Partnering for change (P4C) in Sweden- a study protocol of a collaborative school-based service delivery model to create inclusive learning environments.

BACKGROUND: Inclusive learning environments are considered as crucial for children's engagement with learning and participation in school. Partnering for change (P4C) is a collaborative school-based service delivery model where services are provided at three levels of intensity based on children's needs (class, group-, individual interventions). Interventions in P4C are provided universally to support all children with learning, not only children with special education needs (SEN), and as such are expected to be health-promoting. AIM: The aim of the study is to evaluate the effectiveness and cost-effectiveness of P4C as well as school staff members' and children's experiences after P4C. METHODS: In a parallel, non-randomised controlled intervention design, 400 children, aged 6-12 years, and their teachers, will be recruited to either intervention classes, working according to the P4C, or to control classes (allocation ratio 1:1). Data will be collected at baseline, post-intervention (4 months), and 11 months follow-up post baseline. The primary outcome is children's engagement with learning in school. Secondary outcomes include for example children's health-related quality of life and wellbeing, occupational performance in school, attendance, and special educational needs. The difference-in-differences method using regression modelling will be applied to evaluate any potential changes following P4C. Focus group interviews focusing on children, and professionals' experiences will be performed after P4C. A health economic evaluation of P4C will be performed, both in the short term (post intervention) and the long term (11-month follow-up). This study will provide knowledge about the effectiveness of P4C on children's engagement with learning, mental health, and wellbeing, when creating inclusive learning environments using a combination of class-, group- and individual-level interventions. TRIAL REGISTRATION NUMBER: NCT05435937.

Implementation of information and communication technology to facilitate participation in high school occupations for students with neurodevelopmental disorders.

PURPOSE: Information and communication technology (ICT) has been proposed to enable an inclusive learning environment and increased participation for students with special educational needs. The aim of this study was to investigate the perceived need for ICT before and after an individualized ICT intervention among high school students with neurodevelopmental disorders and describe how the ICT was used to improve participation in school activities. MATERIALS AND METHODS: This mixed-method study, with a one-group pre- and post-test design, included 99 high school students with neurodevelopmental disorders. Data from questionnaires and assessments using the School Setting Interview (SSI) were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Deductive content analysis was performed on written notes in the SSI assessment. RESULTS: The results showed that students' median number of perceived needs for ICT in school activities had decreased from six needs at baseline to one need at follow-up (t16.5 df(98), p<.001). There were five SSI items for which over 50% of the students perceived a need for ICT, with most students (95%) needing support in the item Remember things. Students received a laptop, tablet or smartphone (95%), software for planning or structure (84%) and ICT for writing and reading (66%). The ICT facilitated participation in multiple school activities, providing reminders and structure, facilitating notetaking and improving spelling. After the ICT intervention, students (61%) experienced improved study results and improved ability to manage difficult school situations (68%). CONCLUSION: To conclude, an individualized ICT intervention as support to increase school participation is promising among high school students with neurodevelopmental disorders.

All stakeholders in the school's student health service must be aware of the importance of following the service-delivery process even when it comes to using information and communication technology (ICT) as an assistive technology, in which training and follow-up are important parts.It is of great importance to include the students in the service-delivery process for ICT to be effective and useful for the students.Because it is easily accessible, mainstream technology has great potential as a cognitive assistive technology to support students with neurodevelopmental disorders.Students, as well as teachers, may need to receive knowledge from rehabilitation staff, such as occupational therapists, concerning ICT as an enabler for increased participation in school activities.

Establishment in productive occupations and perceived work ability among former students with special educational needs one year after upper secondary education.

