Helping adolescents who have disabilities negotiate transitions to adulthood

The importance of assistive technology in the productivity pursuits of young adults with disabilities

BACKGROUND

Young adults with disabilities often use assistive technology (AT) to address personal needs, engage in communities and pursue educational and vocational goals. Little is known about their personal experiences and challenges of accessing and using AT for productivity-related activities.

OBJECTIVE

This study aimed to learn from young adults about their experiences and use of AT in supporting their productivity.

METHODS

Using a qualitative approach, 20 young adult AT users engaged in semi-structured interviews and a photovoice process. Data were analysed inductively.

RESULTS

Three primary themes were identified: I Have to Figure it out Myself, With the Right AT, and Relational Aspects of AT Use. Although participants were experienced AT users, they were often left alone to figure out their emerging needs. They relied on AT to participate in productivity pursuits however stigma around AT use in unsupportive work environments were new concerns.

CONCLUSIONS

Young adults with disabilities draw on their experiences of AT use but may need to develop advocacy skills to ensure their needs are met in productivity-related environments. Employers and supervisors should recognize AT as essential to young adult's engagement with productivity-related activities and have an important role in developing inclusive work environments.

A Comparison of Social Support among Adolescents with and without Visual Impairments in Jordan: A Case Study from the Arab Region

Introduction

Research to date on social support for adolescents with visual impairments (that is, blindness or low vision) has been primarily carried out in developed countries, and very little is known about the social support systems that are available for such adolescents in developing countries such as those in the Arab world. In the present study, social support among adolescents with and without visual impairments was investigated in Jordan, which is considered a developing country.

Methods

Study participants included 86 adolescents with visual impairments and 73 sighted adolescents. The instrument used to collect information in this study was an Arabic version of the Multidimensional Scale of Perceived Social Support (MSPSS).

Results

The level of social support reported by adolescents with visual impairments was higher than that reported by sighted adolescents. In all three domains of the MSPSS (family, friends, and significant others), students with visual impairments reported receiving more social support than those without impairments. However, there was no statistically significant effect for gender.

Discussion

The results of the study are not consistent with findings of previous studies, all of which were conducted in Western countries. The disparities in experiences of adolescents with visual impairments in developed and developing countries may be attributed to differences in cultural values as well as to the conceptualization of support by those involved.

Implications for practitioners

Special education teachers need to be aware of the cultural backgrounds of their students and to develop and implement culturally appropriate programs for them.

Systems thinking perspectives applied to healthcare transition for youth with disabilities: a paradigm shift for practice, policy and research

BACKGROUND

Healthcare transition (HCT) for youth with disabilities is a complex phenomenon influenced by multiple interacting factors, including health, personal and environmental factors. Current research on the transition to adulthood for disabled youth has primarily focused on identifying these multilevel factors to guide the development of interventions to improve the HCT process. However, little is known about how this complex array of factors interacts and contributes to successful HCT. Systems thinking provides a theoretically informed perspective that accounts for complexity and can contribute to enhanced understanding of the interactions among HCT factors. The objective of this paper is to introduce general concepts of systems thinking as applied to HCT practice and research.

METHODS

Several systems thinking concepts and principles are introduced and a discussion of HCT as a complex system is provided. Systems dynamics methodology is described as one systems method for conceptualizing HCT. A preliminary systems dynamics model is presented to facilitate discourse on the application of systems thinking principles to HCT practice, policy and research.

CONCLUSIONS

An understanding of the complex interactions and patterns of relationships in HCT can assist health policy makers and practitioners in determining key areas of intervention, the impact of these interventions on the system and the potential intended and unintended consequences of change. This paper provides initial examination of applying systems thinking to inform future research and practice on HCT.

Enough of the problem: a review of time for health care transition solutions for young adults with a chronic illness

AIMS AND OBJECTIVES

In this article, we critically assess the state of the science of transition care in chronic conditions using diabetes care as an exemplar and provide a case for the adoption of the principles of the Chronic Care Model in driving health care reform.

