Co-designing solutions to enhance access and engagement in pediatric telerehabilitation.

Introduction: Prior to the COVID-19 pandemic, children's therapy appointments provided by Ontario's publicly-funded Children's Treatment Centre (CTCs) primarily occurred in-person. With COVID-19 restrictions, CTCs offered services via telerehabilitation (e.g., video, phone), which remains a part of service delivery. CTC data shows that families experience barriers in attending telerehabilitation appointments and may need supports in place to ensure service accessibility. Our study aimed to co-design innovative solutions to enhance access and engagement in ambulatory pediatric telerehabilitation services. This manuscript reports the co-design process and findings related to solution development. Methods: This research project used an experience based co-design (EBCD) approach, where caregivers, clinicians and CTC management worked together to improve experience with telerehabilitation services. Interview data were collected from 27 caregivers and 27 clinicians to gain an in-depth understanding of their barriers and successes with telerehabilitation. Next, 4 interactive co-design meetings were held with caregivers, clinicians and CTC management to address priorities identified during the interviews. Using qualitative content analysis, data from the interviews and co-design meetings were analyzed and findings related to the solutions developed are presented. Findings: Four topics were identified from the interview data that were selected as focii for the co-design meetings. Findings from the co-design meetings emphasized the importance of communication, consistency and connection (the 3C's) in experiences with telerehabilitation. The 3C's are represented in the co-designed solutions aimed at changing organizational processes and generating tools and resources for telerehabilitation services. Discussion: The 3C's influence experiences with telerehabilitation services. By enhancing the experience with telerehabilitation, families will encounter fewer barriers to accessing and engaging in this service delivery model.

Video messaging: what works to persuade mothers to supervise young children more closely in order to reduce injury risk?

Recent research reveals that supervision can be a protective factor for childhood injury. Parents who closely supervise young children at home have children who experience fewer injuries. What is not known, however, is what messaging approaches (e.g., injury statistics, graphic images of injured children, personal testimonials by parents) are best to persuade parents to supervise more closely. Using video as the medium, the present focus group study of urban Canadian mothers explored their reactions to different formats and messages in order to: identify best practices to convince mothers that childhood injury prevention is important; determine how best to communicate messages about supervision to mothers; and identify what the nature and scope of these messages should be for motivating and empowering mothers to supervise closely. Results suggest that those who become aware of the scope of childhood injuries are motivated to pay attention to messaging about supervision, that such messages must be delivered with care so that parents do not feel guilty or blamed for acknowledging they could more closely supervise than they already are, that certain messages are not useful for encouraging closer supervision, and that both the content and presentation characteristics (images, accompanying sound) of messages are important determinants of effectiveness for motivating mothers to supervise more closely. Implications for developing interventions that effectively communicate information about child-injury risk and supervision to mothers are discussed.

The impact of accumulated experience on children's appraisals of risk and risk-taking decisions: implications for youth injury prevention.

OBJECTIVES: This study assessed whether repeated experience with a physical activity leads to increased risk taking and compared what factors (risk appraisals, emotion ratings, child attributes) predict risk taking before and after practice doing the activity. METHOD: Children 7 to 12 years of age participated in an ecologically valid risk-taking task in which they chose the highest height at which to set a balance beam before and after they practiced walking across it. RESULTS: Prior to accumulating experience, predictors of risk taking included appraisals of risk, child attributes, and extent of past experience with the activity. After accumulating experience, risk taking increased and was predicted by behavioral attributes (low inhibitory control, high sensation seeking) and appraisal of perceived vulnerability. CONCLUSION: When aiming to reduce risk taking, the best approach will be one that targets different determinants depending on children's extent of experience with the recreational activity.

Understanding risk compensation in children: Experience with the activity and level of sensation seeking play a role.

The aims of this study were to determine if children 7-12 years show risk compensation when engaging in ecologically valid recreational sports tasks, and to explore how experience with the activity and extent of sensation seeking influence this. Children were positioned up on a platform, on a bike or wearing rollerblades, and they were presented varying heights and inclines from which they selected the greatest one they go down when wearing and not wearing safety gear appropriate to the activity; when making their ratings they anticipated actually doing the task. Results revealed that children engaged in significantly more risk taking when wearing safety gear, thereby demonstrating risk compensation, and this was significantly greater for the activity with which they had greater experience. However, children high in sensation seeking demonstrated significantly more risk compensation in both the high and low experience activities, although the injury risk appraisals that predicted risk compensation varied with experience level. Implications for the design of injury prevention programs and directions for future research are discussed.

Psychological determinants of risk taking by children: an integrative model and implications for interventions.

OBJECTIVES: To draw on empirical findings of the psychological factors that cause elementary-school children to engage in risky play behaviors that can lead to injury, with the aim of developing an integrative model that can support intervention-program planning. METHODS: An extensive review of literature on this topic was conducted, determinants of risk taking for which there was empirical support were identified, and results were synthesized to create an integrative model of children's risk taking. RESULTS: Research on risk taking in children is limited, but the findings support the importance of examining child, family and socio-environmental factors to understand children's risk-taking behaviors. CONCLUSIONS: Development of a model outlining the determinants of risk behaviors can provide a foundation for initiatives that aim to reduce such behaviors and prevent childhood injuries.

Understanding children's injury-risk behaviors: the independent contributions of cognitions and emotions.

OBJECTIVE: Unintentional injuries are a leading threat to the health of elementary-school children, with many injuries happening when children are left to make their own decisions about risk taking during play. The present study sought to identify determinants of children's physical taking. METHODS: An ecologically valid task that posed some threat of injury was used (i.e., highest height of a balance beam they would walk across). Ratings of cognitions (extent of danger, perceived vulnerability for personal injury, potential severity of injury) and emotional reactions (fear, excitement) were taken when on the beam, just before the children walked across. RESULTS: Regression analysis, controlling for age and sex, revealed that risk taking was predicted from ratings of danger, fear, and excitement. CONCLUSIONS: Both cognitive and emotional factors independently contribute to predict children's physical risk taking. Theoretical and practical implications of these findings are discussed.