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Woodgate RL, Isaak CA, Kipling A, Kirk S. Challenges and recommendations for advancing respite care for families of children and youth with special health care needs: A qualitative exploration. Health Expect 2024; 27:e13831. [PMID: 37705308 PMCID: PMC10753137 DOI: 10.1111/hex.13831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Caring for children and youth with special health care needs (CYSHCN) is a significant undertaking for families. While respite care is intended to address this burden, demand continues to exceed supply. Exploring the perspectives of respite service providers (SPs) and stakeholders (SKs) provides unique insight into families' needs and respite care systems. METHODS We conducted semistructured interviews with 41 respite care SPs and SKs across four Canadian provinces to ascertain perspectives on current and ideal respite care for families of CYSHCN. The analysis included delineating units of meaning from the data, clustering units of meaning to form thematic statements and extracting themes. The second-level analysis involved applying themes and subthemes to cross-functional process maps. FINDINGS Participants noted the critical, but sometimes absent role of Community Service Workers, who have the ability to support families accessing and navigating respite care systems. SPs and SKs identified current respite systems as operating in crisis mode. New findings suggest an ideal respite care system would incorporate advocacy for families, empower families and value CYSHCN, their families and respite workers. CONCLUSION The evidence of unmet respite care needs of families of CYSHCN across Canada has long been available. Our findings identifying respite system challenges and solutions can be used by funders and policymakers for planning and enhancing resources, and by healthcare professionals, respite care providers and SKs to understand barriers and take action to improve respite outcomes to meet the respite needs of all families and CYSHCN. PATIENT OR PUBLIC CONTRIBUTION The research team is composed of patients, researchers, clinicians and decision-makers along with our Family Advisory Committee (FAC) composed of members of families of CYSHNC. The FAC was formed and met regularly with research team members, knowledge users and collaborators throughout the study to provide input on design, review themes and ensure findings are translated and disseminated in a meaningful way.
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Affiliation(s)
- Roberta L. Woodgate
- College of NursingRady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Corinne A. Isaak
- College of NursingRady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Ardelle Kipling
- College of NursingRady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Sue Kirk
- School of NursingUniversity of ManchesterManchesterUK
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Finlay B, Wittevrongel K, Materula D, Hébert ML, O'Grady K, Lach LM, Nicholas D, Zwicker JD. Pan-Canadian caregiver experiences in accessing government disability programs: A mixed methods study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 134:104420. [PMID: 36621140 DOI: 10.1016/j.ridd.2022.104420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/14/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND At present, little is known about the factors that contribute to the relatively low uptake of government-funded disability programs in Canada. AIM Understand how parents/caregivers of Canadian youth with neurodevelopmental disability (NDD) experience the process of applying for and accessing disability programs. METHODS AND PROCEDURES This mixed methods sequential explanatory study utilized two phases: an online survey (quantitative), followed by semi-structured interviews (qualitative). The quantitative phase gathered sociodemographic information and preliminary information about participant experiences applying for and accessing programs. The qualitative phase provided greater depth by asking participants to describe barriers and facilitators to program access. OUTCOMES AND RESULTS 499 participants completed the online survey and 81 participants completed an interview. Analysis of survey data revealed that many participants are not accessing disability programs and experience difficulty when applying. Regression analyses revealed that factors relating to the process of applying and applicant/family attributes are significantly associated with program access. Inductive thematic analysis of interview data revealed four barriers and three facilitators to access. Integration of findings provided an overview of the multi-faceted journey to program access. CONCLUSIONS AND IMPLICATIONS The results of this study highlight policy changes that are needed to ensure disability programs adequately support Canadian families.
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Affiliation(s)
- Brittany Finlay
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada.
| | - Krystle Wittevrongel
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada.
| | - Dercia Materula
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada.
| | - Michèle L Hébert
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada; Faculty of Social Work, University of Calgary, Canada Central and Northern Alberta Region, 3-250, 10230 Jasper Avenue, Edmonton T5J 4P6, AB, Canada.
| | - Kathleen O'Grady
- Simone de Beauvoir Institute, Concordia University, ER building, 2155 Guy St., 6th floor, Montréal H3H 2R9, QC, Canada.
| | - Lucyna M Lach
- School of Social Work, McGill University, 550 Sherbrooke Ouest, Suite 100, Tour Est, Montréal H3A 1B9, QC, Canada.