BACKGROUND

Globally, there is an increasing burden of chronic conditions including among adolescents and young adults. As a consequence adolescents are transitioning, at an increasing rate, from paediatric services into mainstream adult services, which are often ill equipped to meet their needs.

DESIGN

Integrative literature review.

METHODS

An integrative literature review method was used to summarise key issues facing adolescents with chronic illness and generate strategies for improving health care services.

CONCLUSION

Strengthening the capacity for transitioning from a service that is family focused to one with an individual orientation requires a paradigmatic shift and clear identification of roles and responsibilities in the health care system. The absence of empirically developed models of care, in a context of growing need, signals the importance of ongoing discussion, debate and research.

IMPLICATIONS FOR CLINICAL PRACTICE

There is a need for a change in philosophical orientation to promote service provision on the basis of need, rather than a model based on diagnosis and chronology. Nurses and other health professionals need to increase their awareness of issues facing adolescents with chronic conditions making the transition to adult health services.

What Do We Really Know About the Transition to Adult-Centered Health Care? A Focus on Cerebral Palsy and Spina Bifida

OBJECTIVES

To address the lack of synthesis regarding the factors, processes, and outcomes specific to the transition from child-centered to adult-centered health care for people with cerebral palsy (CP) and spina bifida (SB); more specifically, to identify barriers, to outline key elements, to review empirical studies, and to make clinical and research recommendations.

DATA SOURCES

We searched Medline and CINAHL databases from 1990 to 2006 using the key words: transition, health care transition, pediatric health care, adult health care, health care access, health care use, chronic illness, special health care needs, and physical disability. The resulting studies were reviewed with a specific focus on clinical transition for persons with CP and SB, and were supplemented with key information from other diagnostic groups.

STUDY SELECTION

All studies meeting the inclusion criteria were included.

DATA EXTRACTION

Each article classified according to 5 criteria: methodology, diagnostic group, country of study, age group, and sample size.

DATA SYNTHESIS

We identified 149 articles: 54 discussion, 21 case series, 28 database or register, 25 qualitative, and 34 survey articles (some included multiple methods). We identified 5 key elements that support a positive transition to adult-centered health care: preparation, flexible timing, care coordination, transition clinic visits, and interested adult-centered health care providers. There was, however, limited empirical evidence to support the impact of these elements.

CONCLUSIONS

This review summarizes key factors that must be considered to support this critical clinical transition and sets the foundation for future research. It is time to apply prospective study designs to evaluate transition interventions and determine long-term health outcomes.

Facilitating the transition of adolescents with developmental disabilities: nursing practice issues and care

The purpose of this article is to provide an overview of salient issues that adolescents with developmental disabilities face as they approach adulthood. For nurses who provide services to this population of youth, knowledge of these significant issues is essential to developing a youth-centered transition plan that addresses their comprehensive health needs. Health care professionals, including pediatric nurses, have important roles as service coordinators, consultants, or direct service providers to ensure that the health-related transition needs of the youth are met. Transition assessment, planning, and intervention strategies that can be integrated into a comprehensive plan of care are discussed.

Updated competencies for physical therapists working in schools

PURPOSE

The purpose of this project was to update the 1987 competencies for physical therapists who work in schools and their content to reflect present practice, legislation, and terminology.

METHODS

A review of the literature and competencies for professionals working in schools was completed. Four focus groups of school physical therapists were formed to ascertain their perspectives of the roles and responsibilities of school therapists and what knowledge and skills enabled them to be effective. This information was integrated into a listing of competencies. The competencies were reviewed regionally and nationally by experts in the field.

RESULTS

Nine content areas with specific competencies were identified for physical therapists working in schools. These competencies reflect an expanded role of school-based therapists compared with previous competencies.

CONCLUSION

Physical therapists who work in schools require specific skills and knowledge to effectively serve children with disabilities. Competencies help guide professional development.

