The Effectiveness of Transition Strategies for Youth With Disabilities

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The Effectiveness of TransitionStrategies for Youth WithDisabilitiesGillian A. King , Patricia J. Baldwin , Melissa Currie& Jan EvansPublished online: 07 Jun 2010.

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CHILDREN’S HEALTH CARE, 35(2), 155–178Copyright © 2006, Lawrence Erlbaum Associates, Inc.

The Effectiveness of TransitionStrategies for Youth With Disabilities

Gillian A. King, Patricia J. Baldwin,Melissa Currie, and Jan Evans

Thames Valley Children’s CentreLondon, Ontario, Canada

This article reviews the effectiveness of the 10 main strategies used to providetransition education and planning services for youth with disabilities. The reviewsuggests that multifaceted interventions are most effective. Integrated and compre-hensive transition services should address skill instruction and self-awareness; pro-vide customized informational, emotional, and instrumental supports to meet theneeds of youth and families; provide direct opportunities and experiences for skilldevelopment; and address the welcoming nature of community activities and settings.The information can be used by rehabilitation managers and therapists in the designand delivery of transition services. Recommendations are made for future researchwith respect to strategies to facilitate youth transitions.

The design and delivery of effective transition education and planning serviceshas become increasingly important for pediatric rehabilitation service providersand managers. Transition education and planning services refer to the programs,supports, and linkages designed to assist children or youth and their families toprepare for, and successfully adapt to, major normative transitions, such as entryinto school and entry into the adult world. The focus of this article is on the transi-tion of youth with disabilities from school to adult roles. We use the term youthwith disabilities to refer to youth with emotional or behavioral disorders, learningdisabilities, developmental disabilities, and chronic physical health conditions.

Increasingly, rehabilitation services are based on holistic, life span oriented mod-els in which life outcomes, such as community participation and child and family

Correspondence should be sent to Gillian A. King, Thames Valley Children’s Centre, 779 BaseLine Road East, London, Ontario, Canada N6C 5Y6. E-mail: [email protected]

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quality of life, are seen as the ultimate goals of intervention (G. King et al., 2002;Wax, 1972). These holistic models view health as a state of complete physical,mental, and social well being (World Health Organization, 2001) and encompass thechild’s physical, social, emotional, communication, and behavioral needs. There hasbeen growing awareness of the life goals of youth with disabilities, which are thesame as those of youth without disabilities. These goals encompass relationships andfriendships, the opportunity to achieve personal potential and to contribute (work,family, helping others), and recognition for that contribution (G. A. King, Cathers,Miller Polgar, MacKinnon, & Havens, 2000; Saleebey, 1992; Schalock et al., 2002).

There also has been a heightened awareness of parents’ needs for support,information, and the skills and capacities required to navigate the complex ser-vice delivery system and advocate effectively for their child’s and family’s needs(Bailey & Simeonsson, 1988; Burden & Thomas, 1986; G. King, Law, King, &Rosenbaum, 1998; G. King et al., 2002). It is recognized that transition periodsmay involve issues for family members, as well as for youth, and that the transi-tion from school to the adult world can be stressful for families as a whole(Muñoz, Karmosky, Gaugler, Lang, & Stayduhar, 1999; Wehman, 1996).Increasingly, transition is being viewed as a long-term process, rather than as amore time-limited event (Cowan, 1991).

Many articles have indicated that there are gaps in service for youth and fami-lies during the transition from high school to further education, employment, orthe adult world in general (e.g., Ko & McEnery, 2004; Schidlow & Fiel, 1990;Stewart, Law, Rosenbaum, & Willms, 2001). When needed supports and linkagesare not established to assist youth and families to adapt to new environments andexpectations, then youth may experience difficulties in engaging in desired adultroles. This lack of engagement can become intertwined with psychosocial issuessuch as feelings of social isolation, lowered self-esteem, poorer self-concept,and a lack of hope for the future (G. A. King, Baldwin, Currie, & Evans, 2005).Legislation in the United States (Individuals With Disabilities Education Act,1990), Canada, and other countries addresses the need for guidelines and processesto facilitate transition planning and to provide needed supports, services, andopportunities for youth and families at this crucial time of change.

To appropriately support youth and families, and design transition services andprograms, it is important to be aware of the various types of transition approachesand strategies that can be utilized. It is also important to consider how effectivethese approaches and strategies are in assisting youth to adopt adult roles involvingengagement in social relationships, productive work or volunteer opportunities, andleisure and recreational activities (G. A. King, Baldwin, et al., 2005) because theseare considered to be the three major types of life roles (Miezio, 1983).

To our knowledge, comprehensive reviews of intervention approaches and strate-gies for transitioning youth have not been conducted. Betz (2004) reviewed the

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literature on youth with chronic illnesses and physical, developmental, behavioral,and emotional conditions, and summarized major research themes, transitionbarriers, and service recommendations but did not identify key interventionapproaches and strategies, or examine their effectiveness. We use the termapproaches to refer to philosophical orientations that have been taken towardtransition; the term strategies refers to interventions designed to achieve particu-lar short-term goals.

