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Bury SM, Zulla R, Spoor JR, Flower RL, Nicholas DB, Hedley D. An ecological systems model of employee experience in industry-led autism employment programmes. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1457-1470. [PMID: 38551173 PMCID: PMC11134994 DOI: 10.1177/13623613241241574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
LAY ABSTRACT We asked 33 autistic adults from two industry-led employment programmes about their experiences in the programmes. These are programmes started by companies to recruit and support autistic people in work. We also asked about their workplace supports, relationships and how they thought the programme had impacted their life. Understanding the experiences of people in these industry-led employment programmes is important as the information can help to improve the programmes and participants' experiences. After reviewing the interviews, we found five themes that best described the employee's experience: (1) working involves multiple job tasks that evolve as the employment context changes; (2) relationships in the workplace are diverse and are influenced by the type of work participants do and the work environment; (3) workplace needs change as the autistic employees learn to navigate their work environment; (4) autistic employees develop a professional identity in the workplace as they master work and feel more integrated in the workplace; and (5) recommendations for the development of supportive workplace environments for autistic people. We explored the way that aspects of the two employment programmes (e.g. training) and factors outside the programme changed with time and contributed to the participant's experience. We developed a new model to capture individual and workplace factors that contribute to the experience of autistic people who participate in industry employment programmes.
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Affiliation(s)
| | - Rosslynn Zulla
- University of Calgary, Canada
- University of Alberta, Canada
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Hu Y, Callander E. Long-Term Effect of Having a Child at Risk of Developmental Delays on Parental Labor Force Participation. Matern Child Health J 2024; 28:1052-1060. [PMID: 38334864 PMCID: PMC11058796 DOI: 10.1007/s10995-024-03897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study aimed to examine the long-term influence of having a child at risk of different developmental delays (communication, mobility, self-care, relating, learning, coping, or behaving) on parental labor force participation as the child grows. METHOD A retrospective cohort was conducted using data from the Longitudinal Study of Australian Children survey, Waves 1-8 covering birth to 15 years of age of children. Multivariable logistic regressions were used to explore the odds ratio of mothers being out of the labor force at different children's ages. Cox proportional hazards models were utilized to identify the 'risk' of mothers returning to the workforce after leaving. All models were adjusted for the mother's age, education attainment, and employment status at time of birth, as well as marital status at the current wave. RESULTS There were 5,107 records of children, and 266 of them were at risk of any developmental delays at age 4-5 years. This sample represents 243, 026 children born in Australia in 2003/04. After adjusting for potential confounders, mothers of children at risk of each type of developmental delay (except mobility and self-care) had greater odds of being out of, and not returning to the labor force from children aged 2-3 to 14-15 years, when compared to mothers of children who are not at risk of developmental delays. Similar differences were found for fathers but were distinctly small and with narrower fluctuations, compared to mothers. CONCLUSION Policies and programs funded by the government are greatly needed to support the mothers of children at risk of developmental delays.
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Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- University of Technology Sydney, Building 10, Level 8, Room 109 235-253 Jones Street, Ultimo, NSW, 2007, Australia.
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Pedersen ER, Anke A, Langøy EE, Olsen MI, Søndenaa E. Mental health, challenging behaviour, diagnosis, and access to employment for people with intellectual disabilities in Norway. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13217. [PMID: 38459896 DOI: 10.1111/jar.13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/09/2023] [Accepted: 02/10/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Studies have found that presence of challenging behaviours and mental health problems limits employment for people with intellectual disabilities. This study investigates the associations between age, gender, living condition, level of intellectual disability, diagnoses, behaviour, mental health, and employment in adults with intellectual disabilities in Norway. METHOD A cross-sectional community-based survey including 214 adult participants (56% men) with intellectual disabilities. RESULTS In our sample, 25% had no organised day activity, 27% attended non-work day care, 19% attended sheltered employment, or day care with production, without pay and 29% worked in paid sheltered employment. One participant attended mainstream employment. Moderate and severe/profound level of intellectual disability, possible organic condition and irritability significantly reduced the odds of employment (paid and unpaid). CONCLUSION Findings suggest unequal access to the sheltered employment that was meant to be inclusive. More individualised evaluation of prerequisites is suggested to further facilitate employment for this group.
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Affiliation(s)
- Erlend Refseth Pedersen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Model and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Emmy Elizabeth Langøy
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Høgskolen i Molde, Molde, Norway
| | - Monica Isabel Olsen
- Faculty of Humanities, Social Sciences and Teacher Education, Department of Teacher Education and Pedagogy, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Erik Søndenaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway
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Bury SM, Hedley D, Uljarević M, Stokes MA, Begeer S. A repeated cross-sectional study of daily activities of autistic adults. Autism Res 2024; 17:947-954. [PMID: 38634518 DOI: 10.1002/aur.3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
It is crucial to arrive at a comprehensive understanding of the types of daily activities autistic adults typically engage in. However, previous research has almost exclusively focused on vocational or education activities. Further, it remains unclear how and whether specific daily activities participation rates change proportionally over time, vary by gender, or compare to nationally representative data. Utilizing eight annual data waves from the Netherlands Autism Register (NAR) this study aims to bridge this gap. Participants were 2449 autistic adults who indicated their participation in 18 daily activities. Results suggest that autistic adults engaged most frequently in vocational activities (e.g., paid employment, study) and participation rates were stable over time. Participation rates in non-vocational activities (e.g., hobbies, homemaking) fluctuated proportionally over time, with reports of no structured daytime activities reducing over time. Labor force participation amongst NAR participants was significantly lower than Dutch population data for the same time periods. Unemployment rates fluctuated, and were significantly higher than population data, but not for all time points. Females compared to males were overrepresented in unpaid daily activities (e.g., study, volunteer, housemaker) and work incapacitation, and underrepresented in paid employment. Employment differences in gender corresponded to national data. These findings characterize more clearly the daily activities of autistic adults, and highlights areas where support may have greater impact (e.g., females in employment).
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Affiliation(s)
- Simon M Bury
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Darren Hedley
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Mirko Uljarević
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Mark A Stokes
- Healthy Autistic Life Lab, School of Psychology, Deakin University, Melbourne, Australia
| | - Sander Begeer
- Department of Clinical, Neuro- & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Cai RY, Hall G, Pellicano E. Predicting the financial wellbeing of autistic adults: Part I. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1203-1215. [PMID: 37665058 DOI: 10.1177/13623613231196085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
LAY ABSTRACT Researchers have found the way people feel about their financial situation is related to their quality of life. We know that many autistic people find it hard to find a job. And for those autistic people who have a job, they are often underpaid. Not having a job or being underpaid often means having low income. Having low income is likely to influence how autistic people feel about their financial situation. However, no research has looked at these issues for autistic people. This is the first study that helps us learn more about what autistic adults think about their financial situation. We looked at autistic people's thoughts on this issue compared to people from the general Australian population. We also looked at what things might impact how autistic people feel about their financial situation-which might be how much money they earn, what they do with that money, and their mental health. Many autistic adults felt they were struggling with financial wellbeing and this was connected both to the level of their income and how they said they managed their money. Those who were able to save and not borrow for everyday expenses reported feeling a greater sense of financial wellbeing. Concrete changes might help to improve autistic people's financial wellbeing. We need to investigate how we can help autistic people find and keep well-paying jobs. And we need to work out the best ways of equipping autistic people with the skills they need in financial matters.
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Affiliation(s)
- Ru Ying Cai
- Autism Spectrum Australia, Australia
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Gabrielle Hall
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Elizabeth Pellicano
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- University College London, UK
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Pellicano E, Hall G, Ying Cai R. Autistic adults' experiences of financial wellbeing: Part II. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1090-1106. [PMID: 37795595 PMCID: PMC11067415 DOI: 10.1177/13623613231191594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
LAY ABSTRACT Money matters in people's lives. It helps to meet people's basic needs (food, clothes, shelter) and live the lives they want to. When people talk about 'financial wellbeing', they mean how much you feel in control over day-to-day finances and how much freedom you have to make choices to enjoy life. We don't know what autistic people think about these things. That's why we did our study. We spoke to 21 autistic adults (24-69 years) about how they felt about their financial situation. We deliberately spoke to people who had told us previously they felt 'financially well' or 'financially unwell' so we could hear a range of opinions. Autistic people told us financial wellbeing meant having enough money to pay for their basics needs, to have a safety net for unexpected bills and not having to worry about money now or in the future. But many felt that good financial wellbeing was not possible for them. They often did not have a stable income to cover day-to-day expenses. This limited the choices they could make. Despite these challenges, autistic people told us they worked hard to budget and save money when they could - because feeling financial insecure was just too stressful, especially when they could not rely on family or friends for support. It made them feel mentally unwell. Our study shows there are many factors that influence autistic people's financial wellbeing. We need more research to help us understand how autistic people can be supported to achieve financial security.
