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Fakolade A, Stone C, Bobbette N. Identifying Research Priorities to Promote the Well-Being of Family Caregivers of Canadians with Intellectual and/or Developmental Disabilities: A Pilot Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7072. [PMID: 37998303 PMCID: PMC10671217 DOI: 10.3390/ijerph20227072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
Current programming and resources aimed at supporting the well-being of family caregivers often fail to address considerations unique to those caring for people with intellectual and/or developmental disabilities (IDDs). As a result, many caregivers of people with IDD feel isolated, stressed, and burnt out. A targeted research agenda informed by key stakeholders is needed and would allow research teams to coordinate resources, talents, and efforts to progress family caregiver well-being research in this area quickly and effectively. To address this aim, this pilot study used a Delphi design based on 2 rounds of questionnaires. In round 1, 19 stakeholders (18 females, 1 male), including 12 family caregivers, 3 rehabilitation providers, 2 researchers, and 2 organizational representatives, identified broad areas for caregiver well-being research. After collating the responses from round 1, stakeholders were asked to rank whether each area was considered a research priority in round 2. Data were analyzed using descriptive statistics and conventional content analysis. Eighteen stakeholders completed the round 2 survey (1 caregiver did not complete the round 2 survey), after which a consensus was reached. Stakeholders identified nine broad priorities, including system-level programs and services, models of care, health promotion, social inclusion, equity and diversity, capacity building, care planning along the lifespan, and balancing formal and natural community-based supports. Although preliminary in nature, the research priorities generated using an inclusive and systematic process may inform future efforts to promote the well-being of caregivers of Canadians with IDD.
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Affiliation(s)
- Afolasade Fakolade
- Louise D. Acton Building, School of Rehabilitation Therapy, Queen’s University, 31 George Street, Kingston, ON K7L 3N6, Canada (N.B.)
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Chi IJ, Lin LY. Using the Assessment of Motor and Process Skills and the Pediatric Evaluation of Disability Inventory to Assess Self-Care Performance Among Preschool Children With Autism Spectrum Disorder. Am J Occup Ther 2022; 76:23195. [PMID: 35143605 DOI: 10.5014/ajot.2022.046326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Caregiver rating scales often give an unclear picture of the actual self-care performance of preschool children with autism spectrum disorder (ASD). OBJECTIVE To assess self-care performance among preschool children with ASD using two standardized instruments. DESIGN Cross-sectional study. SETTING Clinics, hospitals, and early intervention centers in Tainan, Taiwan. PARTICIPANTS Sixty children with ASD (ages 48-71 mo). Outcomes and Measures: The Standard Version of the Childhood Autism Rating Scale-Second Edition, the Assessment of Motor and Process Skills (AMPS), and the Chinese version of the Pediatric Evaluation of Disability Inventory (PEDI-C). RESULTS About 53.3% of children with ASD scored below 1.5 logits for AMPS motor skills and below 1 logit for AMPS process skills, indicating difficulties performing activities of daily living tasks. The average PEDI-C self-care normative standard scores were moderately low (between -1 and -2 SDs), indicating poor self-care performance. The correlations between the two measures were also low (rs = .27-.44). Overall, the results for 36 children were consistent with AMPS and PEDI-C scores; however, those for 24 children (40.0%) were discrepant. CONCLUSIONS AND RELEVANCE These findings have implications for how preschool children with ASD perform their self-care activities and suggest that more than half of preschool children with ASD have a need for occupational therapy interventions that target self-care skills. Occupational therapy practitioners can work with preschool children with ASD and their families to help them improve their self-care performance. What This Article Adds: Many children with ASD need occupational therapy interventions that target self-care skills. Both the AMPS and the PEDI-C provide valuable information from different perspectives on the self-care performance of preschool children with ASD.
