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Fortune J, Ryan JM, Walsh A, Walsh M, Kerr C, Kroll T, Lavelle G, Owens M, Hensey O, Norris M. Transition from child to adult services for young people with cerebral palsy in Ireland: Influencing factors at multiple ecological levels. Dev Med Child Neurol 2024; 66:623-634. [PMID: 37849380 DOI: 10.1111/dmcn.15778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 10/19/2023]
Abstract
AIM To explore the factors that influence the process of transitioning from child to adult services in Ireland among young people with cerebral palsy, their parents, and service providers. METHOD This study followed a qualitative descriptive approach. Semi-structured interviews were conducted with 54 participants, including young people with cerebral palsy aged 16 to 22 years (n = 13), their parents (n = 14), and service providers (n = 27). Data were analysed using the Framework Method. Findings were categorized using an ecological model across four levels: individual, microsystem, mesosystem, and exosystem. RESULTS Limited awareness, preparation, and access to information hindered successful transition. Microsystem factors such as family knowledge, readiness, resilience, and health professional expertise influenced transition experience. Mesosystem factors encompassed provider-family interaction, interprofessional partnerships, and interagency collaboration between child and adult services. Exosystem factors included inadequate availability and distribution of adult services, limited referral options, coordination challenges, absence of transition policies, staffing issues, and funding allocation challenges. INTERPRETATION Transition is influenced by diverse factors at multiple ecological levels, including interactions within families, between health professionals, and larger systemic factors. Given the complexity of transition, a comprehensive multi-level response is required, taking into account the interactions among individuals, services, and systems.
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Affiliation(s)
- Jennifer Fortune
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer M Ryan
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Thilo Kroll
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Grace Lavelle
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mary Owens
- Central Remedial Clinic, Dublin, Ireland
| | | | - Meriel Norris
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
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2
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Green C, Joyce A, Hutton RWA, Dembek K, Carey G. A systems science leverage point analysis of climate change advocacy. Health Promot Int 2023; 38:daad168. [PMID: 38128082 DOI: 10.1093/heapro/daad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Failure of governments across the world to address climate change has fuelled social movements focused on climate-related policy and action. Research analysing these movements has focused mainly on the types of strategies employed including blockades and occupations, marches and petitions, divestment, boycotts and litigation as well as how groups are framing climate change as a problem. What has been largely missed are the ways these groups are framing the change they want to see, that is their demands to governments. Not all demands and actions have the same potential to create the changes needed to mitigate climate change. Used in public health and health promotion, the systems science Intervention Level Framework (ILF) is a tool that can help analyse to what extent different demands have the leverage to create change in a system. We use the ILF to analyse 131 demands from 35 different climate-related advocacy groups in Australia. Results show demands are more focused on lower system leverage points, such as stopping particular projects, rather than on more impactful leverage points, such as the governance structures that determine climate-related policy and decision-making mechanisms. Further, the results highlight the lack of attention on public health related topics of transport and food systems. This paper shows how a systems science framework used in health promotion, the ILF, could enable climate advocacy groups to more effectively target demands to achieve more impactful outcomes from governments, corporations and the public.
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Affiliation(s)
- Celia Green
- School of Management and Governance, Business School, UNSW Sydney, High St, Kensington, NSW 2052, Australia
| | - Andrew Joyce
- School of Business, Law and Entrepreneurship, Centre for Social Impact, Swinburne University of Technology, Level 2, AGSE Building Cnr John and, Wakefield St, Hawthorn, VIC 3122, Australia
| | - Rebecca Willow-Anne Hutton
- School of Business, Law and Entrepreneurship, Centre for Social Impact, Swinburne University of Technology, Level 2, AGSE Building Cnr John and, Wakefield St, Hawthorn, VIC 3122, Australia
| | - Krzysztof Dembek
- School of Business, Law and Entrepreneurship, Centre for Social Impact, Swinburne University of Technology, Level 2, AGSE Building Cnr John and, Wakefield St, Hawthorn, VIC 3122, Australia
| | - Gemma Carey
- Centre for Social Impact, UNSW, 704, Level 7, Science Engineering Building, Sydney, NSW 2052, Australia
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3
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Boyle P, Galvin KT, Vuoskoski P, Stew G. The Experience of Living through the Transition from Adolescence to Adulthood for Young People with Cerebral Palsy. Occup Ther Health Care 2023:1-20. [PMID: 37184443 DOI: 10.1080/07380577.2023.2211669] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study explored the lived experience of transition from adolescence to adulthood for young people with cerebral palsy to inform occupational therapy practitioners as to what might promote positive life opportunities. A phenomenological methodology was used with six participants, aged 18 to 25 years with cerebral palsy. The findings are presented in the form of hermeneutic stories and three themes: The storm of uncertainty; time, space and the body, Capsizing in a world of others and, Securing anchorage; being heard and understood. Recommendations include service integration across health, social care and education based on partnership and provision of coordinators.
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Affiliation(s)
- Paul Boyle
- Occupational Therapy, School of Sport and Health Sciences, University of Brighton, Eastbourne, United Kingdom
| | - Kathleen T Galvin
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Graham Stew
- (Retired), School of Health Sciences, University of Brighton, Eastbourne, UK
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4
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Haig-Ferguson A, Wallace V, Davis C. The lived experience of adults and parents: Transitioning from paediatric to adult health care with oesophageal atresia and tracheo-oesophageal fistula. J Clin Nurs 2023; 32:1433-1442. [PMID: 35460126 DOI: 10.1111/jocn.16333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/26/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
AIM AND OBJECTIVE To explore the experience of healthcare transition from paediatric to adult health care for adults born with oesophageal atresia and tracheo-oesophageal fistula (OA/TOF) and parents. BACKGROUND OA/TOF is a rare and chronic health condition that can require lifelong medical follow-up and management. There is evidence to suggest that transitioning from paediatric to adult health care can be problematic for people with rare and chronic conditions, including OA/TOF. The previous literature suggests that the experience of transitioning with a rare condition is more complex than transitioning with a common chronic condition. DESIGN The current study was a qualitative, cross-sectional, survey-based study. METHODS Data were collected through an online survey. Parents of children born with OA/TOF (n = 23) and adults born with OA/TOF (n = 16) were recruited through a UK-based OA/TOF patient charity. Data from six open-ended questions were analysed using a hybrid approach combining elements of inductive and deductive thematic analyses. Throughout the research process, the SRQR were followed. RESULTS Five themes were constructed during the analysis, reflecting the experience of parents and adults transitioning from paediatric to adult health care: thrown into the unknown; a cultural shift; stepping back and stepping up; 'no transition as such'; and living with uncertainty. CONCLUSIONS The findings suggested that a formalised, managed healthcare transition is not commonly experienced by people born with OA/TOF and parents. RELEVANCE TO CLINICAL PRACTICE We recommend a formalised healthcare transition process in OA/TOF, including preparation for transition and having a named key worker to manage the multidisciplinary transition process. The results also highlighted the need for adults born with OA/TOF to have access to a specialist health service with knowledge and understanding of issues related to OA/TOF.