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Affiliation(s)
- Elizabeth Pellicano
- University College London, UK
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Gabrielle Hall
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Ru Ying Cai
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- Aspect Australia, Australia
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Davies J, Romualdez AM, Malyan D, Heasman B, Livesey A, Walker A, Pellicano E, Remington A. Autistic Adults' Priorities for Future Autism Employment Research: Perspectives from the United Kingdom. AUTISM IN ADULTHOOD 2024; 6:72-85. [PMID: 38435326 PMCID: PMC10902279 DOI: 10.1089/aut.2022.0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background A growing body of research has sought to understand autistic people's research priorities. Several of these studies have identified employment as a key research priority. Yet, there have been a few attempts to identify specific, actionable priorities within this area. Methods Using an online survey, we asked 197 autistic people in the United Kingdom about their priorities for future autism-employment research. Results Participants spoke of their challenges in gaining and sustaining meaningful employment and called for researchers to conduct research that results in direct improvements to employment experiences. Regarding their research priorities, participants indicated a need for research covering all aspects of the employment lifecycle from accessing employment to transitioning out of employment. Importantly, participants also discussed how such research should be conducted: with autistic people as co-researchers and ensuring a diverse range of autistic people are listened to. Conclusion While much existing autism-employment research appears to align with the priorities outlined in this study, seemingly minimal attention has been paid to later stages of the work lifecycle (e.g., progressing into more senior job roles or transitioning out of work). By identifying disparities between autistic people's priorities and the research being conducted, we can support autistic people to drive the research agenda and ensure autism-employment research positively impacts the community it aims to serve.
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Affiliation(s)
- Jade Davies
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
| | - Anna Melissa Romualdez
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
| | - Danae Malyan
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
| | - Brett Heasman
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Adam Livesey
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
| | - Amy Walker
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
- Neurodiversity Works, London, United Kingdom
| | - Elizabeth Pellicano
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Anna Remington
- UCL Centre for Research in Autism and Education (CRAE), University College London, London, United Kingdom
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Jessiman-Perreault G, Gignac MAM, Thompson A, Smith PM. Understanding the Unmet Accommodation Needs of People Working with Mental or Cognitive Conditions: The Importance of Gender, Gendered Work, and Employment Factors. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:251-264. [PMID: 37878157 PMCID: PMC10899322 DOI: 10.1007/s10926-023-10132-4] [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] [Accepted: 07/20/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Workplace support needs for women and men living with mental health conditions are not well understood. This study examined workplace accommodation and support needs among women and men with and without mental health or cognitive conditions and individual and workplace factors associated with having unmet needs. METHODS A cross-sectional survey of 3068 Canadian workers collected information on disability, gender, gendered occupations, job conditions, work contexts, and workplace accommodations. Multivariable logistic regression analyses examined gender- and disability-based differences in unmet needs for workplace flexibility, work modifications, and health benefits, and the association of work context (i.e., work schedule, job sector) and job conditions (i.e., precarious work) on the likelihood of unmet accommodation needs. The additive (i.e., super- or sub-additive) and multiplicative effects of disability, gender, and occupational gender distribution on the probability of unmet accommodation needs were also assessed. RESULTS The most common unmet workplace accommodation was work modifications reported by 35.9% of respondents with mental/cognitive disability and workplace flexibility reported by 19.6% of individuals without a mental/cognitive disability. Women, employees in female dominant occupations, and participants with mental/cognitive disabilities were more likely to report unmet needs compared with men, employees in non-female dominant occupations, and participants without disabilities but these findings were largely explained by differences in job conditions and work contexts. No interacting effects on the likelihood of reporting unmet needs for workplace accommodations were observed. CONCLUSIONS To support employee mental health, attention is needed to address work contexts and job conditions, especially for people working with mental/cognitive disabilities, women, and workers in female-dominated occupations where unmet accommodation needs are greatest.
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Affiliation(s)
- Geneviève Jessiman-Perreault
- Institute for Work and Health, 400 University Ave Suite 1800, Toronto, ON, M5G 1S5, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada.
| | - Monique A M Gignac
- Institute for Work and Health, 400 University Ave Suite 1800, Toronto, ON, M5G 1S5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Aaron Thompson
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
- Workplace Safety and Insurance Board, 200 Front Street West, Toronto, ON, M5V 3J1, Canada
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - Peter M Smith
- Institute for Work and Health, 400 University Ave Suite 1800, Toronto, ON, M5G 1S5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
- School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
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Southey S, Morris R, Nicholas D, Pilatzke M. Autistic Perspectives on Employment: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-023-10163-x. [PMID: 38326702 DOI: 10.1007/s10926-023-10163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE Inclusive recruitment and employment of autistic adults has garnered recent attention in research and policy. To address a need to better understand the experiences of autistic adults in relation to paid employment, we asked the literature, what are the experiences of autistic individuals (from their perspectives) in competitive employment? METHODS A scoping review was conducted to summarize and consolidate the findings across research to date. A systematic search and screen of the literature resulted in 32 relevant studies. FINDINGS Key study characteristics, participant demographics, and thematic findings are shared, along with considerations and recommendations for future research and practice. Six key themes were described by autistic participants across the 32 studies: (1) accessibility of employment, (2) workplace relationships and communication, (3) role alignment, (4) sensory needs and/or mental health, (5) colleagues' knowledge and beliefs about autism, and (6) family and community context. CONCLUSION It is anticipated that the results of this review will be beneficial for stakeholders engaging in discussions and decision-making across research and employment contexts.
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Affiliation(s)
- Sarah Southey
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada.
- The Redpath Centre, Toronto, Canada.
| | - Rae Morris
- School of Social Work, University of British Columbia, Vancouver, Canada
- Rae Morris Counselling Group, Vancouver, BC, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Canada
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Kim H, Jung YH, Park S, Shin J, Jang SI. Effects of disability-related limitations in daily living on unmet needs: a longitudinal-study 1. BMC Public Health 2024; 24:351. [PMID: 38308206 PMCID: PMC10835996 DOI: 10.1186/s12889-024-17674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/04/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Unmet health needs are particularly important to people with disabilities; however, these unmet needs owing to limitations in daily life have been under-researched thus far. This study examined the effects of disability-related limitations in daily life on unmet needs. METHODS This study included 5,074 adults with disabilities from the 2018-2020 Korea Disability and Life Dynamics Panel. We analyzed the effects of disability-related limitations in daily life on unmet needs using logistic regression with a generalized estimating equation model. RESULTS Overall, 4.8% men and 4.6% women with disabilities had unmet needs. For men, unmet needs were 1.46 times (95% confidence interval [CI] 1.09-1.96) higher for those with moderate limitations in daily life. For women, unmet needs were 1.79 times (95% CI 1.22-2.39) higher when there were moderate limitations in daily life. The prominent factors causing this effect were physical or brain lesion disability for men and internal or facial disability and burden of medical expenses for women. CONCLUSIONS Limitations in daily life due to disability increase the risk of having unmet needs, an effect that is significantly more pronounced in men. These unmet needs differ depending on an individual's sex, disability type, limited body parts, and other specific causes. Efforts are required to reduce the unmet needs of people with disabilities by considering the type of disability, impaired body parts, and causes of unmet needs in daily life.
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Affiliation(s)
- Hanseul Kim
- Southern Seoul Regional Headquarters, National Pension Service, Seoul, Republic of Korea
| | - Yun Hwa Jung
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
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Bury SM, Hedley D, Uljarević M, Li X, Stokes MA, Begeer S. Employment profiles of autistic people: An 8-year longitudinal study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231225798. [PMID: 38243409 DOI: 10.1177/13623613231225798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
LAY ABSTRACT Autistic adults experience difficulties finding and keeping employment. However, research investigating reasons that might explain this difficulty produce mixed results. We gave a survey to 2449 autistic adults and used a statistic method to group them based on their employment status over 8 years. We identified four employment groups that best captured the experiences of autistic adults; this included a group that experienced stable unemployment, a group that experienced stable employment, a group that had high employment that reduced over time, and a group whose employment increased over the 8 years. Further analysis showed that those with fewer autistic traits, younger age, male gender, higher education, later diagnosis age and no co-occurring conditions were more likely to have stable employment. People whose employment changed over time were more likely to have a higher level of education than the stable unemployment group, and those in the increasing employment group were younger age and had no co-occurring conditions. These findings help us better understand that not all autistic adults' experiences of employment are the same, which helps focus where employment programmes and support may be most needed, for example, people who identify as women or have a co-occurring condition.
