Aim

To practise emergency care situations during the education can be stressful. The aim of this study is to identify factors that cause stress in simulated emergency care.

Design

A descriptive observational study.

Methods

Video recordings (N = 26) subjected to observation with written field notes in turn subjected to interpretive qualitative content analysis.

Results

To assess the patient's condition and decide what measures to take trigger stress reactions. If the students failed to connect the correct and relevant information in the conversation with the physician, the students showed signs of stress. Also, to calculate medication dosages stress the students.

Background: Children with developmental coordination disorder (DCD) often experience difficulties with handwriting legibility and speed. This study investigates the relationship between handwriting and upper limb kinematics to characterize movement patterns of children with DCD and typically developing (TD) children.

Methods: 30 children with and without DCD matched for age, gender, and parent education were compared across handwriting abilities using a standardized handwriting assessment of both copied and dictated tasks (A-A Handwriting). The 3D motion capture system (Qualysis) was used to analyze upper limb kinematics and characterize movement patterns during handwriting and contrasted with written output.

Results: Children with DCD wrote fewer legible letters in both copying and dictation. Children with DCD also showed poor automatization of key writing concepts. Atypical wrist postures were associated with reduced legibility for children with DCD (F (1,27) 4.71, p = 0.04, p = 0.04, p-η2  0.15); whereas for TD children, better legibility was associated with greater variations in movement speed, particularly of the wrist (rho = −0.578, p < 0.05).

Conclusion: Results reflect different movement parameters influencing handwriting in children with DCD. An improved understanding of the movement characteristics during handwriting of these children may assist intervention design.

Aim

Enhancement of participation has been described as the ultimate outcome for health and educational interventions. The goal of this systematic review was to identify and critically appraise studies that aimed to improve the participation outcomes of children with disabilities.

Method

Nine databases that index literature from the fields of health, psychology, and education were searched to retrieve information on research conducted with children with disabilities aged between 5 years and 18 years. Articles were included if the author(s) reported that participation was an intended outcome of the intervention. The articles included were limited to those reporting high-level primary research, as defined by Australia's National Health and Medical Research Council evidence hierarchy guidelines. No restrictions were placed on the type of intervention being investigated.

Results

Seven randomized controlled or pseudo-randomized studies were included. Only three of these studies identified participation as a primary outcome. Both individualized and group-based approaches to enhancing participation outcomes appeared to be effective. Studies of interventions with a primary focus on body function or activity level outcomes did not demonstrate an effect on participation outcomes.

Intepretation

Few intervention studies have focused on participation as a primary outcome measure. Approaches using individually tailored education and mentoring programmes were found to enhance participation outcomes, while exercise programmes, where participation was a secondary outcome, generally demonstrated little effect.

AIM:

We aimed to identify measures used to assess the participation of disabled children and to map the measures' content to the family of participation-related constructs (fPRC) to inform future research and practice.

METHOD:

Six databases were searched to identify measures used to assess participation in health, psychology, and education research. Included studies involved children aged 0 to 18 years with a permanent impairment or developmental disability and reported use of a quantitative measure of participation. A second search sought relevant literature about each identified measure (including published manuals) to allow a comprehensive understanding of the measure. Measurement constructs of frequently reported measures were then mapped to the fPRC.

RESULTS:

From an initial yield of 32 767 articles, 578 reported one or more of 118 participation measures. Of these, 51 measures were reported in more than one article (our criterion) and were therefore eligible for mapping to the fPRC. Twenty-one measures quantified aspects of participation attendance, 10 quantified aspects of involvement as discrete scales, and four quantified attendance and involvement in a manner that could not be separated.

INTERPRETATION:

Improved understanding of participation and its related constructs is developing rapidly; thoughtful selection of measures in research is critical to further our knowledge base.

WHAT THIS PAPER ADDS:

The fPRC can support our rapidly evolving and expanding understanding of participation. Instruments selected to measure participation do not always align with emerging concepts. Matching research aims to a chosen measure's content will improve understanding of participation. Opportunities exist to develop validated participation measures, especially self-reported measures of involvement.

Objective:This study explored how professionals in interdisciplinary teams perceived the implementation of the World Health Organization’s International Classification of Functioning, Disability and Health, version for Children and Youth (ICF-CY) in Swedish habilitation services.

Design:Descriptive longitudinal mixed-methods design.

Methods:Following participation in a 2-day in-service training on the ICF-CY, 113 professionals from 14 interdisciplinary teams described their perceptions of the implementation of the ICF-CY at 3 consecutive time-points: during in-service training, after 1 year, and after 2.5 years.

Results:Implementation of the ICF-CY in daily work focused on assessment and habilitation planning and required adaptations of routines and materials. The ICF-CY was perceived as useful in supporting analyses and in communication about children’s needs. Professionals also perceived it as contributing to new perspectives on problems and a sharpened focus on participation.