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Canada Central and Northern Alberta Region, 3-250, 10230 Jasper Avenue, Edmonton T5J 4P6, AB, Canada.
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Downtown Campus (5th floor), 906 8th Ave SW, Calgary, AB T2P 1H, Canada; Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary T2N 1N4, AB, Canada.
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Russell MJ, Scott CWM, Berrigan P, Murias K, Gibbard WB, Cui X, Tough S, Zwicker JD. The transition to adult income supports for youth that received special education in British Columbia, Canada: A cohort study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4363-e4374. [PMID: 35574712 DOI: 10.1111/hsc.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 03/28/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Youth in special education have complex needs that are supported across multiple systems. Our research investigates the use of adult income assistance, as one structure that supports youth as they transition to adulthood. We created a cohort of youth (5-22 years old) using linked administrative data from British Columbia government ministries from 1996 to 2018. Youth were grouped by their special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education). We investigated (1) youth characteristics and service use patterns, (2) which youth used income supports after the child-to-adult transition (19-22 years old), and what youth characteristics and service use patterns were associated with use, and (3) how much income support they used (CAD$). Of 174,527 youth, 254 (0.1%) were Level 1, 6020 (3.4%) were Level 2, 4409 (2.5%) were Level 3, 21,232 (12.2%) were Unfunded, and 142,612 (81.7%) were not in special education. Youth assigned higher funding levels, compared to lower levels, generally had increased service use, and in the transition to adult services were more likely to use income supports, and received more income support. An important exception was youth with serious behavioural/mental health special education funding (Level 3), who had increased service use for their level of funding, but received less income support due to a reliance on Temporary versus Disability Assistance. Youth that received an accredited diploma were less likely to use income supports. Factors related to the use of income supports are further described. This study highlights differences in access to income support when youth transition to adult services and considerations around equitable access to support.
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Affiliation(s)
- Matthew Joseph Russell
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | | | - Patrick Berrigan
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Kara Murias
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - W Ben Gibbard
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Xinjie Cui
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | - Suzanne Tough
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Scott CWM, Russell MJ, Tough S, Zwicker JD. Income assistance use among young adults who were in British Columbia special education: A longitudinal cohort study. PLoS One 2022; 17:e0274672. [PMID: 36206290 PMCID: PMC9543764 DOI: 10.1371/journal.pone.0274672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Persons with disability (PWD) experience disproportionately high poverty rates in Canada. This trend is apparent especially among youth compared to those who develop disabilities later in life. PWD in poverty have additional needs that increase barriers to full participation in society and translate to higher basic costs for daily living. Despite the existence of income assistance programs in Canada to mitigate income inequalities faced by PWDs, access to these programs can be limited. OBJECTIVE To describe use of income assistance for young adults with disability in British Columbia for the development of potential approaches to improve realized access to these programs. METHODS We conducted a population-based retrospective cohort study using British Columbia linked administrative data. We described differences in income assistance use among PWD by the level of special education funding received during primary school education (from most to least; Level 1, Level 2, Level 3, Unfunded, and no special education) and family composition. We also provided longitudinal patterns of income assistance use. RESULTS Of 218,324 young adults, 88% received no special education, 0.1% used Level One, 1.6% used Level Two, 2.9% used Level Three, and 7.1% used Unfunded special education coding. Young adults with Level One special education funding had the highest rates of hospitalizations and continuing care, with no hospitalization due to homelessness. Those with Level Three special education coding had higher rates of hospitalization and hospitalization due to homelessness than Level Two young adults. When transitioning to adulthood initially, Level One and Two funded individuals used relatively more disability income assistance than individuals from the other funding levels. Nearly all BCEA users with higher funded special education codes used this disability-specific program, while lesser funded special education codes used the Temporary Assistance more frequently, for a longer duration and were more likely to be persistent Temporary Assistance users. CONCLUSIONS Sustainable and reliable access to income assistance programs remains an issue across the heterogeneity of needs faced by young adults with disability.
