Dana Anaby

The effect of the environment on participation of children and youth with disabilities: a scoping review

Abstract Objective: The study’s purpose was to identify and synthesize research evidence regarding the effect of the environment on community participation of children with disabilities. Methods: A scoping review of peer-reviewed studies published from 1990 to 2011 was performed. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria for studies were: participants with a disability, aged 5–21 years, whose environment was examined in relation to participation in out-of-school activities. Data were organized and synthesized based on environmental domains within the International Classification of Functioning, Disability and Health (ICF): Natural Environment/Products and Technology; Support and Relationships; Attitudes; and Services, Systems and Policies. Results: Searching identified 1232 articles and 31 met the inclusion criteria. Each domain of the environment within the ICF influenced participation as a facilitator and/or barrier. The most common facilitators involved social support of family and friends and geographic location. The most common barriers included attitudes, physical environment, transportation, policies and the lack of support from staff and service providers. Conclusions: Knowledge derived from this review can assist practitioners in addressing the specific environmental domains that influence childrens participation. Such awareness can also foster new research questions and assist policy makers in identifying the factors influencing participation. Implications for Rehabilitation All domains of the environment, suggested by the ICF, have an influence on children’s participation. Evidence regarding the effect of the environment on participation is focused primarily on children with physical disabilities; more studies are needed involving various health conditions and age groups. Practitioners and decision-makers can focus attention on specific aspects of the environment, e.g. attitudinal challenges and social support, in order to foster inclusion and participation-based communities.

The Mediating Role of the Environment in Explaining Participation of Children and Youth With and Without Disabilities Across Home, School, and Community

OBJECTIVE To test the effect of personal and environmental factors on childrens participation across 3 different settings (home, school, community); to ascertain the interrelations between these factors; and to propose and test 3 models, 1 for each setting, using structural equation modeling. DESIGN Survey, cross-sectional study, and model testing. SETTING Web-based measures were completed by parents residing in North America in their home/community. PARTICIPANTS Parents (N=576) of children and youth with and without disabilities, (n=282 and n=294, respectively), ages 5 to 17 years (mean age, 11y 2mo), completed the Participation and Environment Measure for Children and Youth (PEM-CY). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The PEM-CY measured levels of participation frequency and involvement, as well as environmental barriers and supports of participation, in each of the following 3 settings: home, school, and community. Information about the childs health condition and functional issues was also collected. RESULTS All 3 models fit the data well (comparative fit index, .89-.97) and explained 50% to 64% of the variance of participation frequency and involvement. Environmental barriers and supports served as significant mediators between child/personal factors (income, health condition, functional issues) and participation outcomes, across all models. The effect of the environment was most pronounced, however, in the community setting. CONCLUSIONS Our findings highlight the unique role of the environment in explaining childrens participation across different settings and, therefore, support the development of interventions targeting modifiable environmental factors.

The Assessment of Preschool Children's Participation: Internal Consistency and Construct Validity

ABSTRACT Participation in activities provides the means for young children to learn, play, develop skills, and develop a sense of personal identity. The Assessment of Preschool Childrens Participation (APCP) is a newly developed measure to capture the participation of children aged 2 to 5 years and 11 months in the areas of play, skill development, active physical recreation, and social activities. Data from a clinical trial involving 120 children with cerebral palsy indicated that the APCP has moderate to very good internal consistency. The measure distinguishes between children below or above 4 years of age across levels of the Gross Motor Classification System, and between income levels below or above the median regional income range. The APCP, with a focus on preschool children, has potential use for assessment and identification of activity areas in which the child is participating and areas in which participation may be restricted.

Participation in the Home Environment among Children and Youth with and without Disabilities

Introduction: This study examines participation patterns and environmental supports and barriers for children with and without disabilities within their home setting. Method: The Participation and Environment Measure for Children and Youth (PEM-CY) is a newly developed, reliable parent/caregiver-report tool, which combines assessment of childrens participation and the environment. The PEM-CY was completed online by 576 parents of children or youth (5 to 17 years old) with and without disabilities from Canada and the United States. ANOVA analyses were performed to examine group differences in PEM-CY summary scores. Item-level differences are presented descriptively using radar plots. Results: After controlling for age and income, significant differences between children with and without disabilities were observed for all home-based PEM-CY participation and environment summary scores. Differences between the two groups were also evident at the item level, particularly when comparing the percentage of children and youth who never participate in specific home-based activities and when comparing perceived barriers to participation. Conclusion: Although all children and youth participate frequently in home-based activities, those with disabilities tend to participate in less complex and quieter/sedentary activities. This, in addition to parental report of environmental barriers to participation, highlights the potential importance of home-based occupational therapy intervention to optimise participation in this setting.