Performance of physical activities by adolescents with cerebral palsy

BACKGROUND AND PURPOSE

Mobility and self-care are important considerations for successful transition of adolescents with cerebral palsy to adulthood. The purpose of this study was to characterize performance of physical activities from the perspective of adolescents themselves.

SUBJECTS

The subjects were 156 adolescents with cerebral palsy, 11.6 to 17.7 years of age.

METHODS

A therapist completed the Gross Motor Function Classification System (GMFCS). Adolescents completed the Activities Scale for Kids-Performance Version (ASKp) twice over a 1-year period.

RESULTS

A repeated-measures analysis of variance indicated a main effect for GMFCS level. The main effect for time and the GMFCS level x time interaction were not significant. Post hoc comparisons indicated that ASKp scores differed among all GMFCS levels.

DISCUSSION AND CONCLUSION

Performance of physical activities by adolescents with cerebral palsy differed based on GMFCS level and did not change over 1 year. The ASKp scores of adolescents in levels II through V suggest the need for physical assistance at times throughout the day. The results have implications for the role of the physical therapist in transition planning.

Assistive technology use among adolescents and young adults with spina bifida

OBJECTIVES

We sought to determine the use of assistive technology among a population of individuals with spina bifida.

METHODS

We performed a descriptive analysis of individuals aged 13 to 27 years diagnosed with myelomeningocele (n=348) using data obtained from an existing database at Children's Hospital and Regional Medical Center, Seattle, Washington. We summarized disease characteristics, utilization of assistive technology, community and self-care independence, and other variables.

RESULTS

Eighty-four percent of the respondents lived with at least 1 of their natural parents. Fifty-seven percent used wheelchairs, 35% used braces, and 23% used walking aids. Independent self-care was a common skill, but 72% reported limited participation in structured activities. Half were aged 18 years or older; of those, only 50% had completed high school and 71% were unemployed. Those aged younger than 18 years were all still in school (100%).

CONCLUSIONS

Adolescents and young adults with spina bifida rely on assistive technology and specialized care routines to maintain their health. Assistive technology use for mobility is common; little is known about secondary complications associated with use of these technologies or the use of assistive technology to address learning disabilities and other societal barriers. Underutilization of assistive technology could delay successful transitions to independent living and community participation.

Adolescents in transition of adult care: why the concern?

This article has described issues associated with transition planning for youth with CHD. A number of approaches have been described to address the needs of this growing number of youth with CHD. Transition to adulthood has been and will continue to be a significant clinical concern as the adult survival rate increases. Health care professionals who are involved in transition planning will be focused on the health-related concerns of the transfer to an ACHD, insurability, and long-term CHD management, as well as issues related to employment, education, social relationships, and independent living. Successful transitioning is dependent on long-term planning,. youth-centered approaches, service coordination, and referral to adult agencies. As youth, families, adult survivors, and experts have discovered, long-term survival means more than the physical aspects of CHD.

Förderung der sozialen und emotionalen Kompetenz bei krebskranken Kindern und Jugendlichen

Zusammenfassung. Mit verbesserten Überlebensraten für die meisten Krebserkrankungen des Kindes- und Jugendalters erhalten Rehabilitationsmaßnahmen stetig mehr Aufmerksamkeit. Während die Mehrheit der Patienten Krankheit und Behandlung erstaunlich gut bewältigt, sind einige Kinder, insbesondere jene, die sichtbare und andere körperliche Langzeitkomplikationen aufweisen, einem erhöhten Risiko für Ablehnung durch Gleichaltrige, geringere Beliebtheit und unzureichende soziale Unterstützung ausgesetzt. Trainingsprogramme zur Förderung sozialer Fertigkeiten können hier die soziale Eingliederung erleichtern. Bisher liegen nur wenige Erkenntnisse zum Einsatz dieser Programme mit Krebspatienten vor. Diese Interventionen sollten in ein Rehabilitationskonzept eingebunden werden, welches zusätzlich weitere Maßnahmen der sozialen Integration vorsieht (z.B. Schulwiedereingliederungsprogramme). Methodische Probleme werden diskutiert.