Rachel Teplicky

Psychometric evaluation of the Participation and Environment Measure for Children and Youth.

Aim  The aim of this study was to examine the psychometric properties (reliability and validity) of the Participation and Environment Measure for Children and Youth (PEM‐CY).

Development of the participation and environment measure for children and youth: conceptual basis

Purpose: The purpose of this paper is to describe the conceptual foundation of a new parent-report measure of the participation and environment of children and youth: the Participation and Environment Measure − Children and Youth version (PEM-CY). Methods: The ICF-CY provided an initial conceptual framework. Results from a qualitative study to obtain parent perspectives and in-depth review of the literature were used to identify relevant dimensions, items and rating scales for measurement. Results: Life situations, defined as sets of activity categories, were identified for three settings: home, school and community. Participation was operationalized as a multidimensional construct with three measurement dimensions: frequency, extent of involvement and desire for change. Parallel sets of items examining environmental factors that are perceived to help or facilitate participation were defined in relation to the typical activities of each setting. Conclusions: The PEM-CY provides a new measure of participation and environment that reflects the perspectives of parents of children and youth. The instrument will facilitate research and professional practice to understand and support the participation of children and youth with and without disabilities. Implications for Rehabilitation As defined by the International Classification of Functioning, Disability, and Health (ICF), participation and environment are multidimensional constructs that have been challenging to measure. A new parent-report survey measure has been developed that is feasible for use in large-scale studies of children and youth with and without disabilities. The instrument examines participation and environment of children and youth aged 5 to 17 years across three major settings: home, school and community.

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.

School participation, supports and barriers of students with and without disabilities

BACKGROUND We compared school participation patterns of students ages 5-17 with and without disabilities and examined whether features of the school environment were perceived to help or hinder their participation. METHODS Parents (n = 576) residing in the USA and Canada completed the Participation and Environment Measure for Children and Youth (PEM-CY) via the internet. RESULTS Parents of students with disabilities reported that their children participated less frequently in school clubs and organizations and getting together with peers outside the classroom and that they were less involved in all school activities. Parents of students with disabilities also were significantly more likely to report that features of the environment hindered school participation and that resources needed to support their childs participation were not adequate. CONCLUSIONS Parents of students with disabilities report that their children are participating less in important school-related activities. Barriers limiting school participation include features of the physical and social environment as well as limited resources.

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.

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.

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.