Focus on Function – a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy

<p>Abstract</p> <p>Background</p> <p>Children with cerebral palsy receive a variety of long-term physical and occupational therapy interventions to facilitate development and to enhance functional independence in movement, self-care, play, school activities and leisure. Considerable human and financial resources are directed at the "intervention" of the problems of cerebral palsy, although the available evidence supporting current interventions is inconclusive. A considerable degree of uncertainty remains about the appropriate therapeutic approaches to manage the habilitation of children with cerebral palsy. The primary objective of this project is to conduct a multi-site randomized clinical trial to evaluate the efficacy of a task/context-focused approach compared to a child-focused remediation approach in improving performance of functional tasks and mobility, increasing participation in everyday activities, and improving quality of life in children 12 months to 5 years of age who have cerebral palsy.</p> <p>Method/Design</p> <p>A multi-centred randomized controlled trial research design will be used. Children will be recruited from a representative sample of children attending publicly-funded regional children's rehabilitation centers serving children with disabilities in Ontario and Alberta in Canada. Target sample size is 220 children with cerebral palsy aged 12 months to 5 years at recruitment date. Therapists are randomly assigned to deliver either a context-focused approach or a child-focused approach. Children follow their therapist into their treatment arm. Outcomes will be evaluated at baseline, after 6 months of treatment and at a 3-month follow-up period. Outcomes represent the components of the International Classification of Functioning, Disability and Health, including body function and structure (range of motion), activities (performance of functional tasks, motor function), participation (involvement in formal and informal activities), and environment (parent perceptions of care, parental empowerment).</p> <p>Discussion</p> <p>This paper presents the background information, design and protocol for a randomized controlled trial comparing a task/context-focused approach to a child-focused remediation approach in improving functional outcomes for young children with cerebral palsy.</p> <p>Trial registration</p> <p>[clinical trial registration #: NCT00469872]</p

Collaboration Between Mental Health and Vocational Rehabilitation Programs for Transition-Age Youth Vocational Outcomes

Transition-age youth (TAY) with serious mental health conditions (SMHC) face many challenges as they establish adult employment. Mental health (MH) programs and vocational rehabilitation (VR) programs each provide key supports toward this goal, but collaboration is required. Objective: The present study’s objective was to assess the extent of collaboration between VR programs and MH programs that serve this age group and to identify interorganizational factors associated with collaboration levels. Method: Participants were 100 key informants from VR, and child mental health (CMH), transition-age youth MH (TAYMH), and adult mental health (AMH) programs in communities that received federal funding to improve services for TAY with or at risk of SMHC. Participants completed web surveys that queried four interorganizational factors and employed a modified social network analysis methodology to assess collaboration levels. Results: The interorganizational factor, depth of knowledge, had a strong and consistent association with collaboration levels. There was little difference in MH–VR collaboration levels between MH programs serving different age groups. However, VR programs and CMH programs had both lower depth of knowledge of each other and lower collaboration levels, compared to TAY and AMH programs. Conclusions and Implications for Practice: Collaboration between VR and MH programs is instrumental to making sure that TAY with SMHC receive appropriate career development and employment services. Increasing the depth of knowledge that programs have about each other may enhance collaboration and appears particularly needed between VR and CMH programs

Defining "necessary" services and supports: Why systems of care must take direction from service-level processes

A crucial element of the system of care definition is the specification of its purpose, namely, "to ensure access to and availability of necessary services and supports." This article discusses the structures and processes that must be in place so that systems of care can acquire and respond to high-quality information about what services and supports are truly necessary.System of care Policy Implementation Mental health Children Adolescents

Crossing the Age Divide: Cross-Age Collaboration Between Programs Serving Transition-Age Youth

Programs that serve transition-age youth with serious mental health conditions typically reside in either the child or the adult system. Good service provision calls for interactions among these programs. The objective of this research was to discover programmatic characteristics that facilitate or impede collaboration with programs serving dissimilar age groups, among programs that serve transition-age youth. To examine this cross-age collaboration, this research used social network analysis methods to generate homophily and heterophily scores in three communities that had received federal grants to improve services for this population. Heterophily scores (i.e., a measure of cross-age collaboration) in programs serving only transition-age youth were significantly higher than the heterophily scores of programs that served only adults or only children. Few other program markers or malleable program factors predicted heterophily. Programs that specialize in serving transition-age youth are a good resource for gaining knowledge of how to bridge adult and child programs