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Mirzaian CB, Deavenport-Saman A, Hudson SM, Betz CL. Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders' Perspectives. Community Ment Health J 2024; 60:1104-1116. [PMID: 38619698 PMCID: PMC11199219 DOI: 10.1007/s10597-024-01262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/25/2024] [Indexed: 04/16/2024]
Abstract
Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.
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Affiliation(s)
- Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Alexis Deavenport-Saman
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sharon M Hudson
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA
| | - Cecily L Betz
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Seko Y, Oh A, Thompson L, Bowman LR, Curran CJ. Transitions Pop-ups: Co-designing client-centred support for disabled youth transitioning to adult life. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1286875. [PMID: 38322700 PMCID: PMC10844453 DOI: 10.3389/fresc.2024.1286875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
Background When transitioning to adulthood, youth with disabilities and their families face many service gaps. Successful inter-agency collaborations can promote family-centred, inclusive transition support amenable to personal choice and health conditions. This paper reports the 3-year co-design process of an innovative transition service that links a pediatric hospital and adult service agencies and addresses key areas of transition preparedness with joint accountability. Methods A team of pediatric rehabilitation professionals, adult service providers, young adults with disabilities and their families, and researchers engaged in a co-design process over three years. Following a design thinking (DT) framework, the team went through an iterative process of Empathize. Define, Ideation, Prototyping, and Testing phases. The trial-and-error process allowed for deeper reflection and an opportunity to pivot the design. Results The co-design yielded Transitions Pop-ups, a nimble service model that can "pop up" at critical times and places to meet clients' urgent and emergent transition-related needs. Two pilot sessions were conducted at the testing phase with adult service agencies. The final model included five key elements: (1) community partnership; (2) targeted information sharing; (3) peer mentoring; (4) action (on-the-spot completion of a key transition task/activity such as submitting an adult funding application); and (5) warm handover. Conclusion The co-design process highlighted the importance of open communication and iterative prototype testing as a means for trialing new ideas and clarifying the intent of the project. The DT framework optimally facilitated the co-development of a contextually relevant and sustainable service model for pediatric rehabilitation clients and families.
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Affiliation(s)
- Yukari Seko
- School of Professional Communication, Ryerson University, Toronto, ON, Canada
- Bloorview Research Institute, Toronto, ON, Canada
| | - Anna Oh
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Laura R. Bowman
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - C. J. Curran
- London Health Sciences Centre, London, ON, Canada
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Nguyen L, Dawe-McCord C, Frost M, Arafeh M, Chambers K, Arafeh D, Pozniak K, Thomson D, Mosel J, Cardoso R, Galuppi B, Strohm S, Via-Dufresne Ley A, Cassidy C, McCauley D, Doucet S, Alazem H, Fournier A, Marelli A, Gorter JW. A commentary on the healthcare transition policy landscape for youth with disabilities or chronic health conditions, the need for an inclusive and equitable approach, and recommendations for change in Canada. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1305084. [PMID: 38192636 PMCID: PMC10773791 DOI: 10.3389/fresc.2023.1305084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
There is a growing number of youth with healthcare needs such as disabilities or chronic health conditions who require lifelong care. In Canada, transfer to the adult healthcare system typically occurs at age 18 and is set by policy regardless of whether youth and their families are ready. When the transition to adult services is suboptimal, youth may experience detrimental gaps in healthcare resulting in increased visits to the emergency department and poor healthcare outcomes. Despite the critical need to support youth with disabilities and their families to transition to the adult healthcare system, there is limited legislation to ensure a successful transfer or to mandate transition preparation in Canada. This advocacy and policy planning work was conducted in partnership with the Patient and Family Advisory Council (PFAC) within the CHILD-BRIGHT READYorNot™ Brain-Based Disabilities (BBD) Project and the CHILD-BRIGHT Policy Hub. Together, we identified the need to synthesize and better understand existing policies about transition from pediatric to adult healthcare, and to recommend solutions to improve healthcare access and equity as Canadian youth with disabilities become adults. In this perspective paper, we will report on a dialogue with key informants and make recommendations for change in healthcare transition policies at the healthcare/community, provincial and/or territorial, and/or national levels.