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Affiliation(s)
- I-Jou Chi
- I-Jou Chi, MS, is Occupational Therapist, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan. At the time this research was conducted, Chi was Graduate Student, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ling-Yi Lin
- I-Jou Chi, MS, is Occupational Therapist, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan. At the time this research was conducted, Chi was Graduate Student, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Gardiner E, Miller AR, Lach LM. Service adequacy and the relation between child behavior problems and negative family impact reported by primary caregivers of children with neurodevelopmental conditions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 104:103712. [PMID: 32554267 DOI: 10.1016/j.ridd.2020.103712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Raising a child with a neurodevelopmental disorder or disability (NDD/D) presents unique challenges to the family, and presence of behavior problems has been identified as a critical risk factor for a broad range of family outcomes. AIMS The current study examines whether caregivers' perceptions of child and family service adequacy mediate or moderate the relation between children's behavioral difficulties and negative family impact. METHODS AND PROCEDURES Caregivers provided data for 215 children with NDD/D (M = 8.16 years), completing measures of child behavior problems (Strengths and Difficulties Questionnaire), perceived child and family service inadequacy (Supports and Services Questionnaire), and family impact (Family Impact of Childhood Disability Scale). OUTCOMES AND RESULTS Both child and family service inadequacy partially mediated, but did not moderate the association between child behavior problems and perceived negative family impact. CONCLUSIONS AND IMPLICATIONS The current study highlights that all families of children with NDD/D are in need of support, irrespective of the severity of their child's behavioral difficulties. Furthermore, the findings reinforce that access to a range of supports serving both the child and family is critical to ameliorating negative perceptions regarding the impact of a child's disability on family life.
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Affiliation(s)
- Emily Gardiner
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Anton R Miller
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Lucyna M Lach
- School of Social Work, McGill University, 3506 University Street, Suite 300, Montreal, QC, H3A 2A7, Canada; Department of Pediatrics, Neurology and Neurosurgery, McGill University, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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Gardiner E, Miller AR, Lach LM. Family impact of childhood neurodevelopmental disability: considering adaptive and maladaptive behaviour. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:888-899. [PMID: 30230656 DOI: 10.1111/jir.12547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 10/10/2017] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The aim of the current study was to identify functional predictors of perceived impact of childhood disability among families of children with neurodevelopmental disorders and disabilities. We first examined the relationship between sub-domains of adaptive and problematic behaviour and perceived family impact. Second, we examined whether the same sub-domains would emerge as significant after controlling for the impact of child diagnosis, including autism spectrum disorder, cerebral palsy and intellectual disability. METHOD Caregivers of 216 children and adolescents (M = 8.17 years) with neurodevelopmental disorder and disability completed measures of children's practical, conceptual and social skills (i.e. adaptive behaviour), behaviour problems and positive and negative family impact. RESULTS Indices of child adaptive and problematic behaviour were only significantly associated with perceived negative family impact. Children's practical and social skills, as well as emotional symptoms, emerged as significant predictors of perceived negative family impact, with emotional symptoms accounting for greatest variance. Including diagnosis in our statistical models did not explain additional variance above and beyond these particular sub-domains of child functioning. CONCLUSIONS The study findings suggest that it is not children's most impaired domains of functioning that are perceived as significantly impactful by the family. The findings highlight the importance of devoting consideration to the ways in which the functional limitations experienced by children with chronic developmental health conditions similarly impact family life and well-being, regardless of disorder designation.
