A Pilot Study of a Future Planning Program for Siblings of People With Intellectual and Developmental Disabilities

Future care planning of adults with childhood-onset neurodevelopmental disabilities: A scoping review

BACKGROUND

Advances in medicine have increased the life expectancy of adults with neurodevelopmental disabilities (ND). These individuals often reside with aging family caregivers, who also experience age-related health issues. However, many caregivers lack future care plans for their adult children. Thus, there is a pressing need for practical solutions for family-centered future care planning (FCP).

AIMS

To summarize the literature on the key components of FCP for adults with ND and their familial caregivers.

METHODS AND PROCEDURES

This scoping review adhered to the Joanna Briggs Institute guidelines. It utilized search terms related to ND and FCP and conducted searches in four databases. Data were analyzed thematically.

OUTCOMES AND RESULTS

The initial search generated over unique 9000 articles. The review identified facilitators, such as preferences, family-centered approaches, advocacy, and formal support, which promote effective FCP. Barriers to FCP included caregiver hesitancy, limited resources, the emotional nature of future care planning. Recommendations for addressing these challenges included policy and practice support, healthcare professional education and training, and the active involvement of clients and caregivers in FCP discussions.

CONCLUSIONS AND IMPLICATIONS

This review contributes to the understanding of FCP for adults with ND and offers insights for improving family-centered care planning processes. WHAT THIS PAPER ADDS?: This paper contributes to the literature by highlighting the pressing need for comprehensive future care planning (FCP) for adults with neurodevelopmental disabilities (ND) and their aging caregivers. With increasing life expectancy for adults with ND, there is a growing population of aging caregivers who often lack proactive FCP. The review identifies common FCP facilitators, barriers, and recommendations, emphasizing the emotional and financial challenges caregivers face. On the macro level, distrust of the public sector, a crisis-driven healthcare system, and a lack of funding and information present significant challenges. On the micro level, emotional attachment to adult children with ND can lead to family instabilities, uncertainties about the "right decision," and feelings of helplessness and guilt among caregivers. It underscores the importance of taking a family-centered approach, involving the adult with ND, and providing healthcare professionals with the necessary education and support to guide caregivers through the FCP process. The paper also highlights the limited existing interventions and calls for further research to address this critical issue. By reviewing a broad range of studies, the paper sets the stage for future research and practice in this area. It offers valuable insights into the components of FCP that can inform recommendations for healthcare professionals, caregivers, and individuals with ND to enhance the continuity of care. In doing so, it aims to address the gaps in the existing literature, particularly the lack of caregiver-informed recommendations for comprehensive FCP.

Siblings FORWARD: Development of a New Program to Engage Siblings of Autistic Adults in Future Planning

The adult service system does not adequately meet the needs of autistic adults, prompting families to continue their supportive roles. Siblings frequently assume these roles when parents are no longer able to do so, often without preparation or planning. We received feedback on the proposed Siblings FORWARD (Focusing on Relationships, Well-being, and Responsibility aheaD) program concept, which would involve 6-7 individualized sessions over ~ 3 months and would facilitate siblings' proactive future planning involvement with their autistic family member. Siblings FORWARD would bolster siblings' skills, knowledge, and self-efficacy to engage in future planning with their family members. We report on perceived need for a sibling program and feedback on the proposed program goals, content, and design. Adult siblings (n = 13), autistic adults (n = 6), and service providers (n = 17) participated in individual interviews or focus groups. Data were systematically coded and analyzed using directed content analysis. Siblings, autistic adults, and service providers expressed high enthusiasm for the Siblings FORWARD concept. Participants indicated that the combination of skill-building and education would promote continued, collaborative future planning that persists after the formal program ends. They had positive impressions of the program concept, goals, content, and design, including the telehealth delivery model. Siblings and autistic adults reported wanting to participate in Siblings FORWARD. This uniform, strong enthusiasm for the Siblings FORWARD concept warrants moving forward to examine preliminary acceptability and feasibility. Ultimately, greater sibling involvement in family future planning may improve autistic adults' functioning through improved continuity of care and support across adulthood.

Caregiving and future planning perspectives of siblings of individuals with intellectual and developmental disabilities: Insights from South Korea, Japan and Taiwan

BACKGROUND

As individuals with intellectual and developmental disabilities age, their siblings are more likely to assume caregiving responsibilities. However, little is known about experiences of East Asian siblings with respect to their caregiving and future-planning within their own country, as well as other East Asian countries.

METHODS

Using a national survey, this study explored experiences of 576 siblings across South Korea, Japan and Taiwan.

RESULTS

A common factor across the three countries was that siblings were less engaged in advocacy and future-planning activities and felt less competent to play the role of caregiving. Korean siblings reported more negative views about disability, while Japanese siblings reported less engagement in future-planning and Taiwanese siblings reported greater involvement in caregiving.

CONCLUSION

Based on 'universalism without uniformity', it is recommended to develop culturally sensitive sibling-targeted intervention based on each country's context.

What is 'sibling support'? Defining the social support sector serving siblings of people with disability

'Sibling support' is a form of support for the brothers and sisters of people with disability within medical, health and social care practice, promoting outcomes for them such as improved self-expression, mental health, wellbeing, skills and networks. There has been significant research interest in sibling support, however most has only evaluated individual interventions. There has been little-to-no research that has examined what sibling support is as a sector or overall field of practice. This paucity of research on sibling support as a field of practice is a problematic gap as it prevents recognition of sibling support as a distinct service type/sector, and may ultimately prevent sibling support from getting due support, acknowledgement, funding and promotion. Drawing on a study of national-level sibling support providers in the USA, UK, Canada, New Zealand and Australia, this article therefore seeks to describe sibling support as a sector and field of practice: the principles underpinning it, purposes/functions it addresses and delivery methods used. The article also discusses variation and emerging practice between sibling support providers, as well as the importance and implications of the findings for building greater recognition of sibling support within medicine, health and social care, particularly within the context of policy changes and increasing conditions of austerity, requiring more targeted decisions about what service types service systems support and promote.