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Affiliation(s)
- Linda Nguyen
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Claire Dawe-McCord
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Bachelor of Health Sciences Program, McMaster University, Hamilton, ON, Canada
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Michael Frost
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Musa Arafeh
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Kyle Chambers
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Dana Arafeh
- Patient and Family Advisory Council (young adult/patient partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Kinga Pozniak
- Patient and Family Advisory Council (Parent/Family Partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - Donna Thomson
- Patient and Family Advisory Council (Parent/Family Partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | - JoAnne Mosel
- Patient and Family Advisory Council (Parent/Family Partner), READYorNot™ Brain-Based Disabilities Project, CHILD-BRIGHT Network, Canada
| | | | - Barb Galuppi
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Sonya Strohm
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | | | - Caitlin Cassidy
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dayle McCauley
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Shelley Doucet
- Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Hana Alazem
- Department of Pediatrics, Faculty of Medicine, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Anne Fournier
- CHU Mère-Enfant, Sainte Justine Hospital, Montreal, QC, Canada
| | - Ariane Marelli
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- Centre of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
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Feather J, Kaehne A, Kiernan J. Evaluating the implementation of a person-centred transition programme for adolescents and young adults with long-term conditions: the role of context and organisational behaviour. J Health Organ Manag 2023; ahead-of-print. [PMID: 38057278 DOI: 10.1108/jhom-03-2023-0095] [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: 12/08/2023]
Abstract
PURPOSE Drawing on the experiences of healthcare professionals in one paediatric hospital, this paper explores the influence of context and organisational behaviour on the implementation of a person-centred transition programme for adolescents and young adults (AYA) with long-term conditions. DESIGN/METHODOLOGY/APPROACH A single embedded qualitative case study design informed by a realist evaluation framework, was used. Participants who had experience of implementing the transition programme were recruited from across seven individual services within the healthcare organisation. The data were gathered through semi-structured interviews (n = 20) and analysed using thematic analysis. FINDINGS Implementation of the transition programme was influenced by the complex interaction of macro, meso and micro processes and contexts. Features of organisational behaviour including routines and habits, culture, organisational readiness for change and professional relationships shaped professional decision-making around programme implementation. ORIGINALITY/VALUE There exists a significant body of research relating to the role of context and its influence on the successful implementation of complex healthcare interventions. However, within the area of healthcare transition there is little published evidence on the role that organisational behaviour and contextual factors play in influencing transition programme implementation. This paper provides an in-depth understanding of how organisational behaviour and contextual factors affect transition programme implementation.
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Affiliation(s)
- Julie Feather
- Evaluation and Policy Analysis Unit, Edge Hill University, Ormskirk, UK
| | - Axel Kaehne
- Medical School, Edge Hill University, Ormskirk, UK
| | - Joann Kiernan
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Slade K, Shaw RL, Larkin M, Heath G. Care-giving experiences of parents of young people with PMLD and complex healthcare needs in the transition to adulthood years: a qualitative poetic synthesis. Arts Health 2023:1-18. [PMID: 38018798 DOI: 10.1080/17533015.2023.2288058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To synthesise qualitative research exploring the care-giving experiences of parents of young people with profound and multiple learning disabilities (PMLD) and complex healthcare needs, in the transition to adulthood years. METHOD Four databases were systematically searched: Scopus, WoS Core Collection, Medline and SciELO. Included papers were assessed for quality and thematically synthesised. Findings are presented in the form of free-verse poems. RESULTS Nineteen papers from eight countries were included. Analysis generated three themes: interdependency of parent and child, where parents retained responsibility for their child's care; apprehension regarding sharing and shifting responsibility between parents and professionals; an uncertain future in terms of care provision. CONCLUSIONS Parents are concerned about the future care of their children. Training professionals in alternative and effective communication is fundamental to successful transition. Encouraging discussions about advanced care planning may also alleviate parental concerns and ensure good outcomes for young people with PMLD.
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Affiliation(s)
- Katharine Slade
- Institute of Health & Neurodevelopment Aston University Birmingham United Kingdom of Great Britain and Northern Ireland
| | - Rachel L Shaw
- Institute of Health & Neurodevelopment Aston University Birmingham United Kingdom of Great Britain and Northern Ireland
| | - Michael Larkin
- Institute of Health & Neurodevelopment Aston University Birmingham United Kingdom of Great Britain and Northern Ireland
| | - Gemma Heath
- Institute of Health & Neurodevelopment Aston University Birmingham United Kingdom of Great Britain and Northern Ireland
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Thomas N, Atherton H, Dale J, Smith K, Crawford H. General practice experiences for parents of children with intellectual disability: a systematic review. BJGP Open 2023; 7:BJGPO.2023.0010. [PMID: 37185167 PMCID: PMC10646198 DOI: 10.3399/bjgpo.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Parents of children diagnosed with intellectual disability are at increased risk of mental and physical health difficulties compared with other parents. They are likely to regularly seek medical treatment for their health concerns from general practice as well as on behalf of their child with intellectual disability, yet there is limited evaluation of the role general practice plays for this patient group. AIM To explore parents' experiences of general practice support when caring for a child with intellectual disability. DESIGN & SETTING Systematic review of studies reporting experiences of general practice as described by parents who care for children with intellectual disability. METHOD Databases were searched using a pre-defined search strategy. Studies were included based on detailed inclusion criteria, title, abstract, and full-text screening. Quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted. RESULTS A total of nine studies were identified. There was a clear absence of data on parents' own health experience and consultation in general practice. Findings related to navigating general practice on behalf of their child's health including accessibility of general practice and positive and negative experiences of GPs. CONCLUSION Findings from this review highlight priority areas for research, including further exploration of parents' perspectives on seeking support specifically for their own health concerns, while caring for a child with intellectual disability, to bring more awareness and understanding of the role general practice plays in supporting the health of this carer group. This review also considers implications for clinical services, including tailoring appointments for this patient group as a priority for continuity of care, which may result in improved experiences of general practice and encourage better communication.