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Affiliation(s)
| | - Vuokko Wallace
- Department of Clinical Psychology, University of Bath, Bath, UK
| | - Cara Davis
- Department of Clinical Psychology, University of Bath, Bath, UK
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5
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Thelen J, Sant Fruchtman C, Bilal M, Gabaake K, Iqbal S, Keakabetse T, Kwamie A, Mokalake E, Mupara LM, Seitio-Kgokgwe O, Zafar S, Cobos Muñoz D. Development of the Systems Thinking for Health Actions framework: a literature review and a case study. BMJ Glob Health 2023; 8:bmjgh-2022-010191. [PMID: 36931663 PMCID: PMC10030275 DOI: 10.1136/bmjgh-2022-010191] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/19/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Systems thinking is an approach that views systems with a holistic lens, focusing on how components of systems are interconnected. Specifically, the application of systems thinking has proven to be beneficial when applied to health systems. Although there is plenty of theory surrounding systems thinking, there is a gap between the theoretical use of systems thinking and its actual application to tackle health challenges. This study aimed to create a framework to expose systems thinking characteristics in the design and implementation of actions to improve health. METHODS A systematised literature review was conducted and a Taxonomy of Systems Thinking Objectives was adapted to develop the new 'Systems Thinking for Health Actions' (STHA) framework. The applicability of the framework was tested using the COVID-19 response in Pakistan as a case study. RESULTS The framework identifies six key characteristics of systems thinking: (1) recognising and understanding interconnections and system structure, (2) identifying and understanding feedback, (3) identifying leverage points, (4) understanding dynamic behaviour, (5) using mental models to suggest possible solutions to a problem and (6) creating simulation models to test policies. The STHA framework proved beneficial in identifying systems thinking characteristics in the COVID-19 national health response in Pakistan. CONCLUSION The proposed framework can provide support for those aiming to applying systems thinking while developing and implementing health actions. We also envision this framework as a retrospective tool that can help assess if systems thinking was applied in health actions.
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Affiliation(s)
- Jenna Thelen
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Carmen Sant Fruchtman
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Muhammad Bilal
- Public Health, Child Advocacy International, Islamabad, Pakistan
| | - Kebabonye Gabaake
- Public Health, Institute of Development Management, Gaborone, Botswana
| | - Shahid Iqbal
- Public Health, Child Advocacy International, Islamabad, Pakistan
| | | | - Aku Kwamie
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Ellen Mokalake
- Public Health, Institute of Development Management, Gaborone, Botswana
| | | | - Onalenna Seitio-Kgokgwe
- Monitoring Evaluation and Quality Assurance, Ministry of Health Botswana, Gaborone, Botswana
| | - Shamsa Zafar
- Department of Obstetrics and Gynecology, Fazaia Medical College, Islamabad, Pakistan
| | - Daniel Cobos Muñoz
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Kokorelias KM, Lee TSJ, Bayley M, Seto E, Toulany A, Nelson MLA, Dimitropoulos G, Penner M, Simpson R, Munce SEP. "I Have Eight Different Files at Eight Different Places": Perspectives of Youths and Their Family Caregivers on Transitioning from Pediatric to Adult Rehabilitation and Community Services. J Clin Med 2023; 12:jcm12041693. [PMID: 36836228 PMCID: PMC9960001 DOI: 10.3390/jcm12041693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The number of young adults (youth) living with childhood-onset disabilities, and requiring transitional support to adult community and rehabilitation services, is increasing. We explored facilitators and barriers to accessing and sustaining community and rehabilitation services during the transition from pediatric to adult care. METHODS A qualitative descriptive study was conducted in Ontario, Canada. Data were collected through interviews with youth (n = 11) and family caregivers (n = 7). The data were coded and analyzed using thematic analysis. RESULTS Youth and caregivers face many types of transitions from pediatric to adult community and rehabilitation services, e.g., those related to education, living arrangements, and employment. This transition is marked by feelings of isolation. Supportive social networks, continuity of care (i.e., same care providers), and advocacy all contribute to positive experiences. Lack of knowledge about resources, changing parental involvement without preparation, and a lack of system responses to evolving needs were barriers to positive transitions. Financial circumstances were described as either a barrier or facilitator to service access. CONCLUSIONS This study demonstrated that continuity of care, support from providers, and social networks all contribute markedly to the positive experience of transitioning from pediatric to adult services for individuals with childhood-onset disabilities and family caregivers. Future transitional interventions should incorporate these considerations.
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Affiliation(s)
- Kristina M. Kokorelias
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Tin-Suet Joan Lee
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
| | - Mark Bayley
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Center for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Alene Toulany
- Department of Adolescent Medicine, the Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle L. A. Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Melanie Penner
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Simpson
- St. John’s Rehab Research Program at Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, North York, ON M2M 2G1, Canada
| | - Sarah E. P. Munce
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Correspondence:
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Coetzee ME, Veldsman T, Odendaal A. Problematising current coaching strategies from a worldview perspective. SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2022. [DOI: 10.4102/sajip.v48i0.2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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8
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Bui HT, Galanou E. Translation of systems thinking to organizational goals: A systematic review. JOURNAL OF GENERAL MANAGEMENT 2022. [DOI: 10.1177/03063070211035749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines how systems thinking theories have been applied within organizational learning and management. This study follows the six phases developed in the systematic review undertaken by Greenhalgh et al. (2004) to review all publications of applications of systems thinking in organizations for a period of 25 years (1990–2015). This study reveals that using a unifying model that incorporates both soft systems thinking (SST) and critical systems thinking (CST) can enrich the stages of the application process (i.e. the data collection, data analysis, and evaluation). It offers a meticulous process that helps the individuals and organizations learn, plan, and implement systems thinking in their operations successfully. Understanding the application of systems thinking in organizational management will significantly help organizations strategize its priority, particularly when systems thinking is crucial for innovation and sustainability. The study shows that the participation of both practitioners and researchers during the process of applying systems thinking in improving organizational outcomes. This study develops a unifying model which incorporates both SST and CST by using systems thinking researchers as facilitators to solve complicated issues or transform the organization.