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Affiliation(s)
- E Gardiner
- BC Children's Hospital Research Institute, Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - A R Miller
- BC Children's Hospital Research Institute, Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - L M Lach
- School of Social Work, Department of Pediatrics, Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Phillips CD. The Pediatric Personal Care Allocation Model for Home Care (PCAM): A Personal Care Case-Mix Model for Children Facing Special Health Care Challenges. Health Serv Insights 2018; 11:1178632918795444. [PMID: 30202208 PMCID: PMC6128076 DOI: 10.1177/1178632918795444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/27/2018] [Indexed: 11/23/2022] Open
Abstract
Background: State Medicaid programs in the United States provide services to children with special health care challenges through the Early Prevention, Screening, Diagnostic, and Treatment program. One element of the services provided is Medicaid Personal Care Services (PCS), which are intended to correct or ameliorate any functional impairments faced by a child or youth (C/Y) in the community. Previous research indicates that considerable variation in the allocation of PCS depends on the assessor. A case-mix model is developed that might make the distribution of such services more uniform and equitable. Data: The sample in this research includes 2708 C/Y aged 4 to 20 who were receiving PCS in Texas in 2008. Results: A case-mix model was developed that groups sample members into 33 categories based on the number of hours of PCS authorized by an assessor. The Pediatric Personal Care Allocation Model (PCAM) explains 27% of the variance in the allocation of PCS hours. Discussion: The implementation of the PCAM should provide guidance to assist in ensuring that C/Y facing similar functional challenges receive similar levels of PCS. However, implementation of any case-mix model is only a first step in moving to a prospective payment system for PCS.
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Affiliation(s)
- Charles D Phillips
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
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Miller AR, Rosenbaum P. Perspectives on "Disease" and "Disability" in Child Health: The Case of Childhood Neurodisability. Front Public Health 2016; 4:226. [PMID: 27833905 PMCID: PMC5080371 DOI: 10.3389/fpubh.2016.00226] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/28/2016] [Indexed: 12/30/2022] Open
Abstract
Chronic health conditions are often associated with what is termed disability. Traditional thinking has focused on diagnosis and treatment of chronic diseases and disorders, with less attention to people's functional abilities and their contextual determinants. Understanding all of these factors is integral to addressing the predicaments and needs of persons with chronic conditions. However, these complementary yet distinct "worldviews" reflected in what we call disease and disability perspectives often remain, at best, only vaguely articulated. In this paper, we explore and expand on these perspectives in light of conceptual advances, specifically the framework of the World Health Organization's International Classification of Functioning, Disability and Health, and their epistemic underpinnings with reference to Wilhelm Windelband's notions of nomothetic and idiographic types of knowledge. Our primary focus is the children with neurodisability - life-long conditions that onset early in life and have functional consequences that impact developmental trajectories. We critically review and analyze conceptual material, along with clinical and research evidence relevant to the experiential and clinical realities of this population, to demonstrate the limitations of a biomedically based diagnostic-therapeutic paradigm at the expense of a developmental and disability-oriented perspective. Our main aim in this paper is to argue for an explicit recognition of both disease and disability perspectives, and a more balanced and appropriate deployment of these concepts across the continuum of clinical services, research, policy-making and professional and public education in relation to children with neurodisability; we also provide concrete recommendations to advance this progressive strategy. The relevance of these aims and strategies, however, extends beyond this particular population.
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Affiliation(s)
- Anton Rodney Miller
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
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Phillips CD. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges. Health Serv Insights 2016; 8:35-43. [PMID: 26740744 PMCID: PMC4694607 DOI: 10.4137/hsi.s35366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/21/2022] Open
Abstract
Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.
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Affiliation(s)
- Charles D Phillips
- Department of Health Policy and Management, School of Public Health, Health Science Center, Texas A&M University, College Station, TX, USA
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Phillips CD, Hawes C. The interRAI Pediatric Home Care (PEDS HC) Assessment: Evaluating the Long-term Community-Based Service and Support Needs of Children Facing Special Healthcare Challenges. Health Serv Insights 2015; 8:17-24. [PMID: 26401100 PMCID: PMC4567103 DOI: 10.4137/hsi.s30775] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/05/2022] Open
Abstract
The vast majority of assessment instruments developed to assess children facing special healthcare challenges were constructed to assess children within a limited age range or children who face specific conditions or impairments. In contrast, the interRAI Pediatric Home Care (PEDS HC) Assessment Form was specifically designed to assess the long-term community-based service and support needs of children and youth aged from four to 20 years who face a wide range of chronic physical or behavioral health challenges. Initial research indicates that PEDS HC items exhibit good predictive validity—explaining significant proportions of the variance in parents’ perceptions of needs, case managers’ service authorizations, and Medicaid program expenditures for long-term community-based services and supports. In addition, PEDS HC items have been used to construct scales that summarize the strengths and needs of children facing special healthcare challenges. Versions of the PEDS HC are now being used in Medicaid programs in three states in the United States.
