Mary Alunkal Khetani

Aims: The purpose of this study was to explore the utility of the Participation and Environment Measure for Children and Youth (PEM-CY) for collaborative care planning with parents of children with disabilities. Methods: An explanatory sequential mixed methods approach was employed to examine how community-based service providers interpret and apply PEM-CY case results to set goals and formulate care plans with parents. We used two distinct, interactive phases that included collection and summary of PEM-CY data in Phase One (quantitative) and sequential collection and analysis of interview data during Phase Two (qualitative). Twenty-three parents of children with disabilities (mean age = 10.7 years) completed the PEM-CY community section during Phase One (quan). Four PEM-CY case reports were used with seven providers who were interviewed during Phase Two (QUAL). Results: Providers identified a four-step decisional support algorithm for leveraging PEM-CY case results in care planning: (1) parent rank orders activities in which change is desired, (2) child preferences are incorporated, (3) provider clarifies parent and child goals, and (4) activity-specific supports, barriers, and strategies are identified. Conclusions: Further validation and refinement of the decisional support algorithm with parents and children when applied to PEM-CY home and school reports is discussed.

Background: We examined activity‐specific patterns and child, family and environmental correlates of participation restriction in nine community‐based activities among preschoolers with disabilities who have receivedPartCearly intervention services.Methods: Data were gathered from a subsample of 1509 caregivers whose children (mean age = 67.7 months) had enrolled in theNationalEarlyInterventionLongitudinalStudy (NEILS) and completed a 40‐min computerized telephone interview or 12‐page mailed survey. Data were analysed on cases with complete data on the variables of interest. Bivariate relationships were examined between variables, including patterns of co‐reporting participation difficulties for pairs of community activities.Results: Caregivers were more than twice as likely to report difficulty in one activity (20%) than difficulties in 2–3, 4–5, or 6–9 activities. Co‐reporting paired difficulties was strong for activities pertaining to neighbourhood outings but less conclusive for community‐sponsored activities and recreation and leisure activities. Our data show strong and positive associations between child functional limitations in mobility, toileting, feeding, speech, safety awareness, and friendships and participation difficulty in 7–9 activities. Lower household income was associated with participation difficulty in 7 out of 9 activities and difficulty managing problematic behaviour was strongly associated with participation difficulty in all 9 activities. Each of the three environmental variables (limited access to social support, transportation and respite) was associated with participation restrictions in all nine activities.Conclusion: Results provide practitioners with detailed descriptive knowledge about modifiable factors related to the child, family and environment for promoting young children's community participation, as well information to support development of a comprehensive assessment tool for research and intervention planning to promote community participation for children enrolled in early intervention.

The purpose of this study was to examine factors that best discriminated among families based on their level of community participation when transitioning from Part C early intervention services. Data were drawn from 2,003 families enrolled in the National Early Intervention Longitudinal Study and who completed a 40-minute computerized telephone interview. Classification and Regression Tree (CART) analysis was used to examine correlates of full and limited community participation among these families from variables representing child, family, and service factors. Two classification trees were developed that suggest difficulty in managing behavior is a significant barrier to community participation and is associated with degree of social support. Based on this association, occupational therapists could elicit information from caregivers about their strategies to manage problematic behavior during community events to identify whether families experience participation restriction. Future studies should examine whether problematic behavior restricts young children's participation in activities other than community events.