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Lou TM, Zhang KL, Slesinger NC, Taddeo M, Serrano E, Begolka WS, Capozza K, Paller AS, Griffith JW, Fishbein AB. Positive Psychology Themes in Interviews of Children With Atopic Dermatitis: Qualitative Study. JMIR Pediatr Parent 2022; 5:e38725. [PMID: 36103242 PMCID: PMC9520397 DOI: 10.2196/38725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atopic dermatitis is a pruritic chronic condition associated with significant sleep disturbance, inattention, and sometimes behavioral problems. Enhancing resiliency in children with atopic dermatitis may promote coping strategies to improve quality of life. Positive psychology is one strategy that can be used to strengthen resiliency. OBJECTIVE Our objective was to identify positive psychology concepts mentioned by children with atopic dermatitis and their parent to inform strategies to strengthen resiliency in children with atopic dermatitis. METHODS A total of 20 patient-parent dyads were interviewed to share their experience with atopic dermatitis to help develop a novel psychologic intervention for atopic dermatitis. Patients were 8 to 17 years old and diagnosed with atopic dermatitis. Trained coders analyzed transcripts using a coding dictionary developed based on Seligman's PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) model of positive psychology. The frequency of unprompted mentions of PERMA themes and relevant quotations was captured. Transcripts were also separately coded for resiliency, which is the ultimate goal of PERMA. RESULTS Positive psychology concepts were mentioned by 100% (20/20) of children and 95% (19/20) of parents. Engagement and relationships, both negative and positive aspects, were the most common unprompted PERMA themes mentioned by children (14/20, 70%) and parents (13/20, 65%). Emotion elicited the most negative comments from children (19/20, 95%) and parents (17/20, 85%). When analyzed for resiliency, 8 participants were identified with at least one resiliency code. On average, participants with a resiliency code mentioned PERMA concepts 9.1 (SD 4.7) times compared to those who mentioned none (mean 5.9, SD 4.6) (P=.14). When participants were stratified by disease severity, on average, more positive psychology concepts were mentioned by patients with mild atopic dermatitis (mean 13, SD 3.0) than those with moderate symptoms (mean 6.2, SD 4.9) or severe symptoms (mean 6.1, SD 4.0) (P=.03). CONCLUSIONS Among PERMA themes, engagement and relationships are the two most commonly mentioned categories for children with atopic dermatitis. Strategies targeting PERMA such as affirmations and positive reframing may improve psychosocial well-being and resiliency in pediatric atopic dermatitis. Future directions will look at incorporating "positive medicine" into atopic dermatitis treatment to not only relieve symptoms but also strengthen positive aspects of life.
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Affiliation(s)
- Terry M Lou
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
| | - Kenneth L Zhang
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
| | - Noël C Slesinger
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Michelle Taddeo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eloisa Serrano
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, CA, United States
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Anna B Fishbein
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
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Okumura MJ, Kuo DZ, Ware AN, Cyr MH, White PH. Improving Health Care Transitions for Children and Youth With Special Health Care Needs. Acad Pediatr 2022; 22:S7-S13. [PMID: 35248248 DOI: 10.1016/j.acap.2021.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 11/19/2022]
Abstract
Health care transitions (HCT) from pediatric to adult health care remain a challenge for children and youth with special health care needs (CYSHCN), their families and their clinicians. While the HCT literature has expanded, gaps remain in how to improve health outcomes during transitions. HCTs broadly encompass three key domain areas: transition planning, transfer to adult health care clinicians or an adult model of care, and integration into an adult care/model of care. The CYSHCNet national research agenda development process, described in a previous article, prioritized several key research areas to address deficiencies in the HCT process. The highest priority questions identified were "What are the best models to accomplish youth-adult transition planning? How might this translate to other transitions (eg, to new clinicians, new settings, new schools, etc.)?" and "How do gaps in insurance and community supports during early adulthood effect CYSHCN health outcomes, and how can they be reduced?". Based upon these priorities, we describe the current state of transition research and recommendations for future investigation. Recommendations: The authors recommend 3 primary areas of investigation: 1) Understanding the optimal development and implementation of HCT service models in partnership with youth and families to improve transition readiness and transfer 2) Defining the process and outcome measures that capture adequacy of transition-related activities and 3) Evaluating fiscal policies that incentivize the processes of transition readiness development, transfer to adult health care services, and continuity of care within an adult health care setting. This article explores approaches within each research domain.
