Specific needs of families of young adults with profound intellectual disability during and after transition to adulthood: What are we missing?

Family Caregiver Adaptation during the Transition to Adulthood of Individuals with Intellectual Disabilities: A Scoping Review

During the transition to adulthood, individuals diagnosed with intellectual disability (ID) and their family caregivers have unique experiences. This scoping review studies the sources of the family caregiver's objective burden, support, coping mechanisms, positive caregiving, and quality of life to understand the caregiver's adaptation process when the individual with ID transits to adulthood, according to Joanna Briggs Institute (JBI) Scoping Review methodology guidelines. The inclusion criteria included studies of family caregivers of any age who provide unpaid care and live with individuals diagnosed with ID who are transitioning to adulthood. Of 2875 articles identified, 12 published studies were included. The main themes included caregivers reporting dissatisfaction with the available adult services and exhaustion from being a caregiver. Overall, a vicious cycle of likely increased demands during the transition, with caregivers not being prepared to cope with these demands while concurrently being dissatisfied with the adult services system, leads the caregivers to develop a pervasive sense of helplessness. Future studies would benefit from recruiting caregivers from sources other than adult-only service centres and using qualitative (to identify the broad aspects of the key factors) and quantitative (to identify the significant differences between the key factors) methodologies.

'From my world to yours…': exploring the availability of social networks among parents from culturally diverse backgrounds caring for children with developmental disabilities in Australia

This paper reports findings from an ethnographic study of families from culturally and linguistically diverse (CALD) families in Australia caring for children with disability. The study aimed to contribute insights into the unique experiences, challenges and supports that characterise experiences of families of a child with disability living in a country where the mainstream culture is different from their own. Four families from different cultural backgrounds participated in the study over a period of nine months. During this time, they participated in a series of semi-structured interviews during which they shared their encounters with formal early intervention services and reflected on important informal supports. Findings presented here indicate three key areas associated with accessing informal supports that can pose challenges for families who hold values that are different from those of the dominant culture: lack of social support; cultural adaptations, and socialization problems and coping strategies. The findings indicate that formal services could ameliorate feelings of social isolation by enabling parents to access informal supports such as parenting groups.

Transitional Care for Young People with Movement Disorders: Consensus-Based Recommendations from the MDS Task Force on Pediatrics

Background

The International Parkinson and Movement Disorders Society (MDS) set up a working group on pediatric movement disorders (MDS Task Force on Pediatrics) to generate recommendations to guide the transition process from pediatrics to adult health care systems in patients with childhood-onset movement disorders.

Methods

To develop recommendations for transitional care for childhood onset movement disorders, we used a formal consensus development process, using a multi-round, web-based Delphi survey. The Delphi survey was based on the results of the scoping review of the literature and the results of a survey of MDS members on transition practices. Through iterative discussions, we generated the recommendations included in the survey. The MDS Task Force on Pediatrics were the voting members for the Delphi survey. The task force members comprise 23 child and adult neurologists with expertise in the field of movement disorders and from all regions of the world.

Results

Fifteen recommendations divided across four different areas were made pertaining to: (1) team composition and structure, (2) planning and readiness, (3) goals of care, and (4) administration and research. All recommendations achieved consensus with a median score of 7 or greater.

Conclusion

Recommendations on providing transitional care for patients with childhood onset movement disorders are provided. Nevertheless several challenges remain in the implementation of these recommendations, related to health infrastructure and the distribution of health resources, and the availability of knowledgeable and interested practitioners. Research on the influence of transitional care programs on outcomes in childhood onset movement disorders is much needed.

Comparing self-reported vs. parent/caregiver reported levels of social participation for young adults with intellectual disabilities: A pilot study

BACKGROUND

This study focused on the level of satisfaction of social participation reported by young adults with intellectual disabilities, and the comparison of these levels to those reported by their caregivers.

METHODS

Fifteen young adults with intellectual disabilities and their parents/caregivers completed the Patient-Reported Outcomes Measurement Information System Satisfaction with Participation in Discretionary Social Activities-Calibrated Items (PROMIS SF-Social Sat DSA) and the Satisfaction with Social Roles and Activities-Short Form (Neuro-QoL SF).