In a previous article (G. A. King, Baldwin, et al., 2005), we reviewed various lit-eratures to determine the main types of approaches and strategies utilized to supportyouth with disabilities (i.e., emotional or behavioral disorders, learning disabilities,developmental disabilities, and chronic physical health conditions). Based on thisreview, we developed a comprehensive, integrated model of approaches and strate-gies that have been used to address the planning of role transitions for youth withdisabilities (see Figure 1). This framework outlines the four most commonly usedtransition approaches that appear in the literature: skills training, prevocational/vocational guidance, a client-centered approach, and an ecological/experientialapproach. Our literature review also indicated that 10 strategies, aligned with theseapproaches, were commonly used to support youth with disabilities. These 10 mainstrategies are encompassed in the six groups of strategies presented in Figure 1:(a) skill instruction, (b) self-awareness, (c) emotional support, (d) communityknowledge, (e) direct experience, and (f) community intervention.

This article provides in-depth information about the effectiveness or utility of the10 strategies for transition education and planning outlined in the model. Informationon the effectiveness of these strategies was obtained from a review of literatures onchild development, early intervention, special education, and health promotion. Theliterature on youth transitions from school to the adult world provides little informa-tion on what approaches and strategies are effective (Betz, 2004; Forbes et al., 2001;Peraino, 1992). We therefore adopted a broader scope for the review of strategyeffectiveness and integrated information from other literatures, as well as researchstudies on youth transition. It is hoped that this information will be useful to pediatricrehabilitation service providers and managers in making decisions about the natureof strategies to use in the design and delivery of transition services. Based on thereview, we also provide suggestions for future research in this area.

According to the model of transition approaches, the long-term goal of transitioneducation and planning services is for youth to be engaged in multiple roles withincommunities of their choice (G. A. King, Baldwin, et al., 2005). Transition interven-tion approaches and strategies differ in the focus or emphasis of the change effort—on youth themselves (i.e., their skills and knowledge), on the adaptation or interfacebetween youth and their environment, or on the environmental context itself. Theselevels of intervention reflect a systems framework (Bronfenbrenner, 1979). By utiliz-ing this framework, the transitions model indicates that different philosophical

TRANSITION STRATEGIES 157

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approaches to transition all have a role to play because each approach addressesan important level of intervention. The model suggests that comprehensiveinterventions, targeting the personal, person–environment fit, and environmentallevels, are required because role transitions are complex; involve a wide set ofattitudes and behaviors; encompass issues of impairment, activity limitation,and participation restriction; and involve many players. Furthermore, ongoing

FIGURE 1 An integrated model of approaches and strategies to address role transitions foryouth with disabilities.

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successful role engagement requires the presence of particular skills in youth,supportive families and relationships, and supportive and welcoming communityenvironments.

This multifaceted approach to intervention is in accordance with what hasbeen proposed in other literatures. For example, the most effective health promo-tion programs are considered to use multifaceted interventions and span multiplesettings and levels of analysis (Stokols, 1992). This integrated perspective alsoaligns with the conceptualization of disability espoused by the World HealthOrganization’s (2001) International Classification of Functioning, Disability, andHealth (ICF), in which disability is considered to reflect impairments, activitylimitations, and participation restrictions. The ICF is guided by a biopsychosocialperspective that acknowledges the interaction between a person’s health condi-tion; his or her physical, psychological, and social functioning; other personalfactors; and the environment. These literatures therefore emphasize various levelsof analysis and suggest the importance of individual, person–environment, andenvironmental levels of intervention.

In the following sections, we present the 10 most commonly used transitionstrategies according to Bronfenbrenner’s (1979) framework: (a) personal levelstrategies (i.e., skill instruction and self-awareness), (b) competence-enhancingstrategies involving the person–environment fit (i.e., emotional support, commu-nity knowledge, and direct experience), and (c) strategies involving the environ-ment (i.e., community intervention). In each section, we summarize existingevidence for the effectiveness of the strategies. The review is not exhaustive, butis comprehensive in scope. Given the state of knowledge about transition strate-gies, a critical systematic review could not be performed and was not the intent.The aim was to survey the existing evidence to provide a summary of what iscurrently known and a starting place for further investigation.

PERSONAL-LEVEL STRATEGIES

Personal-level strategies provide the individual with needed capacities or skills. Thestrategy groupings of skill instruction and self-awareness (through self-assessmentstrategies and planning for the future) both involve facilitating change on the level ofthe individual—in skills, self-knowledge, and beliefs about self-efficacy.

Skill Instruction

The skill instruction strategy is based on a social learning model of change(Bandura, 1977) in which skills training is thought to encourage self-efficacybeliefs. According to the social learning model, it is important to develop support


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networks to maintain the new behaviors, and to maintain behavior throughreinforcement and generalization to different settings.

Many researchers have discussed the skills and competencies needed for successin life (e.g., Brinckerhoff, 1996; Brotherson, Berdine, & Sartini, 1993; Davis,Anderson, Linkowski, Berger, & Feinstein, 1985). The skills thought to be neededto be independent and successful in chosen adult roles include social skills, lifeskills, leisure skills, and the skills underlying self-determination (Algozzine,Browder, Karvonen, Test, & Wood, 2001; Brolin, 1993; Hostler, Gressard, Hassler,& Linden, 1989). The main method used in skill instruction is a curriculum, whichoften involves role-playing and rehearsal in segregated group or classroom settings.

