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Savaş EH, Aydin A, Bertan İ. The effect of Transition to Adulthood Training Program for mothers of young adults with intellectual disability on family quality of life and perceived stress level: A pilot randomized controlled study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024:17446295241259100. [PMID: 38821559 DOI: 10.1177/17446295241259100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Families cannot easily identify and cope with the changing health problems and needs of children transitioning into adulthood. This pilot randomized controlled study aims to improve the family's quality of life and reduce mothers' perceived stress levels by implementing an educational program (Transition to Adulthood Training Program - TATP). A total of 33 mothers of children with intellectual disabilities were randomly assigned to the groups. Data were collected using the Personal Information Form, Beach Center Family Quality of Life (BCFQOL), and Perceived Stress Scale. The intervention group showed a significant increase in the BCFQOL mean score rather than the control group (p<.001). There was a significant decrease in the perceived stress scores of the mothers in the intervention group after the TATP training sessions (p<0.05). The TATP intervention not only increased the quality of family life for these mothers but also led to a reduction in their perceived stress levels.
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Affiliation(s)
| | - Ayfer Aydin
- Faculty of Nursing, Istanbul University, Türkiye
| | - İpek Bertan
- Center for Children with Special Needs and Families (EÇADEM) Koç University, Türkiye
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Guertin JR, Gilbert-Ouimet M, Dugas M, Carnovale V, Jalbert L, Svyntozelska O, Demers J, Matteau L, Bergeron F, LeBlanc A. Methods used to account for caregivers' sex and gender within studies examining the financial burden of caregivers of children and adolescents : Results from a scoping review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:35-53. [PMID: 38298908 PMCID: PMC10829241 DOI: 10.2147/ceor.s443077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Background Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden. Purpose We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies. Data Sources Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases. Study Selection Manuscript selection was performed by pairs of reviewers. Data Extraction Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach. Data Synthesis We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers' financial burden. Less than half (n = 93, 47%) of studies reported on caregivers' sex and none reported on their gender. Conclusion We conducted an unrestricted review of published studies examining caregiver's financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.
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Affiliation(s)
- Jason Robert Guertin
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, Quebec, Canada
| | - Mahée Gilbert-Ouimet
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Valérie Carnovale
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Juliette Demers
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Léonie Matteau
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Quebec City, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
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Laermans P, Morisse F, Lombardi M, Gérard S, Vandevelde S, de Kuijper G, Audenaert K, Claes C. Aligning quality of life and guidelines for off-label psychotropic drugs in adults with intellectual disabilities and challenging behaviour. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:398-413. [PMID: 37213586 PMCID: PMC10197992 DOI: 10.1080/20473869.2023.2195721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/23/2023]
Abstract
Introduction Adults with intellectual disabilities have an increased vulnerability to mental health problems and challenging behaviour. In addition to psychotherapeutic or psychoeducational methods, off-label pharmacotherapy, is a commonly used treatment modality. Objective The aim of this study was to establish evidence-based guideline recommendations for the responsible prescription of off-label psychotropic drugs, in relation to Quality of Life (QoL). Method A list of guidelines was selected, and principles were established based on international literature, guideline review and expert evaluation. The Delphi method was used to achieve consensus about guideline recommendations among a 58-member international multidisciplinary expert Delphi panel. Thirty-three statements were rated on a 5-point Likert-scale, ranging from totally disagree to totally agree, in consecutive Delphi rounds. When at least 70% of the participants agreed (score equal or higher than 4), a statement was accepted . Statements without a consensus were adjusted between consecutive Delphi rounds based on feedback from the Delphi panel. Results Consensus was reached on 4 general:the importance of non-pharmaceutical treatments, comprehensive diagnostics and multidisciplinary treatment. Consensus was reached in 4 rounds on 29 statements. No consensus was reached on 4 statements concerning: freedom-restricting measures, the treatment plan, the evaluation of the treatment plan, and the informed consent. Conclusion The study led to recommendations and principles for the responsible prescription - aligned with the QoL perspective - of off-label psychotropic drugs for adults with intellectual disabilities and challenging behaviour. Extensive discussion is needed regarding the issues on which there was no consensus to furthering the ongoing development of this guideline.
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Affiliation(s)
- P. Laermans
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
- Correspondence to: Pauline Laermans, EQUALITY//ResearchCollective, University College Ghent.