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Affiliation(s)
- Megumi J Okumura
- University of California, San Francisco, Divisions of General Pediatrics, General Internal Medicine and Philip R. Lee Institute for Health Policy Studies (MJ Okumura), San Francisco, Calif.
| | - Dennis Z Kuo
- University at Buffalo, Division of General Pediatrics, Division of Developmental Pediatrics & Rehabilitation (DZ Kuo), Buffalo, NY
| | | | - Mallory H Cyr
- Healthcare Transition Consultant, Mallory Cyr, LLC (MH Cyr), Denver, Colo
| | - Patience H White
- George Washington University School of Medicine and Health Sciences, The National Alliance to Advance Adolescent Health (P White), Washington, DC
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Betz CL, Hudson SM, Skura AL, Rajeev ND, Smith KA, Van Speybroeck A. Exploratory study of the provision of academic and health-related accommodations to transition-age adolescents and emerging adults with spina bifida. J Pediatr Rehabil Med 2022; 15:593-605. [PMID: 36442216 DOI: 10.3233/prm-210116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this exploratory study was to investigate the types of academic and health-related accommodations provided to adolescents and emerging adults with spina bifida aged 9-20 years. METHODS Data were extracted from the paper and electronic records of transition-age youth enrolled in the study. Four open ended items involved content analysis. RESULTS The most frequently identified accommodation was enrollment in special education classes in 47.7% of the charts. Other academic accommodations that were most often reported were adaptive physical education (n = 71, 39.9%), tutoring (n = 28; 15.7%), and home schooling (n = 21; 11.8%). Clean intermittent catheterization was the most frequently identified health-related accommodation provided by the school nurse/aide (n = 57; 32%).The largest percentage of requests for additional accommodations were made during the middle school grades (15; 54.8%) followed by high school (10; 32.2%). CONCLUSION Findings demonstrated that persistent issues were identified by parents/adolescents regarding the provision of school-related accommodations. This is a relevant area for clinical practice to ensure students with special health care needs and those with spina bifida receive the academic and health-related accommodations in their Individualized Education Program/504 plans.
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Affiliation(s)
- Cecily L Betz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
| | - Sharon M Hudson
- Implementation Science and Evaluation, Alta Med Institute for Health Equity, Los Angeles, CA, USA
| | - Adam L Skura
- Chan Medical School, University of Massachusetts, Worcester, MA, USA
| | - Nithya D Rajeev
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathryn A Smith
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
| | - Alexander Van Speybroeck
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
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Zimmerman C, Garland BH, Enzler CJ, Hergenroeder AC, Wiemann CM. The roles of quality of life and family and peer support in feelings about transition to adult care in adolescents with gastroenterology, renal, and rheumatology diseases. J Pediatr Nurs 2022; 62:193-199. [PMID: 34116868 DOI: 10.1016/j.pedn.2021.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Transition to adult healthcare is a critical time in the lives of adolescents with chronic medical conditions, with clear impacts on health outcomes. Little is known about factors that impact feelings about healthcare transition, including HRQOL, family and peer support, and utilization of a framework such as the SMART Model can guide exploration of these factors. The goal of this study is to examine how HRQOL (i.e., functional impact of disease) and family and peer support may impact adolescents' feelings about healthcare transition. DESIGN AND METHODS 135 adolescents (17-23 years) with chronic gastroenterology, renal, or rheumatology disease completed four questionnaires as part of a larger study examining health, relationships, and healthcare transition. Questions assessed current HRQOL (i.e., number of days health was "not good"), peer and family support, and feelings about transition. Data were analyzed using SPSSv25 and linear regressions were performed. RESULTS Lower HRQOL (β = 0.283, p < .01) and less peer support (β = -0.198, p < .05) were associated with worse feelings about transition (R2 = 0.203, p < .001). Family support was significantly correlated at the bivariate level. There were no differences by type of disease, race/ethnicity, or gender that impacted study findings. CONCLUSION(S) Results are concerning as healthcare transition is a milestone for every patient. Lower HRQOL (i.e., greater functional impact of disease) and less peer support were associated with worse feelings about transition. PRACTICE IMPLICATIONS This study highlights potential targets for intervention such as improving HRQOL (e.g., acceptance and commitment therapy) and increasing peer support (e.g., social skills training, family facilitation) to improve transition to adult care for pediatric patients with chronic diseases.
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Affiliation(s)
- CortneyT Zimmerman
- Section of Psychology and Renal Service, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin, Houston, TX 77030, USA.
| | - Beth H Garland
- Sections of Adolescent Medicine & Sports Medicine and Pediatric Psychology, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin, Suite 1710, Houston, TX 77030, USA.
| | - Cassandra J Enzler
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin, Suite 1710, Houston, TX 77030, USA.
| | - Albert C Hergenroeder
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin, Suite 1710, Houston, TX 77030, USA.
| | - Constance M Wiemann
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin, Suite 1710, Houston, TX 77030, USA.