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Affiliation(s)
- Nicky Thomas
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Atherton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kayla Smith
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hayley Crawford
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Song M, Le TTA, Denny S, Lennox NG, McPherson L, Ware RS, Harley D. Reasons for Encounters and Comorbidities in Adolescents with Intellectual Disability in General Practice: A Retrospective Analysis of Data from the Ask Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1450. [PMID: 37761411 PMCID: PMC10528096 DOI: 10.3390/children10091450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Adolescents with intellectual disability have substantial health needs. This retrospective analysis of data from the Ask Study describes reasons for primary care encounters and the prevalence and incidence of chronic physical and mental conditions among a cohort of community-dwelling adolescents with intellectual disability. Participants attended secondary schools in southern Queensland, Australia. Primary care data were extracted from primary care records. Demographic and health information was collected using carer-completed questionnaires. Reasons for primary care encounters, disease prevalence at age 16 years, and disease incidence through adolescence were reported. Data were obtained for 432 adolescents with intellectual disability (median follow-up: 4.1 years). Skin problems (29.4 per 100 encounters) were the most common reason patients presented for primary care, followed by psychological and behavioural problems (14.4 per 100 encounters) and musculoskeletal problems (13.8 per 100 encounters). Conditions with the highest prevalence were autism spectrum disorder (18.6%) and asthma (18.1%). The prevalence of epilepsy, visual impairment, and cerebral palsy were 14.7, 11.1, and 8.0%, respectively. Gastroesophageal reflux had the highest incidence (9.4 cases per 1000 person-years). Adolescents with intellectual disability have significant healthcare needs, which general practitioners need to be aware of and address. Study findings should inform the development of training programs for general practitioners.
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Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Tran T. A. Le
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Department of Psychiatry, University of Medicine and Pharmacy, Hue University, Hue 530000, Vietnam
| | - Simon Denny
- Mater Young Adult Health Centre, Mater Hospitals, Brisbane, QLD 4072, Australia;
| | - Nicholas G. Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
| | - Lyn McPherson
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia;
| | - Robert S. Ware
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia;
| | - David Harley
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-University of Queensland, Brisbane, QLD 4101, Australia; (M.S.); or (T.T.A.L.); (N.G.L.); (D.H.)
- Centre for Clinical Research, University of Queensland, Brisbane, QLD 4006, Australia
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Betz CL. Health care transition planning for adolescents and emerging adults with intellectual disabilities and developmental disabilities: Distinctions and challenges. J SPEC PEDIATR NURS 2023:e12415. [PMID: 37380603 DOI: 10.1111/jspn.12415] [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] [Received: 01/10/2023] [Revised: 03/29/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE The purpose of this article is to provide the reader with insight and enhanced understanding of the health care transition planning process for adolescents and emerging adults with intellectual disabilities and developmental disabilities. There are distinctly different programmatic considerations that need to be addressed in advancing their transfer of care to adult providers and promoting their transition to adulthood. These differences are due in part to the federal and state legislative initiatives that were established in the education, rehabilitation, employment, and developmental disabilities service systems. In contrast, no comparable federal and state mandates exist in the system of health care. The legislative mandates in education, rehabilitation, and employment are presented and discussed as well as the federal legislation on rights and protections for individuals with intellectual disabilities and developmental disabilities. Consequently, health care transition (HCT) planning involves application of a framework of care that is characteristically different than the planning efforts undertaken for adolescents and emerging adults (AEA) with special health care needs (SHCN)/disabilities and for typically developing AEA. The best practice HCT recommendations are discussed in the context of this intellectual disabilities and developmental disabilities framework of care. CONCLUSIONS Health care transition planning for adolescents and emerging adults with intellectual disabilities and developmental disabilities involves additional and distinctly clinical and programmatic models of care. PRACTICE IMPLICATIONS Health care transition planning guidance for adolescents and emerging adults with intellectual disabilities and developmental disabilities are provided based upon best practice recommendations.
