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Van Doren S, De Coninck D, Hermans K, Declercq A. Interrater reliability of the BelRAI Social Supplement in Flanders, Belgium: Simultaneous rating of community-dwelling adults with care needs during COVID-19. Front Psychol 2022; 13:941648. [PMID: 36186298 PMCID: PMC9523913 DOI: 10.3389/fpsyg.2022.941648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe BelRAI Screener is a short-form assessment consolidating internationally validated interRAI items focusing on physical and psychological aspects of functioning and problems with activities of daily living. It was fully implemented in the Flemish home care setting as of June 2021. In a biopsychosocial model for developing a personalized and effective care plan social and contextual aspects are considered equally important to biomedical ones. Thus, a social supplement to the BelRAI Screener was collaboratively developed with stakeholders and tested to gather additional information on the social context of community-dwelling adults with care needs.Objective and methodsTo examine the interrater reliability of the BelRAI Social Supplement in Flanders, Belgium, an observational study was conducted using a convenience sample. The method of simultaneous rating was used due to strict COVID-19 guidelines at the time and to minimize assessment burden. Fifty two community-dwelling adults requesting home care support were simultaneously assessed by two independent assessors during home visits. Interrater reliability was tested on all 80 items of the BelRAI Social Supplement using observed agreement, kappa coefficients, and intraclass correlation coefficients.ResultsThe kappa mean (0.74) and median (0.79) values for nominal items, show substantial agreement, while the kappa mean and median values for ordinal items were 0.81 and 0.90, which correspond to almost perfect agreement. Following the traditional cut-off points for the interpretation of the kappa statistic, reliability was almost perfect (κ > 0.81) for 49% of all items, substantial (0.60 < κ ≤ 0.80) for 33%, moderate (0.40 < κ ≤ 0.60) for 8%, and poor (κ < 0.40) for 10%. The majority of items with poor kappa value, showed a high observed agreement, reflecting homogeneity of the sample rather than poor agreement.ConclusionThe strength of kappa agreement for the items in this version of the BelRAI Social Supplement is generally substantial to almost perfect, with high proportions of observed agreement. COVID-19 restrictions had a large impact on the planning and execution of the home visits. A final optimization of the instrument and accompanying manual according to the findings will result in an improved version ready for nation-wide implementation.
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Affiliation(s)
- Shauni Van Doren
- LUCAS—Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- *Correspondence: Shauni Van Doren,
| | | | - Kirsten Hermans
- LUCAS—Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Anja Declercq
- LUCAS—Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
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Van Doren S, Hermans K, Declercq A. Towards a standardized approach of assessing social context of persons receiving home care in Flanders, Belgium: the development and test of a social supplement to the interRAI instruments. BMC Health Serv Res 2021; 21:487. [PMID: 34022861 PMCID: PMC8140469 DOI: 10.1186/s12913-021-06453-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Apart from a person's physical functioning, the early identification of social context indicators which affect patient outcomes - such as environmental and psychosocial issues - is key for high quality and comprehensive care at home. During a home care assessment, a person's biomedical and functional problems are typically considered. Harder to define concepts, such as psychosocial well-being or living arrangements, are not routinely documented, even though research shows they also affect functioning and health outcomes. The purpose of this study is to develop and test a concise, integrated assessment (BelRAI Social Supplement) that evaluates these social context indicators for persons receiving home care to complement existing interRAI- instruments. METHODS The development of the BelRAI Social Supplement is a multi-stage process, based upon the revised MRC-framework, involving both qualitative and quantitative research with stakeholders such as; clients, informal caregivers, care professionals and policy makers. The developmental process encompasses four stages: (I) item generation based on multiple methods and content validation by a panel of stakeholders (II) assessing feasibility and piloting methods, (III) early evaluation, and (IV) final evaluation. Stage II and III are covered in this paper. RESULTS During Stages I and II, a testable version of the BelRAI Social Supplement was developed in an iterative process. In Stage III, 100 care professionals assessed 743 individuals receiving home care in Flanders between December 2018 and December 2019. Using inter-item correlation matrixes, frequency distributions and regular feedback from the participants, the BelRAI Social Supplement was improved and prepared for Stage IV. The updated version of the instrument consists of four main sections: (1) environmental assessment; (2) civic engagement; (3) psychosocial well-being; and (4) informal care and support. In total, the BelRAI Social Supplement contains a maximum of 76 items. CONCLUSIONS The BelRAI Social Supplement was reviewed and shortened in close collaboration with care professionals and other experts in Flanders. This study resulted in an instrument that documents need-to-know social context determinants of home dwelling adults.