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Affiliation(s)
- Charles D Phillips
- Department of Health Policy and Management, School of Public Health, Health Science Center, Texas A&M University, College Station, TX, USA
| | - Catherine Hawes
- Department of Health Policy and Management, School of Public Health, Health Science Center, Texas A&M University, College Station, TX, USA
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Elliott TR, Patnaik A, Naiser E, Fournier CJ, McMaughan DK, Dyer JA, Phillips CD. Medicaid personal care services for children with intellectual disabilities: what assistance is provided? When is assistance provided? INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:24-31. [PMID: 24635689 DOI: 10.1352/1934-9556-52.1.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report on the nature and timing of services provided to children with an intellectual disability (ID) identified by a new comprehensive assessment and care planning tool used to evaluate children's needs for Medicaid Personal Care Services (PCS) in Texas. The new assessment procedure resulted from a legal settlement with the advocacy community. Participants in the study were 1,109 children ages 4-20 with an intellectual disability diagnosis who were assessed between January and April of 2010. The need for assistance is higher on Saturday and Sunday, when school services are not available. We report differences in service patterns for children who vary in ID severity. Finally, we consider the implications of our results for policies and programs that serve families with children with an ID.
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Miller TR, Elliott TR, McMaughan DM, Patnaik A, Naiser E, Dyer JA, Fournier CJ, Hawes C, Phillips CD. Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services. Disabil Health J 2013; 6:317-24. [PMID: 24060254 DOI: 10.1016/j.dhjo.2013.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/29/2013] [Accepted: 02/25/2013] [Indexed: 11/25/2022]
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The care burden of families with members having intellectual and developmental disorder: a review of the recent literature. Curr Opin Psychiatry 2012; 25:348-52. [PMID: 22744406 DOI: 10.1097/yco.0b013e3283564248] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review recent studies on the care burden of families with a member having intellectual and developmental disorder. RECENT FINDINGS The family is the core unit for providing care to people with intellectual and developmental disorder, regardless of where they live. Recent research on this issue has been focused on two areas: the lifelong burden itself and its impact on the family. The research has incorporated a range of different approaches and has yielded diverse findings. SUMMARY The longevity of people with intellectual and developmental disorder has made caring for older adults with intellectual developmental disorder developing dementia a new challenge. In addition, worldwide deinstitutionalization has made it possible for people with intellectual and developmental disorder to live within their communities and integrate with the general population. Because disabled individuals may become parents themselves, the requirements of family care for children born to persons with intellectual and developmental disorder may be different from previous generations of parents who raised children with IDD.
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Phillips CD, Patnaik A, Moudouni DK, Naiser E, Dyer JA, Hawes C, Fournier CJ, Miller TR, Elliott TR. Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items. BMC Health Serv Res 2012; 12:19. [PMID: 22270147 PMCID: PMC3280154 DOI: 10.1186/1472-6963-12-19] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 01/23/2012] [Indexed: 11/20/2022] Open
Abstract
Background To test the validity and reliability of scales intended to measure activity limitations faced by children with chronic illnesses living in the community. The scales were based on information provided by caregivers to service program personnel almost exclusively trained as social workers. The items used to measure activity limitations were interRAI items supplemented so that they were more applicable to activity limitations in children with chronic illnesses. In addition, these analyses may shed light on the possibility of gathering functional information that can span the life course as well as spanning different care settings. Methods Analyses included testing the internal consistency, predictive, concurrent, discriminant and construct validity of two activity limitation scales. The scales were developed using assessment data gathered in the United States of America (USA) from over 2,700 assessments of children aged 4 to 20 receiving Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, specifically Personal Care Services to assist children in overcoming activity limitations. The Medicaid program in the USA pays for health care services provided to children in low-income households. Data were collected in a single, large state in the southwestern USA in late 2008 and early 2009. A similar sample of children was assessed in 2010, and the analyses were replicated using this sample. Results The two scales exhibited excellent internal consistency. Evidence on the concurrent, predictive, discriminant, and construct validity of the proposed scales was strong. Quite importantly, scale scores were not correlated with (confounded with) a child's developmental stage or age. The results for these scales and items were consistent across the two independent samples. Conclusions Unpaid caregivers, usually parents, can provide assessors lacking either medical or nursing training with reliable and valid information on the activity limitations of children. One can summarize these data in scales that are both internally consistent and valid. Researchers and clinicians can use supplemented interRAI items to provide guidance for professionals and programs serving children, as well as older persons. This research emphasizes the importance of developing medical information systems that allow one to integrate information not only across care settings but also across an individual's life course.
