Preparing at-risk youth for a changing world: Revisiting a person-in-context model for transition to employment

Background: The current global cohort of youth has been called ‘a generation at-risk’, marked by a dramatic rise in youth who are not in employment, education or training programmes. In 2010, youth were three times as likely as adults to be unemployed, with youth unemployment worsening in 2012 and 2013. Accordingly, there is an urgent need to examine educational structures that can promote greater labour market attachment and successful transition into employment for youth worldwide. Vocational and work-based education (WBE) has been identified as one of the most recommended and promising educational structures for curtailing youth under- and unemployment. However, WBE takes many forms, making it difficult to discern which WBE programme is most likely to meet the diverse needs of any individual at-risk youth. Moreover, there has been a dearth of theoretical conceptualisations to explain WBE as a context that promotes resilience for at-risk youth as they transition into the world of work. Purpose: The purpose of this paper is to present a revised model for WBE as an enabling context for at-risk youth in transition from school to employment. Specifically, a person-in-context approach is used, situating youth-related facets (e.g. agency) in relation to systemic facets (e.g. political, cultural) to provide a comprehensive theoretical basis for WBE. The revised model maintains three overlapping domains – the individual, the social-cultural and the economic-political – to address a theoretical gap in the literature on transition systems while providing a foundation for practical efforts to prepare at-risk youth for engaging in a changing labour market. Design and Methods: The model was constructed through a systematic and interdisciplinary integrative literature review that examined empirical, conceptual, policy-based and practice-based literature on at-risk youth transition from school to work. Articles and documents were analysed for both individual and contextual factors that influence transition, in order to contribute towards the development of a robust person-in-context model. Existing models of transition and other systems were also examined that addressed the needs of at-risk youth. A ‘person-in-context’ approach was selected for our model as it enabled representation of both macro- and microcosmic factors that shape effective WBE programming. Conclusions: The model is organised around three critical domains that were identified as being influential for school-to-work transition: the individual domain, the social-cultural domain and the economic-p

Development of a Chronic Care Model for Neurological Conditions (CCM-NC)

Abstract Background Persons with neurological conditions and their families face a number of challenges with the provision of health and community-based services. The purpose of this study was to understand the existing health and community service needs and gaps in care and to use this information to develop a model to specify factors and processes that may improve the quality of care and health and well-being for persons with neurological conditions. Methods We conducted semi-structured interviews with health care professionals, community-based non-health care professionals working with individuals with neurological conditions, and policy makers –from the Ministries of Health, Community and Social Services, Transportation and Education– across Canada. We used a purposive sampling and snowballing approach to obtain maximum variation across professions, sector and geography (provinces and territories, rural and urban). Data analysis was an iterative, constant comparative process involving descriptive and interpretive analyses and was initially guided by the components of the Expanded Chronic Care Model. Results A total of 180 individuals completed the interviews: 39% (n = 70) health care professionals, 47% (n = 85) community-based non-health care professionals, and 14% (n = 25) policy makers. Based on the data we developed the Chronic Care Model for Neurological Conditions (CCM-NC). The major needs/gaps are represented by the following themes: acceptance and openness to neurological conditions, evidence informed policy, investments and funding, supported transitions, caregiver support, and life enhancing resources (education, employment, housing and transportation), knowledge and awareness of neurological conditions and availability and access to health services. The model maintains that intersectoral collaboration across the health system, community and policy components is needed. It recognizes that attitudes, policies, enhanced community integration and health system changes are needed to develop activated patients and families, proactive service delivery teams, a person-centred health system and healthy public policy for persons with neurological conditions. Conclusion The CCM-NC will generate debate and discussion about the actions needed in each of the model components to enable people with neurological conditions to sustain healthier lives. Next steps include validating the model with persons with neurological conditions, in and outside of the Canadian context and developing and evaluating interventions to test the model

The everyday experience of living with and managing a neurological condition (the LINC study): study design

Background: The impact of neurological conditions on individuals, families and society is increasing and having a significant economic impact in Canada. While some economic data is known, the human costs of living with a neurological condition are poorly understood and rarely factored into future burden analyses. The “Living with the Impact of a Neurological Condition (LINC)” study aims to fill this gap. It seeks to understand, for children and adults with neurological conditions, the supports and resources that make everyday life possible and meaningful. Methods/design: The LINC study is a nested study using mixed methods. We are interested in the following outcomes specifically: health status; resource utilization; self-management strategies; and participation. Three studies captured data from multiple sources, in multiple ways and from multiple perspectives. Study One: a populationbased survey of adults (n = 1500), aged 17 and over and parents (n = 200) of children aged 5 to 16 with a neurological condition. Study Two: a prospective cohort study of 140 adults and parents carried out using monthly telephone calls for 10 months; and Study Three: a multiple perspective case study (MPCS) of 12 adults and 6 parents of children with a neurological condition. For those individuals who participate in the MPCS, we will have data from all three studies giving us rich, in depth insights into their daily lives and how they cope with barriers to living in meaningful ways. Discussion: The LINC study will collect, for the first time in Canada, data that reflects the impact of living with a neurological condition from the perspectives of the individuals themselves. A variety of tools will be used in a combination, which is unique and innovative. This study will highlight the commonalities of burden that Canadians living with neurological conditions experience as well as their strategies for managing everyday life