RESULTS

Reports from these young adults were compatible to that of the general population. There was general agreement on the Social Sat DSA between the individuals and their caregivers, but there were differences between groups on the Neuro-QoL SF, with the caregivers typically giving higher scores (p = .025).

CONCLUSION

This pilot study demonstrates the importance of involving both the individuals with intellectual disabilities, and their parents/caregivers when conducting survey research. Further research is encouraged.

Parents perception and experience of transitioning to adulthood for their child diagnosed with an intellectual disability

Definitions of adulthood for people with intellectual disability are often complicated, with milestones being markedly different for this population. This is then associated with difficulties for both the people with intellectual disability and their parents, who are closely involved in this transitional period. This paper aims to report on parents' perception and experience of adulthood for their son or daughter with an Intellectual Disability (ID). Qualitative data were collected through 30 - 60-minute phone interviews with eight parents of a person with an intellectual disability aged 15 or older (mean parent age = 60; mean child age = 23). Thematic analysis found that Perception of Adulthood encompassed themes of Independence and Normality. Experiences of Adulthood were categorised under Government Services, Responsibility and Social Supports. Findings of this research provide information for the growing literature around adulthood for people with intellectual disability, as well as how to amend policies and procedures for services that cater to people with intellectual disability and their parents during this transition.

Improved health care transition for young adults with developmental disabilities referred from designated transition clinics

PURPOSE

Young adults with intellectual/developmental disabilities (YAIDD) are a vulnerable population during HCT due to their complex care coordination and adaptive needs, yet factors associated with transition preparedness are not well defined. We aimed to determine factors associated with health care transition (HCT) preparation satisfaction for YAIDD establishing care with an adult medical home.

DESIGN AND METHODS

408 YAIDD or their families completed the HCT Feedback Survey 2.0 upon establishing adult care. Logistic regression models were used to determine associations between a composite of six HCT Feedback Survey questions that most correlated with the 2019 National Survey of Children's Health transition questions.

RESULTS

YADD who had HCT preparation visits with a designated HCT clinic were 9 times more likely to have met all six composite HCT criteria after controlling for the number of technologies required and race/ethnicity (adj OR 9.04, 95% CI: 4.35, 18.76) compared to those referred from the community. Compared to patients who were referred from the community, the odds of feeling very prepared versus somewhat or not prepared were 3.7 times higher (adj OR 3.73, 95% CI: 1.90, 7.32) among patients referred from a designated HCT program.

CONCLUSIONS

YAIDD who participated in a structured HCT program prior to transfer to adult care experienced higher transition preparation satisfaction.

PRACTICAL IMPLICATIONS

A structured HCT clinic model to prepare adolescents with DD for transition to adult care may improve HCT preparation satisfaction for this population.

Interventions for Transition-Age Youth With Disabilities: A Meta-Analysis of Group Design Studies

This meta-analytic review investigated interventions for transition-age youth diagnosed with autism, intellectual disability, or extensive support needs. Nineteen group design studies with 215 effect sizes met inclusion criteria. A robust variance estimation procedure that accounts for the clustering effect sizes within studies was used to synthesize effect sizes within each intervention and outcome type. Occupational Therapy/Physical Therapy interventions have significant and positive effects on gross motor outcomes (g = 0.73, p < 0.01). All remaining interventions and outcomes could not be synthesized due to a limited number of studies, but are further described in a narrative manner. Recommendations for future research include improving the methodological quality of intervention studies and further analyzing the effects of interventions for transition-age youth.

Transitioning to adulthood from residential childcare during COVID-19: Experiences of young people with intellectual disabilities and/or autism spectrum disorder in South Africa

For young people with intellectual disabilities and/or autism, the transition from children's residential care into adulthood during COVID-19 has been difficult.Opportunities for greater independence were blocked because of the lockdown.Some of these young people experienced an increase in depression or other mental health difficulties.But more time at home due to public health restrictions also helped to deepen the relationship with caregivers.Service continuity is crucial, both in person and online, to support care leavers with intellectual disability and/or autism, as well as training and support to caregivers to continue with independent and interdependent living programmes at home.