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Pierce JS, Jordan SS, Arnau RC. Development and Validation of the Pediatric Diabetes Routines Questionnaire for Adolescents. J Clin Psychol Med Settings 2018; 26:47-58. [DOI: 10.1007/s10880-018-9563-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lindsay S. A scoping review of the experiences, benefits, and challenges involved in volunteer work among youth and young adults with a disability. Disabil Rehabil 2015; 38:1533-46. [DOI: 10.3109/09638288.2015.1107634] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mannino JE. Resilience and Transitioning to Adulthood among Emerging Adults with Disabilities. J Pediatr Nurs 2015; 30:e131-45. [PMID: 26257131 DOI: 10.1016/j.pedn.2015.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/18/2015] [Accepted: 05/24/2015] [Indexed: 11/19/2022]
Abstract
Transitioning to adulthood is not without challenges. The move away from family influence towards independence and self-determination is filled with uncertainty. Increased challenges and vulnerabilities in transitioning are evident among emerging adults with disabilities because they face additional challenges related to their disability over and above what others of this developmental stage experience. The purpose of this convergent parallel mixed methods study was to understand resilience in a select group of emerging adults with disabilities, who have been recognized for their accomplishments, as they are transitioning to adulthood. Quantitative instruments were used to measure the relationship among resilience, physical health, mental health, satisfaction with life, future orientation, and social support resources, while a qualitative focus group and individual interviews further explored the central phenomenon of resilience. This study revealed transitioning goals and values, challenges encountered while transitioning, and key attributes of resilience that have aided in transitioning. Findings conclude that resilience mitigates adversity and facilitates transitioning, the capacity for resilience is well within reach, and resilience comes from a variety of individual and environmental attributes. Nurses care for individuals and are uniquely present to intervene throughout all stages of the transitioning process. Knowing which resilient attributes are most effective in facilitating transitioning would be especially useful in the development of preventative holistic patient-centered nursing interventions. The research and practice implications of this study may suggest that resilience is a viable concept for the development of strength-based, patient-centered nursing interventions that facilitate transitioning.
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Betz CL, Nehring WM, Lobo ML. Transition Needs of Parents of Adolescents and Emerging Adults With Special Health Care Needs and Disabilities. JOURNAL OF FAMILY NURSING 2015; 21:362-412. [PMID: 26283056 DOI: 10.1177/1074840715595024] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The period of health care transition (HCT) for adolescents and emerging adults with special health care needs and disabilities involves a complex realignment of the parent-child relationship, including alterations in role responsibilities and decision making. The purpose of this systematic review was to analyze the research designs, methodology, and findings reported in studies of parents during this transition period to provide new insights for research and clinical practice. Results showed that parents were unable to clearly envision what the future held for their children and were not well prepared by the service system to anticipate future prospects. These parents have a myriad of needs that are not yet fully understood, as HCT research is in the early stages of development.
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Holwerda A, Brouwer S, de Boer MR, Groothoff JW, van der Klink JJL. Expectations from different perspectives on future work outcome of young adults with intellectual and developmental disabilities. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:96-104. [PMID: 24935728 DOI: 10.1007/s10926-014-9528-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Expectations strongly influence future employment outcomes and social networks seem to mediate employment success of young adults with intellectual and developmental disabilities. The aim of this study is to examine the expectations of young adults with intellectual and developmental disabilities from special needs education, their parents and their school teachers regarding future work and the extent to which these expectations predict work outcome. METHODS Data on 341 young adults with intellectual or developmental disabilities, coming from special needs education, aged 17-20 years, and with an ability to work according to the Social Security Institute were examined. RESULTS The school teacher's expectation was the only perspective that significantly predicted entering competitive employment, with a complementary effect of the expectation of parents and a small additional effect of the expectation of the young adult. CONCLUSIONS Expectations of school teachers and parents are valuable in predicting work outcome. Therefore, it is important for professionals working with the young adult in the transition from school to work to incorporate the knowledge of school teachers and parents regarding the abilities of the young adult to enter competitive employment as a valuable source of information.
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Affiliation(s)
- Anja Holwerda
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
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10
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Lagging behind or not? Four distinctive social participation patterns among young adults with chronic conditions. J Adolesc Health 2014; 54:397-403. [PMID: 24280304 DOI: 10.1016/j.jadohealth.2013.09.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Typical childhood and adolescent development and acquiring self-management skills are crucial for a satisfying adult life and autonomy in social participation. The aims of this study were to identify patterns of autonomy in social participation and to explore differences between these patterns. METHODS Adolescents with various chronic conditions participating in a survey in 2006 (T0) were re-invited for a follow-up study (T1) in 2012. The young adults (18-25 years of age) assessed self-management skills, their condition's impact on school or work, health-related quality of life (HRQoL), and social participation in various domains. Patterns were identified through cluster analysis. Differences between patterns were analyzed in bivariate and multivariate analyses. RESULTS Compared with healthy age-mates, our sample (n = 483) generally lagged behind in social participation. Four patterns emerged: typical developers, financially secure laggers, slow developers, and outgoing laggers. The patterns differed regarding gender, educational level, attending special education, having disability benefits, and degree of physical limitations. Groups with a higher level of autonomy in social participation did not necessarily have higher HRQoL but did report higher self-efficacy and independence at both measurements. CONCLUSIONS Autonomy in some participation domains can coincide with a lack of autonomy in others. In addition, better social participation does not necessarily correlate with higher HRQoL, or vice versa. Yet, more social participation was associated with more self-efficacy and independence. Our results emphasize that there is no standardized approach. Clinicians should take care to address all life areas in clinical practice to screen patients' lived experiences and the need for social and self-management support.