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Affiliation(s)
| | | | - Mirko Uljarević
- The University of Melbourne, Australia
- Stanford University, USA
| | - Xia Li
- La Trobe University, Australia
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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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Cuppens T, Kaur M, Kumar AA, Shatto J, Ng ACH, Leclercq M, Reformat MZ, Droit A, Dunham I, Bolduc FV. Developing a cluster-based approach for deciphering complexity in individuals with neurodevelopmental differences. Front Pediatr 2023; 11:1171920. [PMID: 37790694 PMCID: PMC10543689 DOI: 10.3389/fped.2023.1171920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Objective Individuals with neurodevelopmental disorders such as global developmental delay (GDD) present both genotypic and phenotypic heterogeneity. This diversity has hampered developing of targeted interventions given the relative rarity of each individual genetic etiology. Novel approaches to clinical trials where distinct, but related diseases can be treated by a common drug, known as basket trials, which have shown benefits in oncology but have yet to be used in GDD. Nonetheless, it remains unclear how individuals with GDD could be clustered. Here, we assess two different approaches: agglomerative and divisive clustering. Methods Using the largest cohort of individuals with GDD, which is the Deciphering Developmental Disorders (DDD), characterized using a systematic approach, we extracted genotypic and phenotypic information from 6,588 individuals with GDD. We then used a k-means clustering (divisive) and hierarchical agglomerative clustering (HAC) to identify subgroups of individuals. Next, we extracted gene network and molecular function information with regard to the clusters identified by each approach. Results HAC based on phenotypes identified in individuals with GDD revealed 16 clusters, each presenting with one dominant phenotype displayed by most individuals in the cluster, along with other minor phenotypes. Among the most common phenotypes reported were delayed speech, absent speech, and seizure. Interestingly, each phenotypic cluster molecularly included several (3-12) gene sub-networks of more closely related genes with diverse molecular function. k-means clustering also segregated individuals harboring those phenotypes, but the genetic pathways identified were different from the ones identified from HAC. Conclusion Our study illustrates how divisive (k-means) and agglomerative clustering can be used in order to group individuals with GDD for future basket trials. Moreover, the result of our analysis suggests that phenotypic clusters should be subdivided into molecular sub-networks for an increased likelihood of successful treatment. Finally, a combination of both agglomerative and divisive clustering may be required for developing of a comprehensive treatment.
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Affiliation(s)
- Tania Cuppens
- Département de Médecine Moléculaire de L'Université Laval, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Manpreet Kaur
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | - Ajay A. Kumar
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, United Kingdom
| | - Julie Shatto
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | - Andy Cheuk-Him Ng
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | - Mickael Leclercq
- Département de Médecine Moléculaire de L'Université Laval, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marek Z. Reformat
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Arnaud Droit
- Département de Médecine Moléculaire de L'Université Laval, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Ian Dunham
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, United Kingdom
| | - François V. Bolduc
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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14
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Finlay B, Wittevrongel K, Materula D, Hébert ML, O'Grady K, Lach LM, Nicholas D, Zwicker JD. Pan-Canadian caregiver experiences in accessing government disability programs: A mixed methods study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 134:104420. [PMID: 36621140 DOI: 10.1016/j.ridd.2022.104420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/14/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND At present, little is known about the factors that contribute to the relatively low uptake of government-funded disability programs in Canada. AIM Understand how parents/caregivers of Canadian youth with neurodevelopmental disability (NDD) experience the process of applying for and accessing disability programs. METHODS AND PROCEDURES This mixed methods sequential explanatory study utilized two phases: an online survey (quantitative), followed by semi-structured interviews (qualitative). The quantitative phase gathered sociodemographic information and preliminary information about participant experiences applying for and accessing programs. The qualitative phase provided greater depth by asking participants to describe barriers and facilitators to program access. OUTCOMES AND RESULTS 499 participants completed the online survey and 81 participants completed an interview. Analysis of survey data revealed that many participants are not accessing disability programs and experience difficulty when applying. Regression analyses revealed that factors relating to the process of applying and applicant/family attributes are significantly associated with program access. Inductive thematic analysis of interview data revealed four barriers and three facilitators to access. Integration of findings provided an overview of the multi-faceted journey to program access. CONCLUSIONS AND IMPLICATIONS The results of this study highlight policy changes that are needed to ensure disability programs adequately support Canadian families.
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Affiliation(s)
- Brittany Finlay
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada.
| | - Krystle Wittevrongel
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada.
| | - Dercia Materula
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada.
| | - Michèle L Hébert
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada; Faculty of Social Work, University of Calgary, Canada Central and Northern Alberta Region, 3-250, 10230 Jasper Avenue, Edmonton T5J 4P6, AB, Canada.
| | - Kathleen O'Grady
- Simone de Beauvoir Institute, Concordia University, ER building, 2155 Guy St., 6th floor, Montréal H3H 2R9, QC, Canada.
| | - Lucyna M Lach
- School of Social Work, McGill University, 550 Sherbrooke Ouest, Suite 100, Tour Est, Montréal H3A 1B9, QC, Canada.
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Canada Central and Northern Alberta Region, 3-250, 10230 Jasper Avenue, Edmonton T5J 4P6, AB, Canada.
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada; Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary T2N 1N4, AB, Canada.
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15
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Berrigan P, Scott CWM, Zwicker JD. Employment, Education, and Income for Canadians with Developmental Disability: Analysis from the 2017 Canadian Survey on Disability. J Autism Dev Disord 2023; 53:580-592. [PMID: 32662052 PMCID: PMC9944698 DOI: 10.1007/s10803-020-04603-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study assessed needs and outcomes for people with developmental disability (DD) to understand the socioeconomic status of this group prior to implementation of the Accessible Canada Act in June 2019. The 2017 Canadian Survey on Disability (CSD) was used to analyze data for a sample of individuals with self-reported disability. Data related to employment, education, income, housing, caregivers, and use of government benefits is reported. Compared to the general Canadian public, persons with DD are less likely to: finish high-school or post-secondary education; participate in the labor force or be employed; and earn on average less/year in total income. To align with recent accessibility legislation, significant progress is needed to address disparities for people with DD.
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Affiliation(s)
- Patrick Berrigan
- The School of Public Policy, University of Calgary, 906 - 8 Ave SW 5th floor, Calgary, AB, T2P 1H9, Canada.
| | - Craig W M Scott
- The School of Public Policy, University of Calgary, 906 - 8 Ave SW 5th floor, Calgary, AB, T2P 1H9, Canada
| | - Jennifer D Zwicker
- The School of Public Policy, University of Calgary, 906 - 8 Ave SW 5th floor, Calgary, AB, T2P 1H9, Canada
- Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, AB, T2N 4V8, Canada
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16
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Hedley D, Hedley DFE, Walkowiak E, Bury SM, Spoor JR, Shiell A. Cost-benefit analysis of a non-government organization and Australian government collaborative supported employment program for autistic people. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221138643. [DOI: 10.1177/13623613221138643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We present a cost-benefit analysis of an Australian Government sponsored 3-year supported employment program for autistic adults—the DXC Dandelion Program—in the information and communications technology sector. We explored the range of direct costs associated with running the program, benefits to participants, and avoided costs to the government. Estimates were based on data from 56 (86% men; Mage = 25.28, standard deviation [SD] = 8.36 years) autistic participants in the program. The program generated a high benefit ratio for government, mainly driven by increases in wage rates and hours worked and avoiding welfare and unemployment benefit payments. Participants received the largest benefit through wages and access to the labor market, with most participants transitioning into productive, open employment following program completion. The results from the model are robust; the benefit ratio remained above 1.0 even when higher discount rates were applied. In sum, our analysis identifies potential economic savings associated with supported employment programs that provide pathways for otherwise unemployed or under-employed autistic adults to enter the workforce. Lay abstract Relative to the size of the population, there are fewer autistic people than non-autistic people in the workforce. Employment programs that provide extra support to autistic people may help them to gain and keep jobs that are suited to their skills and expertise. In this study, we reviewed the DXC Dandelion Program. This is a supported autism employment program run in partnership with the Australian Government. The program provided jobs to autistic people who worked in information and communications technology roles, such as software testing and cyber security. In this study, we examined some of the benefits of the program for the autistic people who participated in it. We also examined the benefits of the program to the government. We found that there are many savings to government when autistic people are employed in jobs that are matched to their skills and abilities, compared to being unemployed or working in jobs that are below their level of education, training, or skills.
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Russell MJ, Scott CWM, Berrigan P, Murias K, Gibbard WB, Cui X, Tough S, Zwicker JD. The transition to adult income supports for youth that received special education in British Columbia, Canada: A cohort study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4363-e4374. [PMID: 35574712 DOI: 10.1111/hsc.13829] [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: 06/11/2021] [Revised: 03/28/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Youth in special education have complex needs that are supported across multiple systems. Our research investigates the use of adult income assistance, as one structure that supports youth as they transition to adulthood. We created a cohort of youth (5-22 years old) using linked administrative data from British Columbia government ministries from 1996 to 2018. Youth were grouped by their special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education). We investigated (1) youth characteristics and service use patterns, (2) which youth used income supports after the child-to-adult transition (19-22 years old), and what youth characteristics and service use patterns were associated with use, and (3) how much income support they used (CAD$). Of 174,527 youth, 254 (0.1%) were Level 1, 6020 (3.4%) were Level 2, 4409 (2.5%) were Level 3, 21,232 (12.2%) were Unfunded, and 142,612 (81.7%) were not in special education. Youth assigned higher funding levels, compared to lower levels, generally had increased service use, and in the transition to adult services were more likely to use income supports, and received more income support. An important exception was youth with serious behavioural/mental health special education funding (Level 3), who had increased service use for their level of funding, but received less income support due to a reliance on Temporary versus Disability Assistance. Youth that received an accredited diploma were less likely to use income supports. Factors related to the use of income supports are further described. This study highlights differences in access to income support when youth transition to adult services and considerations around equitable access to support.
