A transactional framework for pediatric rehabilitation: shifting the focus to situated contexts, transactional processes, and adaptive developmental outcomes

An umbrella review of the characteristics of resiliency-enhancing interventions for children and youth with disabilities

PURPOSE

The current umbrella review aimed to identify key intervention characteristics that have been demonstrated to enhance resiliency in children and youth with disabilities.

MATERIALS AND METHODS

To identify these key ingredients, using JBI guidelines, we conducted comprehensive searches in the fall of 2022 and searches were re-run in June 2023. Using the PICO format, we searched for peer-reviewed review articles that included children and youth with disabilities (6 to 19 years of age), the intervention targeted resiliency, the context was home, school, or community, and the outcome was resiliency enhancement.

RESULTS

The initial searches produced 1031 articles, of which 4 met our inclusion criteria. These articles collectively had reviewed a total of 247 articles representing approximately 2756 participants. We found a wide range of disabilities represented in the studies and many activities that are included in the existing REIs. Our findings identified engagement, self-regulatory processes, capacity building, positive social connectedness, and a customized intervention approach as evidence-based resiliency enhancing features. We propose a model consolidating these findings into a multi-dimensional resiliency process which may help explain successful adaptation.

CONCLUSION

Our proposed model may be helpful in delineating entry points that different REIs have used to generate positive change.

What do parents want from healthcare services? Reports of parents' experiences with pediatric service delivery for their children with disabilities

PURPOSE

Family-centred service (FCS) is an established approach for delivering services in children's rehabilitation and healthcare. This article describes that parents continue to report mixed experiences with healthcare services for their children, as well as their ideas about what they need and want from these services. These findings will inform the development of an up-to-date measure of Family-Centred Service called Measure of Processes of Care (MPOC 2.0).

METHODS

A qualitative descriptive study was conducted with parents, using focus groups and open-ended interviews. Data were analyzed using inductive content analysis.

RESULTS

Parents want care that is individualized, co-ordinated, easily accessible, and takes into account the entire family dynamic. They want service providers (SPs) to be informed and invested in their child's care, and to provide parents with practical assistance. They also want to be treated with respect, caring and empathy, and to work together with SPs on the care plan. Novel components of care not identified in the original FCS guiding principles include: responsiveness to needs and mental health; effective communication (vs information giving); practical support (in addition to emotional and informational support); and availability and scheduling.

CONCLUSIONS

This article identifies components of healthcare that families find helpful and desirable.

Comparing three coaching approaches in pediatric rehabilitation: contexts, outcomes, and mechanisms

PURPOSE

This Perspectives paper advances understanding of coaching in pediatric rehabilitation. We compare three coaching approaches designed for pediatric rehabilitation: Coping with and Caring for Infants with Special Needs (COPCA), Occupational Performance Coaching (OPC), and Solution-Focused Coaching in Pediatric Rehabilitation (SFC-peds).

OBJECTIVES

Our objectives are to contrast the theory underpinning the approaches, discuss the evidence for outcomes and hypothesized mechanisms of change, consider the necessary mindsets of effective coaches, and propose directions for research and practice.

SUMMARY

The coaching approaches have different theoretical bases and are designed for specific contexts, yet are similar in their mechanisms of change and intended outcomes. There is growing evidence of important effects of coaching on coachees' goal achievement, empowerment, and capacity building. Studies indicate that stakeholders value coaching, and provide a preliminary understanding of the mechanisms, including engagement and self-efficacy, by which coaching approaches support clients' self-directed and sustained change. Open, curious, and client-centered practitioner mindsets are fundamental to effective coaching.

CONCLUSIONS

Coaching is a distinctive group of relational, goal-oriented, and evidence-based approaches that support goal achievement and empowerment. These approaches reflect and advance an ongoing paradigm shift in pediatric rehabilitation-a movement from therapist-as-expert approaches to those that build empowerment and capacity.

Looking beyond Body Structure and Function: ICF Foci and Who Is Being Assessed in Research about Adolescents and Young Adults with Cerebral Palsy-A Scoping Review

PURPOSE

The purpose of this study is to summarize the ICF foci, looking beyond body structures and function, and to analyze who has been assessed in research about adolescents and young adults (AYAs) with CP in the phase of transition to adulthood.

METHOD

Medline, EMBASE, PsycINFO, and CINAHL databases were searched using terms related to cerebral palsy, adolescents/young adults, health development, participation, and independence. Studies including youth with CP (13-30 years old) published in English from 2014 to 2021 were considered. The methods of assessment reported in the included studies were used to identify the ICF foci and who was assessed.

RESULTS

In this study, 86 studies were reviewed. The main ICF foci are activity and participation (51% of the studies), personal factors (23%), ICF not covered (14%), ICF not defined (9%), with environmental factors being the least focused ICF component (3%). Most studies assessed AYAs directly (49% of studies).

CONCLUSIONS

Activity- and participation-related constructs are the leading research focus of studies, and more attention is needed concerning environmental factors. AYAs are the main source of information, and the perspectives of other key figures are also being valued. To bridge the gap between child and adult health care, a broader view of health development and approaches to explore AYA developmental issues must be taken.

Understanding factors that influence goal setting in rehabilitation for paediatric acquired brain injury: a qualitative study using the Theoretical Domains Framework

Background While goal setting with children and their families is considered best practice during rehabilitation following acquired brain injury, its successful implementation in an interdisciplinary team is not straightforward. This paper describes the application of a theoretical framework to understand factors influencing goal setting with children and their families in a large interdisciplinary rehabilitation team. Methods A semi-structured focus group was conducted with rehabilitation clinicians and those with lived experience of paediatric acquired brain injury (ABI). The 90-min focus group was audio-recorded and transcribed verbatim. Data were thematically coded and mapped against the Theoretical Domains Framework (TDF) to understand influencing factors, which were then linked to the Capability, Opportunity, Motivation - Behaviour (COM-B) model. Results A total of 11 participants (nine paediatric rehabilitation clinicians, one parent and one young person with lived experience of paediatric ABI) participated in the focus group. Factors influencing collaborative goal setting mapped to the COM-B and six domains of the TDF: Capabilities (Skills, Knowledge, Beliefs about capabilities, and Behavioural regulation), Opportunities (Environmental context and resources), and Motivation (Social/professional role and identity). Results suggest that a multifaceted intervention is needed to enhance rehabilitation clinicians' and families' skills and knowledge of goal setting, restructure the goal communication processes, and clarify the roles clinicians play in goal setting within the interdisciplinary team. Conclusion The use of the TDF and COM-B enabled a systematic approach to understanding the factors influencing goal setting for children with acquired brain injury in a large interdisciplinary rehabilitation team, and develop a targeted, multifaceted intervention for clinical use. These represent important considerations for the improvement of collaborative goal setting in paediatric rehabilitation services to ensure that best practice approaches to goal setting are implemented effectively in clinical practice.

Parents' Perceptions: Environments and the Contextual Strategies of Parents to Support the Participation of Children and Adolescents with Autism Spectrum Disorder-A Descriptive Population-Based Study from Switzerland

Environments have a modifying effect on the participation of children and adolescents with autism spectrum disorder (ASD) in all areas of life. This cross-sectional study investigated parental perspectives on supportive or hindering environments and the daily contextual strategies parents used to enhance their children's participation. Qualitative and quantitative data gathered from 115 parents from German-speaking Switzerland using the participation and environment measure-child and youth (PEM-CY) were analyzed. Results revealed 45 environmental supports and barriers at home, at school, and in the community. Contextual strategies were identified in combination with people, activities, time, objects, and places. Parental perspectives on participation and their contextual strategies should be considered in environmental-based interventions to support the participation of children and adolescents with ASD.