| | - F. Morisse
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - M. Lombardi
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
| | - S. Gérard
- Superior Health Council, Brussels, Belgium
| | - S. Vandevelde
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - G. de Kuijper
- Centre for Intellectual Disabilities & Mental Health, Mental Healthcare Drenthe, the Netherlands
| | - K. Audenaert
- Department of Psychiatry, Ghent University, Ghent, Belgium
| | - C. Claes
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
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Zylbersztejn A, Stilwell PA, Zhu H, Ainsworth V, Allister J, Horridge K, Stephenson T, Wijlaars L, Gilbert R, Heys M, Hardelid P. Trends in hospital admissions during transition from paediatric to adult services for young people with learning disabilities or autism: Population-based cohort study. Lancet Reg Health Eur 2023; 24:100531. [PMID: 36394000 PMCID: PMC9649375 DOI: 10.1016/j.lanepe.2022.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background Transition from paediatric to adult health care may disrupt continuity of care, and result in unmet health needs. We describe changes in planned and unplanned hospital admission rates before, during and after transition for young people with learning disability (LD), or autism spectrum disorders (ASD) indicated in hospital records, who are likely to have more complex health needs. Methods We developed two mutually exclusive cohorts of young people with LD, and with ASD without LD, born between 1990 and 2001 in England using national hospital admission data. We determined the annual rate of change in planned and unplanned hospital admission rates before (age 10–15 years), during (16–18 years) and after (19–24 years) transition to adult care using multilevel negative binomial regression models, accounting for area-level deprivation, sex, birth year and presence of comorbidities. Findings The cohorts included 51,291 young people with LD, and 46,270 autistic young people. Admission rates at ages 10–24 years old were higher for young people with LD (54 planned and 25 unplanned admissions per 100 person-years) than for autistic young people (17/100 and 16/100, respectively). For young people with LD, planned admission rates were highest and constant before transition (rate ratio [RR]: 0.99, 95% confidence interval [CI] 0.98–0.99), declined by 14% per year of age during (RR: 0.86, 95% CI: 0.85–0.88), and remained constant after transition (RR: 0.99, 95% CI: 0.99–1.00), mainly due to fewer admissions for non-surgical care, including respite care. Unplanned admission rates increased by 3% per year of age before (RR: 1.03, 95% CI: 1.02–1.03), remained constant during (RR: 1.01, 95% CI: 1.00–1.03) and increased by 3% per year after transition (RR: 1.03, 95% CI: 1.02–1.04). For autistic young people, planned admission rates increased before (RR: 1.06, 95% CI: 1.05–1.06), decreased during (RR: 0.95, 95% CI: 0.93–0.97), and increased after transition (RR: 1.05, 95%: 1.04–1.07). Unplanned admission rates increased most rapidly before (RR: 1.16, 95% CI: 1.15–1.17), remained constant during (RR: 1.01, 95% CI: 0.99–1.03), and increased moderately after transition (RR: 1.03, 95% CI: 1.02–1.04). Interpretation Decreases in planned admission rates during transition were paralleled by small but consistent increases in unplanned admission rates with age for young people with LD and autistic young people. Decreases in non-surgical planned care during transition could reflect disruptions to continuity of planned/respite care or a shift towards provision of healthcare in primary care and community settings and non-hospital arrangements for respite care. Funding National Institute for Health Research Policy Research Programme.
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Reyes-Martín J, Simó-Pinatella D, Font-Roura J. Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8701. [PMID: 35886552 PMCID: PMC9324269 DOI: 10.3390/ijerph19148701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.
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Affiliation(s)
- Juliana Reyes-Martín
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
- Fundació Vallparadís, Mutua Terrassa, 08221 Barcelona, Spain
| | - David Simó-Pinatella
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
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Kaya A, Wehmeyer ML. A model proposal development study for adults with intellectual disabilities in Turkey compared to USA. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:89-99. [PMID: 38456131 PMCID: PMC10916900 DOI: 10.1080/20473869.2022.2058782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/22/2022] [Indexed: 03/09/2024]
Abstract
Intellectual disability (ID) persists from birth through adulthood and aging. Thus, the support provided to individuals with intellectual disabilities (IwID) in adulthood is essential to increase their self-determination and quality of life. This research aimed to determine how IwID may receive support for education, working life, accommodation, and leisure in adulthood in the Turkish context by increasing their and their families' quality of life without socially discriminating against them. Qualitative data were collected in two stages, combining semi-structured interviews and the Delphi study technique. Results prompted the recommendation that a legal basis for transition-to-adulthood planning be established in Turkey for a functional adult service model. Next, a model with specific standards by which multidisciplinary experts analyse education, work, leisure, and housing alternatives for preadulthood and adulthood should be developed and coordinated by the Turkish Ministry of National Education and the Ministry of Family. Implications for the future are further discussed.
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Affiliation(s)
- Ali Kaya
- Department of Special Education, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
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Shanahan P, Ollis L, Balla K, Patel R, Long K. Experiences of transition from children's to adult's healthcare services for young people with a neurodevelopmental condition. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1429-1438. [PMID: 33064360 DOI: 10.1111/hsc.13198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
Previous research has highlighted a lack of continuity of care when young people with a neurodevelopmental condition make the transition from children's to adult specialist healthcare services. A lack of planning, consistency, and availability of adult services has been found to lead to; increased anxiety, poor health outcomes, reduced support and some young people not receiving healthcare. The majority of transition research has focused on what health professionals consider important in the transition process, rather than focusing on the experiences of the young people and those closest to them. Our objective was to gather evidence from young people (and their families) who had experienced transition from children's to adult specialist healthcare services through semi-structured interviews. Volunteers were recruited from two London boroughs. All young people were aged between 18 and 25 years with a neurodevelopmental condition (Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and/or an Intellectual Disability). Overall, we interviewed six young people with support from a family member. Five further family members were interviewed on behalf of the young person. In total, ten semi-structured interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Four themes emerged from the analysis: (a) Parents as advocates, (b) Availability of adult's specialist health and social care services, (c) Lack of information sharing and (d) Transition as a binary, abrupt change. Our findings suggest the transition experience could be improved by changing service specifications to incorporate assessment and handover across the age range of 16-20 years. Additionally, statutory services should understand and provide the coordination role now offered by parents in transition. We suggest future research could evaluate the feasibility of a patient-owned online information sharing tool with information about relevant services for young people and their families.