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Affiliation(s)
- Matthew Joseph Russell
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | | | - Patrick Berrigan
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Kara Murias
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - W Ben Gibbard
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Xinjie Cui
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | - Suzanne Tough
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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18
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Scott CWM, Russell MJ, Tough S, Zwicker JD. Income assistance use among young adults who were in British Columbia special education: A longitudinal cohort study. PLoS One 2022; 17:e0274672. [PMID: 36206290 PMCID: PMC9543764 DOI: 10.1371/journal.pone.0274672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Persons with disability (PWD) experience disproportionately high poverty rates in Canada. This trend is apparent especially among youth compared to those who develop disabilities later in life. PWD in poverty have additional needs that increase barriers to full participation in society and translate to higher basic costs for daily living. Despite the existence of income assistance programs in Canada to mitigate income inequalities faced by PWDs, access to these programs can be limited. OBJECTIVE To describe use of income assistance for young adults with disability in British Columbia for the development of potential approaches to improve realized access to these programs. METHODS We conducted a population-based retrospective cohort study using British Columbia linked administrative data. We described differences in income assistance use among PWD by the level of special education funding received during primary school education (from most to least; Level 1, Level 2, Level 3, Unfunded, and no special education) and family composition. We also provided longitudinal patterns of income assistance use. RESULTS Of 218,324 young adults, 88% received no special education, 0.1% used Level One, 1.6% used Level Two, 2.9% used Level Three, and 7.1% used Unfunded special education coding. Young adults with Level One special education funding had the highest rates of hospitalizations and continuing care, with no hospitalization due to homelessness. Those with Level Three special education coding had higher rates of hospitalization and hospitalization due to homelessness than Level Two young adults. When transitioning to adulthood initially, Level One and Two funded individuals used relatively more disability income assistance than individuals from the other funding levels. Nearly all BCEA users with higher funded special education codes used this disability-specific program, while lesser funded special education codes used the Temporary Assistance more frequently, for a longer duration and were more likely to be persistent Temporary Assistance users. CONCLUSIONS Sustainable and reliable access to income assistance programs remains an issue across the heterogeneity of needs faced by young adults with disability.
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Affiliation(s)
- Craig William Michael Scott
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Joseph Russell
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | - Suzanne Tough
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer D. Zwicker
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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19
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Improving Care for Families and Children with Neurodevelopmental Disorders and Co-occurring Chronic Health Conditions Using a Care Coordination Intervention. J Dev Behav Pediatr 2022; 43:444-453. [PMID: 35849484 DOI: 10.1097/dbp.0000000000001102] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This clinical intervention study aimed to improve care integration and health service delivery for children with concurrent neurodevelopmental disorders and chronic health conditions. This population has significant unmet needs and disproportionate deficits in service delivery. A lack of coordination across child service sectors is a common barrier to successful treatment and support of children with neurodevelopmental disorders with complex medical needs. METHODS This project implemented an innovative care coordination model, involving one-on-one supports from a trained care coordinator who liaised with the broader intersectoral care team to improve joint care planning, integration of services, and the experience of both families and care providers. To evaluate the impact of care coordination activities, a single-group interventional study was conducted using a repeated-measures framework (at 0, 6, and 12 months) using previously established outcome measures. RESULTS Over 2 years, this project provided care coordination to 84 children and their families, with an age range from 2 to 17 years. The care coordination intervention demonstrated positive impacts for children, families, and care teams and contributed to clinical efficiencies. Children had fewer visits to the emergency department and less frequent acute care use. Improvement in access to services, joint care planning and communication across providers, and better linkage with school supports were demonstrated. Families reported that the program decreased their stress around coordinating care for their child. CONCLUSION This work demonstrated that intersectoral care coordination is attainable through innovative and collaborative practice for children with complex neurodevelopmental and medical needs.
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20
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Manikandan M, Casey C, Doyle A, Kerr C, Walsh M, Walsh A, M Ryan J. Use of health services and unmet needs among adults with cerebral palsy in Ireland. Dev Med Child Neurol 2022; 64:1270-1280. [PMID: 35396701 PMCID: PMC9546397 DOI: 10.1111/dmcn.15233] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
AIM To describe use of health services, unmet needs relating to health services, and identify factors associated with service use among adults with cerebral palsy (CP) in Ireland. METHOD Data relating to demographics, secondary diagnoses, current use of health services and assistive devices, and unmet needs for both were obtained on adults with CP from the National Physical and Sensory Disability Database. Logistic regression was used to identify factors associated with service use. RESULTS A total of 1268 adults with CP were included in this study. Over half were male (56%) and 78% lived with parents, siblings, or other family relatives. Physiotherapy, occupational therapy, and orthotics/prosthetic services were the most commonly used services, used by 57%, 48%, and 35% of the sample respectively. Unmet needs were highest for physiotherapy (23%) and occupational therapy services (13%). Age, sex, living arrangements, and wheelchair use were frequently associated with current service use. INTERPRETATION Adults with CP used a wide range of health services and unmet needs were reported for all services. The findings highlight a need for planning and development of services to meet their needs, regardless of their age, mobility level, or living arrangements. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) in Ireland used a wide range of therapeutic, respite, personal assistance, and support services. Unmet needs were highest for physiotherapy and occupational therapy services. Adults aged 25 years and above were less likely to use therapy services compared with younger adults. Adults living with parents, siblings, or family relatives were less likely to use personal assistance and physiotherapy services.
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Affiliation(s)
- Manjula Manikandan
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
| | - Claire Casey
- National Health Information SystemsHealth Research BoardIreland
| | - Anne Doyle
- Evidence CentreHealth Research BoardIreland
| | - Claire Kerr
- School of Nursing and MidwiferyQueen's University BelfastUnited Kingdom
| | - Michael Walsh
- National Clinical Programme for People with DisabilityClinical Design and Innovation Office, Health Service ExecutiveDublinIreland
| | - Aisling Walsh
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
| | - Jennifer M Ryan
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
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Di Francesco C, Murahara F, Martin V, Flanagan T, Nadig A. The value of employment support services for adults on the autism spectrum and/or with intellectual disabilities: Employee, employer, and job coach perspectives. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-211163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Employment rates among individuals on the autism spectrum or with intellectual disabilities (ID) remain extremely low. Although job coaching services have contributed to successful employment for these individuals, few studies have examined the importance of such support, and even fewer have explored which services are valued most by stakeholders. OBJECTIVE: We examined the importance of employment support services through employee, employer, and job coach perspectives, and employee and employer satisfaction of job coach support. METHODS: A multiple-case study was designed with a community organization providing employment support to individuals on the autism spectrum or with ID, and their employers. Nine employee-employer-job coach triads evaluated the importance of specific services and rated their satisfaction with the job coach support. RESULTS: Services were rated as important, however, some discrepancies were observed between the groups in their ratings of services (e.g., soliciting regular feedback about the employee’s performance). Satisfaction was high for employees and employers; both groups indicated that they would recommend these services. CONCLUSIONS: Job coach support was highly valued by all groups, underscoring the need for these services to be widely available, and suggesting that this support may serve as a critical factor in improving employment outcomes among this population.
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Affiliation(s)
- Cynthia Di Francesco
- School of Communication Sciences and Disorders, McGill University, Montreal, Quebec, Canada
| | - Flavio Murahara
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Valerie Martin
- Department of Psychoeducation, University of Montreal, Montreal, Quebec, Canada
| | - Tara Flanagan
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Aparna Nadig
- School of Communication Sciences and Disorders, McGill University, Montreal, Quebec, Canada
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Bui TA, Shatto J, Cuppens T, Droit A, Bolduc FV. Phenotypic Trade-Offs: Deciphering the Impact of Neurodiversity on Drug Development in Fragile X Syndrome. Front Psychiatry 2021; 12:730987. [PMID: 34733188 PMCID: PMC8558248 DOI: 10.3389/fpsyt.2021.730987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common single-gene cause of intellectual disability and autism spectrum disorder. Individuals with FXS present with a wide range of severity in multiple phenotypes including cognitive delay, behavioral challenges, sleep issues, epilepsy, and anxiety. These symptoms are also shared by many individuals with other neurodevelopmental disorders (NDDs). Since the discovery of the FXS gene, FMR1, FXS has been the focus of intense preclinical investigation and is placed at the forefront of clinical trials in the field of NDDs. So far, most studies have aimed to translate the rescue of specific phenotypes in animal models, for example, learning, or improving general cognitive or behavioral functioning in individuals with FXS. Trial design, selection of outcome measures, and interpretation of results of recent trials have shown limitations in this type of approach. We propose a new paradigm in which all phenotypes involved in individuals with FXS would be considered and, more importantly, the possible interactions between these phenotypes. This approach would be implemented both at the baseline, meaning when entering a trial or when studying a patient population, and also after the intervention when the study subjects have been exposed to the investigational product. This approach would allow us to further understand potential trade-offs underlying the varying effects of the treatment on different individuals in clinical trials, and to connect the results to individual genetic differences. To better understand the interplay between different phenotypes, we emphasize the need for preclinical studies to investigate various interrelated biological and behavioral outcomes when assessing a specific treatment. In this paper, we present how such a conceptual shift in preclinical design could shed new light on clinical trial results. Future clinical studies should take into account the rich neurodiversity of individuals with FXS specifically and NDDs in general, and incorporate the idea of trade-offs in their designs.