Understanding barriers and facilitators to long-term participation needs in children and young people following acquired brain injuries: a qualitative multi-stakeholder study

Background This study focused on exploring the longer-term participation needs of children and young people with acquired brain injury (CYP-ABI) and their families in one region of the UK and identifying the barriers and facilitators of their participation and well-being to inform the development of a behavioural change intervention for clinical implementation. Methods Qualitative interviews were conducted with CYP-ABI and parents. Focus groups were created with health, education, care and charity stakeholders. The International Classification of Functioning, Disability and Health (ICF) and the Behaviour Change Wheel (BCW) were used to map needs, barriers and facilitators. Results A total of 10 CYP/parent dyads (n  = 20) and 17 health, education, care and charity stakeholders were included in this study. Unmet participation needs were mapped to the ICF and barriers/facilitators to the BCW. Significant unmet needs impacting CYP-ABI participation and family well-being were found. Barriers spanned 'Capability', 'Opportunity' and 'Motivation', the greatest being knowledge, skills, social influences, environmental context and resources, social identity and emotion. Facilitators included increasing awareness and understanding, supporting parents, long-term access to specialist assessment and rehabilitation, peer support and integrated collaborative pathways. Conclusion The long-term impact of ABI on CYP and families' participation and well-being were significant, with barriers spanning every sector and level of society. Implementation of collaborative, cross-sector (education, health and social care) accessible and family-centred care pathways is needed to meet the long-term needs of CYP-ABI and their families, ensuring equity of access. Multi-modal, family-centred, needs-led, theory-based interventions should be co-developed with CYP, families and stakeholders to improve the health and well-being outcomes and the lives of CYP-ABI and their families.

Facilitating virtual social connections for youth with disabilities: lessons for post-COVID-19 programming

PURPOSE

Social connections are essential for the development of life skills for youth. Youth with disabilities have long faced barriers to meaningful social connections. The onset of COVID-19 increased barriers to social connections for all youth, and also led to enhanced use of virtual platforms in paediatric rehabilitation programming. Harnessing this opportunity, service providers created a suite of online programs to foster social connections and friendships. The current study explores participant and service provider experiences of such programs.

METHODS

This qualitative descriptive study used interviews and focus groups to explore how youth with disabilities (n = 8), their parents (n = 7), and service providers (n = 13) involved in program development and delivery experienced the programs, the accessibility of the virtual platforms, and their social connections in relation to program participation.

RESULTS

Participants were satisfied with the programs' content, accessibility and ability to meet their social needs. Qualitative themes included facilitating social connections, accessibility of virtual spaces, and recommendations for future virtual programming.

DISCUSSION

For youth with disabilities who have been historically marginalized in social spheres, the newly ubiquitous infrastructure regarding virtual programming must be supported and enhanced. A hybrid approach involving virtual/in-person options in future programming is recommended.

Putting Youth in Charge: Exploring a Multi-Year Interagency Community Engagement Experiential Programme for Youth with Disabilities and Their Families

This paper outlines a qualitative exploration of the experiences of Youth in Charge (YiC), a 3-year pilot programme. YiC was designed to promote early, immersive community participation for students with physical disabilities, and was co-developed/co-hosted by three agencies (hospital, community rehabilitation, school board). To better understand the experiences of the youth, parents, and staff involved in this broad intervention, observation of 10 programme sessions and annual semi-structured interviews with youth (n = 5), parents (n = 4) and staff (n = 6) were undertaken. Qualitative results comprise six themes based in the two major thematic areas of participation-related experiences and programme considerations. Results indicate the need for community-based experiences, measured risk-taking, long-term engagement, parental involvement, and greater interagency collaboration and integration.

Negotiating expectations for therapy between mothers and service providers: a narrative analysis

PURPOSE

To use stories about mothers and service providers negotiating expectations for therapy to illuminate processes contributing to power differences within partnerships.

METHODS

This narrative study presented stories from three mothers and three service providers. Stories were co-constructed between participants and researchers and analyzed using narrative analysis. Building on An and Palisano's (2014) Model of Family-Professional Collaboration, stories were organized into the stages of goal setting, planning, and doing therapy.

RESULTS

Each story illuminated a process unique to that story that can redistribute power between mothers, service providers, and therapy environments while negotiating expectations: protecting sacred issues, facilitating knowledge exposure, filling voids/vacuums, recognizing cultural conditioning, re-discovering eclipsed roles, and connecting relay teams. We propose including three additional strategies to An and Palisano's model to increase the readiness of mothers and service providers to negotiate expectations for therapy and collaborate fully as the model intends: 1) exploring power-sharing conversations; 2) looking for social context clues; and 3) adopting a humility stance.

CONCLUSION

Information on the six illuminated processes can help structure a client story grounded in optimal negotiation of expectations and equal partnerships.Implications for RehabilitationKnowledge of diverse stories about mothers and service providers negotiating expectations for therapy can be a resource to guide actions in related situations.Leaving the topic of expectations for therapy implicit or unchallenged increases the risks that negotiations remain unbalanced and unproductive.Service providers may enhance collaboration with mothers in paediatric rehabilitation by exploring power-sharing conversations, looking for social context clues, and adopting a humility stance.

A case study of a strategic initiative in pediatric rehabilitation transition services: An insiders' perspective on team principles and practices

Aims

The aim was to describe an innovative initiative that took place in a pediatric rehabilitation hospital. The goal of this organization-wide strategic initiative, called the Transition Strategy, was to improve service delivery to children/youth with disabilities and their families at times of life transition. The research question was: What are the key elements that have contributed to the success of the Strategy, from the perspective of team members? The objectives were to describe: (a) the guiding principles underlying team functioning and team practices, (b) key enablers of positive team functioning, (c) the nature of effective team practices, and (d) lessons learned.

Methods

A holistic descriptive case study was conducted, utilizing historical documents, tracked outcome data, and the experiences and insights of multidisciplinary team members (the authors). Reflecting an insiders' perspective, the impressions of team members were key sources of data. The perspectives of team members were used to generate key teamwork principles, enablers of team functioning, team practices, and key learnings.

Findings and Discussion

Team members identified four guiding humanistic principles (respect, support, partnership, and open communication). These principles underpinned three novel practices that contributed to team effectiveness in the eyes of team members: supportive relational practices, human-centered co-design, and solution-focused communication. Key enablers were the relational style of leadership, and a team climate of innovation, autonomy, and trust, supported by the organizational vision. This team climate fostered a sense of psychological safety, thereby encouraging both experimentation and learning from failure.

Conclusions

This article provides information for other healthcare organizations interested in understanding the Strategy's value and its implementation. It provides a practical example of how to adopt a humanistic approach to health care, leading to both innovative service development and thriving among team members.

