Author
KINGSNORTH Shauna; HEALY Helen; MACARTHUR Colin;
Preparing for adulthood: a systematic review of life skill programs for youth with physical disabilities.
Journal citation/publication details
Journal of Adolescent Health, 41(4), October 2007, pp.323-332.
Summary
Six empirical research studies (five from the USA and one from Canada) were reviewed, all covering multi-component interventions containing a real-world or role playing experiential element. Five demonstrated short term improvements in life skills. The results are of limited general applicability because of the varied nature of the interventions, skill focus and target populations, as well as methodological inadequacies. However, they are sufficiently promising to justify further research.
Context
Advances in health care mean that many more young people with physical disabilities survive into adulthood, but without the life experience that generally teaches the skills needed to pursue an independent life. These skills need to be purposefully taught, and this review examines the effectiveness of teaching programmes.
Methods
What sources were used?
The identification of suitable databases (and search strategies) was developed in collaboration with an information professional. The databases searched were: HealthSTAR [now ceased]; Medline; EMBASE (Excerpta Medica); CINAHL (Cumulative Index to Nursing and Allied Health Literature); PsycINFO; and ERIC (Education Resources Information Center).
What search terms/strategies were used?
A sample search strategy used in CINAHL is given in Figure 1, and was presumably adapted as needed to the requirements of the other databases.
What criteria were used to decide on which studies to include?
Eligible studies were published between 1985 and 2006 and reported empirical research, including a comparison group, that targeted subjects between 12 and 21 with acquired or congenital physical disabilities. At least one quantifiable outcome measure had to be reported.
Who decided on their relevance and quality?
The searches delivered 5,642 references, of which all but 97 were excluded, apparently on the basis of titles, by two unnamed authors working independently. Abstracts of these were then checked and 21 documents retrieved in full text for checking against the inclusion criteria. Any disagreements were resolved through discussion. The final set of selected studies were reviewed by all three authors. Figure 2 summarises the filtering process.
How many studies were included and where were they from?
Six studies were reviewed, five from the USA and one from Canada. They are summarised in Tables 1 (study characteristics) and 2 (study designs and findings).
How were the study findings combined?
The studies were varied, precluding a meta-analysis of the findings. Individual study results, presented as a variety of statistics, are summarised in Table 2 and the conclusions on particular interventions are summarised narratively.
Findings of the review
Three of the studies involved participants with a range of physical disabilities, two focused on visual impairments and one on cranio-facial disfigurements. All the interventions were multi-component and used a variety of approaches to encourage skill building. Four were weekly, classroom-based programmes and two were short term, intense residential programmes. All of the studies were small, ranging from 10-23 participants, and some collected qualitative as well as quantitative data.
Residential programmes
The study of the Independence Program (20 days) showed ‘clinically relevant changes’ at the end of the intervention, and more than half the participants maintained their occupational performance levels at follow-up after four months. Positive results were also found for Adventure Etc, a two-week programme including a nine-day ‘wilderness’ component. Participants demonstrated significant improvements in body image and personal efficacy at the end of the programme, while follow-up at six months showed increased independence, self-confidence and social involvement. However, four of the eleven participants were lost to follow-up.
Classroom-based programmes
Participants in a four-week, 12-session counselling programme showed significantly more favourable attitudes towards disability, and an improved locus of control relative to the comparison group. Qualitative observations supported these findings by documenting behaviours consistent with increased self-awareness, self-assertiveness, empathy and independence. A second programme, Meeting the Challenge (13 weeks, 12 sessions), included a significant role playing element and participants showed a significant increase in the number of social interactions (both self- and peer-initiated) during school lunch times. A third programme, TAKE CHARGE, a five month individualised coaching programme in self-determination skills supplemented by peer mentoring and other components, also produced positive results in terms of psychosocial adjustment, empowerment and levels of personal accomplishment.
The only intervention not to produce positive results was one based on the Assertiveness Training Curriculum for Adolescents with Visual Impairments. Although it was predicted that participants’ social and assertiveness skills would improve, and levels of helplessness and self-criticism decline, no significant differences with the comparison group were reported. However, the authors note that disabled participants in the study had ‘markedly poor social skills’ at baseline, and that the intervention was not implemented as originally intended.
Authors' conclusions
‘The findings of this systematic review of the literature provide some support for the use of multi-component interventions as a means of developing life skills among youth with disabilities.’ However, the quality of the evidence base, and thus the generalisability of the review findings, are jeopardised by: the use in only two studies of the ‘gold standard’ randomised controlled trial design; the general use of non-standardised outcome measures, usually relying on self-report from participants or their parents; small sample sizes; and the limited range of physical disabilities studied. As a result of these deficiencies ‘strong conclusions regarding the long-term effectiveness of the interventions used cannot yet be drawn.’ However, ‘preliminary data are encouraging and support more study to examine whether such programs ensure that youth with disabilities have the necessary life skills to successfully face the long-term challenges of adulthood.’
Implications for policy or practice
None are discussed.