Factors of Service Utilization and Participation Outcomes of Children with Disabilities

Abstract

Home and community participation is measured by a multitude of determinant factors based within the context of a health system. Three studies were completed to understand relationships between environment and personal factors with service utilization and outcomes of participation among children with disabilities. In the first study, a scoping review was completed to identify factors that influenced rehabilitation service utilization among Canadian children with disabilities. Key findings of this review indicated higher rates of service utilization are associated to younger age, males and those with lower cognitive or motor functioning. Occupational therapists, physiotherapists and speech-language pathologists were the most commonly utilized disciplines. Higher perceptions of service satisfaction related to increased presence of family-centered practices. Areas requiring further research include family needs, barriers, personal health practices and participation outcomes. Based on the findings of this review, a survey was created to administer to parents using a large children’s rehabilitation treatment centre in Ontario. Findings from the survey conducted with 279 parents are reported in the second study by providing a descriptive profile of families and children using geographically-based rehabilitation services. Families using the centre typically have younger aged children, with more boys than girls, and a large proportion use the centre for speech services. Complexity scores correlated significantly and positively with service need and service utilization, indicating children with lower functioning desired and received more rehabilitation services. Age, sex, and diagnosis did not predict total time in therapy, but complexity was a significant predictor of total time in therapy. Participation frequency scores showed weaker relationships to complexity in comparison to participation involvement scores. The final study explored the relationship between environmental and personal factors of service utilization and participation using structural equation modeling. Predictors of participation include child’s age, environmental barriers, complexity, and mother’s participation. Findings support that exploring children’s complexity and promoting mother’s participation by removing environmental barriers and modifying inaccessible structures are important to examine from a young age.