Transitions Theatre: Creating a Research-Based Reader's Theatre With Disabled Youth and Their Families

Transition to adult life can be a challenging time for disabled youth and their families. This article describes the collaborative creation of Transitions Theatre, a research-based reader's theatre activity based on narrative interviews with eight disabled youth (aged 17-22) and seven parents. Analysis of these interviews generated two opposing yet interrelated themes. On one hand, youth and families felt lost in transition facing multiple gaps in healthcare, financial support, education, and opportunities for social participation after having "aged out" of the pediatric system. On the other hand, they started cripping "normal" adulthood to envision more inclusive futures wherein disabilities are understood as integral to society. These two themes were transformed into two reader's theatre scripts, one featuring a youth, the other featuring a parent. Seven youth and four parents (six of them were original interview participants) then participated in a Transitions Theatre workshop to read the scripts together and discuss the authenticity and relatability of the scripts. Participant feedback suggested that the reader's theatre method was effective in sharing findings with research participants and stimulating a critical dialogue on how to (re)imagine transition to adulthood. We discuss the importance of implementing inclusive design strategies to make reader's theatre accessible to participants with diverse abilities and preferences.

Central yet overlooked: engaged and person-centred listening in rehabilitation and healthcare conversations

PURPOSE

Listening in healthcare practice is often overlooked. This article addresses the misconception that listening in rehabilitation and healthcare is a simple skill, and proposes a conceptual framework of effective listening in healthcare conversations, based on conceptualizations, attributes, and outcomes associated with listening.

METHOD

A critical review was conducted, encompassing literature on listening in everyday and healthcare conversations. Articles were retrieved through database and hand searching.

RESULTS

Although various types of listening have been proposed, they share common attributes, including being attentive, emotionally involved, and non-judgmental. A conceptual framework is proposed in which listening in healthcare is seen as a relational process fostered by the 'engaged and person-centred listener', leading to relational outcomes (e.g., mutual engagement, collaboration) and client-specific outcomes. Listening in healthcare conversations can be difficult due to situational conditions and the level of self-regulation required.

CONCLUSIONS

Effective listening in healthcare differs from everyday listening with respect to its attributes, intentionality, and challenges. In healthcare, listening is essential to mutual engagement and other relational outcomes that mobilize the client towards pursuing goals. There is a need for greater understanding of the centrality and challenges to effective listening in healthcare conversations. Implications for rehabilitation practice are discussed.Implications for RehabilitationListening in rehabilitation conversations is a core skill or advanced competency-not a 'soft' skill with little effect on client outcomes.Effective listening is essential to mutual understanding, engagement, relationship building, and collaboration, which mobilize the client towards pursing goals in rehabilitation.Listening effectively in rehabilitation conversations involves deliberately adopting a person-centred perspective.Effective rehabilitation professionals have several listening intentions in mind in addition to understanding, including engaging the other person in the therapy session, building relationship, and collaborating.Rehabilitation professionals can deliberately adopt the intention to be an "engaged and person-centred listener" who is with and for the client.

Integrating lived experience into clinical practice: a case study of young peer providers in pediatric rehabilitation

PURPOSE

Youth Facilitators (YFs) are peer service providers (SPs) with childhood-onset disabilities working in pediatric rehabilitation teams. This study explored the YF role focusing on what work YFs do, the perceived facilitators and challenges pertinent to the role integration process, and the evolution of the role over the study period.

METHODS

A longitudinal, qualitative case study approach was used to gather data over a total period of 14 months through interviews, focus groups, workload logs, and observations. Data were analyzed using the method of thematic analysis.

RESULTS

Two YFs, 23 SPs and two managers participated in the study. YFs' work included independent consultation, resource provision, referral making, and program co-facilitation. Analysis produced two contrasting themes. When viewed as a representative of clients, YFs were considered bringing client perspectives to care, adding credibility to clinical services, and empowering clients and families through role modeling. However, when viewed as a professional SP, their expertise was questioned due to role unclarity, limited generalizability of lived experience, and organizational limitations.

CONCLUSIONS

Training tailored to local care contexts and organizational supports are needed to transform YFs' experiential knowledge into experiential expertise. We propose strategies for optimal integration of peer providers into clinical care teams.Implications for rehabilitationAs peer service providers with lived experience of disabilities, Youth Facilitators (YFs) have the potential to benefit pediatric rehabilitation services by facilitating empowerment in clients and families as they navigate through life transitions.The YF scope of practice and training should be adapted to fit with individual clinical teams and local care contexts to help YFs establish their experiential expertise in interdisciplinary teams.Establishing YF's core competencies (e.g., advocacy, coaching, and boundary setting skills) can help transform their experiential knowledge into experiential expertise.

Exploring 10 years of dissemination of the F-words for Child Development: A multifaceted case study

BACKGROUND

There is growing interest in exploring how to move research findings into practice. Since 2014, a team of families and researchers has been working to promote and study the dissemination of the "F-words for Child Development" (Function, Family, Fitness, Fun, Friends, and Future). This case study describes our dissemination strategies and uses the Diffusion of Innovation theory to understand the factors contributing to the uptake of the F-words-a function-promoting, strengths-based, and family-centred innovation in child health and development.

METHODS

Between November 2011 and November 2021, we collected data from multiple sources: our dissemination strategies, including affiliated documents/artefacts (e.g., videos and presentations) and evaluation data (e.g., surveys and Google/video analytics). We used a two-step analysis: (1) a chronological time series to describe the processes involved along with indicators of dissemination over time (e.g., increase knowledge and awareness); and (2) Diffusion of Innovation theory to explore the factors that contributed to the uptake of the F-words.

RESULTS

Multifaceted dissemination strategies were essential to raise awareness and increase families' and service providers' knowledge of the F-words. These included three primary strategies: (i) development and distribution of educational materials; (ii) presentations at educational meetings; and (iii) educational outreach visits. Additional strategies, such as the use of mass media, collaboration with early adopters/champions, and the involvement of family members further supported dissemination efforts. Diffusion of Innovation factors (innovation characteristics, time, social systems, and communication channels) all contributed to the uptake of this innovation.

CONCLUSIONS

Purposeful planned dissemination practice, to increase knowledge and awareness of an innovation, is an important step in the knowledge translation process. Over a period of 10 years, through the use of multiple dissemination strategies conducted in partnership with families and service providers, the F-words have spread globally. Diffusion of Innovation theory has served to help understand how and why the F-words are being shared and adopted around the world.

A new model to guide identity-focused multidisciplinary rehabilitation for children and young people following acquired brain injury: I-FoRM

A complexity of biological, psychological, environmental and systemic factors influences a child's adaption after acquired brain injury (ABI), all of which transform as the child matures. Multidisciplinary rehabilitation teams are challenged by balancing family system needs and the child's needs, whilst promoting the child's functional skills in difficult or unappealing tasks. This paper presents the conceptual basis for a model for use in childhood ABI neurorehabilitation to address these challenges. A non-systematic narrative review of literature pertinent to integrated neurorehabilitation of pediatric ABI was conducted. Contemporary models of adult and pediatric psychosocial adaptation involving identity following ABI were reviewed. Key findings were then synthesized with models of pediatric resilience and self-concept development. The resulting model describes a cyclical adaptation process whereby the child learns experientially about their self and their world after ABI. Processes of identity development play a central role - particularly emotive processes of self-evaluation - by influencing the child's motivation for participation, tolerance for challenge, self-regulation and emerging self-awareness. The model directs clinicians to use the psychosocial processes of identity development to enhance the child's willingness and capacity to engage in the daily challenges of rehabilitation. Further systematic development and evaluation of the model is needed.

