Transitions

This month I’d like to talk about the challenges of successful life transitions. These are challenges for all of us- some have referred to transitions as a period of floundering- and especially so for individuals with cognitive and/or movement challenges. Physical Therapists are uniquely positioned to help these individuals (and their families) anticipate and plan for and successfully navigate these transition times with as little floundering as possible. I would argue that this is one of the most important things that we do, because almost all of the families we’re working with have no experience and very little knowledge about what their next phase will look like and what resources are available in that next phase.

There is some evidence to guide our clinical decision making around transition, and specifically for transitioning from the pediatric systems to the adult systems. As always with evidence-based practice, we also need to integrate our own expertise and the individual and family preferences. Our own expertise should include knowledge about the adult systems in our communities and the resources that are available. I would also argue that it is our professional responsibility to advocate for optimizing these services. Individual and family preferences are also crucial- what goals does the individual have and how can we support the attainment of those goals?

What does the evidence suggest? I had the opportunity to attend a session titled Listen to Me! Incorporating Self-Determination Strategies into Physical Therapy Interventions with School Age Children at CSM last week, led by Toni Doty and Amy Brooks, so I’ll share some of that information. Also my colleague Stacy Zousmer shared an article with me: “I Have Eight Different Files at Eight Different Places”: Perspectives of Youths and Their Family Caregivers on Transitioning from Pediatric to Adult  Rehabilitation and Community Services by Kokorelias et al. This provides some qualitative research evidence to guide our thinking on this topic as well. Lastly, a couple of excellent websites:

https://www.gottransition.org/

https://www.ou.edu/education/centers-and-partnerships/zarrow.

The importance of fostering Self-Determination

Evidence suggests that transitioning can be an isolating and overwhelming experience. However, students with higher levels of self-determination achieve better outcomes related to transitions. I would also speculate that families with higher levels of self-determination also do better. There are four components of self-determination to consider:

• Self-awareness

• Self-efficacy

• Self-advocacy

• Self-regulation

An important first step is often to assess where an individual is at with regard to self-determination. There are several options, and here is a link to one self-determination scale: https://www.ou.edu/education/centers-and-partnerships/zarrow/self-determination-assessment-tools/arc-self-determination-scale. Once we have a sense as to areas of strength and areas for potential improvement, intervention strategies can include:

• Supporting competence (knowledge about diagnosis and related challenges; also about potential barriers and available supports),

• Encouraging relatedness and belonging (friends and recreation and community activities),

• Fostering autonomy (optimizing advocacy, problem solving, and independence).

One specific strategy is to guide individuals and families in a goal setting approach- set a goal, take action, and adjust goal or plan. This goal-setting approach can be both short term- within a specific therapy session- and long term- anticipating a transition period. Another related strategy might be to encourage and support the active participation of the individual in the IEP process, which should then lead to an active role in making choices that are based on their individual preferences, skills & abilities, and goals. Both of these strategies, and indeed all transition-focused interventions, should begin early- as early as 5th grade for participation in the IEP- and continue as essential components of Physical Therapy intervention throughout the lifespan.

For additional information, see the references below and let me know if you have any questions or additional thoughts. A transition focused continuing education course is in development and planned for early fall in the Pittsburgh area- check the website and sign up for the monthly blog post here: http://eepurl.com/iiDKwP.

Doty T & Brooks A. Listen to Me! Incorporating Self-Determination Strategies into Physical Therapy Interventions with School Age Children. APTA CSM Session- February 2023

Kokorelias K et al. I Have Eight Different Files at Eight Different Places”: Perspectives of Youths and Their Family Caregivers on Transitioning from Pediatric to Adult Rehabilitation and Community Services. Journal of Clinical Medicine. 2023. 12, 1693. https://doi.org/10.3390/jcm12041693.

Doty T, Cicirello N, Palisano R. Chapter 34 in “Campbell’s Physical Therapy for Children 6th edition” Eds Palisano R, Orlin M, Schreiber J. 2023. Elsevier.