With respect to social skills, studies have examined the effectiveness of socialskills training for children and adolescents with physical disabilities (e.g., Hostleret al., 1989; G. King et al., 1997). Training packages use different techniques forskill acquisition and differ in the strategies used to enhance the generalization ofskills to the home and school environments (e.g., classroom interventions, peercoaches, and parent training sessions). Hostler et al. reported that a social skillstraining program involving a curriculum and an experiential orientation led toincreased knowledge about disability and increased optimism for the future, but didnot increase youths’ sense of autonomy. G. King et al. (1997) reported a significantimprovement in children’s perceptions of their social acceptance due to a socialskills training program, but these gains were not maintained 6 months later.

In terms of leisure skills, a leisure education program involving a curriculumfor adolescents with mental retardation found positive but nonsignificant changesin leisure awareness and participation (Bedini, Bullock, & Driscoll, 1993).Individuals with mental retardation often fail to maintain taught leisure skills(Anderson & Allen, 1985).

Self-determination is a broad construct referring to a combination of skills,knowledge, and beliefs that enable people to engage in goal-directed, self-regulated, and autonomous behavior (Algozzine et al., 2001). The concepts ofchoice, control, and freedom are crucial to the notion of self-determination (Field,Hoffman, & Posch, 1997). Self-determination encompasses skills in thinking(e.g., choice making, decision making, goal setting, and critical thinking), beliefsand knowledge about the self (e.g., self-awareness and self-efficacy), and skills inacting or behaving (e.g., problem solving, self-advocacy; Lehman, Clark, Bullis,Rinkin, & Castellanos, 2002).

Algozzine and his colleagues (2001) conducted a meta-analysis of the out-comes achieved using self-determination interventions, focusing on individualswith learning disabilities and mental retardation. They found that the majority ofstudies involved teaching (i.e., skills training) as the main intervention strategy,and that existing information about the acquisition of self-determination skillswas largely limited to choice making. Studies indicated that there was moderate


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gain as a result of intervention, and that the best effects were found wheninterventions had multiple areas of focus and longer time frames, involvedmultiple intervention techniques, and involved parents of youth.

Based on this meta-analysis, Algozzine et al. (2001) concluded that research isneeded to demonstrate that (a) more complex self-determination skills, such asself-advocacy and goal setting, can be taught, and (b) self-determination skillsactually do make a difference in the lives of individuals with disabilities. Fewstudies of self-determination interventions have included measures of life out-comes, such as new opportunities for school, employment, or leisure activities(Algozzine et al., 2001). Although not an intervention study, in one of the fewstudies relating self-determination to other outcomes, Wehmeyer and Schwartz(1997) found that students with mental retardation or learning disabilities whohad a higher level of self-determination in high school were reported to be morelikely to be employed for pay 1 year after graduation.

The main drawback to a curriculum-based skill instruction approach is lack ofgeneralizability to real world situations. Few skill instruction programs haveshown changes persisting over time and across settings. Furthermore, problemswith maintenance and generalization are thought to be intensified for childrenwith severe disabilities (Odom & Strain, 1984).

Self-Awareness Strategies

In a prevocational/vocational guidance approach, self-evaluation is viewed as thefoundation for transition planning (Halpern, 1994). Youth need to be able to makerealistic self-appraisals (Brinckerhoff, 1996).

There are two types of self-awareness strategies: (a) those that create self-awareness through self-assessment and developmental guidance or counseling,and (b) those that create self-awareness through the activities of planning for thefuture and goal setting.

Self-assessment and developmental guidance/counseling. Self-assessmentrefers to gaining self-knowledge and self-awareness about strengths and valuesthrough the use of assessment instruments, which ideally are functional in nature(Brollier, Shephard, & Markley, 1994). Self-assessment can lead to awareness ofone’s strengths and to a sense of self-efficacy. Although not an intervention study,Spencer and Sands (1999) found that students’ ability to monitor and self-regulatetheir behavior was a significant predictor of their involvement in transition services,which may be assumed to lead to better outcomes. In addition to services providedby professionals, interactions with parents and other adults around school and workcan assist youth in finding a career direction (Dillon, Liem, & Gore, 2003).


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Developmental guidance or counseling refers to providing advice directlygeared to the youths’ self-assessment and situation. Counseling may address issuesof independence, autonomy, self-confidence, or feelings of isolation and depres-sion. A counseling program for youth with learning disabilities, consisting ofself-assessment and self-awareness in life context, led to significant improvements,compared to a control group, in youths’ career maturity (Hutchinson, Freeman,Downey, & Kilbreath, 1992).

Planning and goal setting. Planning provides a vision of postschool success(Steere, Rose, & Gregory, 1996). Goal setting involves identifying postschooltransition goals that are consistent with the outcomes of youths’ self-evaluations(Halpern, 1994). According to Elder (1968), adolescents’ involvement in decisionmaking about their future is instrumental to the growth of their self-confidenceand autonomy.