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Affiliation(s)
- Hong T.M. Bui
- University of Bath, UK
- International School, Vietnam National University, Hanoi, Vietnam
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9
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Tools for Supporting the MCH Workforce in Addressing Complex Challenges: A Scoping Review of System Dynamics Modeling in Maternal and Child Health. Matern Child Health J 2022; 26:176-203. [PMID: 35188621 PMCID: PMC9482604 DOI: 10.1007/s10995-022-03376-8] [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] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Objectives System Dynamics (SD) is a promising decision support modeling approach for growing shared understanding of complex maternal and child health (MCH) trends. We sought to inventory published applications of SD to MCH topics and introduce the MCH workforce to these approaches through examples to support further iteration and use. Methods We conducted a systematic search (1958–2018) for applications of SD to MCH topics and characterized identified articles, following PRISMA guidelines. Pairs of experts abstracted information on SD approach and MCH relevance. Results We identified 101 articles describing applications of SD to MCH topics. Approach: 27 articles present qualitative diagrams, 10 introduce concept models that begin to quantify dynamics, and 67 present more fully tested/analyzed models. Purpose: The most common purposes described were to increase understanding (n = 55) and support strategic planning (n = 26). While the majority of studies (n = 53) did not involve stakeholders, 40 included what we considered to be a high level of stakeholder engagement – a strength of SD for MCH. Topics: The two Healthy People 2020 topics addressed most frequently were early and middle childhood (n = 30) and access to health services (n = 26). The most commonly addressed SDG goals were “End disease epidemics” (n = 26) and “End preventable deaths” (n = 26). Conclusions for Practice While several excellent examples of the application of SD in MCH were found, SD is still underutilized in MCH. Because SD is particularly well-suited to studying and addressing complex challenges with stakeholders, its expanded use by the MCH workforce could inform an understanding of contemporary MCH challenges. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03376-8.
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10
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Betz CL, Hudson SM, Skura AL, Rajeev ND, Smith KA, Van Speybroeck A. Exploratory study of the provision of academic and health-related accommodations to transition-age adolescents and emerging adults with spina bifida. J Pediatr Rehabil Med 2022; 15:593-605. [PMID: 36442216 DOI: 10.3233/prm-210116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this exploratory study was to investigate the types of academic and health-related accommodations provided to adolescents and emerging adults with spina bifida aged 9-20 years. METHODS Data were extracted from the paper and electronic records of transition-age youth enrolled in the study. Four open ended items involved content analysis. RESULTS The most frequently identified accommodation was enrollment in special education classes in 47.7% of the charts. Other academic accommodations that were most often reported were adaptive physical education (n = 71, 39.9%), tutoring (n = 28; 15.7%), and home schooling (n = 21; 11.8%). Clean intermittent catheterization was the most frequently identified health-related accommodation provided by the school nurse/aide (n = 57; 32%).The largest percentage of requests for additional accommodations were made during the middle school grades (15; 54.8%) followed by high school (10; 32.2%). CONCLUSION Findings demonstrated that persistent issues were identified by parents/adolescents regarding the provision of school-related accommodations. This is a relevant area for clinical practice to ensure students with special health care needs and those with spina bifida receive the academic and health-related accommodations in their Individualized Education Program/504 plans.
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Affiliation(s)
- Cecily L Betz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
| | - Sharon M Hudson
- Implementation Science and Evaluation, Alta Med Institute for Health Equity, Los Angeles, CA, USA
| | - Adam L Skura
- Chan Medical School, University of Massachusetts, Worcester, MA, USA
| | - Nithya D Rajeev
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathryn A Smith
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
| | - Alexander Van Speybroeck
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Hospital Los Angeles Spina Bifida Program, Los Angeles, CA, USA
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11
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Duncan A, 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. Prioritizing a Research Agenda of Transitional Care Interventions for Childhood-Onset Disabilities. Front Pediatr 2021; 9:682078. [PMID: 34589448 PMCID: PMC8475648 DOI: 10.3389/fped.2021.682078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/11/2021] [Indexed: 01/20/2023] Open
Abstract
Transitional care interventions have the potential to optimize continuity of care, improve health outcomes and enhance quality of life for adolescents and young adults living with chronic childhood-onset disabilities, including neurodevelopmental disorders, as they transition to adult health and social care services. The paucity of research in this area poses challenges in identifying and implementing interventions for research, evaluation and implementation. The purpose of this project was to advance this research agenda by identifying the transitional care interventions from the scientific literature and prioritize interventions for study. A modified-Delphi approach involving two rounds of online surveys followed by a face-to-face consensus meeting with knowledge users, researchers and clinician experts in transitional care (n = 19) was used. A subsequent virtual meeting concluded the formulation of next steps. Experts rated 16 categories of interventions, derived from a systematic review, on importance, impact, and feasibility. Seven of the 16 interventions categories received a mean score rating of ≥7 (out of 10) on all three rating categories. Participants then rank ordered the reduced list of seven interventions in order of priority and the top four ranked interventions advanced for further discussion at a consensus meeting. Using the Template for Intervention Description and Replication (TIDieR) checklist as a guide, the participants identified that a study of a peer system navigator was worthy of future evaluation. This study highlighted that transitional care interventions are complex and multifaceted. However, the presence of a peer to support system navigation, advocacy and individual and family education was considered the most ideal intervention addressing the current gap in care. Future research, which aims to engage patients and families in a co-design approach, is recommended to further develop this intervention.
