The Effectiveness of Transition Strategies for Youth With Disabilities

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  • This article was downloaded by: [University of Cambridge]On: 13 October 2014, At: 07:43Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

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

    To cite this article: Gillian A. King , Patricia J. Baldwin , Melissa Currie & Jan Evans(2006) The Effectiveness of Transition Strategies for Youth With Disabilities, Children'sHealth Care, 35:2, 155-178, DOI: 10.1207/s15326888chc3502_4

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  • CHILDRENS HEALTH CARE, 35(2), 155178Copyright 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 Childrens 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 Childrens Centre, 779 BaseLine Road East, London, Ontario, Canada N6C 5Y6. E-mail: gilliank@tvcc.on.ca

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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 thechilds 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 childs and familys 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(Muoz, 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

    156 KING, BALDWIN, CURRIE, EVANS

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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 efforton 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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  • 158 KING, BALDWIN, CURRIE, EVANS

    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, personenvironment 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 HealthOrganizations (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 persons 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, personenvironment, andenvironmental levels of intervention.

    In the following sections, we present the 10 most commonly used transitionstrategies according to Bronfenbrenners (1979) framework: (a) personal levelstrategies (i.e., skill instruction and self-awareness), (b) competence-enhancingstrategies involving the personenvironment 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 individualin 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...

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