Various terms have been used for customized empowerment-based planning,including a youth-centered support approach (Lehman et al., 2002), a lifestyleplanning approach (Steere et al., 1996), student-centered transition planning(Brinckerhoff, 1996), and person-centered planning (Holburn & Vietze, 2002). Theliterature is limited concerning the effectiveness of a person-centered planningapproach, although it is used widely with adults with disabilities. In one study, aperson-centered training program for adults with mental retardation was found toincrease their knowledge of later-life options and to increase the number of dailychoices they made, in comparison to a group who did not receive the program(Heller, Miller, Hsieh, & Sterns, 2000). A case study of four individuals with severemental retardation reported an increase in their community presence and participa-tion due to a person-centered planning approach (Malette et al., 1992).

With respect to youth, it has been reported that students are more likely to beactive participants in the transition process when they have overt opportunities to beinvolved in planning their futures—when they set, express, and act on transition-related goals (Sands, Spencer, Gliner, & Swaim, 1999). Halpern, Yovanoff, Doren,and Benz (1995) found that student participation in transition planning was associ-ated with postsecondary success. The National Longitudinal Transition Study, con-ducted by the U.S. Department of Education, reported that 12th-graders who had atransition goal related to competitive employment or postsecondary education weremore likely to find jobs or go on to postsecondary school (Wagner, Blackorby,Cameto, Hebbeler, & Newman, 1993). This indicates the importance of goal setting.People are more likely to achieve goals they specifically set themselves, and which,therefore, are pertinent and motivating (M. S. Clark & Caudrey, 1983).

The involvement of family and friends is seen as a best practice in transitionplanning (Steere et al., 1996), and reports by youth indicate the importance ofinvolving family members, including extended family, in the planning process(Morningstar, Turnbull, & Turnbull, 1995). Parental involvement in vocational


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education has been found to have positive effects on postsecondary school success(Blackorby & Wagner, 1996).

STRATEGIES DESIGNED TO OPTIMIZE THEPERSON–ENVIRONMENT FIT

Most theories of behavior change emphasize the person–environment fit. Forexample, Wampold’s (2001) contextual model stresses aspects of the therapeuticcontext and relationship as being central to change in individuals receiving coun-seling or psychotherapy. Other theories, such as those in the health promotionliterature, deal with broader community-level changes in awareness, attitudes,and behavior. For example, Stokol’s (1992) social-ecological model deals bothwith change on the level of the individual (changing attitudes, values, and behav-ior) and change in the social setting itself.

Strategies that aim to help individuals adapt or optimally match their environ-ment (Wapner & Demick, 1998) include (a) emotional support, (b) communityknowledge strategies (i.e., linking youth and family to community supports, enhancingknowledge of community opportunities), and (c) direct experience strategies (i.e.,coaching and mentoring, creating individualized opportunities and providing experi-ences). These three strategy groupings are linked in the model in Figure 1 to indicatethat they often occur in combination. Support, opportunities, and skill developmentthrough participation or direct experience reflect fundamental strategies used tofacilitate adaptation and the development of competence (G. A. King, 2005; G. King,McDougall, et al., 2005).

Emotional Support

This strategy involves providing emotional and informational support to both theclient and family (Brotherson et al., 1993). Social support is experienced when aperson feels valued, listened to, encouraged, understood, and “believed in.” Youthface many new challenges and expectations in assuming adult roles and responsibili-ties; having a support network is thought to empower them to act in self-determinedways (Lehman et al., 2002). In keeping with the principle of customization, whichunderlies the use of this strategy and a client-centered approach (see Figure 1), sup-ports must be matched to the strengths, needs, and life events of each client andtheir family (Lehman et al., 2002).

Social support is important in ameliorating the stresses linked with the changingenvironments and expectations inherent in transitions (Pearson, 1990). Further-more, there is good evidence for the effectiveness of social support in facilitatingpositive outcomes for children and youth. Social support from family, friends, and


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community members is crucial for the well being of children with disabilities(Wallander & Varni, 1998) and their parents (G. King, King, Rosenbaum, & Goffin,1999). Social support has been linked to increased self-esteem (Heal, Khoju, & Rusch,1997) and is instrumental to transcending life crises and climbing over barriers(G. King, Brown, & Smith, 2003).

Families may need support in adjusting to the changes brought about byyouths’ transition to adult roles. Parents’ needs for information, emotional sup-port, practical assistance, respite, and skill development have been identifiedrepeatedly in the literature (e.g., Bailey & Simeonsson, 1988). As well, parentsmay need to be prepared for the responsibility of acquiring, navigating, and coor-dinating adult services (Hallum, 1995). Parent-led support groups can be useful toparents because they involve information sharing and problem solving, and pro-vide emotional support and understanding (Bennett, DeLuca, & Allen, 1996).Strong support networks are critical when families choose to engage in advocacyon behalf of their adult child or on a broader social scale.

The presence of family support systems has been found to increase the likeli-hood that youth successfully gain employment (Hasazi, Gordon, & Roe, 1985).Furthermore, parents can have an important influence on what youth believe theycan and cannot do in terms of adult roles (Safilios-Rothschild, 1970). TheNational Longitudinal Transition Study indicated that youth whose parentsexpected them to go on to higher education were more likely to do so than youthwhose parents did not hold that expectation (Wagner et al., 1993).