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Affiliation(s)
- Truong An Bui
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Julie Shatto
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Tania Cuppens
- Centre de Recherche du CHU de Québec-Université Laval et Département de Médecine Moléculaire de l'Université Laval, Laval, QC, Canada
| | - Arnaud Droit
- Centre de Recherche du CHU de Québec-Université Laval et Département de Médecine Moléculaire de l'Université Laval, Laval, QC, Canada
| | - François V. Bolduc
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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Fong CJ, Taylor J, Berdyyeva A, McClelland AM, Murphy KM, Westbrook JD. Interventions for improving employment outcomes for persons with autism spectrum disorders: A systematic review update. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1185. [PMID: 37052419 PMCID: PMC8354554 DOI: 10.1002/cl2.1185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND The incidence of autism spectrum disorders (ASD) is on the rise. Currently, 1 in 59 children are identified with ASD in the United States. ASD refers to a range of neurological disorders that involve some degree of difficulty with communication and interpersonal relationships. The range of the spectrum for autism disorders is wide with those at the higher functioning end often able to lead relatively independent lives and complete academic programs even while demonstrating social awkwardness. Those at the lower functioning end of the autism spectrum often demonstrate physical limitations, may lack speech, and have the inability to relate socially with others. As persons with ASD age, options such as employment become increasingly important as a consideration for long-term personal planning and quality of life. While many challenges exist for persons with ASD in obtaining and maintaining employment, some research shows that, with effective behavioral and social interventions, employment can occur. About 37% of individuals with ASD report having been employed for 12 months or more, 4 years after exiting high school. However, several studies show that individuals with ASD are more likely to lose their employment for behavioral and social interaction problems rather than their inability to perform assigned work tasks. Although Westbrook et al. (2012a, 2013, 2015) have reviewed the literature on interventions targeting employment for individuals with ASD, this review is outdated and does not account for recent developments in the field. OBJECTIVES The objective of this review is to determine the effectiveness of employment interventions in securing and maintaining employment for adults and transition-age youth with ASD, updating two reviews by Westbrook et al. (2012a, 2013). SEARCH METHODS The comprehensive search strategy used to identify relevant studies included a review of 28 relevant electronic databases. Search terminology for each of the electronic databases was developed from available database thesauri. Appropriate synonyms were used to maximize the database search output. Several international databases were included among the 28 databases searched. In addition, the authors identified and reviewed gray literature through analysis of reference lists of relevant studies. Unpublished dissertations and theses were also identified through database searches. The programs of conferences held by associations and organizations relevant to ASD and employment were also searched. In sum, the search strategy replicated and expanded the prior search methods used by Westbrook et al. (2012a, 2013). SELECTION CRITERIA Selection criteria consisted of an intervention evaluation using a randomized controlled trial or quasi-experimental design, an employment outcome, and a population of individuals with ASD. DATA COLLECTION AND ANALYSIS We updated the search from Westbrook et al., replicating and broadening the information retrieval processes. Our wide array of sources included electronic databases, gray literature, and conference and organization websites. Once all potentially relevant studies were located, pairs of coders evaluated the relevance of each title and abstract. Among the studies deemed potentially relevant, 278 were subjected to full-text retrieval and screening by pairs of coders. Because many intervention studies did not include employment outcomes, only three studies met our inclusion criteria. Given the small number of included studies, meta-analytic procedures were not used; rather, we opted to use more narrative and descriptive analysis to summarize the available evidence, including an assessment of risk of bias. RESULTS The systematic review update identified three studies that evaluated employment outcomes for interventions for individuals with ASD. All three studies identified in the review suggest that vocation-focused programs may have positive impacts on the employment outcomes for individuals with ASD. Wehman et al. indicated that participants in Project SEARCH had higher employment rates than control participants at both 9-month and 1-year follow-up time points. Adding autism spectrum disorder supports, Project SEARCH in Wehman et al.'s study also demonstrated higher employment rates for treatment participants than control participants at postgraduation, 3-month follow-up, and 12-month follow-up. Smith et al. found that virtual reality job interview training was able to increase the number of job offers treatment participants received compared to control participants. AUTHORS' CONCLUSIONS Given that prior reviews did not identify interventions with actual employment outcomes, the more recent emergence of evaluations of such programs is encouraging. This suggests that there is a growing body of evidence regarding interventions to enhance the employment outcomes for individuals with ASD but also greater need to conduct rigorous trials of vocation-based interventions for individuals with ASD that measure employment outcomes.
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Córdoba J, Bagnato MJ. Characterization of People with Functional Limitations from ICF Components Using the Longitudinal Social Protection Survey (ELPS) of Uruguay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158012. [PMID: 34360305 PMCID: PMC8345411 DOI: 10.3390/ijerph18158012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
Characterising people with disabilities at the population level using the ICF approach is a challenge, as it implies that researchers are able to identify variables that can account for the components that make up the multidimensional definition of disability. The purpose of this study is to generate updated information on disability in Uruguay, as there has been no in-depth analysis of how this population lives, how they access the services and benefits that affect their quality of life, and what the significant differences are between those who make up this population. A quantitative analysis was applied to the target population, consisting of participants in the Longitudinal Survey of Social Protection (2016) who reported at least one limitation in performing ADLs and who were in the age range of 18–64 years. Significant differences were found between the different groups in terms of their reported limitations in relation to obtaining necessary services due to their health condition, dropping out of education before completing the compulsory level, low labour market insertion, feelings of loneliness, and low participation. More research needs to be done as it is clear that people with disabilities do not have access to the support they need, which leads to even greater exclusion.
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Russell MJ, Michael Scott CW, Murias K, Ben Gibbard W, Cui X, Tough S, Zwicker JD. Cross-ministry data on service use and limitations faced by children in special education. Disabil Health J 2021; 14:101118. [PMID: 34074619 DOI: 10.1016/j.dhjo.2021.101118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children with disabilities often face limitations that cross support sectors. OBJECTIVE Our aim was to measure cross-ministry service use, outcomes, and functional limitations faced by children who qualified for special education. METHODS We used longitudinal British Columbia ministry data linked to children (0-18y) registered in K-12 education. Children were grouped by special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education), and related to 1) service use patterns, 2) the age they first used disability services, and 3) functional limitations reported in health visits. We also reported how length of special education use related to disability service use. RESULTS Of 111,274 children, 154(0.1%) were Level 1, 4427(4.0%) Level 2, 2897(2.6%) Level 3, 13472(12.1%) Unfunded, and 90324(81.2%) not in special education. Children with higher funding levels, compared to lower levels of funding, generally were more likely to experience poorer outcomes, have functional limitations, have service needs, and receive early support. One exception was children with serious behavioural/mental health special education coding, which had poorer outcomes for their level of funding. Children received child disability supports early (about half of users started by 4y), but use was mostly limited to those with many years (9+years) of funded special education (70.7% of the all users) and biased to certain special education codes (i.e., Level 1, severe intellectual disability, and autism). CONCLUSIONS This study provides evidence of the long-term, diverse needs of children in special education and may be used to inform decisions surrounding their support.
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Affiliation(s)
- Matthew Joseph Russell
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada; PolicyWise for Children & Families, 1000-9925 109 St NW, Edmonton, AB T5K 2J8, Canada.
| | - Craig William Michael Scott
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada
| | - Kara Murias
- Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - W Ben Gibbard
- Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Xinjie Cui
- PolicyWise for Children & Families, 1000-9925 109 St NW, Edmonton, AB T5K 2J8, Canada
| | - Suzanne Tough
- Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada; Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, Alberta, T2N 1N4, Canada
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Wittevrongel K, Mitchell W, Hébert ML, Nicholas DB, Zwicker JD. Acceptability of employment readiness measures in youth and young adults on the autism spectrum: a mixed-methods study. Disabil Rehabil 2021; 44:4319-4331. [PMID: 33863243 DOI: 10.1080/09638288.2021.1902578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Reliable, valid, and pragmatic measures are essential for monitoring and evaluating employment readiness and comparing the effectiveness of alternative implementation strategies. The Work Readiness Inventory (WRI) and Ansell-Casey Life Skills Assessment (ACLSA) are valid measures of employment readiness in neurotypical populations; however, their acceptability (i.e., user perception of measure as agreeable/satisfactory) for persons on the autism spectrum is not yet known. This investigation assesses the acceptability of the WRI and a modified ACLSA (ACLSA-M) in measuring employment readiness in youth/young adults on the spectrum. METHODS A concurrent triangulation mixed-methods study design utilizing quantitative pre-post measurement of a community-based employment readiness program alongside qualitative survey assessment was employed to determine concurrent acceptability. For robustness, further explication through peer debriefing of experts evaluated the retrospective acceptability via interview and acceptability-rate assessment. RESULTS Findings indicated that both measures are acceptable, although individual- and job-specific item modifications are advised, particularly due to disability-specific needs. Significant change in employment readiness in youth/young adults on the spectrum supports concurrent acceptability. Peer debriefing provided rich data on retrospective acceptability. Acceptability-rates of 0.84 and 0.91 confirm broad acceptability of these measures. CONCLUSIONS Implications are presented for clinicians and researchers, highlighting the relevance for autism-specific measurement development and acceptability.Implications for rehabilitationGiven the lower labor force participation of persons on the autism spectrum, a combination of measures should be used in the assessment of an individual's employment readiness.In youth and young adults on the spectrum, employment readiness can be measured using the Work Readiness Inventory (WRI) and a modified version of the Ansell-Casey Life Skills Assessment (ACLSA-M).In clinical practice and research, modifying the contents of these measures may be advised to minimize language complexity, and maximize ease in self report.When designing, developing, and testing new measures in rehabilitation practice or research, the intent should be broadened by involving diverse representation from the project outset, by engaging both those on the spectrum and neurotypical populations.