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Affiliation(s)
| | | | - Kate Balla
- Your Healthcare CIC, Surbiton, Surrey, UK
| | | | - Karen Long
- Your Healthcare CIC, Surbiton, Surrey, UK
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Levy BB, Song JZ, Luong D, Perrier L, Bayley MT, Andrew G, Arbour-Nicitopoulos K, Chan B, Curran CJ, Dimitropoulos G, Hartman L, Huang L, Kastner M, Kingsnorth S, McCormick A, Nelson M, Nicholas D, Penner M, Thompson L, Toulany A, Woo A, Zee J, Munce SEP. Transitional Care Interventions for Youth With Disabilities: A Systematic Review. Pediatrics 2020; 146:peds.2020-0187. [PMID: 33046586 DOI: 10.1542/peds.2020-0187] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Transition from the pediatric to the adult health care system is a complex process that should include medical, psychosocial, educational, recreational, and vocational considerations. OBJECTIVE In this systematic review, we aim to synthesize the evidence on transitional care interventions (TCIs) to improve the quality of life (QoL) for adolescents and young adults with childhood-onset disabilities, including neurodevelopmental disorders. DATA SOURCES Four electronic databases (Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature) were searched. STUDY SELECTION In the included studies, researchers examined TCIs for adolescents and young adults (12-24 years of age) with childhood-onset disabilities. Studies were experimental, quasi-experimental, and observational studies published in the last 26 years. DATA EXTRACTION Two reviewers independently completed study screening, data extraction, and risk-of-bias assessment. RESULTS Fifty-two studies were included. Five studies reported on QoL, but statistically significant improvements were noted in only 1 of these studies. Significant improvements were also found in secondary outcomes including disability-related knowledge and transitional readiness. TCIs targeted patients, families and/or caregivers, and health care providers and exhibited great heterogeneity in their characteristics and components. LIMITATIONS Inconsistent reporting on interventions between studies hindered synthesis of the relationships between specific intervention characteristics and outcomes. CONCLUSIONS Although there is limited evidence on the impact of TCIs on the QoL for youth with childhood-onset disabilities, there is indication that they can be effective in improving patient and provider outcomes. The initiation of transition-focused care at an early age may contribute to improved long-term health outcomes in this population.
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Affiliation(s)
- Ben B Levy
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jessica Z Song
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Mark T Bayley
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and.,Division of Physical Medicine, and
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, and.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Brian Chan
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and
| | - Cynthia J Curran
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | | | - Laura Hartman
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lennox Huang
- Departments of Paediatrics.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, and.,Family and Community Medicine, and.,North York General Hospital, Toronto, Ontario, Canada
| | - Shauna Kingsnorth
- Rehabilitation Sciences Institute, and.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and
| | - Michelle Nelson
- Institute of Health Policy, Management and Evaluation, and.,Sinai Health System, Toronto, Ontario, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, and.,Departments of Paediatrics.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Alene Toulany
- Departments of Paediatrics.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Woo
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Joanne Zee
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada; .,Institute of Health Policy, Management and Evaluation, and.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Karakas C, Schultz RJ, Gavvala JR. Challenges in the Transition of Care Process for Patients with Dravet and Lennox–Gastaut Syndromes. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractEpileptic encephalopathies such as Dravet syndrome (DS) and Lennox–Gastaut syndrome (LGS) present unique challenges in the transition of care not only for the providers but also for the patients and families. Some of these challenges include the complexity of disease process, differences in medication management between children and adults, high incidence of comorbidities such as psychosocial issues, a lack of structured transition process from pediatric to adult care, and the lack of parental knowledge and reluctance to transition to an adult provider. Improving transition readiness and transfer of care are essential to long-term management and continuity of care. Studies show that patients/families who possess transition readiness skills have better health outcomes. Furthermore, participation in a structured transition intervention has been shown to improve transition readiness and utilization of ambulatory care in the adult setting. Reported benefits of implementation of transition planning include increased self-esteem, improved health literacy, fewer emergency room visits, decreased hospitalizations and comorbidities, and fewer school absences. Nevertheless, there is a lack of evidenced-based, family/patient-centered transition model of care. This review's primary goal is to provide an overview of challenges in the transition of care and recommendations for an ideal transition for patients with DS and LGS.