Community Knowledge Strategies

Linking youth and family to community supports. This strategy involvesassisting youth in making connections to sources of community services and sup-ports, including agencies, coworkers, mentors, and consumer groups (Halpern,1985; Steere et al., 1996). It involves coordination and collaboration with otherorganizations and groups to assist the youth and family to find a network of sup-port (Luecking & Certo, 2002).

It is important to restructure naturally occurring networks and resources forsupport because these form the basis for long-term behaviors (Berkman, 1995).Research and practice have shown that youth with disabilities experience betterpostschool employment success when links between school and postschool ser-vices are in place and paid work is incorporated into the secondary school cur-riculum (Sax & Thoma, 2002). The collaborative support of parents, secondary,and postsecondary personnel is frequently cited in the literature as crucial to setthe stage for successful transitions (Brinckerhoff, 1996).

Enhancing knowledge of community opportunities. This strategy refers toassisting youth and their families to gain knowledge of community opportunities.


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Youth need (a) awareness of community resources and how to access information,(b) good information about the support they may expect to receive in the future, aswell as their entitlements, and (c) a realistic sense of the opportunities that are in factavailable for them.

Adolescents and young adults with physical disabilities want informationabout their options and opportunities for real-life experiences (Stewart & Whalen,1995). They and their families must be well informed of the rights and entitle-ments of adults with disabilities to ensure they make fully informed choices.Students seeking postsecondary education need a thorough knowledge of theirfuture educational environments and the legislated commitment of these environ-ments to accommodate their needs (Brinckerhoff, 1996).

Ecological assessments of the physical and social environments surroundingyouth (i.e., assessments of available opportunities and supportive individuals, aswell as physical and attitudinal barriers), in conjunction with assessments ofyouth strengths and weaknesses, can be used to determine desirable communityoptions for particular individuals (Steere et al., 1996). The effectiveness of thisstrategy, however, has not been evaluated.

Leisure education programs teach students to access recreation and leisureresources in their communities and thereby to gain experience in decision mak-ing, self-determination, and social skills (Dattilo & St. Peter, 1991). A leisureeducation program for adolescents with mental retardation involving group class-room education (and one-to-one community-based exploration) reported positivechanges in leisure awareness and participation, but these changes were not signif-icantly different from the changes shown by youth in a control group (Bediniet al., 1993).

Direct Experience Strategies

Coaching and mentoring. Coaching and mentoring strategies encompass(a) life coaching, (b) leisure coaching, (c) supported employment, and (d) per-sonal advocacy. Life coaching is considered to be a key strategy for transition ser-vices, which involves matching youth to settings, facilitating learning of relevantskills and self-management strategies, and providing individualized supports andservices in the context of real-world experiences (H. B. Clark & Foster-Johnson,1996). This strategy also involves supporting youth in problem solving withrespect to diminishing or removing barriers affecting their engagement in roles(e.g., mobility and transportation issues).

Leisure coaching involves supporting youth in acquiring knowledge anddeveloping skills to pursue recreation activities and programs (Dattilo & St. Peter,1991). Leisure coaches may act as liaisons and advocates in the community forparticipants (Hoge, Datillo, & Williams, 1999). Supported employment involvesteaching job skills using systematic instruction, modifying job demands and


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environments to meet the needs of workers, mediating workplace problems, andproviding consultation to those who provide actual workplace supports (Fabian,Edelman, Leedy, & Rockville, 1993; Test & Wood, 1997). Last, the personaladvocacy strategy is a consumer-driven practice involving the development of apartnership in which the person is assisted to change a situation (Hyduk &Moxley, 1997). This strategy is thought to foster empowerment, personal control,and self-direction (Hyduk & Moxley, 1997).

Due to a lack of research, there is little evidence for the utility of coaching insupporting successful transitions. In fact, few research studies have examined theeffectiveness of coaching in work or organizational settings for people in general.In one recent study, Grant (2003) reported preliminary evidence that a life coach-ing program for adults in a university setting can facilitate goal attainment andreduce levels of depression, anxiety, and stress. According to Test and Wood(1996), there is little evidence indicating improved client outcomes from sup-ported employment.

A meta-analytic review of the effectiveness of mentoring programs for youthat environmental risk or disadvantage (e.g., poverty) concluded that mentoringprograms were effective but had a small or modest benefit (DuBois, Holloway,Valentine, & Cooper, 2002). As with skills training, there is a lack of evidence forthe generalizability of benefits beyond the end of program involvement. The util-ity of mentoring programs appears to be enhanced when they consider relation-ship and contextual factors (such as the receptivity of youth to mentoring, a strongmentor–protégé relationship, use of structured activities, and involvement ofparents; DuBois et al., 2002).

Creating individualized opportunities and providing experiences. Thisstrategy refers to providing practical support to help youth gain access to opportuni-ties and experiences that will assist with their transitions to adult roles (Halpern,1994). It also involves assisting youth to develop their personal resources, increasingemployer knowledge about disability, and providing job development activities.