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Affiliation(s)
| | - Wendy Mitchell
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Michèle L Hébert
- School of Public Policy, University of Calgary, Calgary, Canada.,Faculty of Social Work, University of Calgary, Edmonton, Canada
| | | | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Canada
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A Scoping Review of the Contextual Factors Impacting Employment in Neurodevelopmental Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021. [DOI: 10.1007/s40474-021-00229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Majnemer A, McGrath PJ, Baumbusch J, Camden C, Fallon B, Lunsky Y, Miller SP, Sansone G, Stainton T, Sumarah J, Thomson D, Zwicker J. Time to be counted: COVID-19 and intellectual and developmental disabilities—an RSC Policy Briefing. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has impacted the lives and well-being of all people globally, with consequences being observed across all domains from physical and mental health, to education and employment outcomes, to access to community supports and services. However, the disproportionate impact of the COVID-19 pandemic and its associated public health restrictions on individuals with intellectual and developmental disabilities (IDD) has largely been overlooked. Not only do people with IDD have a greater risk of severe complications and death from the virus as shown in large-scale studies, but they also face significant short- and long-term consequences of COVID-related public health measures on their mental health and well-being. At a time when this vulnerable population is already feeling undervalued, ignored, and forgotten, it is imperative that the risks facing adults and children with IDD—as well as their families and caregivers—are recognized, valued, and addressed through a disability-inclusive approach to Canada’s pandemic policy response planning. This requires both a mainstreaming of disability inclusion into all COVID-19 response and recovery policies as well as disability-specific policies to address the unique barriers and challenges encountered by people with IDD during the pandemic. The recommendations in this policy briefing aim to achieve a more inclusive, accessible, and sustainable Canada for people with IDD both during and after the pandemic—an approach that will result in benefits for all of society.
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Affiliation(s)
- Annette Majnemer
- School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H3G 1Y5, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
| | - Patrick J. McGrath
- Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
- IWK Health Centre, Halifax, NS B3K 6R8, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Canadian Institute of Health Research Chair in Sex & Gender Science, Ottawa, ON K1A 0W9, Canada
| | - Chantal Camden
- École de Réadaptation, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
- CRCHUS et à l’IUPLSSS, Sherbrooke, QC J1H 5N4, Canada
| | - Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Steven P. Miller
- Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Genevieve Sansone
- Fraser Mustard Policy Bench, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Tim Stainton
- School of Social Work, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
- Canadian Institute for Inclusion and Citizenship, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - John Sumarah
- Counselling Psychology, Acadia University, Wolfville, NS B4P 2R6, Canada
| | | | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB T2P 1H9, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
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Lord C, McCauley JB, Pepa LA, Huerta M, Pickles A. Work, living, and the pursuit of happiness: Vocational and psychosocial outcomes for young adults with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1691-1703. [PMID: 32431163 PMCID: PMC7541415 DOI: 10.1177/1362361320919246] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT It is important to better understand how adults with autism are functioning in adulthood. Studies that have tracked individuals across the lifespan can help identify developmental factors influence differences in adult outcomes. The present study examines the independence, well-being, and functioning of 123 adults that have been closely followed since early childhood. Autism diagnosis and cognitive assessments were given frequently throughout childhood and during adulthood. We examined differences between adults who had received an autism diagnosis at some point with higher cognitive abilities (Ever ASD-High IQ) and lower cognitive abilities (Ever ASD-Low IQ), as well as adults who never received a diagnosis of autism in the course of the study (Never ASD). We found that autistic features specifically related to adaptive skills and friendships, and verbal intelligence related to work outcomes. In many ways, the Never ASD group had similar outcomes compared to the ASD groups. However, adults with ASD tended to have lower well-being and fewer positive emotions. Families played a major role in supporting adults with and without ASD at all intellectual levels. The findings suggest that realistic ways of increasing independence need to be developed by working with adults and their families, while acknowledging the contribution of individual differences in mental health, intelligence and autism symptoms across neurodevelopmental disorders.
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Bury SM, Flower RL, Zulla R, Nicholas DB, Hedley D. Workplace Social Challenges Experienced by Employees on the Autism Spectrum: An International Exploratory Study Examining Employee and Supervisor Perspectives. J Autism Dev Disord 2020; 51:1614-1627. [PMID: 32809168 DOI: 10.1007/s10803-020-04662-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Social challenges represent a significantly under-researched area when it comes to the poor employment outcomes in autism. In this exploratory study employees on the autism spectrum (N = 29) and supervisors (N = 15), representing seven continents, provided 128 written examples of workplace-based social challenges, their interpretation, consequences and resolution. Content analysis revealed that types of social challenges were individually oriented or associated with the work-environment. Social challenges were frequently attributed to internal or personal factors with direct consequences for the employee. Resolutions were more frequently targeted toward the individual than the workplace, and hindered employees' experience of work. This international study represents a first look at the types of social challenges that impact equitable work participation of autistic people.
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Affiliation(s)
- Simon M Bury
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
| | - Rebecca L Flower
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Department of Psychology and Counselling, La Trobe University, Bendigo, Australia
| | - Rosslynn Zulla
- Faculty of Social Work, University of Calgary, Alberta, Canada.,School of Public Health, University of Alberta, Alberta, Canada
| | | | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Gómez LE, Monsalve A, Morán ML, Alcedo MÁ, Lombardi M, Schalock RL. Measurable Indicators of CRPD for People with Intellectual and Developmental Disabilities within the Quality of Life Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5123. [PMID: 32679924 PMCID: PMC7400318 DOI: 10.3390/ijerph17145123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
This article proposes the quality of life (QOL) construct as a framework from which to develop useful indicators to operationalize, measure, and implement the Articles of the Convention on the Rights of Persons with Disabilities (CRPD). A systematic review of the scientific literature on people with intellectual and developmental disabilities (IDD) was carried out, with the aim of identifying personal outcomes that can be translated into specific and measurable items for each of the CRPD Articles aligned to the eight QOL domains. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the systematic review was conducted across the Web of Science Core Collection, Current Contents Connect (CCC), MEDLINE, KCI-Korean Journal Database, Russian Science Citation Index and SciELO Citation Index, for articles published between 2008 and 2020. A total of 65 articles focusing on people with IDD were selected. The results were grouped into four broad categories: conceptual frameworks used to monitor the CRPD; instruments used to assess the rights set out in the CRPD; recommendations on the use of inclusive research; and indicators or personal outcomes associated with specific rights contained in the CRPD.
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Affiliation(s)
- Laura E. Gómez
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain; (A.M.); (M.L.M.); (M.Á.A.)
| | - Asunción Monsalve
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain; (A.M.); (M.L.M.); (M.Á.A.)
| | - Mª Lucía Morán
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain; (A.M.); (M.L.M.); (M.Á.A.)
| | - Mª Ángeles Alcedo
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain; (A.M.); (M.L.M.); (M.Á.A.)