Predictors of change in participation rates following acquired brain injury: results of a longitudinal study

Aim  The purpose of this study was (1) to examine the changes in participation rates over 1 year among children and adolescents after acquired brain injury and (2) to explore the effect of child and family factors on these changes.

Measuring occupational balance: a theoretical exploration of two approaches.

Background. Occupational balance is a fundamental yet complex concept in occupational therapy requiring empirical study. Purpose. To advance the theoretical discussion of occupational balance, its measurement and relationship to well-being. Methods. In part one of this 2-phase study, 122 adults completed a bipolar measure of occupational balance, the Cross Impact Matrix (CIM) of the Personal Project Analysis and two well-being measures: the Satisfaction with Life Scale (SWLS) and Positive and Negative Affect Scales (PANAS). In part two, 24 adults completed the Inter-goal Relations Questionnaire (IRQ), a unipolar measure of occupational balance (harmony) and imbalance (conflict), plus the SWLS and PANAS. Findings. Neither the CIM scores nor IRQ occupational balance/harmony were associated with well-being whereas the IRQ occupational imbalance/conflict was significantly associated with SWLS. Implications. Dimensions of occupational balance (conflict and harmony) may be best measured separately. To promote well-being attention can be given to reducing conflict across occupations.

Improving the participation of youth with physical disabilities in community activities: An interrupted time series design

BACKGROUND/AIM Youth with physical disabilities experience restrictions to participation in community-based leisure activities; however, there is little evidence about how to improve their involvement. This study examined whether an intervention to remove environmental barriers and develop strategies using a coaching approach improved youth participation in leisure activities. METHODS An Interrupted Time Series design was employed, where replication of the intervention effect was examined across individualised participation goals and across participants. Six adolescents with a physical disability participated in a 12-week intervention. An occupational therapist worked with each youth and his/her family to set three leisure goals based on problems identified using the Canadian Occupational Performance Measure (COPM). A coaching approach was used to collaboratively identify and implement strategies to remove environmental barriers. Interventions for each goal were introduced at different time points. Outcomes were evaluated using the COPM. RESULTS Improvements in COPM performance scores were clinically significant for 83% of the identified activities; an average change of 4.5 points in the performance scale (SD = 1.95) was observed. Statistical analysis using the celeration line demonstrated that the proportion of data points falling above the line increased in the intervention phase for 94% of the activities, indicating a significant treatment effect. CONCLUSIONS This study is the first to examine an intervention aimed at increasing leisure participation by changing only the environment. The results indicate that environment-focussed interventions are feasible and effective in promoting youth participation. Such findings can inform the design of a larger study and guide occupational therapy practice.

The participation of children and youth with disabilities in activities outside of school: A scoping review: Étude de délimitation de l’étendue de la participation des enfants et des jeunes handicapés à des activités en dehors du contexte scolaire