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Affiliation(s)
- Cemal Karakas
- Department of Neurology and Neurophysiology, Baylor College of Medicine, Houston, Texas, United States
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States
| | - Rebecca J. Schultz
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, United States
| | - Jay R. Gavvala
- Department of Neurology and Neurophysiology, Baylor College of Medicine, Houston, Texas, United States
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Gauthier-Boudreault C, Gallagher F, Trépanier J, Corbin F, Couture M. Factors impacting the transition to adulthood of youth with fragile X syndrome and their families: Facilitators, obstacles and needs. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 103:103674. [PMID: 32535492 DOI: 10.1016/j.ridd.2020.103674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The transition from school to adulthood is a critical time for families of youth with disabilities. Few studies have focused on the needs of families of youths with fragile X syndrome. This syndrome is often associated with intellectual disability and autism spectrum disorder, which creates specific needs that must be documented to improve transition planning. The aim of the current study was to document factors impacting transition planning and describe parents' experiences during this period. METHOD Individual interviews were conducted with thirteen parents of young people with fragile X syndrome. Two research team members analysed the interviews separately. RESULTS Factors related to the youth, the youth's family and the steps taken by the various institutions involved during this period seem to impact this transition and contributed to families' anxiety. A clear, uniform transition planning process, initiated early enough to have time for exploratory work placements, and gradual integration emerged as crucial facilitators for the parents in this study. CONCLUSIONS Understanding the reality of people with fragile X syndrome and their families will help to adapt services and develop concrete plans for their future.
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Affiliation(s)
- Camille Gauthier-Boudreault
- Health Sciences Research Programme, Université de Sherbrooke, 3001, 12(e) Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.
| | | | | | - Francois Corbin
- Department of Biochemistry and Functional Genomic, Université de Sherbrooke, Canada
| | - Mélanie Couture
- Occupational Therapy Programme, School of Rehabilitation, Université de Sherbrooke, Canada
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Hunter RM, Vickerstaff V, Poppe M, Strydom A, King M, Hall I, Crabtree J, Omar R, Cooper V, Biswas A, Hassiotis A. Staff training in positive behaviour support for behaviour that challenges in people with intellectual disability: cost-utility analysis of a cluster randomised controlled trial. BJPsych Open 2020; 6:e15. [PMID: 32019635 PMCID: PMC7176891 DOI: 10.1192/bjo.2020.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs). AIMS We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276). METHOD We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective. RESULTS Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI -0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI -603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold. CONCLUSIONS There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.
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Affiliation(s)
- Rachael Maree Hunter
- Associate Professor, Research Department of Primary Care and Population Health, University College London, UK
| | - Victoria Vickerstaff
- Senior Research Fellow, PRIMENT Clinical Trials Unit, University College London, UK
| | - Michaela Poppe
- Clinical Trial Manager, Division of Psychiatry, University College London, UK
| | - Andre Strydom
- Professor in Intellectual Disabilities, King's College London and South London and the Maudsley NHS Foundation Trust, UK
| | - Michael King
- Professor of Primary Care Psychiatry, Division of Psychiatry, University College London, UK
| | - Ian Hall
- Consultant Psychiatrist and Clinical Lead, Community Learning Disability Service, East London NHS Foundation Trust, UK
| | - Jason Crabtree
- Clinical Psychologist, East London NHS Foundation Trust, UK
| | - Rumana Omar
- Professor of Medical Statistics, Department of Statistical Science, University College London, UK
| | - Vivien Cooper
- Chief Executive, Challenging Behaviour Foundation, UK
| | - Asit Biswas
- Consultant Psychiatrist, Agnes Unit, Leicestershire Partnership NHS Trust & University of Leicester, UK
| | - Angela Hassiotis
- Professor of Psychiatry of Intellectual Disability, Division of Psychiatry, University College London; and Camden and Islington NHS Foundation Trust, UK
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Doble B, Schofield D, Evans CA, Groza T, Mattick JS, Field M, Roscioli T. Impacts of genomics on the health and social costs of intellectual disability. J Med Genet 2020; 57:479-486. [PMID: 31980565 DOI: 10.1136/jmedgenet-2019-106445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/17/2019] [Accepted: 01/03/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study provides an integrated assessment of the economic and social impacts of genomic sequencing for the detection of monogenic disorders resulting in intellectual disability (ID). METHODS Multiple knowledge bases were cross-referenced and analysed to compile a reference list of monogenic disorders associated with ID. Multiple literature searches were used to quantify the health and social costs for the care of people with ID. Health and social expenditures and the current cost of whole-exome sequencing and whole-genome sequencing were quantified in relation to the more common causes of ID and their impact on lifespan. RESULTS On average, individuals with ID incur annual costs in terms of health costs, disability support, lost income and other social costs of US$172 000, accumulating to many millions of dollars over a lifetime. CONCLUSION The diagnosis of monogenic disorders through genomic testing provides the opportunity to improve the diagnosis and management, and to reduce the costs of ID through informed reproductive decisions, reductions in unproductive diagnostic tests and increasingly targeted therapies.