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Khayatzadeh-Mahani A, Wittevrongel K, Petermann L, Graham ID, Zwicker JD. Stakeholders' engagement in co-producing policy-relevant knowledge to facilitate employment for persons with developmental disabilities. Health Res Policy Syst 2020; 18:39. [PMID: 32303228 PMCID: PMC7164207 DOI: 10.1186/s12961-020-00548-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 03/17/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Persons with developmental disabilities (PWDD) face a number of individual, environmental and societal barriers when seeking employment. Integrated knowledge translation (IKT) involves ongoing and dynamic interactions between researchers and stakeholders for the purpose of engaging in mutually beneficial research to address these types of multi-faceted barriers. There is a knowledge gap in the IKT literature on effective stakeholder engagement strategies outside of the dissemination stage to inform policy. In this paper, we report on a number of engagement strategies employed over a 2-year period to engage a wide range of stakeholders in different stages of an IKT project that aimed to investigate the 'wicked' problem of employment for PWDD. METHOD Our engagement plan included multiple linked strategies and was designed to ensure the meaningful engagement of, and knowledge co-production with, stakeholders. We held two participatory consensus-building stakeholder policy dialogue events to co-produce knowledge utilising the nominal group technique and the modified Delphi technique. A total of 31 and 49 stakeholders engaged in the first and second events, respectively, from six key stakeholder groups. Focused engagement strategies were employed to build on the stakeholder dialogues for knowledge mobilisation and included a focus group attended only by PWDD, a stakeholder workshop attended only by policy/decision-makers, a webinar attended by human resources professionals and employers, and a current affairs panel attended by the general public. RESULTS Our findings suggest that the level of engagement for each stakeholder group varies depending on the goal and need of the project. Our stakeholder dialogue findings highlight the inherent challenges in co-framing and knowledge co-production through the meaningful engagement of multiple stakeholders who hold different ideas and interests. Focused outreach is needed to foster relationships and trust for meaningful engagement. CONCLUSIONS In addition to providing guidance on how to implement adaptable meaningful engagement strategies, these findings contribute to discussions on how IKT projects are planned and funded. More studies to explore effective mechanisms for engaging a wide range of stakeholders in IKT research are needed. More evidence of successful engagement strategies employed by researchers to achieve meaningful knowledge co-production is also key to advancing the discipline.
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Affiliation(s)
- Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Downtown Campus, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta T2P 1H9 Canada
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Krystle Wittevrongel
- School of Public Policy, University of Calgary, Downtown Campus, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta T2P 1H9 Canada
| | - Lisa Petermann
- Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - Ian D. Graham
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Jennifer D. Zwicker
- School of Public Policy, University of Calgary, Downtown Campus, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta T2P 1H9 Canada
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Russell MJ, Premji S, Mcdonald S, Zwicker JD, Tough S. Health care service for families with children at early risk of developmental delay: an All Our Families cohort study. Dev Med Child Neurol 2020; 62:338-345. [PMID: 31469170 PMCID: PMC7028137 DOI: 10.1111/dmcn.14343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 12/15/2022]
Abstract
AIM This study examined children's health care service use, mothers' workforce participation, and mothers' community engagement based on children's risk of developmental delay. METHOD We used data from the All Our Families study, a prospective pregnancy cohort. Ages and Stages Questionnaire (ASQ) scores at year 2 indicated risk of developmental delay. To investigate the impact of risk of developmental delay when children were not diagnosed, a sensitivity analysis excluded reports of neurodevelopmental disorder (NDD) diagnosis at year 3. Outcomes were maternal reports of children's health and allied health visits (and estimated costs), and maternal workforce participation and community engagement from year 2 to 3. RESULTS Among 1314 mother-child dyads, 209 (16%) children were classified as being at risk of developmental delay by the ASQ, and 42 (3%) had a reported diagnosis of NDD. Risk of developmental delay was related to increased use of allied health care services (incidence risk ratio 5.04 [year 3]; 95% confidence interval 2.49-10.2) and health visits (incidence risk ratio 1.33 [year 3]; 95% confidence interval 1.14-1.54). The average expected allied health costs were greater for children at risk versus not at risk of developmental delay. However, when excluding children with reported diagnoses of an NDD from this analysis, increased service use and costs in the remaining at-risk population were not observed. Community engagement and workplace participation among families did not differ on the basis of risk of developmental delay. INTERPRETATION These results suggest increased health care service use by families of children at risk of developmental delay is driven by those receiving a diagnosis of an NDD in the subsequent year. WHAT THIS PAPER ADDS Early developmental delay risk was related to health care service use and costs. Diagnosis of neurodevelopmental disorder drove increased health care service use and costs. Early developmental delay risk did not relate to parental workforce participation. Early developmental delay risk did not relate to community engagement participation.
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Affiliation(s)
- Matthew J Russell
- Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- School of Public PolicyUniversity of CalgaryCalgaryABCanada
- PolicyWise for Children & FamiliesUniversity of CalgaryCalgaryABCanada
| | - Shainur Premji
- Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- School of Public PolicyUniversity of CalgaryCalgaryABCanada
| | - Sheila Mcdonald
- Paediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Jennifer D Zwicker
- School of Public PolicyUniversity of CalgaryCalgaryABCanada
- Department of KinesiologyUniversity of CalgaryCalgaryABCanada
| | - Suzanne Tough
- Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Paediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
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Abstract
Most research on autism spectrum disorder (ASD) has focused on younger individuals, but there is increasing awareness that more must be known about the clinical needs and outcomes of older adults with ASD. This article reviews what is known about barriers to recognition in the elderly, the prevalence of ASD over the lifespan, outcomes in adulthood in comparison to the general population, co-occurring psychiatric diagnoses, and healthcare needs in this population.
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Lamsal R, Finlay B, Whitehurst DGT, Zwicker JD. Generic preference-based health-related quality of life in children with neurodevelopmental disorders: a scoping review. Dev Med Child Neurol 2020; 62:169-177. [PMID: 31225644 PMCID: PMC7065222 DOI: 10.1111/dmcn.14301] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
AIM To describe how generic preference-based health-related quality of life (HRQoL) instruments have been used in research involving children with neurodevelopmental disorders (NDD). METHOD A systematic search of nine databases identified studies that used generic preference-based HRQoL instruments in children with NDD. Data extracted following the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Review guidelines included type of NDD, instrument used, respondent type, justification, and critical appraisal for these selections. RESULTS Thirty-six studies were identified: four cost-utility analyses; 15 HRQoL assessments; five economic burden studies; three intervention studies; and nine 'other'. The Health Utilities Index (Mark 2 and Mark 3) and EuroQoL 5D (EQ-5D; three-level EQ-5D, five-level EQ-5D, and the youth version of the EQ-5D) instruments were most frequently used (44% and 31% respectively). The relatively low use of these instruments overall may be due to a lack of psychometric evidence, inconsistency in justification for and lack of clarity on appropriate respondent type and age, and geographical challenges in applying preference weights. INTERPRETATION This study highlights the dearth of studies using generic preference-based HRQoL instruments in children with NDD. The use of cost-utility analysis in this field is limited and validation of these instruments for children with NDD is needed. The quality of data should be considered before guiding policy and care decisions. WHAT THIS PAPER ADDS Limited use of generic preference-based health-related quality of life (HRQoL) instruments in studies on children with neurodevelopmental disorders. Only 11% of studies were cost-utility analyses. Inconsistencies in justification for choosing generic preference-based HRQoL instruments and respondent types.
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Affiliation(s)
- Ramesh Lamsal
- School of Public PolicyUniversity of CalgaryCalgaryAlbertaCanada
| | - Brittany Finlay
- School of Public PolicyUniversity of CalgaryCalgaryAlbertaCanada
| | - David G T Whitehurst
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada,Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health Research InstituteVancouverBritish ColumbiaCanada
| | - Jennifer D Zwicker
- School of Public PolicyUniversity of CalgaryCalgaryAlbertaCanada,Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
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Nicholas DB, Hedley D, Randolph JK, Raymaker DM, Robertson SM, Vincent J. An Expert Discussion on Employment in Autism. AUTISM IN ADULTHOOD 2019; 1:162-169. [PMID: 35252769 PMCID: PMC8890031 DOI: 10.1089/aut.2019.29003.djn] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- David B. Nicholas
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, Canada
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jena K. Randolph
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, Missouri
| | - Dora M. Raymaker
- Regional Research Institute, School of Social Work, Portland State University, Portland, Oregon
| | - Scott M. Robertson
- Scott Michael Robertson, Collaborative Research, Washington, District of Columbia
| | - Jonathan Vincent
- School of Education, York St. John University, York, United Kingdom
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Nicholas D, Mitchell W, Zulla R, Dudley C. Perspectives of employers about hiring individuals with autism spectrum disorder: Evaluating a cohort of employers engaged in a job-readiness initiative. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-191018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David Nicholas
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, Canada
| | | | - Rosslynn Zulla
- School of Public Health, University of Alberta, Edmonton, Canada
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Lamsal R, Ungar WJ. Impact of growing up with a sibling with a neurodevelopmental disorder on the quality of life of an unaffected sibling: a scoping review. Disabil Rehabil 2019; 43:586-594. [PMID: 31106599 DOI: 10.1080/09638288.2019.1615563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Growing up with a sibling with a neurodevelopmental disorder can have positive and negative effects on personal, social and emotional well-being; however, little is known about the impacts on unaffected siblings' quality of life. The purpose of this review was to synthesize evidence from studies evaluating the quality of life of unaffected siblings of children with neurodevelopmental disorders. METHOD A systematic search was conducted on four databases to identify studies reporting the quality of life of unaffected siblings of children with neurodevelopmental disorders. RESULTS Seven studies met the inclusion criteria. Four studies reported impaired quality of life in unaffected siblings of children with neurodevelopmental disorder while three studies reported not the impaired quality of life. Parents reported the lower quality of life for children with or without neurodevelopmental disorders compared to children's self-reports. CONCLUSIONS This review provides the mixed evidence on the quality of life in unaffected siblings of children with neurodevelopmental disorders, and identifies the substantial gap in the research regarding the impacts of children's neurodevelopmental disorders on the quality of life of their unaffected siblings. Assessment of unaffected siblings' quality of life is necessary to identify those who may be at risk and to provide support programs for physical and emotional well-being. Future research examining the quality of life of unaffected siblings across a variety of NDD is needed.Implications for rehabilitationGrowing up with a sibling with a neurodevelopmental disorder influences the personal and social development of the unaffected child.Measuring quality of life can have a meaningful impact on the lives of unaffected siblings of children with neurodevelopmental disorders and their families. Evidence generated from such studies can be used by healthcare providers such as physicians, nurses, psychologists, and social workers to recommend appropriate supports to the family and siblings.