An Investigation Into the Effects of Destination Sensory Experiences at Visitors’ Digital Engagement: Empirical Evidence From Sanya, China

This study investigates the mechanism of how sensory experiences influence visitors’ digital engagement with a destination through establishing a strong bond and identification between a destination and tourist utilizing a two-step process. First, visitors’ sensory experiences in a destination are identified through a content analysis of online review comments posted by visitors. Afterward, the effects of those sensory experiences on visitors’ digital engagement through destination dependence and identification with that destination are examined. Findings suggest that sensory experiences are critical antecedents of visitors’ bond and identification with a destination. Visitors’ positive destination-related sensory experiences increase their dependence on and identification with the destination, and this dependence and identification positively influence their digital engagement behavior on social media.

Social participation interventions targeting relational outcomes for young people with physical and developmental disabilities: an umbrella review and narrative synthesis

Purpose: To synthesize knowledge about social participation interventions targeting relational outcomes for young people with physical and developmental disabilities.Method: An umbrella review with a narrative synthesis was conducted to integrate findings of review articles examining social participation interventions targeting relational outcomes (e.g., peer interaction and friendships). Six databases were searched to identify reviews published between 2010 and 2021.Results: Five reviews were identified, examining participation interventions, social/community integration interventions, recreational sport programs, online peer mentorship programs, and augmentative and alternative communication interventions to promote social interaction with peers. Interventions associated with improvements in relational outcomes included group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions. Recommendations for future research included better description of interventions to identify active ingredients and key mechanisms, measurement of participants' experiences, and the need for interventions to be aligned with the nature of the outcomes examined. Preliminary intervention principles are proposed to guide the design of social participation interventions: individualizing, contextualizing, and immersion in social settings.Conclusions: There are multiple pathways by which to influence the relational outcomes of young people with disabilities. There are implications for the design of social participation interventions based on an ecological/experiential and relational perspective.IMPLICATIONS FOR REHABILITATIONImprovements in relational outcomes are associated with participation in group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions.Three evidence-informed principles can help guide the design of social participation interventions: (1) personalizing, (2) contextualizing, and (3) immersion in social settings.Greater attention to aligning the nature of intervention with desired outcomes is needed to more effectively measure and promote relational outcomes.

Feasibility and Acceptability of a Complex Telerehabilitation Intervention for Pediatric Acquired Brain Injury: The Child in Context Intervention (CICI)

The current study is a feasibility study of a randomized controlled trial (RCT): the Child in Context Intervention (CICI). The CICI study is an individualized, goal-oriented and home-based intervention conducted mainly through videoconference. It targets children with ongoing challenges (physical, cognitive, behavioral, social and/or psychological) after acquired brain injury (ABI) and their families at least one year post injury. The CICI feasibility study included six children aged 11–16 years with verified ABI-diagnosis, their families and their schools. The aim was to evaluate the feasibility of the intervention components, child and parent perceptions of usefulness and relevance of the intervention as well as the assessment protocol through a priori defined criteria. Overall, the families and therapists rated the intervention as feasible and acceptable, including the videoconference treatment delivery. However, the burden of assessment was too high. The SMART-goal approach was rated as useful, and goal attainment was high. The parents’ ratings of acceptability of the intervention were somewhat higher than the children’s. In conclusion, the CICI protocol proved feasible and acceptable to families, schools and therapists. The assessment burden was reduced, and adjustments in primary outcomes were made for the definitive RCT.

Solution-Focused Coaching to Support Clinicians' Professional Development: An Analysis of Relational Strategies and Co-constructed Outcomes

PURPOSE

To explore solution-focused coaching (SFC) as a means to enhance pediatric rehabilitation practitioners' development of listening skills.

METHODS

Six clinicians each participated in two SFC sessions with an experienced coach who used a practice model developed for pediatric rehabilitation (SFC-peds). The transcribed interviews were analyzed by inductive content analysis to identify the coach's use of relational strategies and the nature of what was being co-constructed in the sessions.

RESULTS

The coach used six relational strategies (e.g., supporting reflective and critical thinking). Through dialogue and reflection, the coach and clinician co-constructed four important outcomes, including shared meaning, awareness and discovery of strengths and values, discovery of strategies and opportunities, and forward movement.

CONCLUSIONS

The study informs our understanding of the relational processes and benefits of SFC conversations. These conversations appear to provide an optimal learning space to enhance professional development, by facilitating the co-creation of meaning, awareness, and intentionality.

Measurement Invariance of the Short Home Attachment Scale: A Cross-Cultural Study

The home environment is a particularly significant part of life that is supposed to satisfy inhabitants' needs, form their identity, and contribute to psychological wellbeing. The construct of home attachment is especially relevant for students as a most mobile social group. This study is devoted to the validation of the Short Home Attachment Scale (SHAS) in a student sample from five countries (Armenia, India, Indonesia, Russia, and Ukraine). A total of 1,349 (17-26 years; Mage = 19.82, SDage = 2.14; 78% females) university students participated in the study and filled in the 14 items of HAS. In order to avoid redundant items with high error covariances damaging the model, a new scale-the SHAS was developed by eliminating seven items. The shortened scale has satisfactory structure validity in terms of model fit in all countries except Indonesia; internal reliability values were acceptable in all countries. Measurement invariance across countries was tested with Multi-Group Confirmatory Factor Analysis (MG CFA) and Alignment Analysis. MG CFA confirmed both configurational and metric invariance. The invariance of item factor loadings, as well as item intercepts, was also confirmed by the Alignment Analysis. The mean scores varied across cultures, with the highest in India and the lowest in Russia. The final version of SHAS is a valid, reliable tool that may be recommended for use in cross-cultural research. However, the SHAS factor structure robustness in the Indonesian population should be investigated thoroughly.

Social Outcomes of School Leavers With Cerebral Palsy Living in Victoria

Objective: In Australia, the National Disability Strategy provides a framework to guide actions and investment to achieve equity in social inclusion and economic participation for people with disability. We investigated the social outcomes of school leavers with cerebral palsy (CP) in Victoria, Australia and explored the determinants of desirable outcomes. Methods: We used the Victorian CP Register to invite all adults with CP aged 18-25 years (n = 649). On-line and/or paper-based surveys explored participation in education, employment, community activities, living situation, relationships and life satisfaction. Functional and health status data were collected. Social outcomes were summarized descriptively and compared between individuals with CP and non-disabled peers aged 18-25 years from the Household Income and Labor Dynamics in Australia dataset. Within the CP cohort we explored whether physical and mental health and level of functioning were associated with social outcomes. In addition, a descriptive comparison was undertaken between the social outcomes of the current CP cohort with that of a previously reported 2007 cohort. Results: Ninety participants (57% male; mean age 22.4 years (SD: 2.2) in 2020; 61.1% self-reported) provided data for analyses; response rate 16.9%. CP characteristics were similar between respondents and non-respondents. In comparison to similar aged peers, 79.8% had completed secondary school (compared to 83.2%); 32.6% (compared to 75.8%) were in paid work; 87.5% (compared to 48.2%) were living in their parental home; and 3.4% (compared to 31.6%) were married or partnered. Individuals with CP and higher levels of functional capacity and better physical health were more likely to undertake post-secondary education. Higher levels of functional capacity and physical health, as well as lower mental health status were associated with being employed. Conclusions: While foundational education completion rates were similar to non-disabled peers, significant gaps in social outcomes remain, including residence in the parental home and single status. While addressing these issues is challenging, substantial efforts are needed to reduce these disparities-work that needs to be done in collaboration with people with CP and their families.