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Preskitt JK, Goldfarb SS, Mulvihill BA, Colburn S, Davis MM. Future plans and social/recreational activities of youth with special health care needs: the implications of parental help in completing surveys. Disabil Health J 2013; 6:343-51. [PMID: 24060257 DOI: 10.1016/j.dhjo.2013.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/15/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND A major focus of the literature on youth with special health care needs (YSHCN) is the transition to adult health care. As perceptions of disability are a product of interactions between youth and their environment, it is important to understand youth's needs and experiences beyond health care. Few studies have addressed social/recreational activity participation and future plans and none have included parent/caregiver help in survey completion as a potential factor impacting responses. OBJECTIVES We describe activity participation and identification of future plans among YSHCN and examine the impact of receiving parent/caregiver assistance to complete a survey on these responses. Implications for research, policy, and practice affecting programs serving and providing transition assistance for YSHCN are discussed. METHODS Data are from a survey of YSHCN conducted during Alabama's 2010 Title V Maternal and Child Health Needs Assessment. Analyses included descriptive statistics, bivariate analysis, and multivariable logistic regression. RESULTS Youth who received help completing the survey were less likely to report participating in certain social/recreational activities and key future plans, including hobbies, getting married, having children, and working for pay. CONCLUSIONS For YSHCN, parent/caregiver assistance to complete a survey is a critical consideration in analyses and interpretation of results. Whether, how much, and what type of help received may represent a more objective proxy measure of perceptions of condition severity or impact on abilities than do self-reported ratings of these factors. Our results also raise questions about the distinctions between youth and parent/caregiver perceptions of independence, participation, and potential.
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Affiliation(s)
- Julie K Preskitt
- Maternal and Child Health Policy and Leadership, Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, RPHB 330, 1720 2nd Ave. S, Birmingham, AL 35294, USA.
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Wang G, McGrath BB, Watts C. Health care transitions among youth with disabilities or special health care needs: an ecological approach. J Pediatr Nurs 2010; 25:505-50. [PMID: 21035018 PMCID: PMC2994364 DOI: 10.1016/j.pedn.2009.07.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 06/02/2009] [Accepted: 07/14/2009] [Indexed: 11/29/2022]
Abstract
This literature review of 46 articles uses the ecological model as a framework for organizing concepts and themes related to health care transition among youth with disabilities or special health care needs (SHCN). Transition involves interactions in immediate and distal environmental systems. Important interactions in immediate environments include those with family members, health care providers, and peers. Activities in distal systems include policies at the governmental and health system levels. The ecological model can help researchers and practitioners to design experimental interventions in multiple settings that ensure smooth transitions and support the well-being of youth with disabilities or SHCN.
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Affiliation(s)
- Grace Wang
- Institute for Public Health Genetics, School of Public Health, University of Washington, Seattle, WA, USA.
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13
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Ried S. Transition of Youth From Pediatric to Adult Care: Physician’s Perspective and Recommendations. Top Spinal Cord Inj Rehabil 2010. [DOI: 10.1310/sci1601-38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bellin MH, Zabel TA, Dicianno BE, Levey E, Garver K, Linroth R, Braun P. Correlates of depressive and anxiety symptoms in young adults with spina bifida. J Pediatr Psychol 2009; 35:778-89. [PMID: 19880443 PMCID: PMC2908707 DOI: 10.1093/jpepsy/jsp094] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Based on social ecological theory, this study was designed to examine the unique relationships between multi-level ecological factors and psychological symptoms in young adults with spina bifida (SB). METHOD A sample of 61 individuals with SB, 18-25 years of age, completed standardized self-report measures of attitude toward SB, satisfaction with family functioning, Chronic Care Model (CCM) services, and depressive and anxiety symptoms. A chart review yielded SB clinical data. RESULTS High rates of depressive and anxiety symptoms were found. Hierarchical regression analysis identified the proximal individual (attitude toward SB) and family (satisfaction with family functioning) factors as more strongly related to depressive symptoms than the distal healthcare system factor (CCM services). Self-reported pain was the only ecological factor associated with anxiety symptoms. CONCLUSIONS Study findings provide a potential foundation for multi-factor screening of young adults with SB at risk for psychological symptoms.
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Affiliation(s)
- Melissa H Bellin
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA.
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