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Affiliation(s)
- Andrea Duncan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Mark T Bayley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada.,Division of Physical Medicine, University of Toronto, Toronto, ON, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kelly Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Brian Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - C J Curran
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | | | - Laura Hartman
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Lennox Huang
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Shauna Kingsnorth
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Sinai Health System, Toronto, ON, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Alene Toulany
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Amanda Woo
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Joanne Zee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Sarah E P Munce
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
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12
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Deschênes JM, Roy L, Girard N, Abdel-Baki A. Comment aider les jeunes atteints de psychose à éviter l’itinérance ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088183ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Jesus TS, Kamalakannan S, Bhattacharjya S, Bogdanova Y, Arango-Lasprilla JC, Bentley J, Gibson BE, Papadimitriou C. People with Disabilities and Other Forms of Vulnerability to the COVID-19 Pandemic: Study Protocol for a Scoping Review and Thematic Analysis. Arch Rehabil Res Clin Transl 2020; 2:100079. [PMID: 32839757 PMCID: PMC7438226 DOI: 10.1016/j.arrct.2020.100079] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To develop a protocol for a scoping review mapping as well as thematically analyzing the literature on the effect of, and responses to, the coronavirus disease 2019 (COVID-19) pandemic, focused on people with disabilities with other layers of individual vulnerability or social disadvantage. METHODS We will search scientific databases (Medline/PubMed, Web of Science, Scopus, AgeLine, PsycINFO, CINAHL, ERIC) and preprint servers (MedRxiv, SocArXiv, PsyArXiv). Google searches, snowballing, and key-informant strategies were also used, including a focus on the gray literature (eg, official reports). Peer-reviewed and preprint publications will be covered in 6 languages, and the gray literature in English. Publications will be included if they address individuals with disabilities; the COVID-19 pandemic or subsequent socioeconomic or occupational effects; and individual or social vulnerabilities, including any form of discrimination, marginalization, or social disadvantage. Two independent reviewers will perform eligibility decisions and key data extractions. Beyond mapping the literature, the results will thematically analyze any disproportionate risks people with disabilities and other forms of vulnerability experience in terms of being infected by COVID-19, having severe health consequences, and facing negative socioeconomic effects. Actions taken or recommended to reduce identified inequalities will also be synthesized. Our entire research team, with diverse backgrounds, will be involved in the synthesis. CONCLUSIONS This review, which we plan to expedite, aims to inform policy makers, health authorities, disability advocates, and other stakeholders regarding the needs and ways to promote equity and disability-inclusive responses to the COVID-19 pandemic and the resultant socioeconomic shockwaves.
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Affiliation(s)
- Tiago S. Jesus
- Global Health and Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences, Sargent College, Boston University, Boston, MA
| | - Sureshkumar Kamalakannan
- Public Health Foundation of India, South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health–Hyderabad, Hyderabad, India
| | - Sutanuka Bhattacharjya
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - Yelena Bogdanova
- Physical Medicine & Rehabilitation Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Juan Carlos Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Jacob Bentley
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Barbara E. Gibson
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Christina Papadimitriou
- School of Health Sciences, Departments of Interdisciplinary Health Sciences, and Sociology, Oakland University, Rochester, MI
| | - Refugee Empowerment Task Force, International Networking Group of the American Congress of Rehabilitation Medicine
- Global Health and Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences, Sargent College, Boston University, Boston, MA
- Public Health Foundation of India, South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health–Hyderabad, Hyderabad, India
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
- Physical Medicine & Rehabilitation Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- School of Health Sciences, Departments of Interdisciplinary Health Sciences, and Sociology, Oakland University, Rochester, MI
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Rasalingam A, Fegran L, Brekke I, Helseth S. Young people with long-term health challenges experiences in transition to adulthood: A qualitative metasynthesis. J Adv Nurs 2020; 77:595-607. [PMID: 33245156 DOI: 10.1111/jan.14641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to describe the experiences of the transition to adulthood for young people with long-term health challenges. DESIGN The metasynthesis approach was based on the guidelines by Sandelowski and Barroso for synthesizing qualitative research. DATA SOURCES Seven electronic databases: CINAHL, Medline, Embase, PsycINFO, Web of Science, Scopus, and SocIndex were searched on 6-10 February 2020. REVIEW METHODS Studies were critically appraised using the Joanna Briggs critical appraisal tool. Qualitative data were extracted, meta-summarised, then meta-synthesized. FINDINGS Nineteen qualitative studies were included in this review. Six themes illustrated experiences in the transition to adulthood: wishing for an 'ordinary' life, significance of close network, working towards independence, in need of systemic resources and services, psychosocial challenges and keeping a positive attitude. CONCLUSION Young people with long-term health challenges wished for as 'ordinary' a life as possible in the future. In the transition to adulthood, they gradually gained more competence in self-management skills and knowledge and strived to become more independent. By having a positive attitude and using other coping strategies, young people can work on some of the difficulties they experience in this phase. However, to achieve and maintain independence young people with long-term health challenges are dependent on the support of a close network and systemic support and services. IMPACT The findings highlight the need to help alleviate the fears and worries of young people with long-term health challenges and create opportunities for successful transition to adulthood by increased awareness and interventions from policy-makers and professionals in the health and social system.
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Affiliation(s)
- Anurajee Rasalingam
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Liv Fegran
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Idunn Brekke
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Division of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Sølvi Helseth
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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15
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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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16
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Shattuck PT, Garfield T, Roux AM, Rast JE, Anderson K, Hassrick EM, Kuo A. Services for Adults With Autism Spectrum Disorder: a Systems Perspective. Curr Psychiatry Rep 2020; 22:13. [PMID: 32026004 PMCID: PMC7002329 DOI: 10.1007/s11920-020-1136-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW We review original research about services for adults on the autism spectrum published from January 2013 through December 2018. The main aim is to characterize the topical and methodological aspects of research about services. We review research on services related to employment, living in the community, and social participation. We compare our results with those from a similar review published in 2012 to assess progress and identify where new directions in research about services for adults with autism are needed. RECENT FINDINGS We found the evidence base about services for adults on the autism spectrum remains very small and highly variable in aims and methods. There is wide variability in methods used to define sampling frames and recruit participants. Most studies focus on employment. Almost no studies examine the overall ecosystem of services serving autistic adults. Few studies use a conceptual framework for understanding access to, or improvement of, services. The small size of the extant research coupled with inconsistent quality prevents the accumulation of new knowledge in ways that would significantly inform the improvement of systems of care for the growing population of adults on the autism spectrum.