There has been an evolution in thinking about transition from an outcome-basedmodel focusing on employment (Will, 1984) to a model focusing on communityadjustment (Halpern, 1985) and, more recently, to a development-oriented modelstressing the importance of self-determination (Lehman et al., 2002). Philosophically,direct experience is of fundamental importance in the development of self-determination.According to models of self-determination, it is important to create opportunities andexpose youth to situations in which they can make choices and develop their sense ofself-determination (Bremer, Kachgal, & Schoeller, 2003; Wehmeyer, 2001). It also isimportant to promote expectations of personal competency and self-efficacy, and toensure that youth engage in activities that provide optimal challenge.

Providing mastery experiences and assisting youth to establish an area ofcompetence fosters high self-esteem, positive self-concepts, and an ability to setand persevere at goals, all of which are important determinants of success in life


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(R. B. Brooks, 1992). Furthermore, active participation offers youth the chance toacquire decision-making and problem-solving skills, and to develop meaningfulrelationships (R. B. Brooks, 1992; Brown & Gordon, 1987). Benz, Yovanoff, andDoren (1997) found that students with and without disabilities who participatedin two or more work experiences during the last 2 years of high school were twiceas likely to have competitive employment 1 year out of high school than werestudents without this experience.

Studies point to the importance of youth engagement in activities at school andoutside of school activities. This involvement helps youth feel they belong(Roeser, Midgley, & Urdan, 1996). The National Longitudinal Transition Studyindicated that youth who belonged to school or community groups had lowerschool dropout rates, were more likely to go on to postsecondary education, andwere more likely to live independently after high school (Wagner et al., 1993).

A pre–post evaluation of a multifaceted transition program for youth with disabil-ities that involved direct experience strategies (i.e., utilization of coaching, creationof individualized opportunities, and provision of direct experiences) found statisti-cally significant increases in the self-determination skills of youth, their senseof control over their choices and future directions, and their participation in commu-nity leisure activities (Evans, McDougall, & Baldwin, in press). This programalso involved the use of community knowledge strategies, the development ofself-knowledge through prevocational guidance, the use of environmental accommo-dations, client-centered goal setting and planning, and the provision of supports andinformation to youth and parents. Consequently, it is not possible to attribute theeffects to any one strategy per se. The fundamental focus of the program, however,was to support youths’ participation in real-life situations—experiences providingopportunities for the development of self-determination skills through trial-and-errorlearning and coaching.

There is an increasing trend for interventions to focus more on direct participa-tion, which appears to be related to growing awareness of the importance of par-ticipation experiences in leading to many positive outcomes for children (e.g.,Brown & Gordon, 1987), and to the World Health Organization’s (2001) concep-tualization of disability as encompassing participation restrictions. Consequently,there is a need to examine the effectiveness of these participation interventions—interventions that involve youths’ direct engagement in activities in real-worldsettings. Research studies should address the effectiveness of the direct experi-ence strategies identified in our review of the literature (i.e., coaching and men-toring, the creation of individualized opportunities for youth).

ENVIRONMENTAL- OR COMMUNITY-LEVEL STRATEGIES

Environmental-level change theories emphasize the role of community organizationsin the adoption of new ideas, approaches, and innovations. Social marketing (Ward,


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1986) emphasizes the role of communication in increasing the acceptability of anidea or practice. It involves ensuring that the idea or practice is (a) desirable to thetarget group, (b) promoted through various media, and (c) adequately distributed.Diffusion of innovation theory (Rothman, 1974) emphasizes the role of naturalsocial networks and interpersonal channels in changing attitudes and behavior.

The strategies in this grouping consist of two community-level interventions:(a) facilitating on the system level and (b) community education and advocacy.

Facilitating on the System Level

This strategy involves lobbying and advocacy activities beyond the level of theindividual, such as (a) establishing and implementing interagency programs andagreements that facilitate transitions (H. B. Clark & Foster-Johnson, 1996), and(b) advocating for schools to have a range of options for extracurricular activities,to encourage the participation of youth with disabilities.

Interagency programs aim to enhance the effectiveness of the delivery ofhuman services by establishing linkages among various administrative, financial,and service delivery functions (e.g., central intake, information sharing, jointplanning, centralized support services, and joint case management; Weiss, 1981).In a review of outcomes for youth with disabilities, Peraino (1992) recommendedthat systematic cooperative ventures be undertaken between schools, serviceagencies, and other community agencies because these are necessary to facilitatetransition. There are, however, substantial challenges to effective interagency col-laboration and interagency coordination of services (Harbin & Terry, 1991; Stroul &Friedman, 1986; Weiss, 1981), and little is known about the effectiveness of inter-agency agreements in terms of bringing about positive benefits for clients.

Community Education and Advocacy

This strategy involves education and advocacy on the community level to createawareness of the abilities and contributions that can be made by youth with dis-abilities. It aims to dispel myths about disability that may impede involvement insocial, occupational, or leisure/recreation roles, and to foster opportunities forinclusion. Models of pediatric rehabilitation service delivery indicate the impor-tance of community education and class advocacy (e.g., G. King et al., 2002).