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Affiliation(s)
- Cecily L Betz
- Department of Pediatrics, Keck USC School of Medicine, USC University Center for Excellence in Developmental Disabilities, Los Angeles, California, USA
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Zylbersztejn A, Stilwell PA, Zhu H, Ainsworth V, Allister J, Horridge K, Stephenson T, Wijlaars L, Gilbert R, Heys M, Hardelid P. Trends in hospital admissions during transition from paediatric to adult services for young people with learning disabilities or autism: Population-based cohort study. Lancet Reg Health Eur 2023; 24:100531. [PMID: 36394000 PMCID: PMC9649375 DOI: 10.1016/j.lanepe.2022.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background Transition from paediatric to adult health care may disrupt continuity of care, and result in unmet health needs. We describe changes in planned and unplanned hospital admission rates before, during and after transition for young people with learning disability (LD), or autism spectrum disorders (ASD) indicated in hospital records, who are likely to have more complex health needs. Methods We developed two mutually exclusive cohorts of young people with LD, and with ASD without LD, born between 1990 and 2001 in England using national hospital admission data. We determined the annual rate of change in planned and unplanned hospital admission rates before (age 10–15 years), during (16–18 years) and after (19–24 years) transition to adult care using multilevel negative binomial regression models, accounting for area-level deprivation, sex, birth year and presence of comorbidities. Findings The cohorts included 51,291 young people with LD, and 46,270 autistic young people. Admission rates at ages 10–24 years old were higher for young people with LD (54 planned and 25 unplanned admissions per 100 person-years) than for autistic young people (17/100 and 16/100, respectively). For young people with LD, planned admission rates were highest and constant before transition (rate ratio [RR]: 0.99, 95% confidence interval [CI] 0.98–0.99), declined by 14% per year of age during (RR: 0.86, 95% CI: 0.85–0.88), and remained constant after transition (RR: 0.99, 95% CI: 0.99–1.00), mainly due to fewer admissions for non-surgical care, including respite care. Unplanned admission rates increased by 3% per year of age before (RR: 1.03, 95% CI: 1.02–1.03), remained constant during (RR: 1.01, 95% CI: 1.00–1.03) and increased by 3% per year after transition (RR: 1.03, 95% CI: 1.02–1.04). For autistic young people, planned admission rates increased before (RR: 1.06, 95% CI: 1.05–1.06), decreased during (RR: 0.95, 95% CI: 0.93–0.97), and increased after transition (RR: 1.05, 95%: 1.04–1.07). Unplanned admission rates increased most rapidly before (RR: 1.16, 95% CI: 1.15–1.17), remained constant during (RR: 1.01, 95% CI: 0.99–1.03), and increased moderately after transition (RR: 1.03, 95% CI: 1.02–1.04). Interpretation Decreases in planned admission rates during transition were paralleled by small but consistent increases in unplanned admission rates with age for young people with LD and autistic young people. Decreases in non-surgical planned care during transition could reflect disruptions to continuity of planned/respite care or a shift towards provision of healthcare in primary care and community settings and non-hospital arrangements for respite care. Funding National Institute for Health Research Policy Research Programme.
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Bray EA, Salamonson Y, Everett B, George A, Chapman IA, Ramjan L. Transitioning between paediatric and adult healthcare services: a qualitative study of the experiences of young people with spinal cord injuries and parents/caregivers. BMJ Open 2022; 12:e065718. [PMID: 36418132 PMCID: PMC9684994 DOI: 10.1136/bmjopen-2022-065718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Healthcare transition (HCT) interventions are pivotal to paediatric rehabilitation. However, there has been limited research focusing on HCT in young people with spinal cord injury (SCI). To date, little has been reported on key factors that may contribute to a positive or negative transition experience and what, if any, are the gaps in the transition process. This study explored the experiences of transition from paediatric to adult healthcare for young people with SCI and parents/caregivers in pursuit of co-designing and developing an intervention to support transition. DESIGN, SETTING AND PARTICIPANTS This qualitative study forms part of the planning phase of a larger participatory action research project. It supports obtaining a rich understanding of the phenomenon and the issues and actions necessary to achieve change. Semi-structured individual interviews were conducted online between April and June 2021 with young people with SCI and parents/caregivers who had transitioned or were preparing for the transition from paediatric to adult healthcare in NSW, Australia. The interviews were analysed using an inductive reflexive thematic analysis approach. RESULTS The study recruited nine participants, five young people with SCI and four parents/caregivers. The interviews provided invaluable insight into young people with SCI and their parents'/caregivers' experiences of HCT. As HCT experiences were often less than optimal and needs were not adequately met, some recommendations were offered. These included a coordinated and streamlined handover from paediatric to adult healthcare providers, and a 'one-stop shop' for young people with SCI and their parents/caregivers to access transition information, such as how it occurs, who to call for ongoing support and advice, and tips on how to transition successfully. CONCLUSION Providing a coordinated and streamlined handover process as well as access to more context-related information could improve the transition experiences of young people with SCI and parents/caregivers, resulting in improved health outcomes and greater independence. TRIAL REGISTRATION ACTRN12621000500853.