Participation According to Clinicians Working with Young Children with Developmental Disabilities: A Long Way to Go

Participation has become an important measure of outcome in child rehabilitation as young children with developmental disabilities are increasingly at risk of decreased participation. Therefore, this study garnered information on clinicians' perspectives regarding perceived facilitators and barriers when rendering participation-based interventions using a qualitative research design. Semi-structured interviews of clinicians (Ns = 12, 25-57 years) were conducted and evaluated via an inductive thematic analysis. Results denote that current mechanisms of providing participation-based interventions resembled traditionally focused interventions; thus, resulting in a knowledge-to-practice gap. Clinicians desired more opportunities to communicate with caregivers and to be able to influence the children' s natural environments. They also identified shortness of time, resources, and rigid health care regulations as barriers hampering the efficacy of participation-based services.

Community reintegration needs following paediatric brain injury: perspectives of caregivers and service providers

PURPOSE

To explore the processes of community reintegration of children and families at least one year following a paediatric brain injury from the perspective of caregivers and outpatient/community service providers.

MATERIALS AND METHODS

A qualitative analysis of semi-structured interviews from outpatient or community service providers (N = 14; occupational, physical, and speech and language therapists, neuropsychologists, school counsellors, recreational providers) and caregivers of six children (N = 8) at least one year after their injury. Interviews were transcribed and thematically coded using deductive (employing Bronfenbrenner's ecological systems theory) and inductive approaches.

RESULTS

Themes from both providers and caregivers indicated additional supports needed at all levels of Bronfenbrenner's ecological systems theory (i.e., individual, microsystem, mesosystem/exosystem, macrosystem, chronosystem). Participants felt that several characteristics would be needed in an ideal service system following paediatric brain injury including: community solutions ("it takes a village"), long-term approaches to care, and new financial approaches.

CONCLUSIONS

The results suggest that children and families have substantial community reintegration needs following paediatric brain injury. Multi-system interventions are needed to support long-term community reintegration, especially those that increase communication and support transitions. There is also a strong need for alternative funding to support these efforts.Implications for RehabilitationFamilies with a child with a moderate to severe brain injury face challenges with community reintegration a year or more after their child's injury.Effort should be put into helping families navigate the complex medical, insurance, and school systems with a navigator service and step-down care to ensure a continuum of care and to support community reintegration.Special support should be provided during transitions, such as transitions from hospital care to outpatient care, and across school transitions.

Exploring two subdimensions of participation, involvement and engagement: A scoping review

BACKGROUND

The conceptualisation of participation is an ongoing discussion with importance for measurement purposes. The aim of this study was to explore the two subjective subdimensions of participation, involvement and engagement. The purpose was related to measure development within the field of paediatric rehabilitation.

METHODS

In a scoping review, following the PRISMA-ScR, the databases MEDLINE, PubMed, Academic Research Complete, PsychINFO, and Business Source Complete were searched for publications that described engagement and/or involvement constructs.

RESULTS

Thirty-nine publications met the inclusion criteria. Involvement could be conceptualised as an unobservable state of motivation, arousal, or interest towards a specific activity or product. Building a consensus over different fields of research, engagement can be seen as the individual's behavioural, cognitive and affective investment during role performance.

CONCLUSIONS

This scoping review points in a direction that the two subdimensions of participation need to be separated, with involvement being a more stable internal state of interest towards an activity, and engagement referring to the specific behaviour, emotions, and thoughts meanwhile participating in a specific setting. Clear definition of concepts will enhance the development of measures to evaluate rehabilitation interventions in the field of occupational therapy and related fields.

"Here we are together, at home you are alone" - social interactions and personal engagement during a group-based rehabilitation program for young adults with disability

PURPOSE

Young adults with disabilities often report feeling alone in their experience of disability. Group-based rehabilitation programs provide opportunities to participate in learning processes and share experiences of living with a disability. The aim of this study was to explore and interpret social interactions and personal processes of engagement and development of young adults with disabilities during a rehabilitation program.

METHODS

Fifty-four young adults attending a group-based rehabilitation program at Beitostølen Healthsports Center (BHC) participated in the study. A grounded theory methodology employing ethnographic data enabled an in-depth exploration of the social processes occurring during the rehabilitation stay.

RESULTS

The social environment was important to personal processes during the stay. Fundamental to the social processes was a culture defined by opportunities, competence, and involvement of the young adults that promoted feelings of safety and the freedom to challenge themselves. Being with peers with disabilities enabled a sense of community underpinned by a shared understanding. Peers fostered motivation to actively engage in the participation processes, built courage and promoted self-reflection.

CONCLUSION

This article contributes to the understanding of the dynamic interactions between social contextual structures and interrelations, and personal processes of engagement and developmental experiences during a group-based rehabilitation program.IMPLICATIONs FOR REHABILITATIONRehabilitation in context of a peer-group was highly valued and made a unique contribution to the rehabilitation experience.Being in a group with peers sharing the experience of disability resulted in a safe learning environment, improving participants' motivation, encouraging them to engage in challenging activities and social interactions.The informal interactions and shared experience of living with a disability promoted self-reflection and improved self-understanding.Being with peers sharing the experience of disability provided opportunities for role modelling and mentoring, inspiring participants as to what might be possible.

A Swedish cultural adaptation of the participation questionnaire Functional Scale of the Disability Evaluation System - Child version

PURPOSE

The aim was to culturally validate a questionnaire about children's/youth's participation to be used in a Swedish context.

METHODS

FUNDES-Child, based on the well-established CASP, was chosen. Questions about engagement and hindering factors were added to the existing questions about frequency and independence in 20 activity areas. Using a qualitative, explorative design, 16 interviews with children/youths/caregivers were made to explore opinions about the questionnaire. Follow-up interviews confirmed the result of the revised questionnaire. Qualitative content analysis was performed.

RESULTS

The interviews provided support for the questionnaire's relevance by being a tool to assess important aspects of participation, to gain insights into one's own/the child's participation, and to promote ideas about what causes the degree of participation. To achieve comprehensiveness, no activity area was found to be missing nor superfluous. However, some examples were needed to be modified where "parades" are unusual in Sweden and therefore removed, while "singing in choir" was added. In search for comprehensibility, opinions about the layout of the first version were raised and a varying degree of understanding of wording and concepts were found and thus taken into account.

CONCLUSIONS

The questionnaire can be used for establishing meaningful goals and to potentially increase children's participation.Implications for rehabilitationParticipation is of great importance for children's functioning, well-being, and development.Cultural validation of well-established participation questionnaires is a priority and questions about important aspects of participation need to be included.Interviews with children/youth and caregivers guided revisions to reach relevance, comprehensiveness, and comprehensibility of the Swedish FUNDES-Child (FUNDES II-SE).Children/youths, caregivers, and others may increase their awareness concerning the child's/youth's participation by responding to the questionnaire.

Co-constructing engagement in pediatric rehabilitation: a multiple case study approach

PURPOSE

To explore engagement principles and contextual conditions in high-engagement therapy sessions involving youth with disabilities and service providers.

