applying an intersectional ecological framework to understand ableism and racism in employment among youth and young adults with disabilities.

PURPOSE: Youth with disabilities often face many barriers in finding employment. A knowledge gap exists surrounding the experiences of racially minoritized youth with disabilities who arguably encounter multiple and complex forms of discrimination. The purpose of this study was to understand the experiences of ableism and racism in employment among racially minoritized youth and young adults with non-apparent disabilities. METHODS: Individual semi-structured interviews were conducted with 19 racially minoritized participants aged 17-30 with non-apparent disabilities. Data were analyzed using a deductive thematic analysis approach informed by an intersectional ecological framework. RESULTS: Themes that affected racially minoritized youth's employment included: (1) microsystems (i.e., individual barriers and facilitators to employment); (2) mesosystems (i.e., peers, family, disability, race/ethnicity, and work); (3) exosystems (i.e., workplace policies, healthcare system, educational institutions, community organizations); (4) macrosystems (i.e., ableism, racism, gendered discrimination and intersectional forms of discrimination); (5) the chronosystem (i.e., timing of obtaining employment, diagnosis and discrimination); and (6) ecological niche, which involved the extent to which work environments were safe and inclusive. CONCLUSION: Applying an intersectional ecological framework facilitates our understanding of ableism and racism in employment among youth and young adults with disabilities. Further attention is urgently needed to minimize discrimination and enhance supportive, inclusive and psychologically safe, work environments for minoritized youth with disabilities.

Racially minoritized youth with disabilities experience multiple forms of discrimination including ableism and racism occurring at multiple levels.Clinicians and service providers should develop and implement more tailored supports to optimize the employment outcomes and work experiences for youth with multiple minoritized identities.Clinicians should consider enhancing their knowledge about the challenges that youth with multiple minoritized identities encounter and help to connect them with appropriate supports and opportunities.Clinicians and service providers should consider their own potential biases to help improve health delivery and outcomes for multiply marginalized clients.

Emergency and disaster preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers: a scoping review.

PURPOSE: People with disabilities, especially children and youth, are often not considered in emergency and disaster preparedness planning, which leaves them vulnerable and at a higher risk of the negative effects of natural and human caused disasters. The purpose of this study was to understand the extent of emergency and disaster preparedness and factors influencing preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers. METHODS: Our scoping review involved searching six international databases that identified 1146 studies of which 27 met our inclusion criteria. RESULTS: The studies in this review involved 2613 participants (i.e., children, parents, educators and clinicians) across nine countries over a 20-year period. Our results highlighted the following trends: (1) the extent of emergency preparedness; (2) factors affecting emergency preparedness; and (3) interventions to enhance preparedness. CONCLUSIONS: Our findings underscore the critical need for more attention to emergency preparedness for children and youth with disabilities, their families and service providers and their inclusion in planning.

Support is needed for emergency preparedness for children with disabilities at an individual, family and community level.Clinicians should assist children with disabilities and their families to develop a disaster and emergency preparedness plan that includes their medical needs, basic supplies and connections to relevant resources and supports.Clinicians and educators should advocate for the inclusion of children and youth with disabilities in emergency and disaster preparedness.

Exploring racial disparities and inequalities among children and youth with acquired brain injury: a systematic review.

PURPOSE: Racial minoritized children and youth with acquired brain injury (ABI) often experience multiple forms of discrimination. The purpose of this systematic review was to understand the racial disparities in health care among children and youth with ABI and their caregivers. METHOD: Six international databases (Ovid Medline, Embase, Healthstar, Psychinfo, Scopus, and Web of Science) were systematically searched for peer-reviewed articles. Studies were screened by two researchers who also conducted the data extraction and quality appraisal. A narrative synthesis approach was used to analyze the data. RESULTS: Of the 8081 studies identified in the search, 34 met the inclusion criteria, which involved 838,052 children and youth with brain injuries (or caregivers representing them) across two countries. The following themes were noted in the studies in our review: (1) racial disparities in accessing care (i.e., diagnosis, hospital admission, length of stay, rehabilitation treatment); (2) racial disparities in ABI-related health outcomes (i.e., functional outcomes and mortality rates); and (3) factors affecting racial disparities (i.e., sources in injury, insurance and expenditures, and intersectionality). CONCLUSIONS: Our findings reveal the concerning racial disparities among children and youth with ABI. Further research should explore solutions for addressing such racial disparities and solutions to address them.

Racial minoritized youth with acquired brain injury experience many barriers and inequalities in accessing care and health care leaders should help to address such gaps and disparities in the health system.Clinicians should familiarize themselves with the common factors affecting racial disparities in acquired brain injury outcomes including sources of injury, types of insurance and cultural factors.Additional training in working with patients from racially diverse backgrounds and in providing culturally appropriate care among healthcare providers is needed.More efforts are needed to address racial disparities at the individual and structural levels that continue to exist in rehabilitation services for children and youth with acquired brain injury.

More than just double discrimination: a scoping review of the experiences and impact of ableism and racism in employment.

PURPOSE: Research has shed light on the employment barriers faced by individuals with disabilities, and by racialized people. The challenges faced by people belonging to both marginalized groups are less well-understood. The purpose of this scoping review was to examine existing research on labour market and workplace experiences of racialized people with disabilities, and to identify how ableism and racism intersect to shape employment experiences and outcomes. METHODS: Seven international databases were searched, covering the period from 2000 to April 2022. Four reviewers independently conducted the screening, and data extraction and analysis were performed on 44 articles that met our inclusion criteria. RESULTS: The findings highlighted rates of workplace ableism and racism (including discrimination allegations and perceived discrimination); types and forms of experiences arising from the intersection of ableism and racism (including unique individual stereotyping and systemic and institutional discrimination); and the role of other demographic variables. The intersection of ableism and racism impacted labour market outcomes, well-being in the workplace, and career/professional advancement. CONCLUSIONS: Our review highlights the need for greater in-depth research focusing explicitly on the intersection of ableism and racism (and of other forms of discrimination), to better understand and address the barriers that racialized people with disabilities face in employment.IMPLICATIONS FOR REHABILITATIONThe experiences of racialized people with disabilities have been under explored, and clinicians and rehabilitation specialists should consider incorporating intersectionality into their practices to better understand and serve these populations.Ableism and racism do not operate in isolation, and clinicians and other professionals need to be aware that racialized people with disabilities may face unique challenges and barriers as a result.Service providers should aim to address gaps and inequities in services faced by racialized people with disabilities which may prevent them from finding and/or maintaining meaningful employment.