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Affiliation(s)
- Emily Alice Bray
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bronwyn Everett
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ajesh George
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Isabel A Chapman
- SpineCare Foundation, a Division of Northcott, Parramatta, New South Wales, Australia
| | - Lucie Ramjan
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
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Brown M, MacArthur J, Truesdale M, Higgins A. The transition from child to adult health services for young adults with intellectual disabilities: An evaluation of a pilot of an online learning resource for Registered Nurses. Nurse Educ Pract 2022; 64:103424. [PMID: 35947941 DOI: 10.1016/j.nepr.2022.103424] [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] [Received: 11/08/2021] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 10/16/2022]
Abstract
AIM This study formed the third phase of a national study on the experience of transition from child to adult health services for young adults with intellectual disabilities. The aim of this phase was to evaluate the accessibility and acceptability of an on-line learning resource for Registered Nurses. BACKGROUND The population of young adults with intellectual disabilities and complex needs is increasing. Consequently, more will move from child to adult healthcare, with evidence highlighting that for some their experiences of the transition process is poor. The main study provided contemporary evidence to raise the awareness of Registered Nurses of the needs of young adults with intellectual disabilities and their role in enabling an effective transition from child to adult services. METHODS The online learning resource was developed and piloted with Registered Nurses involved in the transition from child to adult health services for young adults with intellectual disabilities and complex needs. Data collection involved an online survey and semi-structured interviews. RESULTS Twelve Registered Nurses from 2 Scottish NHS Boards completed the questionnaire and 3 participated in a follow-up interview. The findings suggest that the mode of on-line delivery and most of the content of the learning resource were both acceptable and accessible to Registered Nurses across a range of areas of nursing practice. The learning resource was further adapted in response to the participant data. CONCLUSION This on-line learning resources offers the potential for Registered Nurses, and potentially other healthcare professionals to undertake evidence-based, structured further education regarding the effective transitions for young adults with intellectual disabilities and their families. TWEETABLE ABSTRACT Registered Nurses have key contributions to enable the transition from child to adult healthcare for young adults with intellectual disabilities.
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Affiliation(s)
- Michael Brown
- School of Nursing & Midwifery, Queen's University, Belfast, Northern Ireland, UK.
| | | | - Maria Truesdale
- Institute of Health and Well-being, University of Glasgow, Glasgow, Scotland, UK
| | - Anna Higgins
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland, UK
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12
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MacNeill L, Doucet S, Luke A. Caregiver experiences with transitions from pediatric to adult healthcare for children with complex care needs. Child Care Health Dev 2022; 48:800-808. [PMID: 35187705 DOI: 10.1111/cch.12989] [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] [Received: 08/06/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Caring for a youth with complex care needs (CCN) who is transitioning from paediatric to adult healthcare can produce many challenges. For example, caregivers must often manage their youth's care at home, coordinate care and advocate for their youth. Experiences of fragmented and uncoordinated care often result in caregivers feeling ill-prepared and uncertain about the transition process. The current study explores caregiver experiences with the transition from paediatric to adult healthcare for youth with CCN in a semi-rural Canadian province. METHODS This study used a cross-sectional qualitative descriptive design, involving semi-structured interviews with caregivers of youth with CCN who were preparing for, in the process of, or completed a transition from paediatric to adult healthcare within the province of New Brunswick, Canada. Thematic analysis focused on describing caregiver experiences with the transition from paediatric to adult healthcare. RESULTS Seventeen caregivers completed interviews for this study. Four key themes emerged relating to caregiver experiences with the transition from paediatric to adult healthcare for these youth: (1) lack of caregiver support, (2) lack of continuity of care, (3) need for collaborative care and (4) difficulty navigating transition. CONCLUSION There is a clear need to address the challenges experienced by youth with CCN and their caregivers throughout the transition from paediatric to adult healthcare. An effective transition strategy should involve early and coordinated planning between the paediatric and adult care team; continued communication across the care team throughout the transition process; and coordination among health, education and social services.
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Affiliation(s)
- Lillian MacNeill
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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13
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Toulany A, Gorter JW, Harrison M. A call for action: Recommendations to improve transition to adult care for youth with complex health care needs. Paediatr Child Health 2022; 27:297-309. [PMID: 36016593 PMCID: PMC9394635 DOI: 10.1093/pch/pxac047] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
Youth with complex health care needs, defined as those requiring specialized health care and services for physical, developmental, and/or mental health conditions, are often cared for by paediatricians and paediatric specialists. In Canada, the age at which provincial/territorial funders mandate the transfer of paediatric care to adult services varies, ranging between 16 and 19 years. The current configuration of distinct paediatric and adult care service boundaries is fragmentary, raising barriers to continuity of care during an already vulnerable developmental period. For youth, the lack of care integration across sectors can negatively impact health engagement and jeopardize health outcomes into adulthood. To address these barriers and improve transition outcomes, paediatric and adult care providers, as well as family physicians and other community partners, must collaborate in meaningful ways to develop system-based strategies that streamline and safeguard care for youth transitioning to adult services across tertiary, community, and primary care settings. Flexible age cut-offs for transfer to adult care are recommended, along with considering each youth's developmental stage and capacity as well as patient and family needs and circumstances. Specialized training and education in transitional care issues are needed to build capacity and ensure that health care providers across diverse disciplines and settings are better equipped to accept and care for young people with complex health care needs.