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Affiliation(s)
- Paul T. Shattuck
- 0000 0001 2181 3113grid.166341.7A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Tamara Garfield
- 0000 0001 2181 3113grid.166341.7A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Anne M. Roux
- 0000 0001 2181 3113grid.166341.7A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Jessica E. Rast
- 0000 0001 2181 3113grid.166341.7A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Kristy Anderson
- 0000 0001 2181 3113grid.166341.7A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Elizabeth McGhee Hassrick
- 0000 0001 2181 3113grid.166341.7A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Alice Kuo
- 0000 0000 9632 6718grid.19006.3eUCLA School of Medicine, Los Angeles, CA USA
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17
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Issaoui B, Mjirda A, Zidi I, Ghédira K. Impact of decentralization, negotiation policies, and conflict management rules on the caregivers’ tours’ problem. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1698863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Brahim Issaoui
- Complex Outstanding Systems Modelling Optimization and Supervision (COSMOS) Stratégie d’Optimisation et Informatique intelligentE (SOIE), National School of Computer Science (ENSI), Manouba, Tunisia
| | - Anis Mjirda
- Faculty of Economic Science and Management, University of Sfax, Sfax, Tunisia
| | - Issam Zidi
- Complex Outstanding Systems Modelling Optimization and Supervision (COSMOS) Stratégie d’Optimisation et Informatique intelligentE (SOIE), National School of Computer Science (ENSI), Manouba, Tunisia
| | - Khaled Ghédira
- Complex Outstanding Systems Modelling Optimization and Supervision (COSMOS) Stratégie d’Optimisation et Informatique intelligentE (SOIE), National School of Computer Science (ENSI), Manouba, Tunisia
- Member of the Academy of Sciences, Letters and Arts, Beit Al-Hekma
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18
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Straus EJ, Brown HJ. The potential contribution of critical theories in healthcare transition research and practice. Disabil Rehabil 2019; 43:2521-2529. [PMID: 31841058 DOI: 10.1080/09638288.2019.1700566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Healthcare transition has been established as a significant topic of interest in pediatric rehabilitation. Healthcare transition research has primarily focused on barriers to self-management and achievement of a productive adulthood. Healthcare transition experts have recently called for further attention to social structural factors. Theoretical approaches are, therefore, needed to account for how such factors shape the lives of youth with disabilities, particularly those who experience marginalization and social exclusion. PURPOSE Taking up this call, the aim of this paper is to examine the potential contributions of two critical theories to healthcare transition research and practice. METHODS Review two theories - intersectionality and critical discourse analysis. RESULTS Intersectionality highlights how multiple intersecting social locations and social structures interact with youth's experiences, choices and health care needs. Critical discourse analysis focuses on how discourses and assumptions in healthcare transition research and practice contribute to marginalization and can be resisted and changed by youth, families, researchers, and clinicians. CONCLUSIONS The uptake of critical theories within health care transition research and practice can account for the complex interplay of social structures, power relations and youth's experiences. Such analysis can contribute to refining assessments and developing interventions that reflect how marginalization and exclusion impact youth's well-being.IMPLICATIONS FOR REHABILITATIONWhile critical theories have been applied in health and rehabilitation, there has been limited uptake of these theories in healthcare transition research and practice.Critical theories can promote awareness of how youth's experiences, choices and actions throughout the healthcare transition process are shaping and shaped by structural factors and assumptions about a productive adulthood.Applying critical theories in healthcare transition practice involves being responsive to the structural factors that may be shaping youth's experiences, choices and opportunities.Intersectional and critical discourse analyses can surface how to reduce social exclusion and marginalization for youth transitioning to adulthood through analyses of language, power, dominant discourse and practices amenable to change.
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Affiliation(s)
| | - Helen J Brown
- School of Nursing, University of British Columbia, Vancouver, Canada
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19
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Wulczyn F, Halloran J. Foster Care Dynamics and System Science: Implications for Research and Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101181. [PMID: 28981469 PMCID: PMC5664682 DOI: 10.3390/ijerph14101181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 11/22/2022]
Abstract
Although system is a word frequently invoked in discussions of foster care policy and practice, there have been few if any attempts by child welfare researchers to understand the ways in which the foster care system is a system. As a consequence, insights from system science have yet to be applied in meaningful ways to the problem of making foster care systems more effective. In this study, we draw on population biology to organize a study of admissions and discharges to foster care over a 15-year period. We are interested specifically in whether resource constraints, which are conceptualized here as the number of beds, lead to a coupling of admissions and discharges within congregate care. The results, which are descriptive in nature, are consistent with theory that ties admissions and discharges together because of a resource constraint. From the data, it is clear that the underlying system exerts an important constraint on what are normally viewed as individual-level decisions. Our discussion calls on extending efforts to understand the role of system science in studies of child welfare systems, with a particular emphasis on the role of feedback as a causal influence.
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Affiliation(s)
- Fred Wulczyn
- Chapin Hall Center for Children, University of Chicago, Chicago, IL 60637, USA.
| | - John Halloran
- Department of Social Work, Lewis University, Romeoville, IL 60446, USA.
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20
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Nguyen T, Embrett MG, Barr NG, Mulvale GM, Vania DK, Randall GE, DiRezze B. Preventing Youth from Falling Through the Cracks Between Child/Adolescent and Adult Mental Health Services: A Systematic Review of Models of Care. Community Ment Health J 2017; 53:375-382. [PMID: 28220340 DOI: 10.1007/s10597-017-0098-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/24/2017] [Indexed: 11/25/2022]
Abstract
Optimizing the transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) is a priority for healthcare systems. The purpose of this systematic review is to: (1) identify and compare models of care that may be used to facilitate the transition from CAMHS to AMHS; and (2) discuss trends and implications to inform future research and practice. Results identified three models of care which move beyond healthcare services and incorporate a broader range of services that better meet the dynamic needs of transition-aged youth. Joint working among providers, coupled with individualized approaches, is essential to facilitating continuity of care.
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Affiliation(s)
- Tram Nguyen
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
- CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Mark G Embrett
- Health Policy & Management, DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Neil G Barr
- Health Policy & Management, DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Gillian M Mulvale
- Health Policy & Management, DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Diana K Vania
- Health Policy & Management, DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada
| | - Glen E Randall
- Health Policy & Management, DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Briano DiRezze
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
- CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
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Jetha A, Pransky G, Fish J, Hettinger LJ. Return-to-Work Within a Complex and Dynamic Organizational Work Disability System. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:276-85. [PMID: 26547909 PMCID: PMC4967424 DOI: 10.1007/s10926-015-9613-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background Return-to-work (RTW) within a complex organizational system can be associated with suboptimal outcomes. Purpose To apply a sociotechnical systems perspective to investigate complexity in RTW; to utilize system dynamics modeling (SDM) to examine how feedback relationships between individual, psychosocial, and organizational factors make up the work disability system and influence RTW. Methods SDMs were developed within two companies. Thirty stakeholders including senior managers, and frontline supervisors and workers participated in model building sessions. Participants were asked questions that elicited information about the structure of the work disability system and were translated into feedback loops. To parameterize the model, participants were asked to estimate the shape and magnitude of the relationship between key model components. Data from published literature were also accessed to supplement participant estimates. Data were entered into a model created in the software program Vensim. Simulations were conducted to examine how financial incentives and light duty work disability-related policies, utilized by the participating companies, influenced RTW likelihood and preparedness. Results The SDMs were multidimensional, including individual attitudinal characteristics, health factors, and organizational components. Among the causal pathways uncovered, psychosocial components including workplace social support, supervisor and co-worker pressure, and supervisor-frontline worker communication impacted RTW likelihood and preparedness. Interestingly, SDM simulations showed that work disability-related policies in both companies resulted in a diminishing or opposing impact on RTW preparedness and likelihood. Conclusion SDM provides a novel systems view of RTW. Policy and psychosocial component relationships within the system have important implications for RTW, and may contribute to unanticipated outcomes.