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Affiliation(s)
- Brett Doble
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia .,Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Deborah Schofield
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,GenImpact, School of Economics, Faculty of Business and Economics, Macquarie University, Sydney, New South Wales, Australia
| | - Carey-Anne Evans
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Tudor Groza
- Pryzm Health, Gold Coast, Queensland, Australia
| | - John S Mattick
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mike Field
- The Genetics of Learning Disability Service, Waratah, New South Wales, Australia
| | - Tony Roscioli
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.,NSW Health Pathology East Laboratory, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
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Brown M, Macarthur J, Higgins A, Chouliara Z. Transitions from child to adult health care for young people with intellectual disabilities: A systematic review. J Adv Nurs 2019; 75:2418-2434. [PMID: 30816570 DOI: 10.1111/jan.13985] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 12/31/2022]
Abstract
AIMS To examine the experiences of health transitions for young people with intellectual disabilities and their carers and identify the implications for nursing practice. DESIGN A systematic review and critical appraisal of qualitative, quantitative, and mixed methods studies. DATA SOURCES A search of the relevant literature published 2007-2017 was carried out in AMED, ASSIA, CINAHL, MEDLINE, PsycINFO, PubMed, and Science Direct Sociological Abstracts databases. REVIEW METHODS A total of 12 of 637 papers identified in the search met the inclusion criteria for this review. A narrative review of the papers was undertaken by synthesizing the key findings and grouping them into concepts and emergent themes. RESULTS Four main themes were identified: (a) becoming an adult; (b) fragmented transition process and care; (c) parents as advocates in emotional turmoil; and (d) making transitions happen. CONCLUSION The range of issues that have an impact on the transition from child to adult health services for young people with intellectual disabilities and their carers raise important implications for policy development, nursing practice, and education.
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Affiliation(s)
- Michael Brown
- School of Nursing & Midwifery, Queen's University, Belfast, UK
| | | | - Anna Higgins
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Zoë Chouliara
- Division in Mental Health & Counselling, Abertay University, Dundee, UK
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Hassiotis A, Poppe M, Strydom A, Vickerstaff V, Hall I, Crabtree J, Omar R, King M, Hunter R, Bosco A, Biswas A, Ratti V, Blickwedel J, Cooper V, Howie W, Crawford M. Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT. Health Technol Assess 2019; 22:1-110. [PMID: 29596045 DOI: 10.3310/hta22150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). OBJECTIVE To evaluate whether or not such training is clinically effective in reducing challenging behaviour in routine care. The study also included longer-term follow-up (approximately 36 months). DESIGN A multicentre, single-blind, two-arm, parallel-cluster randomised controlled trial. The unit of randomisation was the community ID service using an independent web-based randomisation system and random permuted blocks on a 1 : 1 allocation stratified by a staff-to-patient ratio for each cluster. SETTING Community ID services in England. PARTICIPANTS Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist - Community total score (ABC-CT)]. INTERVENTIONS Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. MAIN OUTCOME MEASURES Carer-reported changes in challenging behaviour as measured by the ABC-CT over 12 months. Secondary outcomes included psychopathology, community participation, family and paid carer burden, family carer psychopathology, costs of care and quality-adjusted life-years (QALYs). Data on main outcome, service use and health-related quality of life were collected for the 36-month follow-up. RESULTS A total of 246 participants were recruited from 23 teams, of whom 109 were in the intervention arm (11 teams) and 137 were in the control arm (12 teams). The difference in ABC-CT between the intervention and control arms [mean difference -2.14, 95% confidence interval (CI) -8.79 to 4.51; p = 0.528] was not statistically significant. No treatment effects were found for any of the secondary outcomes. The mean cost per participant in the intervention arm was £1201. Over 12 months, there was a difference in QALYs of 0.076 in favour of the intervention (95% CI 0.011 to 0.140 QALYs) and a 60% chance that the intervention is cost-effective compared with TAU from a health and social care cost perspective at the threshold of £20,000 per QALY gained. Twenty-nine participants experienced 45 serious adverse events (intervention arm, n = 19; control arm, n = 26). PBS plans were available for 33 participants. An independent assessment of the quality of these plans found that all were less than optimal. Forty-six qualitative interviews were conducted with service users, family carers, paid carers and service managers as part of the process evaluation. Service users reported that they had learned to manage difficult situations and had gained new skills, and carers reported a positive relationship with therapists. At 36 months' follow-up (n = 184), the mean ABC-CT difference between arms was not significant (-3.70, 95% CI -9.25 to 1.85; p = 0.191). The initial cost-effectiveness of the intervention dissipated over time. LIMITATIONS The main limitations were low treatment fidelity and reach of the intervention. CONCLUSIONS Findings from the main study and the naturalistic follow-up suggest that staff training in PBS as delivered in this study is insufficient to achieve significant clinical gains beyond TAU in community ID services. Although there is an indication that training in PBS is potentially cost-effective, this is not maintained in the longer term. There is increased scope to develop new approaches to challenging behaviour as well as optimising the delivery of PBS in routine clinical practice. TRIAL REGISTRATION This study is registered as NCT01680276. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Michaela Poppe
- Division of Psychiatry, University College London, London, UK
| | - Andre Strydom
- Division of Psychiatry, University College London, London, UK
| | | | - Ian Hall
- Tower Hamlets Community Learning Disability Service, Mile End Hospital, London, UK