Independent living centers are consumer-driven, community-based centersthat promote both individual empowerment and community change (Hutchison &Pedlar, 1999). The independent living paradigm involves working with key stake-holders in the community to encourage attitude change, physical accessibility ofsettings, and the implementation of inclusive practices and policies (Hutchison,Pedlar, Dunn, Lord, & Arai, 2000). There is a limited body of research on the


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impact of independent living centers on community change through the processesof individual and collective empowerment (Hutchison et al., 2000). A survey byHutchison et al. (2000) found only little evidence of community impact (e.g., thereallocation or realignment of resources) but significant impact on the individuallevel in terms of control, personal empowerment, and skills. Factors constrainingthe community impact on independent living centers appear to be limited andunstable funding and resources, and lack of profile in the community.

Advocacy by both clients and service providers is needed to challenge theexistence of obstacles in physical, social, and political settings (N. A. Brooks, 1984;Goode, 1994). Research on community health promotion, knowledge utilization,and community advocacy indicates the importance of several factors in bringingabout change on this level. These factors include face-to-face interactions withindividuals with disabilities, champions, and targeted communications designedto dispel myths (Fincham, 1992).

Community health promotion programs use a range of strategies (mass media,interpersonal communication, opinion leaders), but there is not much evidenceabout the effectiveness of the specific strategies or the programs as a whole.According to Fincham (1992), the most effective mass media programs are thosethat combine the use of mass media, printed material, and social support.

DISCUSSION

This review indicates that there is limited direct evidence for the effectiveness ofsix major types of transition strategies used in planning and supporting school toadult role transitions for youth with disabilities. There is, however, evidence fromother literatures indicating which strategies may be most likely to be effective—as indicated in this review. The skill instruction strategy is limited in its effective-ness due to issues of skill generalization across settings and maintenance overtime. There is good evidence for the effectiveness of the self-awareness strategies(i.e., self-assessment and developmental guidance/counseling; planning and goalsetting) and for the general effectiveness of the emotional support and communityknowledge strategies underlying a client-centered approach. The experientialstrategies of coaching and creating individualized opportunities appear promis-ing. There is growing evidence that these direct experience strategies providebenefits in terms of life outcomes for youth. More research is required on theeffectiveness of community interventions, such as ecological assessments, intera-gency agreements, and community education and advocacy strategies aimed atchanging institutional policies and the attitudes of community members.

Based on this evidence, it appears that the intervention principles of providingcustomized services and providing support and information (which underlie the


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self-awareness and emotional support strategies) are crucial in promoting youthengagement in adult roles.

Overall, there appears to be limited utility in using single strategies in isola-tion. Based on meta-analyses of intervention studies addressing self-determina-tion and mentoring, researchers have concluded that it is important to utilize acombination of intervention strategies (Algozzine et al., 2001; DuBois et al.,2002). Algozzine et al.’s review suggested that the best approach to encourageself-determination skills is a multifaceted one consisting of multiple areas offocus and multiple intervention techniques. DuBois et al. concluded that mentor-ing programs alone have small or modest benefits, but that these benefits canbe improved by addressing relationship and contextual factors in the design ofinterventions.

In the literature on risk and resilience, Kraemer, Stice, Kazdin, Offord, andKupfer (2001) also indicated that multifaceted interventions are required to pro-mote positive child outcomes. The literature on family-centered service indicatesthat family-centered intervention programs often incorporate a number of aspectsof family-centered service (e.g., providing general and specific information,building on parents’ skills, and individualizing services). The implementation ofsuch multifaceted interventions makes it difficult to disentangle the aspects ofinterventions that are producing the results (a concern of researchers), but reflectsthe importance of a comprehensive, integrated approach to service delivery.

Rather than providing clients with a fixed package of transition services, itappears crucial to provide options for the strategies to be included in a multifac-eted transition package designed to meet their needs. The counseling and psy-chotherapy outcomes literature indicates the importance of utilizing strategiesrelated to aspects of the therapeutic context, which include developing a collabo-rative partnership that motivates and engages the client, providing an interventionrationale that makes sense to the client, and using procedures that fit the client’sunderstanding of his or her situation, beliefs about what strategies will be helpful,and beliefs about how change will occur (Ahn & Wampold, 2001; Lambert &Bergin, 1994; Wampold, 2001). In the context of transition services, these aspectsof therapeutic context are related to the strategies that reflect the principle of cus-tomization (e.g., self-assessment, planning and goal setting, offering individual-ized opportunities, and providing customized experiences). It is crucial forservice providers to facilitate the engagement of youth in the process of decidingon appropriate goals and strategies to achieve these goals.

These various literatures, therefore, indicate that it makes sense to offer youthand families a range of options with respect to transition strategies that could betaken. Because clients differ in their needs, belief systems, ways of learning, and thecircumstances of their lives, strategies that are effective for one client may not be sofor another. When clients do not receive services that match their needs, then theyare less likely to achieve the best possible outcomes (Lambert, Hansen, & Finch,


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2001). The selection of strategies to achieve desired outcomes, therefore, should bedone by youth themselves, with the involvement of their parents when appropriate.This is implicit in a client-centered approach to service delivery, yet not alwaysarticulated clearly nor understood. Client-centeredness is sometimes interpreted tomean simply focusing intervention on client-selected goals; the idea that clientsshould play a role in selecting how to pursue their goals is generally not madeexplicit.