ABSTRACT

BACKGROUND

This study focuses on young people with intellectual disabilities and/or autism who, due to child welfare concerns, have grown up in children's residential care and are now transitioning out of care at the age of 18 years towards young adulthood. This transition is termed "care leaving" and the young people in transition "care leavers". The care leaving transition can be particularly difficult for young people with intellectual disabilities and/or autism. These challenges can be magnified in a time of a global crisis like COVID-19, which has resulted in countries being on lockdown and care leavers' transitions being curtailed. Many mental health problems have emerged due to the COVID-19 outbreak and resultant lockdown that may negatively impact on the care leaving transition of young people with intellectual disabilities.

METHODS

Semi-structured interviews were conducted with six care leavers with intellectual disabilities and their three caregivers in June 2020 in the Cape Peninsula region of South Africa to explore the impact of COVID-19 on their transitional journeys.

FINDINGS

Three core themes emerged from the analysis: young people evidenced regression of independence, rather than the expected growth in young adult independence, due to disruptions to routines and opportunities to move out into the world; some young people experienced an exacerbation or emergence of mental health problems, which impacted on their transition to young adulthood; and young people and their caregivers experienced a deepening of caregiver relationships, which enhanced the transition of the care leaver.

CONCLUSIONS

Services must continue to facilitate progress towards independence and promote personal and caregiver well-being. Support service for care leavers with intellectual disabilities should be essential services, offered in person or online while adhering to COVID-19 regulations. Caregivers should be trained in continuing independent and interdependent living programmes for care leavers in their care, supported through in person or online training, mentoring and supervision. Service continuity is recommended to avoid the contraction of young people's social world at a time when it should be opening up.

Putting the Patient First: A Scoping Review of Patient Desires in Canada

Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.

A Pilot Study of a Future Planning Program for Siblings of People With Intellectual and Developmental Disabilities

Given the increased longevity of people with intellectual and developmental disabilities (IDD), future planning programs are becoming increasingly common. However, although siblings are likely to fulfill caregiving roles for people with IDD, siblings have not been included in future planning interventions. The purpose of this study was to evaluate the outcomes and feasibility of the Sibling Training for Early future Planning (STEP) program. Using quantitative and qualitative data, 18 siblings of individuals with IDD participated in the study. After completing the STEP program, participants demonstrated significantly improved feelings of empowerment, disability connectedness, family communication, and knowledge of adult disability services. The STEP program was also feasible given high attendance, low attrition rates, and high participant satisfaction. Implications for research and practice are discussed.

Improving the transition process to independent living for adolescents with profound intellectual disabilities. Experiences of parents and employees

Background

The transition process from the family home to independent living for young adults with profound intellectual disability (PID) becomes delayed. Those families face challenges that exceed those of typical families such as higher objective and subjective burden, more frequent psychological distress and lower social support. The aim of this study was to explore the collaboration process between parents and employees and identify factors that improve the transition with less burden.

Methods

A descriptive qualitative study was undertaken with 18 persons (9 parents and 9 employees) interviewed individually and in groups. In accordance with the municipality’s guidelines, families with a child with PID should apply for housing, when the child turns 16. The purpose is to ensure interdisciplinary collaboration, information flow and coordinated services according to family’s needs. The main question in the interviews was ‘What was your experience with cooperation in the transition process, and what would you do to improve this process?’ The interviews were analysed with a thematic approach using systematic text condensation.

Results

The parents experienced a lack of general information about the ‘housing waiting list’, level of services, and the plan for time of moving from the family home, and how to choose where and whom to live with. Parents described an unsustainable burden of care during the waiting period, and a family crisis caused the allocation of an apartment in a group house. Employees shared challenges to meet families’ wishes, as there were too few group homes. They experienced good collaboration with families and said they offered respite care, due to reduce parents’ burden of care. Employees experienced that PID adolescents developed skills, mastery and degrees of independence after completing a residency at the Folk High School.

Conclusions

To improve the transition process from family home to independent living for young adults with PID, the informants highlighted some factors to reduce the burden of care on families: 1) Systematic follow-up program for families to observe their needs at an early stage; 2) More available group houses; 3) Information about the housing priorities of the services and; 4) Educational preparation programs for families.