Background. Participation in occupations is vital for learning and development. Children with disabilities are at risk for decreased participation. Purpose. The purpose of this study is to examine peer-reviewed literature about the participation-based experiences of children and youth with disabilities in activities outside of formal preschool and school academics. Method. A scoping review was conducted to examine research studies published between 1990 and 2012. Studies included participants from 2 to 18 years who had at least one physical or intellectual/cognitive disability. Findings. Forty-nine articles discussing 32 studies and three systematic reviews met the inclusion criteria. Perceptions of and influences on participation were important emerging themes about direct impacts on patterns of participation. A child or youth’s level of functioning, activity level, level of enjoyment, and contextual factors were found to influence their level of successful participation. Implications. Occupational therapists can use the findings from this review to consider supports and barriers within interventions to enhance participation in meaningful life situations. Description. La participation à des occupations est essentielle à l’apprentissage et au développement. Les enfants handicapés risquent d’avoir un degré participation moindre que les autres enfants. But. Le but de cette étude est d’analyser la littérature examinée par les pairs traitant des expériences liées à la participation d’enfants et de jeunes handicapés à des activités en dehors des activités préscolaires et scolaires. Méthodologie. Une étude de délimitation de l’étendue a été effectuée en vue d’examiner des études réalisées entre 1990 et 2012. Les participants à ces études étaient âgés de 2 à 18 ans, et ils avaient au moins un handicap physique ou intellectuel/cognitif. Résultats. Quarante-neuf articles décrivant 32 études et trois revues systématiques répondaient aux critères d’inclusion de l’étude. Les perceptions face à la participation et les facteurs influant sur la participation comptaient parmi les thèmes importants ayant des impacts directs sur les schèmes de participation. L’étude a permis de déterminer que le niveau de fonctionnement, le niveau d’activité, le degré de plaisir et les facteurs contextuels exerçaient une influence sur le degré de participation des sujets. Conséquences. Les ergothérapeutes peuvent s’appuyer sur les résultats de cette étude pour examiner les mécanismes de soutien et les barrières face aux interventions, en vue de rehausser la participation des jeunes et des enfants handicapés à des situations significatives de la vie.

Validity of the Participation and Environment Measure for Children and Youth (PEM-CY) for Health Impact Assessment (HIA) in sustainable development projects

BACKGROUND Participation in home, school, and community activities is an important indicator of child health and well-being. Evaluating environmental influences on childrens participation can inform efforts to develop sustainable built environments, but few validated measures exist. OBJECTIVE To examine the concurrent validity and utility of the Participation and Environment Measure for Children and Youth (PEM-CY) for Health Impact Assessment in non-urban sustainable development projects affecting children with disabilities. METHODS Eighty-nine parents of children and youth with disabilities who identified as residing in a small town or rural community were sampled. Sixty-six caregivers completed the PEM-CY online, and 23 caregivers completed the PEM-CY and CHIEF-CP paper forms. Spearman correlational analyses were conducted to establish the concurrent validity of the PEM-CY environment sections against the CHIEF-CP. Group comparisons by childs age, number of functional limitations, and annual household income were used to examine differences in summary and item-level responses on the PEM-CY community section. RESULTS Moderate to strong associations were found between CHIEF-CP Total Product and Magnitude Scores and all PEM-CY Environment Summary Scores. CHIEF-CP Physical/Structural and Policies Subscale Scores were most consistently associated with PEM-CY Environment Summary Scores. Group differences by household income were found for participation frequency and number of supports, including perceived availability and adequacy of money and information about programs and services, even when controlling childs age and number of functional limitations. CONCLUSION Study results lend support to the use of the PEM-CY in HIA to reliably assess for environmental impact on childrens participation. Implications for using the PEM-CY to inform decision-making in non-urban sustainable development projects affecting families of children and youth with disabilities are discussed.

Focusing on the Environment to Improve Youth Participation: Experiences and Perspectives of Occupational Therapists.

The environment plays a key role in supporting children’s participation and can serve as a focus of intervention. This study aimed to elicit the perceptions and experiences of occupational therapists who had applied the PREP approach—Pathways and Resources for Engagement and Participation. PREP is a novel 12-week intervention for youth with physical disabilities, aimed at improving participation in leisure community-based activities by modifying aspects of the environment. Using a qualitative post-intervention only design, 12 therapists took part in individual semi-structured interviews, in which the therapists reflected on their experience using PREP to enable participation. A thematic analysis was conducted. Four themes emerged from the data; two of which were informative in nature, describing elements of the PREP intervention that target multi-layered composition of the environment and use strategies that involve leveraging resources and problem solving. The two remaining themes were reflective in nature, illustrating a new take on the Occupational Therapy role and re-positioning the concept of participation in therapy practices. Results emphasize aspects of the environment that can serve as effective targets of intervention, guided by the PREP approach. Findings can broaden the scope and focus of occupational therapy practice by redefining views on participation and the environment.