Improving Transition to Adult Care for Those With Developmental Disabilities: An Unclear Path

Sleep and physical activity: the experiences of adults with cerebral palsy and recommendations for clinical practice

PURPOSE

Adults with cerebral palsy (CP) face challenges maintaining physical activity and good sleep. This study explores their experiences and describes factors influencing sleep and physical activity.

METHODS

We conducted semi-structured interviews with fourteen adults aged 23 to 58, of whom thirteen were ambulant. Participants were recruited via the Dutch patient organization for individuals with CP. Data were analyzed using inductive qualitative content analysis.

RESULTS

Three main themes emerged: balancing energy, rest and activity, and separate themes on sleep and physical activity. Balancing energy, rest and activity included subthemes of managing personal resources, interaction between sleep and physical activity, and presence of appropriate support and resources. Maintaining a healthy 24-h balance was crucial, yet participants often struggled achieving this balance and finding appropriate support. Experiences with sleep and physical activity were categorized into mental, physical, and environmental subthemes, which are closely interconnected.

CONCLUSIONS

People with CP have difficulties with sleep, physical activity, and maintaining a healthy 24-h balance. Despite their motivation to maintain well-being, they often lack adequate support. Addressing these issues holistically can improve care and support for adults with CP. Youth rehabilitation services play a critical role in preparing adolescents with CP for adulthood by fostering self-management skills.

An Intervention to Promote Healthcare Transition Planning Among Pediatric Residents

PURPOSE

Poorly planned healthcare transition (HCT) from pediatric to adult-based care for adolescents and young adults with special healthcare needs (AYASHCN) is associated with increased morbidity and mortality. Most pediatricians and pediatric residents are not trained to assist AYASHCN with HCT planning. An electronic medical record-based Transition Planning Tool (TPT) was developed at a large children's hospital to guide provider-patient interactions around HCT planning. The purpose of this study was to evaluate an educational intervention to promote residents' use of the TPT.

METHODS

A multimodal (TPT training, demonstrations, use prompts, and case discussions) curriculum promoting the use of the TPT was developed and implemented within a one-month Adolescent Medicine Rotation. A prospective, nonrandomized, quasi-experimental design with Intervention and Historical Control groups was used. Forty-two residents received the intervention. Twenty-three Historical Control residents received minimal formal training in the TPT. Intervention Group residents completed prerotation/postrotation assessments measuring perceived importance of/comfort with HCT planning and self-reported HCT planning activities. TPT use was compared between the two groups.

RESULTS

Compared to the Historical Control Group, Intervention Group residents were significantly more likely to use the TPT (98% vs. 37%, p < .001) and had a higher mean number of uses (5.5 ± 3.0 vs. 2.6 ± 1.2, p < .001). Residents reported greater perceived importance of (p < .001) and engagement in (p < .001) transition planning activities after completing the intervention. Nearly all (91%) reported that their training increased their comfort in HCT planning.

CONCLUSIONS

A targeted intervention improved pediatric residents' use of the TPT and HCT planning activities.

Feasibility of computerized clinical decision support for pediatric to adult care transitions for patients with special healthcare needs

The objective of this study was to determine the feasibility of a computerized clinical decision support (cCDS) tool to facilitate referral to adult healthcare services for children with special healthcare needs. A transition-specific cCDS was implemented as part of standard care in a general pediatrics clinic at a tertiary care academic medical center. The cCDS alerts providers to patients 17-26 years old with 1 or more of 15 diagnoses that may be candidates for referral to an internal medicine adult transition clinic (ATC). Provider responses to the cCDS and referral outcomes (e.g. scheduled and completed visits) were retrospectively analyzed using descriptive statistics. One hundred and fifty-two patients were seen during the 20-month observation period. Providers referred 87 patients to the ATC using cCDS and 77% of patients ≥18 years old scheduled a visit in the ATC. Transition-specific cCDS tools are feasible options to facilitate adult care transitions for children with special healthcare needs.