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Affiliation(s)
- Alene Toulany
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Jan Willem Gorter
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Megan Harrison
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
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14
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Toulany A, Gorter JW, Harrison ME. Appel à l'action : des recommandations pour améliorer la transition des jeunes ayant des besoins de santé complexes vers les soins aux adultes. Paediatr Child Health 2022; 27:297-309. [PMID: 36016598 PMCID: PMC9394631 DOI: 10.1093/pch/pxac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Abstract
Les jeunes qui ont des besoins de santé complexes, définis comme ceux qui nécessitent des soins et services spécialisés en raison d'affections physiques, développementales ou mentales, sont souvent traités par des pédiatres et autres spécialistes en pédiatrie. Au Canada, l'âge auquel les bailleurs de fonds provinciaux et territoriaux exigent le transfert des soins pédiatriques aux soins pour adultes varie entre 16 et 19 ans. La délimitation actuelle entre les services de santé pédiatriques et aux adultes est fragmentaire, ce qui entrave la continuité des soins pendant une période déjà vulnérable du développement. Le peu d'intégration des soins entre les domaines peut nuire à l'engagement des jeunes en matière de santé et compromettre leur santé à l'âge adulte. Pour renverser ces obstacles et améliorer les résultats de la transition, les dispensateurs de soins pédiatriques et de soins aux adultes, de même que les médecins de famille et d'autres partenaires communautaires, doivent collaborer de manière satisfaisante à l'élaboration de stratégies systémiques qui rationalisent et préservent les soins aux jeunes en transition vers des soins aux adultes en milieu tertiaire, communautaire et primaire. Il est recommandé de privilégier des limites d'âge flexibles pour effectuer cette transition vers les soins aux adultes et de tenir compte de la phase de développement et de l'aptitude de chaque jeune, ainsi que des besoins et de la situation de chaque patient et de chaque famille. Une formation et un enseignement spécialisés sur les enjeux liés aux soins de transition s'imposent pour renforcer les capacités et s'assurer que les professionnels de la santé des diverses disciplines et des divers milieux soient mieux outillés pour accepter et traiter les jeunes qui ont des besoins de santé complexes.
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Affiliation(s)
- Alene Toulany
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Jan Willem Gorter
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Megan E Harrison
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
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15
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Bailey K, Lee S, de Los Reyes T, Lo L, Cleverley K, Pidduck J, Mahood Q, Gorter JW, Toulany A. Quality Indicators for Youth Transitioning to Adult Care: A Systematic Review. Pediatrics 2022; 150:188245. [PMID: 35665828 DOI: 10.1542/peds.2021-055033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transition from pediatric to adult care is associated with adverse health outcomes for many adolescents with chronic illness. We identified quality indicators for transition to adult care that are broadly applicable across chronic illnesses and health systems. METHODS Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched, covering earliest available date to July 2021. The Gray Matters framework was used to search gray literature. Two independent reviewers screened articles by title and abstract, followed by full-text review. Disagreements were resolved by a third reviewer. Studies were included that identified quality indicators developed via consensus-building methods. Indicators were organized into a framework categorized by illness specificity, level of care, Donabedian model, and Institute of Medicine quality domain. Appraisal of Guidelines for Research and Evaluation tool was used for critical appraisal. RESULTS The search identified 4581 articles, of which 321 underwent full-text review. Eight peer-reviewed studies and 1 clinical guideline were included, identifying 169 quality indicators for transition. Of these, 56% were illness specific, 43% were at the patient level of care, 44% related to transition processes, and 51% were patient centered and 0% equity focused. Common indicator themes included education (12%), continuity of care (8%), satisfaction (8%), and self-management/self-efficacy (7%). The study was limited by quality indicators developed through consensus-building methodology. CONCLUSIONS Although most quality indicators for transition were patient-centered outcomes, few were informed by youth and parents/caregivers, and none focused on equity. Further work is needed to prioritize quality indicators across chronic illness populations while engaging youth and parents/caregivers in the process.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine.,Institute of Health Policy, Management and Evaluation
| | - Stephanie Lee
- Department of Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Adolescent Medicine, Monash Children's Hospital, Melbourne, Australia
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Kristin Cleverley
- Temerty Faculty of Medicine.,Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science & Sports.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Alene Toulany
- Temerty Faculty of Medicine.,Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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16
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Clemente KAP, da Silva SV, Vieira GI, de Bortoli MC, Toma TS, Ramos VD, de Brito CMM. Barriers to the access of people with disabilities to health services: a scoping review. Rev Saude Publica 2022; 56:64. [PMID: 35792776 PMCID: PMC9239543 DOI: 10.11606/s1518-8787.2022056003893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS A scoping review was carried out from the main question: "What are the main barriers that people with disabilities face in accessing health services?" The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.
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Affiliation(s)
- Karina Aparecida Padilha Clemente
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Simone Vieira da Silva
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Gislene Inoue Vieira
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Maritsa Carla de Bortoli
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeDepartamento de Ciência e TecnologiaSão PauloSPBrasil Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.
| | - Tereza Setsuko Toma
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeDepartamento de Ciência e TecnologiaSão PauloSPBrasil Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.
| | - Vinícius Delgado Ramos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto de Medicina Física e Reabilitação. São Paulo, SP, Brasil.
| | - Christina May Moran de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brasil.