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Affiliation(s)
- Shauni Van Doren
- LUCAS - Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium.
| | - Kirsten Hermans
- LUCAS - Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Anja Declercq
- LUCAS - Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CeSO - Center for Sociological Research, KU Leuven, Leuven, Belgium
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Li L, Bird M, Carter N, Ploeg J, Gorter JW, Strachan PH. Experiences of youth with medical complexity and their families during the transition to adulthood: a meta-ethnography. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractYouth with medical complexity (YMC) are a small subset of youth who have a combination of severe functional limitations and extensive health service use. As these youth become adults, they are required to transition to adult health, education, and social services. The transition to adult services is especially difficult for YMC due to the sheer number of services that they access. Service disruptions can have profound impacts on YMC and their families, potentially leading to an unsuccessful transition to adulthood. This meta-ethnography aims to synthesize qualitative literature exploring how YMC and their families experience the transition to adulthood and transfer to adult services. An in-depth understanding of youth and family experiences can inform interventions and policies to optimize supports and services to address the needs of this population at risk for unsuccessful transition to adulthood. Using Noblit and Hare’s approach to meta-ethnography, a comprehensive search of Medline, CINAHL, Embase, PsycINFO, Social Sciences Index, and Sociological Abstracts databases, supplemented by hand searching, was conducted to identify relevant studies. Included studies focused on the transition to adulthood or transfer to adult services for YMC, contained a qualitative research component, and had direct quotes from youth or family participants. Studies were critically appraised, and data were analyzed using meta-ethnographic methods of reciprocal translation and line of argument synthesis. Conceptual data from ten studies were synthesized into six overarching constructs: (1) the nature and process of transition, (2) changing relationships, (3) goals and expectations, (4) actions related to transition, (5) making sense of transition, and (6) contextual factors impacting transition. A conceptual model was developed that explains that youth and families experience dynamic interactions between their goals, actions, and relationships, which are bounded and influenced by the nature, process, and context of transition. Despite the tremendous barriers faced during transition, YMC and their families often demonstrate incredible resilience, perseverance, and resourcefulness in the pursuit of their goals. Implications for how the conceptual model can inform practice, policy, and research are shared. These implications include the need to address emotional needs of youth and families, support families in realizing their visions for the future, promote collaboration among stakeholders, and develop policies to incentivize and support providers in implementing current transition guidelines.
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Affiliation(s)
- Lin Li
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Marissa Bird
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Canadian Centre for Advanced Practice Nursing Research, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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Heräjärvi N, Leskinen M, Pirttimaa R, Jokinen K. Subjective quality of life among youth with severe physical disabilities during the transition to adulthood in Finland. Disabil Rehabil 2018; 42:918-926. [DOI: 10.1080/09638288.2018.1511756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nina Heräjärvi
- Department of Education, Special Education, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Leskinen
- Department of Education, Special Education, University of Jyväskylä, Jyväskylä, Finland
| | - Raija Pirttimaa
- Department of Education, Special Education, University of Jyväskylä, Jyväskylä, Finland
| | - Kimmo Jokinen
- Department of Social Sciences and Philosophy, Family Research Centre, University of Jyväskylä, Jyväskylä, Finland
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Hartman LR, McPherson AC, Maxwell J, Lindsay S. Exploring the ICF-CY as a framework to inform transition programs from pediatric to adult healthcare. Dev Neurorehabil 2018; 21:312-325. [PMID: 28534693 DOI: 10.1080/17518423.2017.1323969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore the utility of the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) for informing transition-related programs for youth with chronic conditions moving into adult healthcare settings, using an exemplar spina bifida program. METHODS Semi-structured in-depth interviews were conducted with 53 participants (9 youth and 11 parents who participated in a spina bifida transition program, 12 young adults who did not, 12 clinicians, and 9 key informants involved in development/implementation). Interview transcripts were thematically analyzed, and then further coded using ICF-CY domain codes. RESULTS ICF-CY domains captured many key areas regarding individuals" transitions to adult care and adult functioning, but did not fully capture concepts of transition program experience, independence, and parents" role. CONCLUSIONS The ICF-CY framework captures some experiences of transitions to adult care, but should be considered in conjunction with other models that address issues outside of the domains covered by the ICF-CY.
