Mental health practices in rehabilitation for youth with physical disabilities: a chart review study.

PURPOSE: Evidence on co-occurring mental health problems in youth with physical disabilities is growing, however how services are provided remains unclear. This study examined current interprofessional rehabilitation practices for physical and mental health services. METHODS: Youth (aged 15-24) followed for a physical disability that had mental health problems were identified. Chart reviews were used to identify practices. Mental health-related diagnoses/symptoms, assessments, goals, interventions, and referrals were extracted for inductive content analysis. RESULTS: Sixty charts were reviewed. Mental health problems included anxiety (n = 53), depression (n = 25), neurodevelopmental (n = 19) and personality disorders (n = 8), often (n = 36) citing more than one. No mental health assessments were found, and in 43%, no goals or interventions were evident. Relevant goals (n = 98) targeted emotional management, autonomy/communication of needs, acceptance of physical condition, socialization, routines/energy levels, school/work supports, and leisure/calming environments. Interventions (n = 104) included emotional management, formal individual/group therapy, links with external supports, routines/activities, reflection/acceptance, and school/work support. Mental health services were received in-house (n = 24) and/or externally (n = 30), plus 18 referrals pending and 14 not referred. CONCLUSION: Many had more than one mental health problem, suggesting the complexity of their condition. While some mental health goals/interventions are documented, problems may often not be reported or addressed in this context.

Further attention can be directed to the needs of youth with physical disabilities and co-occurring mental health problems as they are not fully addressed by current interdisciplinary rehabilitation practices.Follow-up (services and referrals) should be adapted to the holistic needs of youth and their goals within the rehabilitation context.Rehabilitation professionals can be provided with training to build workforce capacity in mental health screening and have access to guidance when addressing situations related to mental health or referring to external services.

Environment-based approaches to improve participation of young people with physical disabilities during COVID-19.

AIM: To examine the effects of the Pathways and Resources for Engagement and Participation (PREP) intervention during the COVID-19 pandemic on (1) activity performance and satisfaction, and (2) motor, cognitive, and affective body functions. METHOD: An interrupted time-series design with multiple baselines across 21 young people (13 females, eight males) aged 16 to 25 years (median = 21 years 5 months) with physical disabilities was employed. The young people engaged in an 8-week self-chosen leisure activity (e.g. football, piano, photography) at their home or community. The Canadian Occupational Performance Measure (COPM) assessed activity performance and satisfaction weekly. Mental health problems, including affective and cognitive outcomes, were assessed weekly using the Behavior Assessment System for Children, Third Edition. Motor functions (e.g. trunk control, reaching, strength) were assessed biweekly. Linear mixed-effects models were used. RESULTS: The intervention had large effects on activity performance (0.78) and satisfaction (0.88) with clinically significant change in COPM scores (2.6 [95% confidence interval {CI}: 2.0-3.2] and 3.2 points [95% CI: 2.4-3.9] respectively). Young people without mental health problems at baseline benefited more from the intervention (p = 0.028). Improvements in at least one domain of body function occurred in 10 young people especially for motor outcomes. INTERPRETATION: Results demonstrate the effectiveness of PREP during adverse times and suggest benefits going beyond participation, involving outcomes at the body-function level.

Supporting rehabilitation stakeholders in making service delivery decisions: a rapid review of multi-criteria decision analysis methods.

PURPOSE: This review aimed to synthesize knowledge about multi-criteria decision analysis methods for supporting rehabilitation service design and delivery decisions, including: (1) describing the use of these methods within rehabilitation, (2) identifying decision types that can be supported by these methods, (3) describing client and family involvement, and (4) identifying implementation considerations. METHODS: We conducted a rapid review in collaboration with a knowledge partner, searching four databases for peer-reviewed articles reporting primary research. We extracted relevant data from included studies and synthesized it descriptively and with conventional content analysis. RESULTS: We identified 717 records, of which 54 met inclusion criteria. Multi-criteria decision analysis methods were primarily used to understand the strength of clients' and clinicians' preferences (n = 44), and five focused on supporting decision making. Shared decision making with stakeholders was evident in only two studies. Clients and families were mostly engaged in data collection and sometimes in selecting the relevant criteria. Good practices for supporting external validity were inconsistently reported. Implementation considerations included managing cognitive complexity and offering authentic choices. CONCLUSIONS: Multi-criteria decision analysis methods are promising for better understanding client and family preferences and priorities across rehabilitation professions, contexts, and caseloads. Further work is required to use these methods in shared decision making, for which increased use of qualitative methods and stakeholder engagement is recommended. IMPLICATIONS FOR REHABILITATIONMulti-criteria decision analysis methods are promising for evidence-based, shared decision making for rehabilitation.However, most studies to date have focused on estimating stakeholder preferences, not supporting shared decision making.Cognitive complexity and modelling authentic and realistic decision choices are major barriers to implementation.Stakeholder-engagement and qualitative methods are recommended to address these barriers.