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Affiliation(s)
- Arif Jetha
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA.
- Department of Work Environment, University of Massachusetts-Lowell, One University Avenue, Lowell, MA, 01854, USA.
| | - Glenn Pransky
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA
| | - Jon Fish
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA
| | - Lawrence J Hettinger
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA
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22
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Cook KA, Jack SM, Siden H, Thabane L, Browne G. Investing in Uncertainty: Young Adults with Life-Limiting Conditions Achieving Their Developmental Goals. J Palliat Med 2016; 19:830-5. [DOI: 10.1089/jpm.2015.0241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karen A. Cook
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan M. Jack
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hal Siden
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lehana Thabane
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Gina Browne
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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23
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Ersig AL, Tsalikian E, Coffey J, Williams JK. Stressors in Teens with Type 1 Diabetes and Their Parents: Immediate and Long-Term Implications for Transition to Self-Management. J Pediatr Nurs 2016; 31:390-6. [PMID: 26831378 DOI: 10.1016/j.pedn.2015.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 01/21/2023]
Abstract
UNLABELLED Teens with Type 1 diabetes and their parents experience every day and illness-related stress; however, understanding of how these stressors relate to the transition to adulthood is limited. The purpose of this study was to identify stressors of teens with Type 1 diabetes (T1DM) and their parents related to the impending transition to adulthood. DESIGN AND METHODS This study used open-ended questions to identify every day and illness-related stressors among 15 teens with T1DM and 25 parents seen in one pediatric diabetes clinic. Qualitative descriptive analysis identified themes in interview transcripts. RESULTS The primary teen stressor related to impending transition centered on ineffective self-management, often when they were taking over responsibility for T1DM management. Parents' concerns included immediate and long-term negative outcomes of teen self-management as well as financial resources and health insurance for the teen. Teens and parents both expressed specific concerns about outcomes and prevention of nocturnal hypoglycemia, and identified uncertainties related to teen health and diabetes-focused health care when no longer living in the parent's home. CONCLUSIONS Teens with Type 1 diabetes and their parents understand that independent teen self-management is a component of transition to adulthood, but worry about teen self-management outcomes. Concerns specific to health care transition included health insurance, T1DM resources, and teens' abilities to handle new situations. PRACTICE IMPLICATIONS Identifying current and future self-management concerns of individuals and families can facilitate targeted education and interventions to support successful transition to adulthood.
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Affiliation(s)
- Anne L Ersig
- College of Nursing, The University of Iowa, Iowa City, IA.
| | - Eva Tsalikian
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA
| | - Julie Coffey
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA
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24
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Kennedy R, Binns F, Brammer A, Grant J, Bowen J, Morgan R. Continuous Service Quality Improvement and Change Management for Children and Young People with Autism and Their Families: A Model for Change. Compr Child Adolesc Nurs 2016. [DOI: 10.1080/24694193.2016.1178357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Joly E. Integrating transition theory and bioecological theory: a theoretical perspective for nurses supporting the transition to adulthood for young people with medical complexity. J Adv Nurs 2016; 72:1251-62. [DOI: 10.1111/jan.12939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth Joly
- School of Nursing; University of Victoria; British Columbia Canada
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Abstract
BACKGROUND With the number of young people with medical complexity increasing, an increasing number must navigate the transition to adulthood. This transition, in part, involves a situational transition in which young people and their families must access new services in the adult system. OBJECTIVES To explore how societal ideologies, communities, and organizations represent the foundation of barriers to access to services. RESEARCH DESIGN The discussion in this paper, framed within a social justice perspective, outlines barriers to access to services at the societal and community levels including societal ideologies, differences in philosophies of care in pediatric and adult care, physical environments, and availability of services. Ethical Considerations: Since this is an exploratory discussion paper, no ethical approval was required. FINDINGS AND CONCLUSION Based on analysis of the literature from a social justice perspective, it is suggested that the adult health care and social service systems do not provide the supports and services necessary to empower young people and their families to achieve their goals and maintain their health and quality of life. It is, thus, an ethical issue that the transfer from pediatric to adult services is occurring in the absence of appropriate services. Recommendations at the individual, community and policy levels highlight how nurses can address this ethical issue to promote more equitable access to services.
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Abstract
Children with chronic conditions are living into adulthood and present with unique needs. One such need is their transition from pediatric to adult health care. This paper examined the literature to analyze and synthesize the concept of transition within two contexts, health care and adolescents with chronic conditions. Fifty multidisciplinary sources were included for analysis. A refined, working definition of the concept of health care transition in adolescents with chronic conditions is presented. Results will enable the scientific community to discuss salient issues using well-defined, uniform terminology. Nursing implications are delineated to ensure that these youths thrive into adulthood.
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Affiliation(s)
- Sigrid Ladores
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL.
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Joly E. Transition to Adulthood for Young People with Medical Complexity: An Integrative Literature Review. J Pediatr Nurs 2015; 30:e91-103. [PMID: 26144875 DOI: 10.1016/j.pedn.2015.05.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
Abstract
This article explores how the empirical literature on the transition to adulthood for young people with medical complexity can inform nursing and advanced practice nursing. An integrative literature review informed by Meleis' Transition Theory and Bronfenbrenner's Bioecological Theory of Human Development was conducted including 11 studies and yielded three themes: it's like falling off a cliff, the paradox of independence, and it takes a village. The findings demonstrated a need for an increased focus on the process of transition and transfer for this complex population. Recommendations for pediatric nurses and advanced practice nurses based on these findings focus on advocacy, capacity-building, education, and program development and evaluation. Recommendations for future research are offered with a focus on determinants of health, psychosocial concerns, and program development and evaluation.