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Affiliation(s)
- Laura R Hartman
- a Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital , Toronto , ON , Canada.,b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada
| | - Amy C McPherson
- a Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital , Toronto , ON , Canada.,c Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.,d Rehabilitation Sciences Institute , University of Toronto , ON Canada
| | - Joanne Maxwell
- a Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital , Toronto , ON , Canada.,b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada
| | - Sally Lindsay
- a Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital , Toronto , ON , Canada.,b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada.,d Rehabilitation Sciences Institute , University of Toronto , ON Canada
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Lozano P, Houtrow A. Supporting Self-Management in Children and Adolescents With Complex Chronic Conditions. Pediatrics 2018; 141:S233-S241. [PMID: 29496974 DOI: 10.1542/peds.2017-1284h] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/24/2022] Open
Abstract
Self-management improves health outcomes in chronic illness not only by improving adherence to the treatment plan but also by building the individual's capacity to navigate challenges and solve problems. Support for self-management is a critical need among children and adolescents with (medically and/or socially) complex chronic conditions. Self-management support refers to services that health systems and community agencies provide to persons with chronic illness and their families to facilitate self-management; it is a collaboration between the patient, family, and care providers. Evidence has guided the development of self-management support approaches and tools for adults and has led to an increased adoption of best practices in adult chronic illness care. However, adult models fail to account for some key differences between children and adults, namely, the integral role of parents and/or caregivers and youth development over time. There is a need for self-management support models that take into account the developmental trajectory across the pediatric age range. Effective approaches must also recognize that in pediatrics, self-management is really shared management between the youth and the parent(s) and/or caregiver(s). Health systems should design care to address self-management for pediatric patients. Although clinicians recognize the importance of self-management in youth with complex chronic conditions, they need standardized approaches and tools to do the following: assess the self-management skills of youth and families, assess modifiable environmental influences on chronic conditions, collaboratively set self-management goals, promote competence and eventual autonomy in youth, share the responsibility for self-management support among nonphysician members of the health care team, and leverage community resources for self-management support.
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Affiliation(s)
- Paula Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; and
| | - Amy Houtrow
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Nguyen T, Stewart D, Rosenbaum P, Baptiste S, Kraus de Camargo O, Gorter JW. Using the ICF in transition research and practice? Lessons from a scoping review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:225-239. [PMID: 29202331 DOI: 10.1016/j.ridd.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The International Classification of Functioning, Disability and Health (ICF) and subsequent ICF-CY (child and youth version) recognize the importance of personal and environmental factors in facilitating holistic transition planning and service delivery for youth with chronic health conditions (YCHC). AIMS The objective of this scoping review is to investigate the degree to which the ICF and ICF-CY have been used in transition research and practice since its initial publication. METHODS Arksey and O'Malley's five-stage methodological framework guided the scoping review using the following databases: AMED, CINAHL, EMBASE, HealthSTAR, MEDLINE, and PsycINFO. Keywords included: 'ICF', 'ICF-CY', and 'transition', which were adapted to each database. RESULTS 25 articles met final inclusion. Two key themes emerged regarding use of the ICF: 1) the ICF enhances transdisciplinary processes to inform transition planning and interventions; and 2) the ICF facilitates comprehensive and developmentally appropriate transition services over a youth's lifecourse. The strengths and limitations of the ICF in guiding the planning and delivery of transition services are discussed. Some limitations include the large number of items inherent within the ICF and a lack of clarity between the components of activity and participation. CONCLUSION Key recommendations include: i) further explanation and development of items for quality of life and well-being, personal factors, and psychological issues; and ii) additional research to advance knowledge towards developing empirically- based evidence for the application of the ICF in clinical practice to facilitate transition.
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Affiliation(s)
- Tram Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | - Debra Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.
| | - Peter Rosenbaum
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster University, Hamilton, Canada.
| | - Sue Baptiste
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
| | - Olaf Kraus de Camargo
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster University, Hamilton, Canada.
| | - Jan Willem Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster University, Hamilton, Canada.