BACKGROUND: Establishment in productive occupations i.e. work and further studies, is challenging for students who experience special educational needs (SEN). OBJECTIVE: The study aim was to investigate productive occupations and perceived work ability one year after upper secondary education among former students with SEN who had received a student-centred information and communication technology (ICT) intervention. METHODS: Questionnaire data on productive occupations (n = 81) were complemented with the semi-structured Worker Role Interview (WRI) concerning perceived work ability (n = 20), in an embedded mixed methods design. Group comparisons between participants who were and were not established in productive occupations were performed. Written notes from the WRI were analysed with a deductive content analysis. RESULTS: Findings demonstrated that almost two-thirds (63% n = 51) of the former students with SEN were established in productive occupations. The established group had to a higher extent obtained pass grades and had to a lesser extent received time-assisting ICT. Managing daily routines in combination with a productive role in a satisfactory manner was perceived as most challenging for the participants in relation to their work ability. CONCLUSION: The results indicate that students with SEN need person-centred support to handle difficulties both in and outside upper secondary school to promote the transition from school to establishment in productive occupations.

Information and communication technology to improve school participation among upper secondary school students with special educational needs.

BACKGROUND: Evidence-based information and communication technology (ICT) interventions to enhance school participation among students with special educational needs (SEN) are required. AIM: To evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs. MATERIALS AND METHODS: Data on 300 students' assessments with the School Setting Interview (SSI), grades and school attendance were used in this quasi-experimental study, with a one-group pretest-posttest design. Descriptive and inferential statistics and effect size were used, as well as Rasch analysis to generate interval data on the students' ordinal SSI ratings. RESULTS: In the ICT intervention (median time eight hours), 54% of the students received a tablet, and software concerned with planning and structure was received by 85%. After the ICT intervention, a significant decrease in perceived need for adjustments in school activities was found on a group level and 30% of the students improved their school attendance. Students who benefitted the most from the ICT intervention had few adjustment needs in school activities and no special educational support at baseline. CONCLUSION: An ICT intervention is promising for improving school participation among upper secondary school students with SEN.

Rett syndrome: Teenagers' and young adults' activities, usage of time and responses during an ordinary week - a diary study.

Background: Little is known about the everyday life of individuals with Rett syndrome.Aim/Objective: To describe ten participants' (teenagers/young adults) activities during a period of seven days, the time-use, where and with whom the activities were performed and the participants' responses in the form of visible/audible reactions during activities.Material and method: A time-geographic self-administered diary was filled in by 63 informants (parents/support staff) and analysed using the software, DAILY LIFE 2011.Results/Findings: The most frequently reported activities were hygiene/toilet, moving around indoors, eating and getting dressed. Most time was spent in sleeping, daily care, medical health care and travel/transportation. Little time remained for receptive activities, daytime rest, physical, social/creative, communication, school/daily work and domestic chore activities, especially for the young adults. Most time was spent with staff, thereafter with families and the least time was spent with friends. The most reported response was "interested", and "opposed" was the least reported.Conclusions: Daily and medical health care activities were time consuming. Improved communication between all parties may increase participation and well-being and provide solutions for handling unpleasant activities and sedentary time.Significance: A more varied range of activities may improve the everyday life for individuals with Rett syndrome.

Environmental barriers to participation and facilitators for use of three types of assistive technology devices.

The aim was to compare the presence of environmental barriers to participation and facilitators for assistive technology (AT) use and study the relation between barriers and AT use in three different AT devices. A cross-sectional survey was conducted. Inclusion criteria were ≥one year of experience as a user of myoelectric prosthesis (MEP), powered mobility device (PMD), or assistive technology for cognition (ATC) and age 20-90 years. Overall, 156 participants answered the Swedish version of the Craig Hospital Inventory of Environmental Factors and a study-specific questionnaire on facilitating factors. Non-parametric tests were used for comparisons. Barriers to participation were lowest in MEP users (md=0.12; p>0.001), and highest in ATC users (md=1.56; p>0.001) with the least support for AT use (p>0.001 - p=0.048). A positive correlation between fewer barriers and higher use of MEP was seen (r=0.30, p=0.038). The greatest barriers to participation were Natural environment, Surroundings and Information, and the most support came from relatives and professionals. Support, training and education are vital in the use of AT. These factors may lead to a more sustained and prolonged use of AT and may enable increased participation. Future research should focus on interventions that meet the needs of people with cognitive disabilities.

Satisfaction with assistive technology device in relation to the service delivery process-A systematic review.