| | - Jason Crabtree
- Tower Hamlets Community Learning Disability Service, Mile End Hospital, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Rachael Hunter
- University College London PRIMENT Clinical Trials Unit, London, UK
| | - Alessandro Bosco
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Asit Biswas
- Leicestershire Partnership NHS Trust, Directorate of Learning Disabilities, Frith Hospital, Leicester, UK
| | - Victoria Ratti
- Division of Psychiatry, University College London, London, UK
| | | | | | - William Howie
- South West London and St George's Mental Health Trust, Wandsworth Community Mental Health Learning Disabilities Team, Springfield University Hospital, London, UK
| | - Mike Crawford
- Centre for Mental Health, Department of Medicine, Imperial College London, London, UK
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15
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Yang SY, Lin CY, Huang YC, Chang JH. Gender differences in the association of smartphone use with the vitality and mental health of adolescent students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:693-701. [PMID: 29565784 DOI: 10.1080/07448481.2018.1454930] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/27/2018] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The present study examined variations in the degree of smartphone use behavior among male and female adolescents as well as the association between various degrees of smartphone use behavior and the vitality and mental health of each gender. PARTICIPANTS A total of 218 adolescents were recruited from a junior college in September 2014. METHODS All the participants were asked to answer questionnaires on smartphone use. RESULTS The findings showed that adolescent females as compared with adolescent males exhibited significantly higher degrees of smartphone dependence and smartphone influence. Positive correlations were observed between the duration of smartphone use on weekends and the vitality/mental health of the male adolescents; negative correlations were found between smartphone dependence and the vitality/mental health of males. CONCLUSION The findings demonstrate that adolescent females are deeply affected by their smartphone use. Smartphone dependence may decrease the vitality and mental health of male adolescents.
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Affiliation(s)
- Shang-Yu Yang
- a Institute of Allied Health Science, College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Chung-Ying Lin
- b Department of Rehabilitation Sciences , Faculty of Health and Social Sciences, The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Yueh-Chu Huang
- c Department of Physical Therapy , Shu Zen Junior College of Medicine and Management , Kaohsiung , Taiwan
| | - Jer-Hao Chang
- a Institute of Allied Health Science, College of Medicine, National Cheng Kung University , Tainan , Taiwan
- d Department of Occupational Therapy , College of Medicine, National Cheng Kung University , Tainan , Taiwan
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16
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Law EF, Groenewald CB, Zhou C, Palermo TM. Effect on Health Care Costs for Adolescents Receiving Adjunctive Internet-Delivered Cognitive-Behavioral Therapy: Results of a Randomized Controlled Trial. THE JOURNAL OF PAIN 2018; 19:910-919. [PMID: 29578090 DOI: 10.1016/j.jpain.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/12/2018] [Accepted: 03/07/2018] [Indexed: 12/17/2022]
Abstract
The economic burden of pediatric chronic pain is high, with an estimated annual cost of $19.5 billion. Little is known about whether psychological treatment for pediatric chronic pain can alter health care utilization for youth. The primary aim of this secondary data analysis was to evaluate the effect of adjunctive internet cognitive-behavioral therapy intervention or adjunctive internet education on health care-related economic costs in a cohort of adolescents with chronic pain recruited from interdisciplinary pain clinics across the United States. For the full sample, health care expenditures significantly decreased from the year before the intervention to the year after the intervention. Results indicated that the rate of change in health care costs over time was not significantly different between the internet cognitive-behavioral therapy intervention and adjunctive internet education groups. Further research is needed to replicate these findings and determine patterns and drivers of health care costs for youth with chronic pain evaluated in interdisciplinary pain clinics and whether psychological treatments can alter these patterns. This trial was registered at clinicaltrials.gov (identifier NCT01316471). PERSPECTIVE Health care expenditures significantly decreased in youth with chronic pain from the year before initiating treatment to the following year in both intervention conditions, adjunctive internet cognitive-behavioral therapy and adjunctive internet education. Contrary to our hypothesis, the rate of change in health care costs over time was not significantly different between intervention conditions.
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Affiliation(s)
- Emily F Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.
| | - Cornelius B Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Psychiatry, University of Washington, Seattle, Washington
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Barr NG, Longo CJ, Embrett MG, Mulvale GM, Nguyen T, Randall GE. The transition from youth to adult mental health services and the economic impact on youth and their families. Healthc Manage Forum 2017; 30:283-288. [PMID: 29061073 DOI: 10.1177/0840470417709579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) can be challenging for youth, their families, and healthcare providers. The purpose of this study was to identify, summarize, and assess evidence found in scholarly literature regarding the economic impact on youth and their families during the transition from CAMHS to AMHS. Relevant studies were identified through a search of 7 electronic platforms. The search identified 829 articles; 5 of which met all inclusion criteria. Evidence from the included studies suggests that, when continuity of care is lacking, transitions from CAMHS to AMHS have substantial impacts on the financial demands of youth and their families. These demands are due to increases in the cost of care, loss of employment income and productivity, and changes in insurance coverage. However, there remains limited information in this area, which highlights the need for further research.