METHOD

From a larger project on therapy engagement, a dyadic case analysis was conducted involving three youth ages 8-15 with disabilities and their service providers. Participants were interviewed about their engagement experiences after high-engagement sessions focusing on speech articulation, transition goals, and physical mobility. Data were analyzed thematically, with an emphasis on engagement principles illustrated by the cases.

RESULTS

There were four service provider engagement principles: (a) clients differ in what engages them and in how they display engagement (Individual Variation Principle), (b) there are multiple ways to engage clients (Personalizing Principle), (c) engagement is cultivated through relationship (Relationship Principle), and (d) it is important to monitor and be attuned to the client's level of engagement over a session (Monitoring Principle). Service providers' use of engagement strategies varied due to contextual conditions, including therapy type and youths' interests and preferences.

CONCLUSIONS

The findings indicate the value of providers' awareness of the dynamics of engagement, their use of personalized strategies to engage clients, and the fundamental importance of cultivating a good relationship and monitoring client engagement during therapy.IMPLICATIONS FOR REHABILITATIONService providers may benefit from being aware of common principles underlying the co-construction of engagement between service providers and clients.Service providers can use a variety of personalized strategies to heighten client engagement, and can work to cultivate a positive relationship.It is important to monitor clients' non-verbal and verbal signs of engagement and respond to signs of disengagement during therapy.Contextual conditions affecting service providers' use of engagement strategies include the nature of the therapy being provided and youths' interests and preferences.

How transactional relations contribute to adaptive developmental outcomes when young people with disabilities participate in specially designed group programs - a scoping review

BACKGROUND

Meta-synthesis can enhance our existing knowledge regarding experiences of participation in group-based programs designed for young people with disabilities.

AIM

This study aimed to identify the transactional relations between the social contexts in group programs and meaningful personal experiences and developmental processes for young people with disabilities.

METHOD

For this research, 4 electronic data-bases were searched, 3406 citations were reviewed, and 13 qualitative studies describing experiences of participation in specially designed group-based programs from the perspective of young people with disabilities were included. A meta-ethnographic approach was used to synthesise the data, and resulting categories were conceptualised in King et al.'s framework of transactional processes and adaptive development.

RESULTS

Nineteen categories across six themes describing: environment, social context, social mechanisms, personal processes, meaningful experiences, and outcomes demonstrated the dynamic interrelation between social context and personal processes. Peer group interaction was essential for exploring capacities and developing strategies.

CONCLUSION

This review highlights the important role of the peer group in transferring program experiences into the everyday life contexts of young people with disabilities. It may assist professionals who are considering the use of peer groups when planning participation-focussed programs aiming to facilitate personal development for young people with disabilities.

A scoping review of parental roles in rehabilitation interventions for children with developmental delay, disability, or long-term health condition

The importance of parental roles in rehabilitation interventions (i.e. the tasks and responsibilities assigned to parents in intervention) is widely reported but there is a paucity of information regarding the tasks linked with specific parental roles. A rigorous scoping review was conducted to understand the various roles that parents of children with developmental delays, disabilities, and long-term health conditions perform in intervention and the tasks and responsibilities associated with each role. The results confirm that parents take on distinct intervention roles which can be placed on a continuum from passive to active responsibility. Some parental roles are clearly associated with tasks completed in-session, some are linked with out-of-session tasks while others entail a combination of in-and out-of-session tasks. The in-session tasks linked with the Learner role emerged as central to enabling parents to assume other in-and out-of-session roles. The results also highlight the influence of the parent-professional relationship on the type of roles parents take on in their child's intervention. The findings of the scoping review serve as the initial step in generating items for a tool to measure the type of roles that parents assume in intervention to empirically test the relationship between these roles and parental engagement.

Exploring participation in family and recreational activities among children with cerebral palsy during early childhood: how does it relate to motor function and parental empowerment?

PURPOSE

To explore participation in real-life activities during early childhood, compare children's participation based on motor function and investigate relationships between participation and parental empowerment.

METHODS

Data derived from the Cerebral Palsy Follow-up Program (CPOP) in Norway and the research registry Habilitation Trajectories, Interventions, and Services for Young Children with CP (CPHAB). Fifty-six children (12-56 months, GMFCS levels I-IV, MACS levels I-V) and their families were included. Frequency and enjoyment of participation were assessed by the Child Engagement in Daily Life Questionnaire and parental empowerment in family and service situations by the Family Empowerment Scale at least twice during the preschool years. Differences between groups based on motor function were explored by the Kruskal-Wallis tests. A linear mixed model was conducted to explore relationships between child participation and parental empowerment.

RESULTS

Similarities and differences in participation between children at different motor function levels varied between the activities explored. Fluctuations in frequency and stable enjoyment scores over time were most common. A statistically significant relationship was revealed between child participation and parental empowerment in family situations, but not in service situations.

CONCLUSIONS

Child participation appears as context-dependent and complexly influenced by both motor function and parental empowerment. This supports a focus on transactional processes when exploring and promoting child participation.Implications for RehabilitationFamily and recreational activities represent real-life contexts providing opportunities for interactions and experiences supporting development and learning.Children with CP appreciate a wide range of activities in the home and community, which emphasizes the importance of providing opportunities for such participation in order to fulfill their desires and interests.Child participation appears as complexly influenced by the unique activity setting, motor function and characteristics of the family environment, requiring attention to transactional processes when aiming to explore and promote participation.

Exploring the after-hours social experiences of youth with disabilities in residential immersive life skills programs: a photo elicitation study

PURPOSE

This study explored the meaning of the after-hours social experiences of youth with disabilities in a residential life skills program. After-hours experiences occur outside of formal program hours, primarily in the evenings.

METHOD

Five youth with cerebral palsy (three females) participated in an exploratory photo elicitation study while attending one of two residential immersive life skills programs. Following an auto-driven photo elicitation method, youth took photos of their choosing and then were interviewed about photos they elected to share. Interview data were analyzed thematically.

RESULTS

Themes illustrated meaningful social experiences and their benefits. Two themes described the after-hours social experiences of most importance to youth: learning about strengths from working together, and having meaningful individual and group conversations. Three themes reflected benefits reported by youth: learning about differences among people, gaining new perspectives and new knowledge about oneself, and developing friendships and a sense of "family."

CONCLUSIONS

The findings illuminate the benefits of after-hours social experiences for youth who may have had little opportunity previously to informally interact with other youth with disabilities. The findings highlight the importance of the immersive, group nature of a residential, away-from-home youth transition program, particularly the value added by the after-hours program component.IMPLICATIONS FOR REHABILITATIONThe findings support the value of an over-night residential aspect for life skills programs for youth with disabilities.Residential immersive life skills programs provide opportunities for youth to discuss common experiences and shared challenges, leading to the formation of social bonds.Residential immersive life skills programs provide opportunities for youth to interact with peers in the absence of adults, and to make choices about how to use their personal time.It is important to intentionally design transition programs to provide opportunities for after-hours social experiences, including working together and socializing.

Opportunities, experiences, and outcomes of residential immersive life skills programs for youth with disabilities

PURPOSE

To examine the opportunities, experiences, and outcomes of a transition program for youth with disabilities.

METHODS

Over three years, in a prospective study, 29 youth (17 males) attending residential immersive life skills programs reported on their experiences in 55 activity settings in which opportunities were also rated using standardized measures. Youth completed outcome measures of self-determination and self-efficacy pre-and post-intervention, and 3 and 12 months later. The alignment of opportunities and experiences was examined, as well as effects of experiences on outcomes.