The impact of parent involvement on improving participation of children born preterm: The story in the baseline.

Background: Preterm birth continues to be a major public health challenge that has long term consequences on participation into adulthood. However, little is known about effective interventions to improve the participation of children born preterm. Methods: This study gathered initial evidence on the usefulness of a goal-focused, environmental-based approach (Pathways and Resources for Engagement and Participation (PREP)) in improving the participation of children born preterm, and living in Ireland. Three school-age boys (6-7 years old) with a history of preterm birth participated in the 12-week PREP intervention. A 36-week single-subject AB design was employed and replicated across 3 different participation goals within each child and across 3 children. Activity performance was measured repeatedly, through parental involvement, using the Canadian Occupational Performance Measure (COPM), providing 9 individual outcome trajectories. Visual inspection and mixed-effects segmented regression were used. Results: Goals were selected from various participation domains and settings. Throughout the baseline phase, once goals were set, significant improvements in activity performance were observed for all participants (t = 14.06, p < 0.001). Further clinically significant improvements (2.58 on the COPM) for all 9 participation goals were seen in overall performance during the intervention phase. These changes remained at follow-up. Conclusions: Findings support family-centered practice and draw attention to the power of goal setting in improving participation within this context. Challenges with single-subject design with this population were also highlighted. Results demonstrate the potential impact of parent involvement when using an environmental-based approach to improve the participation of this underserved population.

Recommended practices to organize and deliver school-based services for children with disabilities: A scoping review.

BACKGROUND: Inclusive educational environments can have a positive effect on the general health and well-being of children with disabilities. However, their level of academic success and participation remains limited. Considering scarce resources and high needs, identifying efficient methods for providing interdisciplinary services is critical. This scoping review, therefore, aims to (a) synthesize current evidence about principles for organizing and delivering interdisciplinary school-based support services for students with disabilities and (b) ascertain useful strategies for implementation of principles in the school setting. METHODS: Scholarly and grey literature in rehabilitation and education were reviewed collaboratively with school-based stakeholders. A search of five databases identified 13,141 references and resulted in 56 relevant articles published from 1998 to 2017. Information (e.g., principles to organize services and strategies for implementation) was extracted, and thematic analysis was used to summarize findings. RESULTS: Within the documents retained, 65% were scientific and 35% were grey. Services primarily targeted students with behavioral issues, followed by those with cognitive and learning disabilities with a focus on improving social-emotional functioning and academic performance. Thematic analysis revealed 10 common principles to guide service organization (e.g., collaborative interventions and support for teachers) and seven implementation strategies (e.g., training and coordination) for employing these principles. CONCLUSIONS: Findings can guide rehabilitation professionals, educators, and policy makers in restructuring well-coordinated collaborative services involving training and capacity-building of school-based service providers. Such knowledge can contribute to the improved provision of care and, consequently, promote children's school participation and inclusion.

The effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention: improving participation of adolescents with physical disabilities.