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Nguyen T, Henderson D, Stewart D, Hlyva O, Punthakee Z, Gorter JW. You never transition alone! Exploring the experiences of youth with chronic health conditions, parents and healthcare providers on self-management. Child Care Health Dev 2016; 42:464-72. [PMID: 27103590 PMCID: PMC5021141 DOI: 10.1111/cch.12334] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/21/2016] [Accepted: 02/04/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent evidence suggests that fostering strategies to enable youth with chronic health conditions to work towards gradual self-management of their health is key in successful transition to adult healthcare. To date, there is limited research on self-management promotion for youth. The purpose of this study is to explore self-management from the perspectives of youth, parents and healthcare providers in transition to adult healthcare. METHODS Part of a larger longitudinal transition (TRACE-2009-2013) study, interpretive phenomenology was used to explore the meaning of the lived experiences and perceptions of youth, parents, and healthcare providers about transition to adult healthcare. Purposeful sampling was utilized to select youth with a range of chronic health conditions from the TRACE cohort (spanning 20 diagnoses including developmental disabilities and chronic conditions), their parents and healthcare providers. RESULTS The emerging three themes were: increasing independence of youth; parents as safety nets and healthcare providers as enablers and collaborators. The findings indicate that the experiences of transitioning youth, parents and service providers are interconnected and interdependent. CONCLUSIONS Results support a dynamic and developmentally appropriate approach when working with transitioning youth and parents in practice. As youth depend on parents and healthcare providers for support in taking charge of their own health, parents and healthcare providers must work together to enable youth for self-management. At a policy level, adequate funding, institutional support and accreditation incentives are recommended to allow for designated time for healthcare providers to foster self-management skills in transitioning youth and parents.
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Affiliation(s)
- T Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | | | - D Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - O Hlyva
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Z Punthakee
- Department of Pediatrics, McMaster University, Hamilton, Canada
- School of Medicine, McMaster University, Hamilton, Canada
| | - J W Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
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Björquist E, Nordmark E, Hallström I. Parents' Experiences of Health and Needs When Supporting Their Adolescents With Cerebral Palsy During Transition to Adulthood. Phys Occup Ther Pediatr 2016; 36:204-16. [PMID: 26642865 DOI: 10.3109/01942638.2015.1101041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Parents are the primary support providers for adolescents with disabilities, their health and wellbeing is therefore of great importance when planning for youths' transition into adulthood. The aim of this study was to gain a deeper understanding of how parents of adolescents with cerebral palsy (CP) experience their own health and wellbeing and their needs for support during the adolescent's transition to adulthood. METHODS An inductive qualitative approach was used, including interviews with 15 mothers and fathers to 10 adolescents with CP aged 17-18 years. Latent content analysis was used for analyzing the data. RESULTS The main theme "Friction blisters chafing and healing during transition" illustrates the parents' experiences. Five sub-themes formed the parents' experiences of concerns along with sorrow and stress in life, worries about what was to come, their need for support, strategies for coping, and experiences of cohesion. CONCLUSIONS Knowledge of parents' experiences of their health, wellbeing, and needs provide valuable information for the planning of transition for adolescents with disabilities. Help with parents' sorrow, stress, and worry in daily life might be facilitated and parental health safeguarded by a navigator who can both guide and give hands-on support.
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Affiliation(s)
- E Björquist
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden
| | - E Nordmark
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden
| | - I Hallström
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden
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van Dulmen SA, Lukersmith S, Muxlow J, Santa Mina E, Nijhuis‐van der Sanden MW, van der Wees PJ. Supporting a person-centred approach in clinical guidelines. A position paper of the Allied Health Community - Guidelines International Network (G-I-N). Health Expect 2015; 18:1543-58. [PMID: 24118821 PMCID: PMC5060835 DOI: 10.1111/hex.12144] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A person-centred approach in the context of health services delivery implies a biopsychosocial model focusing on all factors that influence the person's health and functioning. Those wishing to monitor change should consider this perspective when they develop and use guidelines to stimulate active consideration of the person's needs, preferences and participation in goal setting, intervention selection and the use of appropriate outcome measures. OBJECTIVE To develop a position paper that promotes a person-centred approach in guideline development and implementation. DESIGN, SETTING AND PARTICIPANTS We used three narrative discussion formats to collect data for achieving consensus: a nominal group technique for the Allied Health Steering Group, an Internet discussion board and a workshop at the annual G-I-N conference. We analysed the data for relevant themes to draft recommendations. RESULTS We built the position paper on the values of the biopsychosocial model. Four key themes for enhancing a person-centred approach in clinical guidelines emerged: (i) use a joint definition of health-related quality of life as an essential component of intervention goals, (ii) incorporate the International Classification of Functioning, Disability and Health (ICF) as a framework for considering all domains related to health, (iii) adopt a shared decision-making method, and (iv) incorporate patient-reported health outcome measures. The position statement includes 14 recommendations for guideline developers, implementers and users. CONCLUSION This position paper describes essential elements for incorporating a person-centred approach in clinical guidelines. The consensus process provided information about barriers and facilitators that might help us develop strategies for implementing person-centred care.