RESULTS

Opportunities were significantly correlated with experiences for males only. There were significant pre-post changes in autonomy (all youth) and self-efficacy (males only). Social and personal growth experiences predicted pre-post changes in autonomy, and experiences of psychological engagement (all youth) and choice and control (males only) predicted changes in psychological empowerment.

CONCLUSIONS

The findings highlight the importance of designing transition programs to provide experiences of social interaction, personal growth, choice, and psychological engagement in order to enhance autonomy and empowerment. Further investigation is needed on how gender influences youth experiences. Context-mechanism-outcome linkages offer a useful frame to examine opportunities, experiences, and outcomes, and reveal multiple pathways to changes in youths' self-determination brought about by program involvement.Implications for rehabilitationResidential immersive life skills (RILS) programs enhance the autonomy and empowerment of youth with disabilities.The findings show the value of RILS programs and other complex interventions that provide youth of transition age with a rich variety of opportunities and capacity-enhancing experiences.It is important to intentionally design opportunities for social interaction, personal growth, choice, and psychological engagement.It is important to ensure youth are engaged with program content, and feel a sense of social belonging, choice, and personal growth, because these experiences were found to be related to changes in youths' autonomy and empowerment.Gender differences in program experiences and outcomes were found, which is an important and overlooked area of research.

The Nature, Value, and Experience of Engagement in Pediatric Rehabilitation: Perspectives of Youth, Caregivers, and Service Providers

Purpose: To conduct a qualitative investigation of engagement in pediatric rehabilitation therapy.Methods: Interviews were conducted with 10 youth, 10 caregivers, and 10 service providers. Transcripts were analyzed thematically using an inductive approach.Results: Themes illustrated three perspectives: engagement as a connection with components of the therapy process, engagement as working together, and engagement as an affective and motivational process. Engagement created valued connections with therapy components and forward momentum for therapy.Conclusions: The themes supported a view of engagement as complex, transactional, and multidimensional. Participants focused on different, yet not discrepant, aspects of engagement. Youth focused on having fun and personal connection with service providers. Caregivers provided a more complex perspective encompassing both their own and their child's engagement, with an emphasis on relationship, understanding what is taking place, and feeling valued in the process. Service providers highlighted goal attainment and the value of engagement in bringing about outcomes.

Investigating a Participation-Based Friendship Intervention for Youth with Disabilities: Effects on Goal Attainment, Social Self-Efficacy, and Engagement

Aims: This preliminary study examined the effects of a participation-based friendship intervention for youth with physical and developmental disabilities on their goal attainment, social self-efficacy, and engagement in program sessions.Methods: Before and after the eight-session intervention, five youth with physical and developmental disabilities ages 15-20 (3 females) completed a measure of goal attainment scaling (GAS) and the Canadian Occupational Performance Measure (COPM) for goals related to friendship, along with a measure of social self-efficacy. Engagement was assessed after every second session (i.e. four times). After the program, youth completed interviews to capture their perceptions of each of these variables. Quantitative data were analyzed descriptively, enriched with the qualitative data.Results: Overall, youth achieved their GAS goals and demonstrated clinically significant change in mean COPM performance and satisfaction. Three youth displayed clinically significant change in social self-efficacy. Engagement in the program was high, with the majority of participants reporting slightly increasing levels of engagement over the sessions. The interviews substantiated these quantitative changes.Conclusions: There are few evidence-informed friendship interventions for youth with disabilities. This study provides initial evidence for the effectiveness of a participation-based friendship intervention incorporating coaching and focusing on real-world goals and contexts.

The complexities and synergies of engagement: an ethnographic study of engagement in outpatient pediatric rehabilitation sessions

PURPOSE

To investigate client (youth/caregiver) and service provider engagement in outpatient pediatric rehabilitation therapy sessions.

METHODS

In an ethnographic study, five research assistants attended 28 outpatient sessions, mostly delivered by occupational, physical, and speech-language therapists, and rated signs of client, provider, and relational engagement using the Pediatric Rehabilitation Intervention Measure of Engagement - Observation version. Post-session interviews were conducted individually with 13 youth, 15 caregivers, and 26 providers.

RESULTS

Overall, there was a moderate to great extent of engagement. Provider engagement was rated as higher than client engagement, particularly in sessions with activities focusing on body structure/function. The interviews indicated associations among engagement-related constructs: (a) expectations influenced engagement/disengagement and therapy progress, (b) engagement was associated with positive affect and relationships, and (c) engagement was strongly associated with relationships and collaboration.

CONCLUSIONS

Engagement is a central process within a complex system of psychosocial constructs operating in therapy. Engagement is emergent, synergistic, and change-inducing - it emanates from, involves, and influences multiple aspects of therapy. Notably, engagement ties two pivotal elements - positive expectations and positive affect - to positive relationships, collaboration, and therapy progress. Implications for practice include an understanding of how providers manage the therapeutic context and work to foster engagement.Implications for rehabilitationEngagement, and its various elements, plays a central role in shaping how clients, parents, and clinicians value therapeutic encounters.Optimal therapy is often thought to include engagement, relationships, and collaboration; the importance of therapy expectations, positive affect, and perceptions of progress are frequently overlooked.Engagement and motivation may be maximized when youth and caregivers are asked explicitly about how they view their engagement in therapy.In addition to clarifying and aligning expectations with youth and caregivers, service providers can enhance engagement and motivation by intentionally creating enjoyable and meaningful interactions, developing relationships, negotiating consensus on goals and plans, and demonstrating therapy progress.Service providers can harness engagement and the system of related constructs by listening and communicating effectively, by entering the world of the client and family, and by being aware of, anticipating, and responding to engagement and disengagement.

Residential immersive life skills programs for youth with disabilities: a case study of youth developmental trajectories of personal growth and caregiver perspectives

Background

Professional support in pediatric and rehabilitation care environments has been recommended as a means to build youth competence in life skills during their transition to adulthood. Life skills are the essential psychosocial competencies and interpersonal skills needed to manage one’s life. Residential immersive life skills (RILS) programs offer youth with physical disabilities enriched learning environments to acquire these skills. This study explored trajectories of personal growth in life skills and positive psychological outcomes among youth participating in a RILS program and related caregiver perspectives.

Method

Delivered by a multidisciplinary healthcare team, The Independence Program is an intensive summer program housed in a college residence that provides realistic experiences of living away from home for small groups of youth between 17 and 21 years of age who have congenital and/or acquired physical disabilities. Using a longitudinal case study and qualitative descriptive design, four youth and their parents/guardians participated in semi-structured interviews prior to, and then 1 month, and 3 to 4 months after the program. A conventional content analysis yielded chronological narratives for each youth and caregiver dyad of their experiences, perceptions and outcomes over time. These narratives were further summarized using a ‘line of development’ perspective to describe individual developmental trajectories of personal growth.

Results

All four of the youth returned from the program with positive reports about the new life skills acquired and new behaviours they engaged in. These positive reports generally continued post-program, albeit with differing trajectories unique to each youth and varying levels of congruence with their caregivers’ readiness to support, accommodate and facilitate these changes. Caregivers differed in their capacity to shift in their parenting role to support consolidation of youth life skill competencies following program participation.