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17
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Appelgren M, Persson K, Bahtsevani C, Borglin G. Swedish registered nurses' perceptions of caring for patients with intellectual and developmental disability: A qualitative descriptive study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1064-1076. [PMID: 34009687 DOI: 10.1111/hsc.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
Patients with intellectual and developmental disability (IDD) are often misinterpreted and misunderstood. Studies show that, in general, healthcare professionals have limited knowledge about IDD, and registered nurses (RNs) often report feeling unprepared to support this group of patients. Therefore, more knowledge about how to adequately address care for this patient group is warranted. This qualitative study employs an interpretative descriptive design to explore and describe Swedish RNs' perceptions of caring for patients with IDD, here in a home-care setting. Twenty RNs were interviewed between September 2018 and May 2019, and the resulting data were analysed through an inductive qualitative content analysis. The study adheres to consolidated criteria for reporting qualitative research (COREQ). Our analysis found that nurses' perceptions of caring for patients with an IDD could be understood from three overarching categories: nursing held hostage in the context of care, care dependent on intuition and proven experience and contending for the patients' right to adequate care. Our findings show that the home-care context and organisation were not adjusted to the needs of the patients. This resulted in RNs feeling unable to provide care in accordance with their professional values. They also explained that they had not mastered the available augmentative and alternative communication tools, instead using support staff as interpreters for their patients. Finally, on a daily basis, the RNs caring for this group of patients took an active stance and fought for the patients' right to receive the right care at the right time by the right person. This was particularly the case with issues involving psychiatric care.
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Affiliation(s)
- Marie Appelgren
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- City of Malmö, Borough Administration Operation Support Management, Malmö, Sweden
| | - Karin Persson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Christel Bahtsevani
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
- Department of Nursing Education, Lovisenberg Diaconal University College, Oslo, Norway
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18
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Birkett K, Liddle M, Jones E, Paulson A. Matching Level of Clinical Support to Patient Risk When Caring for Children With Behavioral Challenges. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:32-40. [PMID: 35104350 DOI: 10.1352/1934-9556-60.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
Adaptive care plans (ACPs) are an innovative method to providing care for children and adolescents with developmental disabilities who have challenging behaviors during healthcare encounters. ACPs take a family-centered approach to ensure that children with developmental disabilities are able to receive safe and appropriate healthcare by increasing communication and collaboration between caregivers and healthcare team members. Differing healthcare professionals are strategically involved in order to appropriately match the level of support to the patient's behavioral risk through a review of two case examples from the pediatric physical medicine and rehabilitation department. Specifically, case examples describe varying levels of accommodations and support provided to children with challenging behaviors, whose behaviors may have otherwise prevented them from receiving appropriate health interventions.
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Affiliation(s)
- Kerri Birkett
- Kerri Birkett, Cincinnati Children's Hospital Medical Center; Melissa Liddle, Psychological Wellness Center; Emily Jones, Cincinnati Children's Hospital Medical Center; and Andrea Paulson, Gillette Children's Specialty Healthcare
| | - Melissa Liddle
- Kerri Birkett, Cincinnati Children's Hospital Medical Center; Melissa Liddle, Psychological Wellness Center; Emily Jones, Cincinnati Children's Hospital Medical Center; and Andrea Paulson, Gillette Children's Specialty Healthcare
| | - Emily Jones
- Kerri Birkett, Cincinnati Children's Hospital Medical Center; Melissa Liddle, Psychological Wellness Center; Emily Jones, Cincinnati Children's Hospital Medical Center; and Andrea Paulson, Gillette Children's Specialty Healthcare
| | - Andrea Paulson
- Kerri Birkett, Cincinnati Children's Hospital Medical Center; Melissa Liddle, Psychological Wellness Center; Emily Jones, Cincinnati Children's Hospital Medical Center; and Andrea Paulson, Gillette Children's Specialty Healthcare
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19
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Shanahan P, Ollis L, Balla K, Patel R, Long K. Experiences of transition from children's to adult's healthcare services for young people with a neurodevelopmental condition. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1429-1438. [PMID: 33064360 DOI: 10.1111/hsc.13198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
Previous research has highlighted a lack of continuity of care when young people with a neurodevelopmental condition make the transition from children's to adult specialist healthcare services. A lack of planning, consistency, and availability of adult services has been found to lead to; increased anxiety, poor health outcomes, reduced support and some young people not receiving healthcare. The majority of transition research has focused on what health professionals consider important in the transition process, rather than focusing on the experiences of the young people and those closest to them. Our objective was to gather evidence from young people (and their families) who had experienced transition from children's to adult specialist healthcare services through semi-structured interviews. Volunteers were recruited from two London boroughs. All young people were aged between 18 and 25 years with a neurodevelopmental condition (Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and/or an Intellectual Disability). Overall, we interviewed six young people with support from a family member. Five further family members were interviewed on behalf of the young person. In total, ten semi-structured interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Four themes emerged from the analysis: (a) Parents as advocates, (b) Availability of adult's specialist health and social care services, (c) Lack of information sharing and (d) Transition as a binary, abrupt change. Our findings suggest the transition experience could be improved by changing service specifications to incorporate assessment and handover across the age range of 16-20 years. Additionally, statutory services should understand and provide the coordination role now offered by parents in transition. We suggest future research could evaluate the feasibility of a patient-owned online information sharing tool with information about relevant services for young people and their families.