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Affiliation(s)
- Simone A. van Dulmen
- Radboud University Nijmegen Medical CentreScientific Institute for Quality of HealthcareNijmegenThe Netherlands
| | | | | | - Elaine Santa Mina
- Daphne Cockwell School of NursingRyerson University TorontoTorontoONCanada
| | | | - Philip J. van der Wees
- Radboud University Nijmegen Medical CentreScientific Institute for Quality of HealthcareNijmegenThe Netherlands
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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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Gorter JW, Stewart D, Cohen E, Hlyva O, Morrison A, Galuppi B, Nguyen T, Amaria K, Punthakee Z. Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: a mixed-methods longitudinal prospective cohort study. BMJ Open 2015; 5:e007553. [PMID: 25948409 PMCID: PMC4431136 DOI: 10.1136/bmjopen-2014-007553] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess use, utility and impact of transition interventions designed to support and empower self-management in youth with chronic health conditions during transition into adult healthcare. DESIGN A 4-year mixed-method prospective cohort study. SETTING 2 academic paediatric hospitals (13 clinics) in Canada. PARTICIPANTS 50 adolescents (42% male; mean age 17.9±0.9 years; 20 underlying diagnoses) with transfer to adult care planned within 1 year. INTERVENTIONS The Youth KIT (an organisational tool that includes goal setting activities); an online transition mentor. MAIN OUTCOME MEASURES Frequency of use, utility and impact of the transition interventions; goal achievement; post-transfer qualitative interviews with youth. RESULTS 50 participants were enrolled during their last year of paediatric care; 36 (72%) were followed into adult care. All participants had access to the transition interventions from enrolment until the end of the study (exposure time: 12-47 months). Most youth (85%) reported using the medical/health section of the Youth KIT at least once; 20 (40%) participants engaged in chats with the mentor. The overall perceived utility of both interventions was modest; the Youth KIT received the highest ratings for 'help with goal setting': (mean (SD): 4.2 (2.3)) on a 7-point Likert scale. 45 (90%) participants set 294 transition goals. Goal achievement performance and satisfaction increased over time (p≤0.001). The qualitative evidence revealed reasons behind the variability in use and utility of the interventions, the interconnectedness of life-course and healthcare transitions, and the need for stronger partnerships between paediatric and adult healthcare systems. CONCLUSIONS Participants' perceptions about the utility of the Youth KIT and the online mentor were modest. Transition supports need to be carefully tailored, timed and integrated into healthcare systems. Individualised goal setting may be an important 'active ingredient' in optimising transition supports and outcomes. Interventions that focus on youth only are insufficient for empowering self-management.
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Affiliation(s)
- Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Deb Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Eyal Cohen
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Oksana Hlyva
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Morrison
- Children's Developmental Rehabilitation Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Barb Galuppi
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Tram Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Khush Amaria
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Björquist E, Nordmark E, Hallström I. Living in transition - experiences of health and well-being and the needs of adolescents with cerebral palsy. Child Care Health Dev 2015; 41:258-65. [PMID: 24798111 DOI: 10.1111/cch.12151] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transition to adulthood for adolescents in general is a multifaceted process, and for adolescents with cerebral palsy (CP) it also involves transition from child- to adult-oriented support. CP entails a variety and combination of disabilities, which in association with external factors may make the transition to adult health services difficult. The aim of this study was to gain a deeper understanding of how adolescents with CP experience their own health, well-being and need of support during their transition to adulthood. METHODS An inductive qualitative approach was used based on interviews with 12 adolescents with CP aged 17-18 years and living in Sweden. Manifest and latent content analysis was used for the analysis of data. RESULTS The results are described in the main theme 'Living in transition and looking forward to being an adult, but not feeling ready yet and being in need of further support'. Five subthemes highlight the adolescents' experiences of belonging to a family, of the importance of friends and love, of managing daily activities, being surrounded by support and having hopes for the future. CONCLUSIONS Interviews with adolescents with CP provide valuable information for the planning of transition programmes and for the support of adolescents with disabilities who are in the transition to adult living. According to the adolescents in this study, the support should be flexible and not be fixed to biological age. Personal, individualized information and support was desired by the adolescents in order to be able to manage their own transition. One option to facilitate transition is the stepping-stone of being close to parents or staff members during the first phase, after leaving the parental home.
