Organization of rehabilitation services for youth with physical disabilities and mental health problems: A scoping review

Abstract

IntroductionYouth with childhood-onset physical disabilities receiving rehabilitation services often present with many complex needs. Emerging evidence confirms co-occurrence of mental health problems in this population is common, and mental health is often overlooked during rehabilitation for chronic physical conditions. For example, symptoms of depression and anxiety are frequently present in adolescents with physical disability such as spina bifida or Duchenne muscular dystrophy, and access to mental health services is often limited. Addressing mental health concerns for this age group is particularly critical as it encompasses a challenging transition to adulthood.ObjectivesBuilding upon findings from a recent scoping review on the co-occurrence of physical disabilities and mental health problems, this paper synthesizes scientific literature related to the organization and delivery of services for youth with co-occurring childhood-onset physical disabilities (e.g., cerebral palsy, spina bifida) and mental health problems (e.g., depression, anxiety).MethodsA scoping review protocol stemming from Arksey & O'Malley's framework and updated guidelines from the Joanna Briggs Institute was developed. Four databases (Medline, PsycINFO, CINAHL, Embase) were searched. The search was limited to French or English peer-reviewed articles published between 2000 and 2021. Articles included were primary papers addressing: 1) youth aged 15 to 24 with a childhood-onset physical disability, 2) mental health problems, and 3) healthcare service organization or delivery. They were screened by two reviewers and discussed with a third to establish consensus on the inclusion criteria and resolve disagreements.ResultsSixteen articles were retained from the 1,010 screened. Many (9/16) were from the United States. Two models were found: the Biopsychosocial, Collaborative, Agency-Based Service Integration Approach (including psychiatry in a pediatric rehabilitation hospital) and the Client Network Consultation (an interagency collaboration in mental health care for children with complex healthcare needs). Twelve key principles for service organization and delivery were identified and categorized into: collaboration and coordination, training and support, and delivery of care.ConclusionIdentified principles can guide improved service delivery for this population. Highlighted research gaps include the need for developing models of collaborative healthcare delivery and subsequently evaluating their effectiveness.

Mental health in children with disabilities and their families: red flags, services' impact, facilitators, barriers, and proposed solutions

“…The results of this study further align with our environmental scan ( 25 ), as the lack of accessible care and the need to adapt care for children with NDDs have emerged. Furthermore, our results are congruent with a recent study that evidenced gaps in access and quality of mental health services for youth with NDDs ( 20 ). We determined that once services were accessed by families, many expressed being satisfied with them in terms of HCPs' understanding of the child's mental health needs.…”

“…Particularly, Scratch et al ( 21 ), recommends a “formal upskilling for rehabilitation team members” (p. 365), where HCPs can learn about solution-focused strategies, suicide and risk assessment, other therapies (e.g., cognitive-behavioral, psychosocial), and form clear roles and responsibilities within their treating teams ( 21 ). In fact, staff training has been previously highlighted as one of the top three key principles in pediatric mental health care, along side family involvement and accessible care ( 20 ). Interestingly, this suggestion is echoed not only by participating HCPs in our study, but also by CGs.…”

“…The COVID-19 pandemic has exacerbated mental health concerns for children with NDDs and caregivers alike ( 17 , 18 ), heightening the need for services ( 19 ). Nevertheless, the latest scoping review on the organization and the delivery of mental health services for youth with physical NDDs such as cerebral palsy highlighted a lack of models of care that are fully integrated into pediatric rehabilitation settings ( 20 ), with only one example from Canada ( 21 ). This further supports existing evidence that pediatric mental health care is primarily distinct from the biomedical care, particularly in pediatric dual diagnosis ( 22 ).…”

“…On a larger scope, it becomes evident that there is a “broken bridge” between the needs (i.e., widespread occurrence of mental health issues in children with NDDs and their families) and the provision of services (including availability, accessibility, and comprehensiveness), where the “fall” can result in long-term devastating impact for this already vulnerable population. While environmental scans, reviews, and a framework of mental health services ( 20 , 21 , 25 , 28 ) have been conducted and proposed in efforts to optimize services delivery and outcomes, the perspectives of key stakeholders are yet to be explored. These include pediatric healthcare practitioners (HCPs) working in rehabilitation settings with children with NDDs and their families, as well as the caregivers (CGs) of children with NDDs.…”