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Jensen PT, Karnes J, Jones K, Lehman A, Rennebohm R, Higgins GC, Spencer CH, Ardoin SP. Quantitative evaluation of a pediatric rheumatology transition program. Pediatr Rheumatol Online J 2015; 13:17. [PMID: 26003474 PMCID: PMC4453213 DOI: 10.1186/s12969-015-0013-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transition from pediatric to adult care can be a challenging process which leaves young people vulnerable to interruptions of care and worsening disease status. Efforts to improve transition processes and outcomes have included development of individualized transition plans, creation of transition clinics, and utilization of transition coordinators. Few interventions have assessed transition outcomes quantitatively. METHODS We assessed transition outcome and satisfaction of a social worker-centered transition program in a pediatric rheumatology clinic. The social worker met with patients who were 16 years or older and their families, provided transition education materials, assisted patients in developing an individualized transition plan, assisted in making appointments with an adult rheumatologist at time of transfer of care, and followed up with patients to assess transition outcomes. Patients were contacted 6-8 months after initial appointment with the adult rheumatologist to assess whether they remained in the care of the adult provider. Participants then completed a questionnaire to rate their satisfaction with the transition program. RESULTS 210 adolescents and young adults participated in the transition program. Twenty-six similarly aged patients were eligible for transition services but did not participate in the program and were used as controls. Of the patients who participated in the program, 42% were considered to have transitioned successfully to adult care compared to 23% of controls (p-value = 0.002) of all patients. In the survey of satisfaction, 81% of participants said that they were satisfied with the transition process. CONCLUSIONS This study shows that a social worker transition coordinator can significantly improve the rate of pediatric rheumatology patients who successfully transition to adult care. Furthermore, patients are largely satisfied with this process.
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Affiliation(s)
- Paul T. Jensen
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue Third Floor, Columbus, OH 43210 USA ,Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Jill Karnes
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Karla Jones
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Amy Lehman
- Center for Biostatistics, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA.
| | - Robert Rennebohm
- Department of Pediatrics, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Gloria C. Higgins
- Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Charles H. Spencer
- Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Stacy P. Ardoin
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue Third Floor, Columbus, OH 43210 USA ,Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
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Jetha A, Pransky G, Hettinger LJ. Capturing complexity in work disability research: application of system dynamics modeling methodology. Disabil Rehabil 2015; 38:189-94. [PMID: 25864874 DOI: 10.3109/09638288.2015.1031291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Work disability (WD) is characterized by variable and occasionally undesirable outcomes. The underlying determinants of WD outcomes include patterns of dynamic relationships among health, personal, organizational and regulatory factors that have been challenging to characterize, and inadequately represented by contemporary WD models. METHOD System dynamics modeling (SDM) methodology applies a sociotechnical systems thinking lens to view WD systems as comprising a range of influential factors linked by feedback relationships. SDM can potentially overcome limitations in contemporary WD models by uncovering causal feedback relationships, and conceptualizing dynamic system behaviors. It employs a collaborative and stakeholder-based model building methodology to create a visual depiction of the system as a whole. SDM can also enable researchers to run dynamic simulations to provide evidence of anticipated or unanticipated outcomes that could result from policy and programmatic intervention. DISCUSSION SDM may advance rehabilitation research by providing greater insights into the structure and dynamics of WD systems while helping to understand inherent complexity. Challenges related to data availability, determining validity, and the extensive time and technical skill requirements for model building may limit SDM's use in the field and should be considered. IMPLICATIONS FOR REHABILITATION Contemporary work disability (WD) models provide limited insight into complexity associated with WD processes. System dynamics modeling (SDM) has the potential to capture complexity through a stakeholder-based approach that generates a simulation model consisting of multiple feedback loops. SDM may enable WD researchers and practitioners to understand the structure and behavior of the WD system as a whole, and inform development of improved strategies to manage straightforward and complex WD cases.
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Affiliation(s)
- Arif Jetha
- a Center for Disability Research and.,b Center for Behavioral Sciences, Liberty Mutual Research Institute for Safety , Hopkinton , MA , USA , and.,c Department of Work Environment , University of Massachusetts-Lowell , Lowell , MA , USA
| | | | - Lawrence J Hettinger
- b Center for Behavioral Sciences, Liberty Mutual Research Institute for Safety , Hopkinton , MA , USA , and
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Rousseau C, Nadeau L, Pontbriand A, Johnson-Lafleur J, Measham T, Broadhurst J. La santé mentale jeunesse : un domaine à la croisée des chemins. SANTE MENTALE AU QUEBEC 2014. [DOI: 10.7202/1025909ar] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Si l’importance grandissante de la santé mentale des jeunes fait consensus, de multiples questionnements émergent cependant quant aux spécificités de ce domaine, qui ne peut être conçu comme une extension des services adultes pour des groupes plus jeunes. Cet article aborde ces questionnements en croisant les savoirs provenant de la documentation et ceux qui émergent à la suite de l’implantation du Plan d’action en santé mentale au Québec.
Le Plan d’action en santé mentale a mis de l’avant la collaboration et le partenariat entre institutions et disciplines. Malgré des avancées significatives, des discontinuités peu favorables à une prise en charge écosystémique persistent. Un ensemble de recherches récentes suggère que les contextes organisationnels qui encadrent les services influencent à la fois la façon dont les interventions sont mises en place et leurs résultats cliniques. Une structure de gestion flexible qui engage les intervenants en favorisant une appropriation du pouvoir, tout en minimisant les sources de stress au travail et en facilitant la création de partenariats, semble nécessaire pour favoriser la concertation interdisciplinaire et intersectorielle. Celle-ci est essentielle à la mise en place de services en santé mentale jeunesse.