Parents' knowledge of their child with profound intellectual and multiple disabilities: An interpretative synthesis

BACKGROUND

Parents' knowledge of their child with profound intellectual and multiple disabilities (PIMD) is seen as crucial in the support and care for their child. The aim of this study was to explore the nature and transferability of this knowledge.

METHOD

We conducted an interpretative synthesis, searched PubMed, CINAHL, Philosopher's Index and PsycINFO and included fourteen studies.

RESULTS

Parents' knowledge was based on their long-lasting and special bond with their child and described as an intuition, a gut feeling, a sixth sense and a sense of knowing. Parents applied their knowledge as experts in interpreting their child's intended communication, well-being and pain, and as advocates opposing the more objectivist approach of medical professionals. Showing by example and passing on narratives were seen as important ways of transferring this knowledge.

CONCLUSIONS

Suggestions are made on how to apply and retain parents' knowledge to improve care and support for people with PIMD.

Belonging through sport participation for young adults with intellectual and developmental disabilities: A scoping review

BACKGROUND

Research suggests that sport facilitates belonging for diverse athletes. This scoping review characterizes literature on sport participation and belonging for young adults with intellectual and developmental disabilities.

MATERIALS AND METHODS

A search of five databases identified 17,497 articles. Selected articles (N = 39) underwent data extraction and analysis guided by a theoretical framework of belonging, outlining four processes through which belonging is experienced by individuals with intellectual and developmental disabilities.

RESULTS

Articles originated from developed countries and in the context of Special Olympics (N = 17). Studies commonly used qualitative interviews with proxy respondents. While all studies described at least one belonging process, only 11 studies applied the term "belonging," and no study defined the construct.

CONCLUSION

Belonging is not well-conceptualized in sports literature for athletes with intellectual and developmental disabilities. Understanding belonging through sport participation for this population may inform sport-based policies and programming.

Factors impacting the transition to adulthood of youth with fragile X syndrome and their families: Facilitators, obstacles and needs

BACKGROUND

The transition from school to adulthood is a critical time for families of youth with disabilities. Few studies have focused on the needs of families of youths with fragile X syndrome. This syndrome is often associated with intellectual disability and autism spectrum disorder, which creates specific needs that must be documented to improve transition planning. The aim of the current study was to document factors impacting transition planning and describe parents' experiences during this period.

METHOD

Individual interviews were conducted with thirteen parents of young people with fragile X syndrome. Two research team members analysed the interviews separately.

RESULTS

Factors related to the youth, the youth's family and the steps taken by the various institutions involved during this period seem to impact this transition and contributed to families' anxiety. A clear, uniform transition planning process, initiated early enough to have time for exploratory work placements, and gradual integration emerged as crucial facilitators for the parents in this study.

CONCLUSIONS

Understanding the reality of people with fragile X syndrome and their families will help to adapt services and develop concrete plans for their future.

Caregiving experiences and expectations of parents with in-school children with intellectual disability in Ghana

BACKGROUND

The literature suggests that there are challenges faced by parents of children with intellectual disabilities (ID), which have resulted in calls for support services to be made available to parents and their children with ID. Although regular schools in Ghana are unable to admit students with ID, it is believed that special schools have the necessary facilities to support parents and their children with ID. However, little has been documented on the experiences and expectations of parents whose children with ID are enrolled in a special school.

METHOD

In this qualitative study, one-on-one semi-structured interviews were conducted with purposively recruited parents (n = 20) from the second most populous city in Ghana to explore their caregiving experiences and expectations regarding the education of their school-going children with ID.

RESULTS

Although the parents acknowledged that access to education has some benefits, such as the protection of their children with ID from negative societal attitudes and a reduction of their caregiving burden, they had low expectations for their children's education. Furthermore, the parents encountered considerable challenges in catering for their children with ID, such as financial problems and limited access to caregiving skills.

CONCLUSION

There is a need to intensify efforts at public education in relation to disability acceptance as well as to develop formidable social support systems.