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Affiliation(s)
- Neil G Barr
- 1 Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Christopher J Longo
- 2 DeGroote School of Business, Health Policy and Management Area, McMaster University, Hamilton, Ontario, Canada
| | | | - Gillian M Mulvale
- 2 DeGroote School of Business, Health Policy and Management Area, McMaster University, Hamilton, Ontario, Canada
| | - Tram Nguyen
- 4 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- 5 CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
- 6 School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Glen E Randall
- 2 DeGroote School of Business, Health Policy and Management Area, McMaster University, Hamilton, Ontario, Canada
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18
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Gauthier-Boudreault C, Couture M, Gallagher F. How to facilitate transition to adulthood? Innovative solutions from parents of young adults with profound intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 2:215-223. [DOI: 10.1111/jar.12394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mélanie Couture
- Department of Occupational Therapy; Université de Sherbrooke; Sherbrooke QC Canada
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19
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Gauthier-Boudreault C, Gallagher F, Couture M. Specific needs of families of young adults with profound intellectual disability during and after transition to adulthood: What are we missing? RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 66:16-26. [PMID: 28577424 DOI: 10.1016/j.ridd.2017.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 03/26/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION At the age of 21, the trajectory of services offered to youth with profound intellectual disability (ID) change significantly since access to specialised services is more limited. Despite the desire of parents to avoid any impact on their child, several factors can influence the course of this transition. However, there is little research on facilitators and obstacles to the transition to adulthood, and impacts on people with a profound ID. It is therefore difficult to provide solutions that meet their specific needs. OBJECTIVE The study aimed to document the needs of parents and young adults with profound ID during and after the transition to adulthood by exploring their transitioning experience and factors that influenced it. METHOD Using a descriptive qualitative design, two individual semi-structured interviews were conducted with fourteen (14) parents of young adults aged between 18 and 26 with a profound ID. RESULTS At this point, many material, informative, cognitive and emotional needs of young adults and their parents are not met. Obstacles, mainly organisational, persist and result in a particularly difficult transition to adulthood experience. CONCLUSION By knowing the specific needs of these families, it is possible to develop and implement solutions tailored to their reality. WHAT THE PAPERS ADDS?: The transition to adulthood is a critical period for families with young adults with an intellectual disability (ID), a reality observed internationally. Current literature on all levels of ID suggests some barriers to transition that lead to negative impacts on both parents and young adults with ID. However, presently, very little research exists on the reality of families of young adults with profound ID and factors influencing transition to adult life. Most of studies target people with mild to moderate ID. Considering the significant disabilities of people with profound ID, it is possible to imagine that their experience of transition will be even more difficult and they will present specific needs. The lack of understanding of these needs makes it difficult to introduce solutions tailored to their reality. The results of this current study suggest that many needs of young adults with profound ID and their parents are not met despite existent transition planning services. Transition to adulthood seems particularly difficult for these families who face many challenges. Parents in this study proposed different obstacles during transition to adulthood that could be improved for creation of future solutions adapted to their reality.
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Affiliation(s)
- Camille Gauthier-Boudreault
- Department of Clinical Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Frances Gallagher
- Department of Nursing, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Mélanie Couture
- Department of Occupational Therapy, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
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McCallum C. Supporting young people's transition from children's to adult services in the community. Br J Community Nurs 2017; 22:668-674. [PMID: 28034336 DOI: 10.12968/bjcn.2017.22.1.668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Queen's Nursing Institute (QNI) is leading a project to improve young people's experience of transitioning from children's services to adult community health services. To gain an understanding of the current evidence, the QNI conducted a review of relevant UK literature from the last 10 years, focusing on community and primary care nursing. Despite the lack of evidence relating to effective practice in community and primary care settings, the literature search suggested that nurses could play a significant role in coordinating the transition process and working with the young person to prepare them for adult services. The review highlights that further work is required to translate current policy recommendations into practice, and the QNI will be supporting health and care professionals to improve transition by developing learning resources for district nurses, general practice nurses and educators, and promoting the sharing and application of best practice.
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Iemmi V, Knapp M, Brown FJ. Positive behavioural support in schools for children and adolescents with intellectual disabilities whose behaviour challenges: An exploration of the economic case. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2016; 20:281-295. [PMID: 26912505 DOI: 10.1177/1744629516632402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
Decision-makers with limited budgets want to know the economic consequences of their decisions. Is there an economic case for positive behavioural support (PBS)? A small before-after study assessing the impact of PBS on challenging behaviours and positive social and communication skills in children and adolescents with intellectual disabilities and behaviours that challenge was followed by an evaluation of costs. Results were compared with the costs of alternative packages of care currently available in England obtained from a Delphi exercise conducted alongside the study. Children and adolescents supported with PBS showed improvement in challenging behaviours and social and communication skills, at a total weekly cost of GBP 1909 (and GBP 1951 including carer-related costs). PBS in schools for children and adolescents with intellectual disabilities and behaviours that challenge may help to support them in the community with potential improvements in outcomes and also cost advantages.