The service delivery process (SDP) of assistive technology devices (ATDs) is attracting interest, as the provision of ATDs is critical for the independence and participation in society of individuals with disabilities. The purpose of the current study was to investigate what impact the SDP has on satisfaction with ATDs in individuals with disabilities in relation to everyday activities. A systematic literature review was conducted, which resulted in 53 articles included. The results showed that there are factors in almost all the different steps of the SDP that affect the satisfaction with of the devices, which can lead to underutilization and abandonment of ATDs. Only a few studies have been conducted with a design robust enough to generalize the results; therefore, more research is needed. Therefore, the conclusion is the SDP as a whole contributes to the satisfaction with and usability of ATDs in individuals with disability in relation to achieving the desired goals of participation in everyday activities, for the articles included must be deemed as moderate. A client-centred approach in the process is advocated, and was found to be an important factor for an effective SDP and satisfied users.

Validity of the school setting interview for students with special educational needs in regular high school - a Rasch analysis.

BACKGROUND: Participation in education is a vital component of adolescents' everyday life and a determinant of health and future opportunities in adult life. The School Setting Interview (SSI) is an instrument which assesses student-environment fit and reflects the potential needs for adjustments to enhance students' participation in school activities. The aim of the study was to investigate the psychometric properties of the SSI for students with special educational needs in regular high school. METHODS: A sample of 509 students with special educational needs was assessed with the SSI. The polytomous unrestricted Rasch model was used to analyze the psychometric properties of the SSI regarding targeting, model fit, differential item functioning (DIF), response category functioning and unidimensionality. RESULTS: The SSI generally confirmed fit to assumptions of the Rasch model. Reliability was acceptable (0.73) and the SSI scale was able to separate students into three different levels of student-environment fit. DIF among gender was detected in item "Remember things" and in item "Homework" DIF was detected among students with or without diagnosis. All items had disordered thresholds. The SSI demonstrated unidimensionality and no response dependence was present among items. CONCLUSION: The results suggest that the SSI is valid for use among students with special educational needs in order to provide and evaluate environmental adjustments. However, the items with the detected DIF and the SSI rating scale with its disordered thresholds needs to be further scrutinized.

An experience-based treatment model for children unwilling to eat.

Background Guidance during Meals is a two-week inpatient intervention undertaken at the Folke Bernadotte Regional Habilitation Centre, Sweden, to help parents deal with children's eating problems. Parents are given advice about medical and/or behavioural reasons for food selectivity and possible treatment strategies. Aims To identify the way parents handle mealtimes and associated difficulties and investigate parents' opinion on children's progress using Guidance during Meals. Method A questionnaire, consisting of 30 statements and answered by 41 parents, was used to investigate parents' opinions regarding the success of the intervention in altering their child's eating habits at home. Findings Most parents thought that the intervention had helped them and their child, by teaching them how to guide their child during mealtimes, what made it easier for their child to eat, and how to communicate with their child in an encouraging way. Most children retained their increased interest in eating once back at home. These results were not dependent on time of onset of eating problems, number of intervention periods, length of time since the intervention, or gastrostomy. Conclusion The Guidance during Meals intervention helps parents develop knowledge about factors that hinder or facilitate eating in their child and tools that can help their child finish meals, and gives them a sense of hope that positive change can occur.

Using a Participatory Action Research Design to Develop an Application Together with Young Adults with Spina Bifida.

INTRODUCTION: Young adults with spina bifida often have cognitive difficulties. As a result, young adults with disabilities are facing challenges with respect to housing, education, relationships and vocation which increases risk of unemployment. AIM: The aim is to describe a method to develop a smartphone application together with young adults with spina bifida as an assistive technology for cognition. METHOD: In a Participatory Action Research approach, young adults (n = 5) with spina bifida were individually interviewed with Canadian Occupational Performance Measure (COPM). The participants' restrictions in everyday life activities, identified by COPM, were discussed in a focus group formed by the young adults and the result was analyzed using qualitative content analysis. Developing the application the principles of Human-Centered-Design and Universal Design was followed. RESULT: An application made for iOS with a focus on usability and worthiness, done by creating a clear and intuitive interface, with a calendar function useful for example to initiate and plan social activities was developed. CONCLUSION: The method seems useful when the outcome from the project, a beta version of an application for iOS Smartphone, was achieved in agreement with the participants. The study highlight the importance of involving individuals with disabilities when developing smartphone applications.