Health Care Transition for Adolescent and Young Adults with Intellectual Disability: Views from the Parents

PURPOSE

This study explored the health care transition (HCT) experiences of parents of adolescents and young adults (AYAs) with intellectual disability (ID), 18-33 years of age, including barriers and facilitators to the AYA's transition to adulthood within and between the medical, educational, community, and vocational systems.

DESIGN AND METHODS

A qualitative descriptive design with semi-structured individual interviews with 16 parent participants was used. Purposive sampling of parents was utilized with variation on race/ethnicity and AYA age, stage in transition, and condition. This study was conducted through a major medical center in the southeast United States. Content analysis was utilized.

RESULTS

Three overarching themes represented the factors and essence of supporting AYAs with ID transition to adulthood. Inefficient and siloed systems illuminated barriers families are commonly experiencing within and between the medical, educational, community, and vocational systems. 'Left out here floundering' in adulthood, described the continued inadequacy of resources within each of these systems and parent's having to find available resources themselves. Hope despite uncertainty, included the perceived costs and benefits of their AYA's disability and the value of parent peer support in providing key knowledge of resources, strategies, and perspectives.

CONCLUSIONS

Our findings illuminate the need for improved infrastructure to provide effective HCT and partnerships to help integrate HCT support within other life course systems. Results support the rationale for non-categorical HCT-focused approach.

PRACTICE IMPLICATIONS

A parent peer coach-facilitated intervention offers promise for bridging the gap between systems and meeting family needs.

Transition to adult mental health services for young people with an intellectual disability

People with intellectual disabilities (ID) experience high rates of mental health problems, particularly during the period of transition to adulthood. It is therefore important that the transition from child- to adult-oriented health services for people with ID is well managed to ensure appropriate orientation to ongoing adult mental health care. The purpose of this paper is to summarise the impact and experience of transition to adult mental health care for people with ID and those who support them, as well as issues related to current policy and practice in this area. Several opportunities for improvement are identified in the broad areas of policy, service structure and organisation, research and workforce capacity. Enhancements in these areas will lead to improved outcomes for young people with ID transitioning from child- to adult-oriented mental health care.

Transition from school to adult services for young people with severe or profound intellectual disability: A systematic review utilizing framework synthesis

BACKGROUND

The transition to adulthood has been described as a difficult time in the lives of young people with intellectual disability. There has been little emphasis on young people with severe or profound intellectual disability specifically, even though their pathways may differ, due to greater support needs across the life course.

METHODS

A systematic review was conducted utilising Bronfenbrenner's ecological model to inform framework analysis to synthesise qualitative findings.

RESULTS

Taking an ecological perspective proved valuable. The transition process was described as stressful and barriers were identified across the ecological levels. Parents accounted for the majority of participants in studies, and the needs of young people and their parents emerged as highly interdependent.

CONCLUSION

Themes reflect the complex nature of the question what adulthood should look like for individuals with severe or profound intellectual disability. There is a lack of involvement of multiple stakeholders and young people themselves within studies.

Health and wellbeing during transition to adulthood for young people with intellectual disabilities: A qualitative study

BACKGROUND

Transition to adulthood may have negative consequences for health and wellbeing in individuals with intellectual disabilities (ID), but this aspect of transition has received little investigation. This qualitative study aimed to explore the transition experiences of individuals with ID from their own perspectives, and from that of their parents, in order to identify health or wellbeing implications of transition.

METHOD

Semi-structured interviews were conducted with 17 young people with mild, moderate and severe ID aged 16-27 years and with 23 parents of young people with mild, moderate, severe and profound ID aged 16-26 years. Interviews were analysed using thematic analysis, deploying both emic and etic coding categories.

RESULTS

This study provides direct insights into the issues on health and wellbeing that young people with ID and their parents find important during transition. The primary health implication of transition centred on mental health and wellbeing; young people experienced heightened anxiety during transition, and themes identified as contributing to anxiety included: a lack of meaningful activity following school exit; inadequate support during transition; and difficulties associated with 'growing up'. Problem behaviours and obesity were also implicated.

CONCLUSION

The transition from school needs to be better supported in order to ease anxiety for young people during this difficult period.