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Affiliation(s)
- Charles D Phillips
- Program on Disability, Aging, and Long-Term Care Policy, Texas A&M Health Science Center, School of Rural Public Health, College Station, Texas, USA.
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Elliott TR, Phillips CD, Patnaik A, Naiser E, Booth EA, Fournier CJ, Miller TR, Moudouni DM, Hawes C, Dyer JA. Medicaid Personal Care Services and caregivers' reports of children's health: the dynamics of a relationship. Health Serv Res 2011; 46:1803-21. [PMID: 21689095 PMCID: PMC3393024 DOI: 10.1111/j.1475-6773.2011.01284.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the relationship between Medicaid Personal Care Services (PCS) and caregivers' reports of activity (activities of daily living [ADL]) limitations for children with chronic health problems. DATA SOURCES/STUDY SETTING Primary data collected in 2008 and 2009. A state Medicaid program was the setting. The focus was children receiving Medicaid PCS. DATA COLLECTION Medicaid case managers assessed children to determine their need for PCS, using information provided by the child or informal caregivers. Two thousand seven hundred assessments were provided to researchers directly from case managers. PRINCIPAL FINDINGS Medical conditions and impairments explained 58 percent of the variance in the child's activity limitations. Activity limitations and problem behaviors explained 28 percent of the variance in PCS hours authorized. Which case manager completed the assessment also played a substantial role in determining hours of care. CONCLUSIONS Caregivers' reports of the severity of a child's activity limitations effectively summarize the effects of conditions and impairments on the child's ADL performance and have a significant impact on the level of services provided. Assessors often respond differently to children's characteristics and circumstances as they move from assessment to decisions concerning care provision. Our results imply that the provision of appropriate services may be enhanced when both case managers and caregivers play an active role in decisions concerning care provision.
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Phillips CD, Patnaik A, Dyer JA, Naiser E, Hawes C, Fournier CJ, Elliott TR. Reliability and the measurement of activity limitations (ADLs) for children with special health care needs (CSHCN) living in the community. Disabil Rehabil 2011; 33:2013-22. [PMID: 21345002 DOI: 10.3109/09638288.2011.555596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Meeting the personal care challenges of children with special health care needs (CSHCN) living in the community demands a reliable assessment of their abilities to perform activities of daily living (ADLs). This research investigates factors affecting the inter-rater reliability of functional assessments of CSHCN conducted in the home. METHODS Dual-standardised assessments were conducted with 236 community-dwelling CSHCN seeking or receiving Medicaid Personal Care Services (PCS) in a single state in USA. RESULTS Analyses revealed that assessments of CSHCN with the greatest or least amount of activity limitations exhibited the greatest agreement. The greatest disagreement occurred when assessors faced children with moderate to moderately severe activity limitations. Specific ADLs, where the greatest and least agreements occurred, varied by the level of the child's overall activity limitation. CONCLUSIONS These results imply that the most serious challenges to the reliability of home-based assessment of ADLs among CSHCN occur in cases of children with moderate or moderately severe activity limitations.
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Affiliation(s)
- Charles D Phillips
- School of Rural Public Health, Texas A&M Health Science Centre, Texas, USA.
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