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Affiliation(s)
- Craig William Michael Scott
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Joseph Russell
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | - Suzanne Tough
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer D. Zwicker
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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Krasovsky T, Barak S, Dishon-Berkovits M, Sadeh Y, Landa J, Brezner A, Silberg T. Factors associated with Multidisciplinary Healthcare Resource Utilization Following Discharge from Pediatric Rehabilitation: A One-year Follow-up Study. Phys Occup Ther Pediatr 2022; 42:579-594. [PMID: 35440261 DOI: 10.1080/01942638.2022.2061887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To characterize multidisciplinary healthcare resource utilization (mHRU), including physical, occupational, speech and psychosocial therapy one-year following discharge from prolonged inpatient and outpatient pediatric rehabilitation in Israel and to identify factors associated with long-term mHRU. METHODS According to Andersen's model of health service use, predisposing (child's age and sex), enabling (district of origin, income level, parental education, insurance) and need factors (injury type, functional status, family psychosocial risk) were collected from parents of children hospitalized for >1 month in a large rehabilitation hospital in Israel, and phone interviews were held 3-months (T1), 6-months (T2) and 12-months (T3) post-discharge. The effect of time and the role of various factors on mHRU, operationalized as number of therapy sessions in the previous 2 weeks, were evaluated. RESULTS Sixty-one families participated at T1 and T2, and 46 participated at T3. HRU was similar over time. Predisposing factors (age) and need factors (functional status and psychosocial risk) were associated with specific disciplines of mHRU, but enabling factors were not. CONCLUSIONS mHRU is high and stable 12-months post-discharge. The lack of impact of enabling factors on mHRU, and the discipline-specific impact of predisposing and need factors, support equity of care provision for children following prolonged rehabilitation.
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Affiliation(s)
- Tal Krasovsky
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Sharon Barak
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Kaye Academic College of Education, Physical Education, Beer-Sheva, Israel.,College of Public Health, Ben Gurion University, Beer-Sheva, Israel
| | | | - Yaara Sadeh
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
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Russell MJ, Michael Scott CW, Murias K, Ben Gibbard W, Cui X, Tough S, Zwicker JD. Cross-ministry data on service use and limitations faced by children in special education. Disabil Health J 2021; 14:101118. [PMID: 34074619 DOI: 10.1016/j.dhjo.2021.101118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children with disabilities often face limitations that cross support sectors. OBJECTIVE Our aim was to measure cross-ministry service use, outcomes, and functional limitations faced by children who qualified for special education. METHODS We used longitudinal British Columbia ministry data linked to children (0-18y) registered in K-12 education. Children were grouped by special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education), and related to 1) service use patterns, 2) the age they first used disability services, and 3) functional limitations reported in health visits. We also reported how length of special education use related to disability service use. RESULTS Of 111,274 children, 154(0.1%) were Level 1, 4427(4.0%) Level 2, 2897(2.6%) Level 3, 13472(12.1%) Unfunded, and 90324(81.2%) not in special education. Children with higher funding levels, compared to lower levels of funding, generally were more likely to experience poorer outcomes, have functional limitations, have service needs, and receive early support. One exception was children with serious behavioural/mental health special education coding, which had poorer outcomes for their level of funding. Children received child disability supports early (about half of users started by 4y), but use was mostly limited to those with many years (9+years) of funded special education (70.7% of the all users) and biased to certain special education codes (i.e., Level 1, severe intellectual disability, and autism). CONCLUSIONS This study provides evidence of the long-term, diverse needs of children in special education and may be used to inform decisions surrounding their support.
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Affiliation(s)
- Matthew Joseph Russell
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada; PolicyWise for Children & Families, 1000-9925 109 St NW, Edmonton, AB T5K 2J8, Canada.
| | - Craig William Michael Scott
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada
| | - Kara Murias
- Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - W Ben Gibbard
- Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Xinjie Cui
- PolicyWise for Children & Families, 1000-9925 109 St NW, Edmonton, AB T5K 2J8, Canada
| | - Suzanne Tough
- Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada; Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, Alberta, T2N 1N4, Canada
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Gubbels A. Use of healthcare services by young people with disabilities: a policy practitioner perspective. Dev Med Child Neurol 2021; 63:10. [PMID: 33084038 DOI: 10.1111/dmcn.14696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- André Gubbels
- Federal Public Service Social Security, Brussels, Belgium
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