Academic journal article International Journal of Child and Adolescent Health

Assistive Technology in Transition Readiness Assessment Instruments for Adolescents with Physical Disabilities: A Scoping Review

Academic journal article International Journal of Child and Adolescent Health

Assistive Technology in Transition Readiness Assessment Instruments for Adolescents with Physical Disabilities: A Scoping Review

Article excerpt


In child and adolescent health, the concept of healthcare transitions is a major focus of research attention (1-3). "Health care transitions" are defined as:

"the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems" (4) (p. 570).

As children progress through typical childhood development and into adolescence, both their health care needs, and responsibilities for managing and directing their health care, change (4-8). Ideally, relationships between the child, their family, caregivers and/or legal guardians, and health care providers evolve so that, over time, responsibility for the leadership of ongoing care shifts from health care practitioners, to the parent/legal guardian, and ultimately to the adolescent into adulthood (7). This also requires an eventual "transfer" or formal handover of health care from pediatric primary and specialty care systems to adult-focused health care systems (4, 6, 7). While transfer itself is a discrete event, "transition" focuses on processes before, during and after transfer of health care (2, 3, 9).

Health care transition interventions incorporate a range of activities to develop self-care, selfmanagement, and self-efficacy skills needed for an adolescent to autonomously manage their health conditions (2, 10). Components can include condition-specific education around treatments, prognosis and care plans, knowledge on accessing and directing care in adult health care settings, and education on eligibility for insurance coverage and reimbursements (7, 10). Some interventions also include strategies to increase knowledge and develop planning skills across psychosocial, educational and vocational life domains (3, 4, 10).

Substantial research shows that poorly planned health care transitions can lead to increased health care utilization, poorer health outcomes and potential life-long consequences (6, 7, 11). Significant policy and research attention is now devoted to understanding and improving health care transitions for adolescents with chronic medical and physical conditions or disability (6, 10). Recent research efforts have included development and validation of instruments to measure transition readiness in adolescents (1-3). These instruments are designed to capture important elements or indicators of transition readiness, to identify specific areas of skill or knowledge development requiring attention, and to guide service planning and provision (1-3), and to "provide an accurate, point-in-time assessment of the individual patient's ability to transition successfully" (7) (p. 183). Such instruments may also be used clinically to measure outcomes of transition readiness interventions (3).

Assistive technology for children and adolescents with physical disabilities

The importance of assistive technologies (ATs) in the lives of children and adolescents with physical disability is well documented (5, 12-15). Successful AT service delivery is associated with a range of patient-reported outcomes for AT users across health, education, employment and participation domains (5, 13). These outcomes include increased independence and improved quality of life (5, 11, 13). AT interventions are highly individualized, and emphasize the uniqueness of individual AT users, the AT and assistance from caregivers required, the activities being undertaken and the environments in which these occur (5, 12, 13). As children who use AT progress through typical development, their AT needs change. This is particularly true during adolescence and the transition to adulthood, where changes may occur across education, employment, housing, relationships and health care domains (5, 6, 11, 12, 16, 17). Adolescents with disability may require AT for participation in post-secondary education, employment and independent living (5, 6, 16-18). It follows that adolescents with disability may therefore require multiple reviews of AT needs in the transition years. …

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