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Affiliation(s)
| | | | - Kate Balla
- Your Healthcare CIC, Surbiton, Surrey, UK
| | | | - Karen Long
- Your Healthcare CIC, Surbiton, Surrey, UK
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20
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Consultation Needs for Young Adults with Intellectual and Developmental Disabilities Admitted to an Adult Tertiary Care Hospital: Implications for Inpatient Practice. J Pediatr Nurs 2021; 60:288-292. [PMID: 34392020 DOI: 10.1016/j.pedn.2021.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/31/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children with intellectual and developmental disabilities (IDD), particularly those with medical complexity, account for a large proportion of pediatric inpatients and are increasingly surviving to adulthood. However, few studies have evaluated the inpatient care of this population after transition to adult hospitals. This paper describes a Med-Peds Hospitalist service providing inpatient consultation for young adults with childhood conditions and offers a window into issues likely to be faced by young adults with IDD as they face increased admissions to adult hospitals. METHODS A single center retrospective chart review was performed of adults with intellectual and developmental disabilities referred to the Med-Peds consult service at a large urban adult academic medical center. FINDINGS The most common medical recommendations provided focused on diagnosis and management of gastrointestinal, neurologic, and respiratory issues. Coordination between pediatric and adult caregivers, disposition planning, communication and family support, and guidance on weight-based dosing were also commonly provided services. DISCUSSION Young adults with IDD face new challenges when admitted to adult hospitals. In this single-center study, several areas were identified where expert consultation could be helpful. The need for structured coordination of care for this vulnerable patient population was highlighted. Knowledgeable consultative services may be an effective intervention to address the unique needs of hospitalized young adults with IDD. APPLICATION TO PRACTICE Hospitals should consider structured inpatient programs, care-paths, or consultation from providers knowledgeable in the care of young adults with intellectual disabilities in order to improve the inpatient care of this population.
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21
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Roos E, Søndenaa E. Improving the transition process to independent living for adolescents with profound intellectual disabilities. Experiences of parents and employees. BMC Health Serv Res 2020; 20:1133. [PMID: 33298053 PMCID: PMC7724626 DOI: 10.1186/s12913-020-05976-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022] Open
Abstract
Background The transition process from the family home to independent living for young adults with profound intellectual disability (PID) becomes delayed. Those families face challenges that exceed those of typical families such as higher objective and subjective burden, more frequent psychological distress and lower social support. The aim of this study was to explore the collaboration process between parents and employees and identify factors that improve the transition with less burden. Methods A descriptive qualitative study was undertaken with 18 persons (9 parents and 9 employees) interviewed individually and in groups. In accordance with the municipality’s guidelines, families with a child with PID should apply for housing, when the child turns 16. The purpose is to ensure interdisciplinary collaboration, information flow and coordinated services according to family’s needs. The main question in the interviews was ‘What was your experience with cooperation in the transition process, and what would you do to improve this process?’ The interviews were analysed with a thematic approach using systematic text condensation. Results The parents experienced a lack of general information about the ‘housing waiting list’, level of services, and the plan for time of moving from the family home, and how to choose where and whom to live with. Parents described an unsustainable burden of care during the waiting period, and a family crisis caused the allocation of an apartment in a group house. Employees shared challenges to meet families’ wishes, as there were too few group homes. They experienced good collaboration with families and said they offered respite care, due to reduce parents’ burden of care. Employees experienced that PID adolescents developed skills, mastery and degrees of independence after completing a residency at the Folk High School. Conclusions To improve the transition process from family home to independent living for young adults with PID, the informants highlighted some factors to reduce the burden of care on families: 1) Systematic follow-up program for families to observe their needs at an early stage; 2) More available group houses; 3) Information about the housing priorities of the services and; 4) Educational preparation programs for families.
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Affiliation(s)
- Eirik Roos
- Department of Health and Welfare, Municipality of Trondheim, Norway
| | - Erik Søndenaa
- Faculty of Medicine and Health Sciences (MH), Department of Mental Health, Norwegian University of Science and Technology, 7491, Trondheim, Norway. .,Department of Brøset, St. Olavs University Hospital, Trondheim, Norway.
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22
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Brown M, Higgins A, MacArthur J. Transition from child to adult health services: A qualitative study of the views and experiences of families of young adults with intellectual disabilities. J Clin Nurs 2019; 29:195-207. [DOI: 10.1111/jocn.15077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Brown
- School of Nursing & Midwifery Queen's University Belfast UK
| | - Anna Higgins
- School of Health & Social Care Edinburgh Napier University Edinburgh UK
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