It is interesting to note that expert pediatric rehabilitation therapists take aholistic or broad approach to their practice that encompasses the use of multipletechniques and strategies (G. King et al., 2006). It appears that expert therapists,as pragmatic facilitators of change, naturally use a combination of strategies tomaximize the likelihood of change and ensure that children and youth experiencecompetence-enhancing processes. They endeavor to make interventions as rele-vant and engaging to children and families as they can.

IMPLICATIONS FOR CLINICAL PRACTICE

This review has provided information about the effectiveness of commonly usedtransition strategies that will be useful for pediatric rehabilitation managers andtherapists considering the nature of approaches and strategies to use in the designand delivery of transition services. The implications of the model and the reviewof the literature on strategy effectiveness include the importance of (a) providinga clear conceptual basis to interventions; (b) utilizing multiple strategies toachieve outcomes; (c) working on multiple levels of intervention; (d) combiningeducational, planning, psychosocial, and family-centered models of intervention;(e) customizing interventions; and (f) dialoguing early on with respect to a visionof the child’s future.

First, the model of transition approaches and strategies can be used to providea foundation for the development of services and programs, which often aredesigned without an identified conceptual or theoretical basis (Betz, 2004). It isimportant to be clear about the philosophical basis of transition programs and ser-vices because this has implications for program goals and, therefore, the ability ofprograms to demonstrate effectiveness. For example, a skills training approach,utilizing instructional strategies, will likely not be effective in enhancingself-knowledge or enhancing awareness of community opportunities becauseinstructional strategies are not designed to address these goals in an explicit ordirect way. These particular short-term program goals are logically linked to othertypes of intervention strategies (see Figure 1).

Second, based on the evidence reviewed here, we recommend that transitionservices employ multiple strategies in a coherent and concerted package, withmany opportunities for client choice. No one strategy will address all the factors


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and processes required to facilitate and promote youth engagement in desiredadult roles. Some strategies focus on self-knowledge and skill instruction, otherson competence enhancement and adjustment to life situations, and others on thereceptivity of the environment; all are needed to promote successful life outcomesfor youth. As seen in Figure 1, different strategies are conceptually related to dif-ferent short-term outcomes, with the ultimate desired outcome being multifacetedrole engagement.

Third, the existing evidence suggests that therapists providing transition servicesshould work on personal, interpersonal, and environmental levels of intervention.Client- or personal-level strategies involve skill instruction; individualizing assess-ments to help youth identify and express their interests, values, and strengths; assist-ing youth in formulating their goals in life; and providing guidance to supportyouths’ selection of experiences that correspond to their goals, values, interests, andskills. Depending on their circumstances, youth may also desire and benefit fromemotional and instrumental support (practical support and coaching), as well asinformation about services, opportunities, and other aspects of the local environ-ment. On the service system level, therapists can work with community partners toensure the availability of opportunities for participation in various roles in real-lifesettings, to strengthen linkages between agencies and organizations offering servicesor playing a role in youths’ transitions, and to strengthen the community’s ability tosupport and encourage youths’participation (G. A. King, Baldwin, et al., 2005).

Fourth, the transition strategies in this review indicate the importance of teach-ing foundational skills and providing opportunities for direct experience that pro-mote skill development, as well as adopting a client-centered approach. It istherefore important to integrate a number of intervention models in terms of clini-cal practice (a) educational models, which deal with cognitive and teaching/learningapproaches (skills training); (b) planning models (prevocational/vocationalguidance); (c) psychosocial models, which emphasize therapeutic alliance andsupport and other variables integral to promoting change; and (d) client- orfamily-centered models, which deal with the interpersonal behaviors of therapiststhat are perceived as enabling and empowering (Dunst, Johanson, Trivette, &Hamby, 1991; Johns & Harvey, 1993; S. King, Rosenbaum, & King, 1996).

Fifth, by providing a comprehensive package of optional transition services, thenature of the selected intervention strategies can be fine-tuned and customized tomeet the needs of individual clients—their priorities with respect to skill instruction,self-awareness, emotional support, community knowledge, or opportunities forreal-world experience. By sharing the gamut of possible strategies with clients andfamilies, and ascertaining what they believe would work best for them, therapistswill essentially be ensuring a fit between the adopted strategies and the belief sys-tems, real-world constraints, and home situations of clients and families.

Last, the timing of transition education and planning services is important.Therapists may find it beneficial to engage early on in dialogue with children and


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families about a vision of the child’s future and the skills, opportunities, andsupport required to attain that vision. This dialogue may involve problem solvingwith children and families to address perceived and actual barriers that may limittheir expectations for the future. For example, parents may want their child to liveindependently yet may not encourage their child’s autonomous behavior in thepresent. Concerns about physical safety and daily time pressures may causeparents to make choices for children that, with prior planning, children couldmake for themselves.

In conclusion, this review of the effectiveness of commonly used transitionintervention strategies suggests that transition services need to address issues andfactors beyond skill instruction and the tailoring of informational, emotional, andinstrumental supports to the needs of children and families. Well-rounded, coordi-nated, integrated, and comprehensive transition services also need to providedirect opportunities for skill development and to address both the welcoming andcompetence-enhancing nature of environmental settings. Well-conceived transi-tion services address environmental context, the skills of the individual, and thefit between both.

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Documents

The Effectiveness of Transition Strategies for Youth With Disabilities