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Affiliation(s)
- Ramesh Lamsal
- Program of Child Health Evaluation Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Wendy J Ungar
- Program of Child Health Evaluation Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Nicholas DB, Mitchell W, Dudley C, Clarke M, Zulla R. An Ecosystem Approach to Employment and Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:264-275. [PMID: 29071564 DOI: 10.1007/s10803-017-3351-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Relatively little is yet known about employment readiness and elements that promote access to, and the retention of, employment for adults with autism spectrum disorder (ASD). This paper posits elements within the ecosystem of employment and ASD. The ecosystem approach locates employment among persons with ASD as inextricably linked with broader community resources, family support, workplace capacity building (e.g., employer, co-workers) and policy. Application of the approach is offered through process evaluation data yielded from an ecosystem-informed job readiness program entitled, 'EmploymentWorks Canada'. Findings illustrate job readiness in the context of the broader ecosystem that envelopes salient components in the aim of community engagement and quality of life. Recommendations are offered for community-based applications and for program and research development.
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Affiliation(s)
- David B Nicholas
- Faculty of Social Work (Central and Northern Alberta Region), University of Calgary, 3-250, 10230 Jasper Avenue NW, Edmonton, AB, T5J 4P6, Canada.
| | - Wendy Mitchell
- Sinneave Family Foundation, 300, 3820 - 24 Avenue NW, Calgary, AB, T3B 2X9, Canada
| | - Carolyn Dudley
- Sinneave Family Foundation, 300, 3820 - 24 Avenue NW, Calgary, AB, T3B 2X9, Canada
| | - Margaret Clarke
- Sinneave Family Foundation, 300, 3820 - 24 Avenue NW, Calgary, AB, T3B 2X9, Canada.,Cummings School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Rosslynn Zulla
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
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Khayatzadeh-Mahani A, Wittevrongel K, Nicholas DB, Zwicker JD. Prioritizing barriers and solutions to improve employment for persons with developmental disabilities. Disabil Rehabil 2019; 42:2696-2706. [PMID: 30856355 DOI: 10.1080/09638288.2019.1570356] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Persons with a developmental disability have the lowest rate of labour force participation relative to other disabilities. The widening gap between the labour force participation of persons with versus without disability has been an enduring concern for many governments across the globe, which has led to policy initiatives such as labour market activation programs, welfare reforms, and equality laws. Despite these policies, persistently poor labour force participation rates for persons with developmental disabilities suggest that this population experiences pervasive barriers to participating in the labour force.Materials and methods: In this study, a two-phase qualitative research design was used to systematically identify, explore and prioritize barriers to employment for persons with developmental disabilities, potential policy solutions and criteria for evaluating future policy initiatives. Incorporating diverse stakeholder perspectives, a Nominal Group Technique and a modified Delphi technique were used to collect and analyze data.Results: Findings indicate that barriers to employment for persons with developmental disabilities are multi-factorial and policy solutions to address these barriers require stakeholder engagement and collaboration from multiple sectors.Conclusions: Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities. Policy and decision makers need to address barriers to employment for persons with developmental disabilities more holistically by designing policies considering employers and the workplace, persons with developmental disabilities and the broader society. Findings call for cross-sectoral collaboration using a Whole of Government approach.Implications for RehabilitationPersons with a developmental disability face lower levels of labour force participation than any other disability group.Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities.Decision and policy makers need to address barriers to employment for persons with developmental disabilities holistically through policies guiding employers and broader societal behaviour in addition to those aimed at the individuals (such as skill development or training).Due to multi-factorial nature of barriers to employment for persons with developmental disabilities, policy solutions are wide-ranging and fall under the responsibility of multiple sectors for implementation. This calls for cross-sectoral collaboration using a "Whole of Government" approach, with shared goals and integrated responses.
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Affiliation(s)
- Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, AB, Canada.,Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Shikako-Thomas K, Shevell M. Promoting the Human Rights of Children With Neurologic Conditions. Semin Pediatr Neurol 2018; 27:53-61. [PMID: 30293590 DOI: 10.1016/j.spen.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Children with neurologic conditions benefit from international conventions, and national treaties, policies and regulations that safeguard their human rights. These regulations also exist to serve as guidance in the creation of comprehensive systems of care, inclusive environments, accessible societies and communities that allow these children to thrive and to achieve the best of their capacities. This narrative review of issues related to human rights and advocacy in pediatric neurologic disabilities will provide an overview of the human rights conventions that relate to children with disabilities, and the most current approaches implicating health care providers in rights promotion for these individuals and their families. We also suggest venues for professionals to advocate for their patients, and suggest strategies to consider rights-based approaches as a mean to provide holistic care in a social neurology framework.
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Affiliation(s)
- Keiko Shikako-Thomas
- *Participation and Knowledge Translation in Childhood Disability Lab, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada; ((†))Department of Pediatrics, Montreal Children's Hospital, Centre for Interdisciplinary Research in Rehablitation (CRIR), Montreal, QC, Canada.
| | - Meaghan Shevell
- *Participation and Knowledge Translation in Childhood Disability Lab, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Lamsal R, Dutton DJ, Zwicker JD. Using the ages and stages questionnaire in the general population as a measure for identifying children not at risk of a neurodevelopmental disorder. BMC Pediatr 2018; 18:122. [PMID: 29614989 PMCID: PMC5883588 DOI: 10.1186/s12887-018-1105-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/27/2018] [Indexed: 01/01/2023] Open
Abstract
Background Early detection of neurodevelopmental disorders (NDDs) enables access to early interventions for children. We assess the Ages and Stages Questionnaire (ASQ)’s ability to identify children with a NDD in population data. Method Children 4 to 5 years old in the National Longitudinal Survey of Children and Youth (NLSCY) from cycles 5 to 8 were included. The sensitivity, specificity, positive and negative predictive values were calculated for the ASQ at 24, 27, 30, 33, 36 and 42 months. Fixed effects regression analyses assessed longitudinal associations between domain scores and child age. Results Specificity for the ASQ was high with 1SD or 2SD cutoffs, indicating good accuracy in detecting children who will not develop a NDD, however the sensitivity varied over time points and cut-offs. Sensitivity for the 1 SD cutoff at 24 months was above the recommended value of 70% for screening. Differences in ASQ domains scores between children with and without NDD increases with age. Conclusions The high specificity and negative predictive values of the ASQ support its use in identifying children who are not at the risk of developing a NDD. The capacity of the ASQ to identify children with a NDD in the general population is limited except for the ASQ-24 months with 1SD and can be used to identify children at risk of NDD. Electronic supplementary material The online version of this article (10.1186/s12887-018-1105-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ramesh Lamsal
- School of Public Policy, University of Calgary, 906 8th Ave SW, Calgary, Canada
| | - Daniel J Dutton
- School of Public Policy, University of Calgary, 906 8th Ave SW, Calgary, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906 8th Ave SW, Calgary, Canada. .,Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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Lamsal R, Zwicker JD. Economic Evaluation of Interventions for Children with Neurodevelopmental Disorders: Opportunities and Challenges. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:763-772. [PMID: 28822113 PMCID: PMC5701958 DOI: 10.1007/s40258-017-0343-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Economic evaluation is a tool used to inform decision makers on the efficiency of comparative healthcare interventions and inform resource allocation decisions. There is a growing need for the use of economic evaluations to assess the value of interventions for children with neurodevelopmental disorders (NDDs), a population that has increasing demands for healthcare services. Unfortunately, few evaluations have been conducted to date, perhaps stemming from challenges in applying existing economic evaluation methodologies in this heterogeneous population. Opportunities exist to innovate methods to address key challenges in conducting economic evaluations of interventions for children with NDDs. In this paper, we discuss important considerations and highlight areas for future work. This includes the paucity of appropriate instruments for measuring outcomes meaningful to children with NDDs and their families, difficulties in the measurement of costs due to service utilization in a wide variety of sectors, complexities in the measurement of caregiver and family effects and considerations in estimating long-term productivity costs. Innovation and application of evaluation approaches in these areas will help inform decisions around whether the resources currently spent on interventions for children with NDDs represent good value for money, or whether greater benefits for children could be generated by spending money in other ways.
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Affiliation(s)
- Ramesh Lamsal
- School of Public Policy, University of Calgary, 906-8th Avenue SW, Calgary, AB T2P 1H9, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906-8th Avenue SW, Calgary, AB T2P 1H9, Canada.
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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