A Scoping Review of Effective Community-Based Primary Healthcare Initiative to Improve Health Outcomes for Persons with Intellectual and Developmental Disabilities
Soroush Khoeiniha, Margherita Cameranesi, Lindsay McCombe, Lisa Demczuk and Shahin Shooshtari
Persons with Intellectual and Developmental Disabilities (IDD) experience poorer health and have more difficulty accessing mainstream healthcare services compared to the general population. To narrow the gap between the health status and healthcare utilization of persons with and without IDD, a number of policies, programs, tools and initiatives have been introduced worldwide, including transitioning persons with IDD residing in institutions to a variety of living arrangements in the community such as group homes. The present scoping review syntheses and critically analyzes empirical evidence on effective healthcare initiatives and programs that best address disparities related to healthcare and social support needs of persons with IDD living in the community. Using an iterative approach, a comprehensive search strategy was constructed to locate literature reviews, as well as quantitative and qualitative empirical studies published between 2008 and 2017. A total of 25 published studies met the inclusion criterion and therefore were included in our analysis.
Results are presented emphasising merits and methodological limitations of included studies, as well as discussing current gaps in the literature and providing recommendations for policy and practice.
Housing for People with Intellectual Disabilities: A Scoping Review
People with intellectual disabilities (ID) continue to report unmet housing needs. The purpose of this scoping review was to explore the extent of research on housing for people with ID, and the complexities of people's housing experiences. A search yielded 44 studies conducted from 2009 to 2018, meeting the study inclusion criteria. The study findings were analyzed thematically, using an ecological systems framework, which examines the inter-relationships between individual experiences and their contexts, such as within families, organizations, communities and socio-political settings. Cross-study comparisons were conducted using qualitative matrices. Regarding housing types, the use of large institutions to house people with ID continues in most countries and countries are at various stages in the deinstitutionalization process. Supported housing was the most promising housing type related to positive outcomes; however, it is highly dependent on availability of affordable housing stock and individualized supports. Study findings show that people's experiences vary greatly and interact with differences in severity of disability, income levels, country of origin, and mental health. Across housing types, people report stigma and loneliness. This article highlights study findings alongside systems-level themes and identifies areas for further study.
Effectiveness of Group Stepping Stones Positive Parenting Program for Children with Autism Spectrum Disorder and Disruptive Behaviour: Program Evaluation from a Large Community Implementation
Jessica Brian, Ami Tint, Julie Chiba Branson and Martha Pilkington
Children on the autism spectrum often experience higher rates of emotional and behavioural difficulties than their typically developing peers. Parenting a child with special needs can place increased stress and demands on parents, and those parents often seek out specialized parenting programs and supports to address the unique needs of their children. This study evaluated the effectiveness of the group Stepping Stones Triple P (SSTP) Program, a 9-week intervention for parents of children with disabilities and behavioural challenges, within the context of a large clinical implementation. Parents of children on the autism spectrum participated in the group SSTP Program and completed measures pre- and post-intervention; 131 families enrolled, and we obtained post-intervention data from 109 on at least some measures. Significant improvements were reported for self-efficacy (Parenting Tasks Checklist; p’s < .001) and parenting over-reactivity and laxness (Parenting Scale; p’s < .001). Reduced parent stress (p < .001) emerged on the Depression Anxiety Stress Scales, and decreases in anxiety (p = .032) and depression (p = .036) approached significance. Improvement was reported, on the Strengths and Difficulties Questionnaire, for children’s overall difficulties, behavioural (conduct) challenges, hyperactivity/inattention, and prosocial behavior (all p’s < .001), but not for emotional symptoms or peer problems. The Parenting Stress Index –Short Form revealed improvements on all domains (p’s range: < .001 to .005). Overall, parents were satisfied with the program, and attrition rates were very low (approx. 15%). This study demonstrates the acceptability, feasibility, and effectiveness of the 9-week group SSTP program, for use with children on the autism spectrum, in a large clinical setting. One logical next step is to explore adaptations to this program for virtual delivery in order to increase access for hard-to-reach families of children on the autism spectrum.
Face Recognition Deficits in Autism Spectrum Disorder are Present in both Central and Peripheral Vision
Meiko Mimura, Nanami Satake, Hiromi Fujii and Shinji Satake
This pilot study aimed to examine whether individuals with autism spectrum disorder (ASD) have face recognition deficits in either their central or peripheral vision or both of these. Ten individuals with ASD and 10 individuals with typical development (TD) were asked to observe a picture of a face with expression that was presented in either the central or peripheral visual field for 160 ms and then to distinguish whether the face was presenting a “happy” or “angry” expression, by pressing the corresponding one of the two labelled buttons. Using an eye tracker, each participant’s vision was confirmed during each trial. Subsequently, upon the performance of the next task series, the stimuli were substituted with numerals (0–9) and their names (zero–nine). Results showed that, in the face recognition task, individuals with ASD demonstrated significantly longer reaction time to stimuli in both their central and peripheral vision compared to individuals with TD. In addition, individuals with ASD gave significantly fewer correct answers for stimuli in their peripheral vision. In the numeral recognition task, no difference was found between the two groups
Integrated Service Delivery in Fetal Alcohol Spectrum Disorder (FASD): A Review of the Alberta FASD Service Network Model
Katherine R. Flannigan, Andres J. Wrath, Audrey McFarlane, Lisa Murphy and Lisa Rogozinsky
Fetal alcohol spectrum disorder (FASD) is one of the most common neurodevelopmental disabilities in North America. Stemming from the brain- and body-based impacts of prenatal alcohol exposure, individuals with FASD experience a range of challenges with physical, cognitive, behavioural, and social-emotional functioning. Most individuals with FASD require ongoing assistance to support day-to-day living and protect against negative life outcomes. Service needs for individuals with FASD often span across multiple areas of functioning, necessitating a range of supports from various disciplines and sectors. The complexity of needs experienced by individuals with FASD underscores the importance of integrated services, however, there is currently a lack of research on integrated service delivery approaches in the FASD population. The Alberta FASD Service Network model is a unique integrated FASD service delivery approach established in 2007 which facilitates the delivery of coordinated FASD supports and programs across Alberta. The aim of the current study was to review the evidence pertaining to this model. We identified 45 relevant documents, the findings of which were synthesized to better understand the aims and scope, impacts, and challenges of the Alberta FASD Service Network model and inform future work in FASD research, practice, and policy.