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

Services Addressing Mental Health Needs of Youth in Physical Rehabilitation: Perspectives of Clinicians, Youth and Family Members

BACKGROUND

Knowledge about services addressing mental health provided in a rehabilitation setting to youth with physical disabilities is limited. This study aimed to better understand the needs, supports, challenges and potential solutions to optimize rehabilitation services for co-occurring physical and mental health needs, from the perspectives of youth, family members and clinicians.

METHODS

A qualitative descriptive approach using 22 individual interviews with youth, parents and clinicians from five rehabilitation centres in a large Canadian city was employed. Inductive thematic analysis was conducted.

RESULTS

Three themes were identified across the three stakeholder groups: (1) available clinical resources for mental health (access to mental health professionals, impact of organizational structures and mandates and continuity of services during transition to adult care); (2) clinician workforce capacity (mental health knowledge, skills and professional development, and therapeutic rapport between clinician and youth); and (3) links and partnerships with key players (improved pathways to access mental health services across programmes and organizations, and family involvement and advocacy).

CONCLUSION

This study provides insights to barriers for mental health care (such as limited mental health knowledge, tools and professional development and access to specialists within the team, restrictive organizational mandates and disruption of services during the transition to adult care), illustrating important aspects to address. Clinicians can be better equipped to address mental health in rehabilitation settings via training opportunities and peer and organizational support in addition to establishing links with external partners. Organizations can also ensure adequate staffing and create pathways within and beyond their institutions to deliver well-coordinated mental health services in a more accessible way.

Landscape of healthcare transition services in Canada: a multi-method environmental scan

BACKGROUND

Poorly supported transitions from pediatric to adult healthcare can lead to negative health outcomes for youth and their families. To better understand the current landscape of healthcare transition care across Canada, the Canadian Health Hub in Transition (the "Transition Hub", established in 2019) identified a need to: (1) describe programs and services supporting the transition from pediatric to adult healthcare across Canada; and (2) identify strengths, barriers, and gaps affecting the provision of transition services.

METHODS

Our project included two iterative steps: a national survey followed by a qualitative descriptive study. Service providers were recruited from the Transition Hub and invited to complete the survey and participate in the qualitative study. The survey was used to collect program information (e.g., setting, clinical population, program components), and semi-structured interviews were used to explore providers' perspectives on strengths, barriers, and gaps in transition services. Qualitative data were analyzed using the Framework Method.

RESULTS

Fifty-one surveys were completed, describing 48 programs (22 pediatric, 19 bridging, and 7 adult) across 9 provinces. Almost half of the surveyed programs were in Ontario (44%) and most programs were based in hospital (65%) and outpatient settings (73%). There was wide variation in the ages served, with most programs focused on specific diagnostic groups. Qualitative findings from 23 interviews with service providers were organized into five topics: (1) measuring transition success; (2) program strengths; (3) barriers and gaps; (4) strategies for improvement; and (5) drivers for change.

CONCLUSIONS

While national transition guidelines exist in Canada, there is wide variation in the way young people and their families are supported. A national strategy, backed by local leadership, is essential for instigating system change toward sustainable and universally accessible support for healthcare transition in Canada.

Navigating meaningful engagement: lessons from partnering with youth and families in brain-based disability research

BACKGROUND

While patient and family engagement in research has become a widespread practice, meaningful and authentic engagement remains a challenge. In the READYorNot™ Brain-Based Disabilities Study, we developed the MyREADY Transition™ Brain-Based Disabilities App to promote education, empowerment, and navigation for the transition from pediatric to adult care among youth with brain-based disabilities, aged 15-17 years old. Our research team created a Patient and Family Advisory Council (PFAC) to engage adolescents, young adults, and parent caregivers as partners throughout our multi-year and multi-stage project.

MAIN BODY

This commentary, initiated and co-authored by members of our PFAC, researchers, staff, and a trainee, describes how we corrected the course of our partnership in response to critical feedback from partners. We begin by highlighting an email testimonial from a young adult PFAC member, which constituted a "critical turning point," that unveiled feelings of unclear expectations, lack of appreciation, and imbalanced relationships among PFAC members. As a team, we reflected on our partnership experiences and reviewed documentation of PFAC activities. This process allowed us to set three intentions to create a collective goal of authentic and meaningful engagement and to chart the course to get us there: (1) offering clarity and flexibility around participation; (2) valuing and acknowledging partners and their contributions; and (3) providing choice and leveraging individual interests and strengths. Our key recommendations include: (1) charting the course with a plan to guide our work; (2) learning the ropes by developing capacity for patient-oriented research; (3) all hands on deck by building a community of engagement; and (4) making course corrections and being prepared to weather the storms by remaining open to reflection, re-evaluation, and adjustment as necessary.

CONCLUSIONS

We share key recommendations and lessons learned from our experiences alongside examples from the literature to offer guidance for multi-stage research projects partnering with adolescents, young adults, and family partners. We hope that by sharing challenges and lessons learned, we can help advance patient and family engagement in research.