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Affiliation(s)
- E Björquist
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Nguyen T, Gorter JW. Use of the international classification of functioning, disability and health as a framework for transition from paediatric to adult healthcare. Child Care Health Dev 2014; 40:759-61. [PMID: 24304334 DOI: 10.1111/cch.12125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/27/2022]
Affiliation(s)
- T Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Supporting adolescents and young adults with cancer through transitions: position statement from the Canadian Task Force on Adolescents and Young Adults with cancer. J Pediatr Hematol Oncol 2014; 36:545-51. [PMID: 24390448 DOI: 10.1097/mph.0000000000000103] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This position statement from the Canadian Task Force on Adolescents and Young Adults with cancer aims to (1) conceptualize the numerous transition experiences encountered by adolescents and young adults (AYA) with cancer; and (2) provide recommendations on how to help the AYA regain a sense of control over their lives as they adjust to these transition experiences. METHODS We reviewed and synthesized a heterogeneous sample of studies and recommendations, ranging from well-designed case-controlled investigations to opinions of respected authorities based on clinical experience, and reports of expert committees. RESULTS We describe the key factors that have an impact on different transitions during the cancer journey, and the need for developmentally appropriate services for AYA with cancer that consider both the system issues and individual transition issues. Our recommendations are not intended to be prescriptive, but they are broad enough to be applicable in different types of settings (eg, family doctor, cancer center, specialty service) and systems beyond health care (eg, school system, social system). CONCLUSIONS The Task Force urges health care providers, parents, and AYA with cancer to work together in planning and implementing strategies that will enable individuals to navigate the transitions they encounter along the cancer journey successfully, and strive for meaningful participation in life situations, achieving their potential as fully functional members of society.
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Foley KR, Jacoby P, Girdler S, Bourke J, Pikora T, Lennox N, Einfeld S, Llewellyn G, Parmenter TR, Leonard H. Functioning and post-school transition outcomes for young people with Down syndrome. Child Care Health Dev 2013; 39:789-800. [PMID: 23294187 DOI: 10.1111/cch.12019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 11/29/2022]
Abstract
AIM To investigate the relationship between functioning and post-school day occupation for young adults with Down syndrome. METHODS Families of young people with Down syndrome (n = 269) aged 15-30 years in 2009 were recruited from the population-based Down syndrome 'Needs Opinion Wishes' database in Western Australia. Questionnaires were mailed to participating families and involved two parts, young person characteristics and family functioning; 203 were returned (75%). Of those families who returned questionnaires, 164 (80.8%) of their young adults had left school. Participation in post-school day occupations was the main outcome and included; open employment, training, sheltered employment or alternatives to employment (ATE). RESULTS Young adults were reported as participating in open employment (n = 42), training (n = 17), sheltered employment (n = 64) or ATE (n = 41) post-school. Those who reported better functioning in self-care, community and communication skills were more likely to be in open employment and/or attending Technical and Further Education compared with those attending sheltered employment and/or ATE after adjusting for age, gender and rural/metropolitan regions. Current health as measured by visits to a general practitioner (GP) and hospitalizations revealed a weak relationship with post-school day occupations, with increasing likelihood of participating in open employment or training with increasing hospitalizations and GP visits. CONCLUSIONS Our analysis shows that functioning in activities of daily living was related to post-school day occupation. Current health status and behaviour were found to have a weak relationship with post-school day occupation adjusting for functioning in the final model.
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Affiliation(s)
- K-R Foley
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia; School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Perth, WA, Australia
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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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Lindgren E, Söderberg S, Skär L. The gap in transition between child and adolescent psychiatry and general adult psychiatry. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 26:103-9. [PMID: 23607821 DOI: 10.1111/jcap.12027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND During transition from child and adolescent psychiatry (CAP) to general adult psychiatry (GenP) young adults with mental illness face multilevel transitions along with a risk for disruption in continuity of care. The aim of this study was to describe professionals' experiences and views of the transition process from CAP to GenP. METHOD Data were collected through six focus group discussions with professionals from both CAP and GenP and analyzed by content analysis. RESULTS The results showed a gap in transition between CAP and GenP when different perspectives and care cultures meet in a complex process. CONCLUSIONS Cooperation, transition planning, and a mutual understanding of care can support young adults in transition from CAP to GenP.
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Affiliation(s)
- Eva Lindgren
- Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
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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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