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Affiliation(s)
| | - Martin Knapp
- London School of Economics and Political Science, UK
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Young-Southward G, Philo C, Cooper SA. What Effect Does Transition Have on Health and Well-Being in Young People with Intellectual Disabilities? A Systematic Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:805-823. [PMID: 27554952 DOI: 10.1111/jar.12286] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transition to adulthood might be a risk period for poor health in people with intellectual disabilities. However, the present authors could find no synthesis of evidence on health and well-being outcomes during transition in this population. This review aimed to answer this question. METHOD PRISMA/MOOSE guidelines were followed. Search terms were defined, electronic searches of six databases were conducted, reference lists and key journals were reviewed, and grey literature was searched. Papers were selected based on clear inclusion criteria. Data were extracted from the selected papers, and their quality was systematically reviewed. The review was prospectively registered on PROSPERO: CRD42015016905. RESULTS A total of 15 985 articles were extracted; of these, 17 met the inclusion criteria. The results of these articles were mixed but suggested the presence of some health and well-being issues in this population during transition to adulthood, including obesity and sexual health issues. CONCLUSION This review reveals a gap in the literature on transition and health and points to the need for future work in this area.
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Affiliation(s)
| | - Christopher Philo
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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McKenzie K, Ouellette-Kuntz H, Blinkhorn A, Démoré A. Out of School and Into Distress: Families of Young Adults with Intellectual and Developmental Disabilities in Transition. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:774-781. [PMID: 27276996 DOI: 10.1111/jar.12264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The transition period out of the educational system can be a source of stress for parents of young adults with intellectual and developmental disabilities, as families lose the support and respite offered by schools. MATERIALS AND METHODS Using a before and after design nested within a 24-month follow-up study of parents seeking adult developmental services for their children, parents' perception of distress was measured using the Brief Family Distress Scale (Journal of Child and Family Studies, 20, 2011, 521) and their perception of helpfulness of formal supports was assessed using the Family Support Scale (Journal of Individual, Family, and Community Wellness, 1, 1984, 45). RESULTS Parents reported significantly higher levels of distress after their child transitioned out of school. Employed parents and parents of a child with an autism spectrum disorder are at increased risk for distress. CONCLUSIONS Families fare worse once their adult children are no longer in school, although this is not associated with a reduction in the perception of the helpfulness of formal supports.
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Affiliation(s)
- Katherine McKenzie
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Ongwanada, Kingston, ON, Canada
| | - Ashleigh Blinkhorn
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Ashley Démoré
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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Health and Health Service Use of Youth and Young Adults with Intellectual and Developmental Disabilities. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0082-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Elstner S, Diefenbacher A, Kirst E, Vandevelde S. A study on the usefulness and reliability of the "Scheme of Appraisal of Emotional Development" (SAED) for persons with ID using direct observation in a group-based assessment procedure. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:108-117. [PMID: 26698407 DOI: 10.1016/j.ridd.2015.11.018] [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: 04/19/2015] [Revised: 10/26/2015] [Accepted: 11/19/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Whereas instruments for the assessment of intellectual and social abilities are widely available, instruments for the evaluation of emotional development of persons with intellectual disabilities (ID) are rare. The Scheme of Appraisal of Emotional Development (SAED), an internationally used tool developed by Dosen (2005a. Journal of Intellectual Disability Research, 49, 1, 2005b. Journal of Intellectual Disability Research, 49, 9), is one of the latter and is based on interviews with caregivers. The present study aims to investigate the internal consistency and interrater-reliability by changing the interview procedure into a direct observation and evaluation approach by a whole team instead of by one expert. METHOD The level of emotional development of 175 patients admitted to a psychiatric inpatient unit specialized in the treatment of adults with ID was evaluated with the SAED by the treatment team after an observation period of up to two weeks. The inter- and intra-rater-reliability was assessed by direct observation of the behaviour of an additional 50 patients by two pairs of raters. RESULTS The internal consistency of the SAED dimensions, once rated by team approach, is excellent, and the reliability measures show also good statistical results. CONCLUSION AND IMPLICATIONS The evaluation of the level of emotional development using the SAED by a group-led and/or direct observational procedure show to be a reliable and useful approach. The group-based procedure yields equal results compared with the usual interview guidelines and might lead to an additional training effect within the respective teams. The rater-reliability measures align with those reported in other studies.
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Affiliation(s)
- S Elstner
- Department for Psychiatry, Psychotherapy and Psychosomatics, KEH, Berlin, Germany.
| | - A Diefenbacher
- Department for Psychiatry, Psychotherapy and Psychosomatics, KEH, Berlin, Germany.
| | - E Kirst
- PHIMEA Φ Methodische und statistische Beratung, Berlin, Germany.
| | - S Vandevelde
- Ghent University, Department of Special Education, Ghent, Belgium.
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