Conclusions

RILS programs can be transformative. Varied youth trajectories identified significant personal growth through enhanced self-determination, self-efficacy and self-advocacy. Congruence in youth and caregiver perceptions of post-program changes was an important transactional factor. Professional support addressing caregiver needs may be beneficial to facilitate developmentally appropriate shifts in parenting roles. This shift is central to a model of shared management whereby adolescents take on greater responsibility for their own care and life choices.

Determining Outcome in Children and Adolescents After Concussion: Viewing Things More Holistically

Pediatric and adolescent concussion is an increasingly high-profile public health issue, but it is also a highly heterogeneous phenomenon. Many factors interact dynamically to influence the recovery trajectory of adolescents and children. Diagnostic assessment must include domains other than self-reported symptoms, yet many prognostic models of outcome focus solely on the presence or absence of postconcussion symptoms to determine recovery. Function after concussion (recovery or persistence of problems) is the result of an interaction between biological, psychological, and social factors. Despite biopsychosocial models of assessment being advocated in rehabilitation for the last 20 years, they are still not routinely implemented in the evaluation of concussions, along the recovery trajectory, in children and adolescents. The International Classification of Functioning, Disability and Health is a framework anchored in a biopsychosocial perspective that can guide clinicians and researchers to include multiple perspectives in their assessments or research designs. By focusing on the patient as a person, researchers and clinicians can provide a more holistic approach that has the potential to contribute to a more successful and sustainable pediatric and adolescent concussion care model. J Orthop Sports Phys Ther 2019;49(11):855-863. Epub 9 Oct 2019. doi:10.2519/jospt.2019.8918.

Intervention strategies in residential immersive life skills programs for youth with disabilities: a study of active ingredients and program fidelity

Objective: To examine intervention strategy use in residential immersive life skills (RILS) programs. Methods: The Service Provider Strategies-Checklist was used to record the strategies used in 100 activity settings across two summers at three RILS program sites. Activity settings were categorized by activity type and session format. Relative occurrence of the strategies was examined using percentages. Results: Socially mediated strategies (listening, engaging youth) and teaching/learning techniques (verbal cues, verbal instruction) were used in over 75% of the settings. Strategy use was highly contextualized, with different strategy patterns observed for different types of activity settings. Conclusion: The findings suggest that RILS programs be characterized by their use of socially mediated strategies and teaching/learning techniques, with socially mediated and non-intrusive strategies appearing to be program hallmarks. Strategy use was aligned with the types of sessions offered, providing evidence of program fidelity and indicating that RILS programs are complex in their formats, activities, and strategy use.

Promoting capacities for future adult roles and healthy living using a lifecourse health development approach

Purposes: First, to describe how young adults with cerebral palsy (CP) experience lifecourse health development, and second, to create key messages for pediatric health service providers to promote children's capacities for future adult roles and healthy adult living.Methods: Interpretive description qualitative design. Participants were a purposive sample of 23 young adults with CP, 25-33 years of age, who varied in functional abilities, education, living, and work situations. Three experienced interviewers conducted 50-60 min interviews. Transcripts were analyzed to identify themes. Subsequently, a one-day meeting was held with an advisory group to inform our interpretive description of key messages.Results: Four themes emerged from the interviews: personal lifecourse, contexts for healthy living, health development through everyday experiences, and healthy living as an adaptive process. Key messages for service providers are: (a) address healthy living across the lifecourse, (b) focus on contexts of healthy living, (c) focus on everyday experiences and experiential learning, and (d) pay attention to the timing of opportunities and experiences.Conclusion: The findings provide first steps toward adoption of an approach to lifecourse health development for individuals with CP that emphasizes physical, mental, and emotional wellbeing and goals for desired social participation over the lifecourse.Implications for rehabilitationYoung adults with cerebral palsy experience lifecourse health development as a personal ongoing and dynamic process occurring in many contexts.Individuals with cerebral palsy continually adjust to changing contexts (adaptive process).Everyday experiences and experiential learning enable individuals with cerebral palsy to develop capacities for current and future healthy living including social participation."Timing" of opportunities and experiences is important for health development.

Solution-Focused Coaching in Pediatric Rehabilitation: Investigating Transformative Experiences and Outcomes for Families

AIMS

A qualitative study was conducted to investigate family experiences and outcomes of Solution-Focused Coaching in pediatric rehabilitation (SFC-peds).

METHODS

Two interviews (5 months apart) were conducted with nine sets of family members who had received SFC-peds, within the past 6 months, from therapists with 3-10 years of experience using the approach. Transcripts were analyzed using thematic analysis and a phenomenological approach.

RESULTS

Participants experienced a goal-oriented collaborative process, high engagement, enhanced capacity and community participation, and empowered mindsets. The therapy process was seen as a collaborative solution-focused conversation, situated in the client's world, and involving individualized and co-created goals and plans. SFC-peds provided families with a supportive, structured, and paced goal-setting process. Reported enhancements to capacity included child/youth skill development, enhanced parent skills, enhanced parent knowledge of their child and options, and changes in parenting. Increased community participation was also reported. Empowered mindsets involved increased confidence, increased self-efficacy and self-determination, and broadened perspectives and expectations.

CONCLUSIONS

The study provides evidence for the utility of SFC-peds and the importance of engaging families in a goal-oriented collaborative process. Implications concern greater understanding of transactional dynamics in therapy and real-world client change, and the need to develop measures of client/family resiliency.

Program opportunities of residential immersive life skills programs for youth with disabilities

PURPOSE

Residential immersive life skills programs provide youth with the skills and outlooks needed to adopt new roles in life. Observed program opportunities and service providers' perceptions of opportunities were examined to determine program fidelity. Service providers' views of how the programs work were also examined.

METHOD

107 activity settings were observed across two summers at three programs, with opportunities assessed using the Measure of Environmental Qualities of Activity Settings (MEQAS-48). Activity settings were classified by session format (instructional versus experiential) and activity type (active physical, skill-based, self-improvement). Qualitative interviews were held with seven service providers.

RESULTS

Service providers indicated the importance of life-preparatory learning opportunities for social interaction, choice, and skill development, which aligned with high observed MEQAS-48 opportunities for social interaction, choice in experiential session formats, and personal growth. Providers individualized program delivery to provide youth with personally meaningful and challenging experiences. Providers also discussed emergent, transformational outcomes, including enhanced awareness of strengths, enhanced confidence in skills, identity development, and greater awareness of future life possibilities.

CONCLUSIONS

The study provided evidence of program fidelity, along with robust evidence for program opportunities as an active ingredient that may be transferable to the design and delivery of other transition-support programs.

Understanding Organisational Ability and Self-Regulation in Children with Developmental Coordination Disorder

PURPOSE OF THE REVIEW

This paper examines physical and emotional coherence in young people with developmental coordination disorder (DCD). Specifically, the transactional relationship between motor and non-motor/executive dysfunction in children with DCD and its impact on psychosocial functioning is explored.

RECENT FINDINGS

This paper integrates the subjective reported experiences of young people with DCD with objective measurements and findings from neuroimaging studies.

SUMMARY

Consideration of the transactional relationship between the person, the activity and the environment, whether these factors be physical, social, attitudinal or virtual, will be fundamental to our understanding of the mechanisms underpinning organisational and emotional issues presenting in DCD. Integrating the experiences of young people with research evidence will be essential to improve outcomes for young people with DCD in clinical practice.