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Affiliation(s)
- Cécile Rousseau
- Professeur titulaire, Université McGill
- CSSS de la Montagne (CLSC de Parc-Extension)
| | | | | | | | | | - Joanna Broadhurst
- Chef de programme DI/TED DP et santé mentale jeunesse CSSS de la Montagne
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Schwartz LA, Daniel LC, Brumley LD, Barakat LP, Wesley KM, Tuchman LK. Measures of readiness to transition to adult health care for youth with chronic physical health conditions: a systematic review and recommendations for measurement testing and development. J Pediatr Psychol 2014; 39:588-601. [PMID: 24891440 DOI: 10.1093/jpepsy/jsu028] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Review measures of readiness to transition to adult-oriented care for youth with chronic physical health conditions. METHODS Identified measures via online searches and reference lists and reviewed methods of development, theoretical underpinnings, characteristics, and psychometrics. Measures were classified according to American Psychological Association Division 54 Evidence-Based Assessment (EBA) Task Force criteria. Strengths and weaknesses of reviewed measures were described. RESULTS 56 measures were identified, of which 10 met inclusion criteria for this review. 6 were disease specific and 4 were generic. Some psychometric properties were reported for each; none reported predictive validity for transition outcomes. According to EBA criteria, the 10 measures met criteria for "promising" assessment. CONCLUSIONS Measurement development in transition readiness is still an underdeveloped area. Measures require further testing and new measures are needed. Recommendations include testing measures with larger and diverse samples, ground measures in theory, test psychometrics, and involve multiple stakeholders in measure development.
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Affiliation(s)
- Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health SciencesDivision of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lauren C Daniel
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lauren D Brumley
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health SciencesDivision of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Kimberly M Wesley
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lisa K Tuchman
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health SciencesDivision of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
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Stewart D, Law M, Young NL, Forhan M, Healy H, Burke-Gaffney J, Freeman M. Complexities during transitions to adulthood for youth with disabilities: person–environment interactions. Disabil Rehabil 2014; 36:1998-2004. [DOI: 10.3109/09638288.2014.885994] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Cameron D Norman
- CENSE Research + Design, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Up against the System: A Case Study of Young Adult Perspectives Transitioning from Pediatric Palliative Care. Nurs Res Pract 2013; 2013:286751. [PMID: 23997951 PMCID: PMC3753759 DOI: 10.1155/2013/286751] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/28/2013] [Indexed: 11/20/2022] Open
Abstract
Advances in pediatric care have not provided the interdisciplinary support services required by those young adults with pediatric life-threatening conditions (pedLTCs) who live beyond childhood but have limited expectations to live past early adulthood. These young adults, the first generation to live into adulthood, face multiple challenges transitioning from a plethora of pediatric palliative services to scant adult health services. In a case study, using an innovative bulletin board focus group, we describe the complex interplay of the health, education, and social service sectors in this transition. Our descriptions include system deficits and strengths and the young adults' resilience and coping strategies to overcome those deficits and move forward with their lives. Young adults with pedLTC need knowledgeable providers, coordinated and accessible services, being respected and valued, and services and supports that promote independence. We recommend implementation of multidisciplinary solutions that are focused on young adult priorities to ensure seamless access to resources to support these young adults' health, educational, vocational, and social goals. The input and voice of young adults in the development of these services are imperative to ensure that multisystem services support their needs and life goals.
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Gignac MAM, Jetha A, Bowring J, Beaton DE, Badley EM. Management of work disability in rheumatic conditions: a review of non-pharmacological interventions. Best Pract Res Clin Rheumatol 2013; 26:369-86. [PMID: 22867932 DOI: 10.1016/j.berh.2012.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 04/25/2012] [Indexed: 01/03/2023]
Abstract
Because of its substantial personal social and economic costs, workforce participation among individuals with rheumatic diseases has received considerable research attention. This chapter reviews non-pharmacological employment interventions for people with rheumatic diseases, focussing on the comprehensiveness of interventions, whether they have been targeted to those groups identified as most at risk, and intervention outcomes and effectiveness. Findings highlight that early diagnosis and treatment of rheumatic diseases may not be enough to keep individuals employed and that comprehensive work interventions may have positive psychological effects, as well as result in increased work participation. However, we lack data addressing the optimum time to intervene and subgroup analyses to determine whether some groups are at increased risk for poor work outcomes. Consistent inclusion of behavioural and psychological outcomes to evaluate interventions and compare studies is also needed, along with cost-benefit studies, to determine the long-term feasibility of work interventions.
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Affiliation(s)
- Monique A M Gignac
- Arthritis Community Research & Evaluation Unit, Toronto Western Research Institute, ON, Canada.
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Tsybina I, Kingsnorth S, Maxwell J, Bayley M, Lindsay S, McKeever P, Colantonio A, Hamdani Y, Healy H, Macarthur C. Longitudinal Evaluation of Transition Services ("LETS Study"): protocol for outcome evaluation. BMC Pediatr 2012; 12:51. [PMID: 22587415 PMCID: PMC3496583 DOI: 10.1186/1471-2431-12-51] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/24/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Because of advances in medical treatment, most children with physical disabilities can expect to achieve near normal life spans. Typically, coordinated teams of health care providers in specialized pediatric settings care for these children. As these children reach adulthood, however, the availability of services and expertise changes because the adult health care system has different processes designed to meet their specialized needs. Gaps in continuity of care during the transition from pediatric to adult services, and associated poor health outcomes are well documented. In response, new models of care are being introduced to address the complex process of health care transition. This paper describes a study protocol of a client-centred, prospective, longitudinal, mixed-method evaluation of linked model of health care across the lifespan (the LIFEspan Model), offered by a pediatric rehabilitation centre and an adult rehabilitation centre. METHOD This project will include a process and an outcome evaluation of the LIFEspan Model. The process evaluation will detail the specific service delivery that occurs with respect to preparation for transition and transfer of care through chart audits of pediatric medical records and qualitative interviews with LIFEspan staff. The outcome evaluation will measure the effect of the model on: 1) maintaining continuity within the health care system from pediatric to adult care; and 2) secondary outcomes related to health, well-being, social participation, transition readiness, and health care utilization of youth with cerebral palsy and acquired brain injury. Standardized instruments will include Health Utilities Inventory, Assessment of Life Habits, Arc's Self-Determination, Assessment of Health-Related Quality of Life, Partners in Health Questionnaire, Social Support Questionnaire, and Self-Efficacy for Managing Chronic Disease. DISCUSSION The LETS study will be original in its undertaking of a prospective examination of outcomes 1-year post-transition, use of multiple comparison groups, and absence of disability-related exclusion criteria ensuring that the transition experiences of varied populations of young people and their families will be represented. TRIAL REGISTRATION http://www.clinicaltrials.gov, ID NCT00975338.
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Affiliation(s)
| | | | - Joanne Maxwell
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, Toronto, Canada
| | | | | | | | - Yani Hamdani
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Helen Healy
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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