AIM: This study examined the effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention in improving the participation of adolescents in community-based activities. METHOD: Twenty-eight adolescents (14 males, 14 females), aged 12 to 18 years (mean 14y 6mo, SD 21.6mo) with moderate physical disabilities participated in a 12-week PREP intervention. An interrupted time series design with multiple baselines was employed, replicating the intervention effect across three chosen activities and all participants. An occupational therapist worked individually with adolescents and parents to identify and implement strategies to remove environmental barriers that impede participation in selected activities. Activity performance was repeatedly measured using the Canadian Occupational Performance Measure (COPM) at baseline, intervention, and follow-up (20wks). For each activity, the trajectory representing change in performance was analyzed descriptively. Segmented regression combined with a mixed-effects modeling approach was used to statistically estimate the overall effectiveness of the intervention within and across 79 activities. RESULTS: A statistically significant improvement (B=2.08, p<0.001) was observed across all activities, 59 per cent of which also indicated a clinically significant change of more than 2 points on the COPM scale. Levels of performance were maintained during follow-up with an additional increase of 0.66 points on the COPM scale (t=3.04, p=0.004). Intervention was most effective for males and those with a higher number of functional issues. INTERPRETATION: Findings illustrate that participation can be improved by changing the environment only. Such evidence further supports emerging therapeutic approaches that are activity-based, goal-oriented, and ecological in nature. WHAT THIS PAPER ADDS: Environment-based intervention strategies, guided by the Pathways and Resources for Engagement and Participation, are effective in improving and maintaining adolescent participation. Intervention was most effective for males and those with a higher number of functional issues. The study design serves as an example for future pragmatic studies accounting for individual-based changes and contexts.

Opening doors to participation of youth with physical disabilities: An intervention study.

BACKGROUND: While participation in leisure activities is beneficial to youth's health, little is known about effective intervention strategies to promote participation. PURPOSE: The aim of this study was to examine the effectiveness of environment-based interventions on participation of youth with physical disabilities. METHOD: Six adolescents ages 14 to 17 years participated in a 12-week intervention aimed at removing environmental barriers and coaching parents. An interrupted time series design was employed and a systematic replication of the intervention effect was examined across three individualized participation goals and across participants (17 goals overall). Goal performance was measured repeatedly using the Canadian Occupational Performance Measure and analyzed using visual inspection and a celeration line approach. FINDINGS: A clinically significant improvement in performance scores (M = 4.5, SD = 1.77) was observed across all 17 goals, and a statistically significant treatment effect was replicated in 13 goals (76%). IMPLICATIONS: Findings support the effectiveness of environment-based interventions in promoting youth participation, but larger studies are required.

The participation of children and youth with disabilities in activities outside of school: A scoping review

BACKGROUND: Participation in occupations is vital for learning and development. Children with disabilities are at risk for decreased participation. PURPOSE: The purpose of this study is to examine peer-reviewed literature about the participation-based experiences of children and youth with disabilities in activities outside of formal preschool and school academics. METHOD: A scoping review was conducted to examine research studies published between 1990 and 2012. Studies included participants from 2 to 18 years who had at least one physical or intellectual/cognitive disability. FINDINGS: Forty-nine articles discussing 32 studies and three systematic reviews met the inclusion criteria. Perceptions of and influences on participation were important emerging themes about direct impacts on patterns of participation. A child or youth's level of functioning, activity level, level of enjoyment, and contextual factors were found to influence their level of successful participation. IMPLICATIONS: Occupational therapists can use the findings from this review to consider supports and barriers within interventions to enhance participation in meaningful life situations.

Measuring occupational balance: a theoretical exploration of two approaches.

BACKGROUND: Occupational balance is a fundamental yet complex concept in occupational therapy requiring empirical study. PURPOSE: To advance the theoretical discussion of occupational balance, its measurement and relationship to well-being. METHODS: In part one of this 2-phase study, 122 adults completed a bipolar measure of occupational balance, the Cross Impact Matrix (CIM) of the Personal Project Analysis and two well-being measures: the Satisfaction with Life Scale (SWLS) and Positive and Negative Affect Scales (PANAS). In part two, 24 adults completed the Inter-goal Relations Questionnaire (IRQ), a unipolar measure of occupational balance (harmony) and imbalance (conflict), plus the SWLS and PANAS. FINDINGS: Neither the CIM scores nor IRQ occupational balance/harmony were associated with well-being whereas the IRQ occupational imbalance/conflict was significantly associated with SWLS. IMPLICATIONS: Dimensions of occupational balance (conflict and harmony) may be best measured separately. To promote well-being attention can be given to reducing conflict across occupations.