Benefits of the use of ICT in school activities by students with motor, speech, visual, and hearing impairment: a literature review.

OBJECTIVE: Information and communication technology (ICT) has the potential to enhance participation in educational activities for students with physical disabilities. Even though incorporating ICTs into teaching and learning in education has become an important issue, it is unclear what evidence research has provided. The aim of this study was to investigate types of ICT items and how ICT is being used by students with physical disabilities, and describe the benefits of ICT use in school activities. METHODS: A systematic literature search, covering the period 2000-May 2012, was performed in the databases AMED, CINAHL, Eric, OTseeker, Psych Info, PubMed, and Scopus. Data analysis entailed extracting, editing, grouping, and abstracting findings. RESULTS: A total of 32 articles were included, 16 of which were intervention studies. More than half of the studies concerned students with motor impairments. Type of ICT used differed among impairment groups, and ICT seemed to be especially beneficial for writing, spelling, and communication. CONCLUSIONS: Even though the review found heterogeneity across the studies students seemed to benefit from ICT use regardless of the type. For future research it is important to highlight intervention studies, especially for students with visual, hearing, and communication impairments.

Computer use in educational activities by students with ADHD.

AIM: The aim of this study was to investigate computer use in educational activities by students with attention deficit hyperactivity disorder (ADHD) in comparison with that of students with physical disabilities and students from the general population. METHODS: The design of the study was cross-sectional with group comparison. Students with ADHD (n = 102) were pair-matched in terms of age and sex with students with physical disabilities and students from the general population (n = 940) were used as a reference group. RESULTS: The study showed that less than half of the students with ADHD had access to a computer in the classroom. Students with ADHD reported significantly less frequent use of computers for almost all educational activities compared with students with physical disabilities and students from the general population. Students with ADHD reported low satisfaction with computer use in school. In addition, students with ADHD reported a desire to use computers more often and for more activities in school compared with students with physical disabilities. CONCLUSIONS: These results indicate that occupational therapists should place more emphasize on how to enable students with ADHD to use computers in educational activities in school.

Computer-based assistive technology device for use by children with physical disabilities: a cross-sectional study.

OBJECTIVE: To investigate the prevalence of children with physical disabilities who used a computer-based ATD, and to examine characteristics differences in children and youths who do or do not use computer-based ATDs, as well as, investigate differences that might influence the satisfaction of those two groups of children and youths when computers are being used for in-school and outside school activities. METHOD: A cross-sectional survey about computer-based activities in and outside school (n = 287) and group comparisons. RESULTS: The prevalence of using computer-based ATDs was about 44 % (n = 127) of the children in this sample. These children were less satisfied with their computer use in education and outside school activities than the children who did not use an ATD. CONCLUSION: Improved coordination of the usage of computer-based ATDs in school and in the home, including service and support, could increase the opportunities for children with physical disabilities who use computer-based ATDs to perform the computer activities they want, need and are expected to do in school and outside school.

Use of assistive technology devices in mainstream schools: students' perspective.

OBJECTIVE: The use and nonuse of assistive technology devices in school by students with physical disabilities was investigated, and the students' experiences in using these devices is described. METHOD: We used a mixed-methods approach with predominantly qualitative methods to collect and analyze data, which included observations of and interviews with 20 students with physical disabilities and the number and type of assistive technology devices provided. RESULTS: It is vital that devices be integrated into educational practice and that students experience immediate benefits for their function in everyday school activities without detrimental effects on their social participation. The latter was often more important than being able to perform activities independently. CONCLUSION: The students adopted both a functional and a psychosocial perspective of their devices, and providers should neglect neither. Children and youth need both verbal information and practical experience using devices to be able to make informed decisions.