Conclusion:Professionals indicated that the ICF-CY enhanced their awareness of families’ views of child participation, which corresponded to organizational goals for habilitation services. An implementation finding was a lack of tools fitting the comprehensive ICF-CY perspective. The study points to the need for ICF-CY-based assessment and intervention methods focusing on child participation.

Purpose: The aim was to determine professionals’ views of everyday life situations (ELS) of importance for children and to explore how ELS correlate with the construct ‘Participation’. This study was part of a larger work to develop a structured tool with code sets to identify child participation and support children with disabilities to describe what matters most for them in intervention planning.

Method: The study had a concurrent mixed methods design. Information from one open-ended question and questionnaires were linked to the ICF-CY component Activities and Participation. Two concurrent data sets were compared.

Results: Proposed ELS were distributed across ICF-CY categories from low to high level of complexity and context specificity. The correlation with participation became stronger for the later chapters of the component (d7-d9). Differences between respondents due to working field, country, and children’s ages were explored. Acts and tasks seemed most important for the youngest children whereas ELS shifted towards societal involvement for adolescents.

Conclusion: Eleven categories related to ICF-CY chapters d3-d9 emerged as ELS. Two age groups (infants/preschoolers and adolescents) are required to develop code sets for the new tool. The results need triangulation with other concurrent studies to provide corroborating evidence and add a family perspective.

Background: Children with cerebral palsy (CP) face particular challenges, e.g. daily pain that threaten their participation in school activities. This study focuses on how teachers, personal assistants, and clinicians in two countries with different cultural prerequisites, Sweden and South Africa, manage the pain of children in school settings.

Method: Participants’ statements collected in focus groups were analysed using a directed qualitative content analysis framed by a Frequency of attendance-Intensity of involvement model, which was modified into a Knowing-Doing model.

Results: Findings indicated that pain management focused more on children’s attendance in the classroom than on their involvement, and a difference between countries in terms of action-versus-reaction approaches. Swedish participants reported action strategies to prevent pain whereas South African participants primarily discussed interventions when observing a child in pain.

Conclusion: Differences might be due to school- and healthcare systems. To provide effective support when children with CP are in pain in school settings, an action-and-reaction approach would be optimal and the use of alternative and augmentative communication strategies would help to communicate children’s pain. As prevention of pain is desired, structured surveillance and treatment programs are recommended along with trustful collaboration with parents and access to “hands-on” pain management when needed.

Participation as a construct can be applied on all ecological levels from participation for individual children in their everyday life to participation for all as a societal goal. It is defined in the ICF-CY as involvement in a life situation. Participation is occurring at the nodal point between children and their environments. Contexts vary with socio-economical standards, culture and geographical characteristics and thus also the expressions of participation. This presentation will discuss cultural diversity in children’s participation in relation to the universal characteristics of participation defined as “being there” and participation defined as “degree of engagement while being there”. The utility of the ICF-CY as a tool to analyze universal characteristics and cultural diversity in conditions for, and actual experiences of, participation are examined in findings from five studies: 1) Maxwell et al. have analyzed national, regional and local educational policy documents in Scotland and Sweden regarding children in need of special support  in relation to conditions for participation and participation; 2) Ståhl et al. have linked and compared ICF-CY codes to information regarding children’s health in Child Health Care and School Health Care and analyzed whether biomedical or participation information is the focus of the information; 3) Adolfsson et al. have collected and compared data from respondents in Sweden, the USA, and Portugal concerning what professionals consider to be important everyday situations for child participation; 4) Klang et al. has studied domains of participation and environment related to child and caregiver interaction in a Russian context to identify factors related to participation; and 5) Ullenhag et al. have studied participation in  leisure activities and  leisure activity preferences  of Swedish children and compared with data from the Netherlands and Canada using the same questionnaire.

Purpose. This study was part of a larger work to develop an authentic measure consisting of code sets for self- or proxy-report of child participation. The aim was to identify common everyday life situations of children and youth based on measures of participation.

Method. The study was descriptive in nature and involved several stages: systematic search of literature to find articles presenting measures for children and youth with disabilities, identifying measures in selected articles, linking items in included measures to the ICF-CY, analysing content in measures presented as performance and participation and identifying aggregations of ICF-CY codes across these measures.

Results. A large number of measures for children and youth with disabilities were identified but only 12 fulfilled the inclusion criteria. A slight distinction in content and age appropriateness appeared. Measures presented as performance covered all the ICF-CY Activities and Participation chapters, whereas measures presented as participation covered five of nine chapters. Three common everyday life situations emerged from the measures: Moving around, Engagement in play and Recreation and leisure.

Conclusion. Only a small number of life situations for children and youth emerged from items in selected measures, thus, other sources are needed to identify more everyday life situations.

Child Participation is defined by the International Classification of Functioning, Disability and Health forChildren and Youth (ICF-CY) as involvement in life situations but knowledge on children´s specific everydaylife situations (EDLs) is lacking. Professionals in early intervention services need a structured tool to identifyand assess child participation in everyday life situations. It should support children with disabilities indescribing what matters most for them in intervention planning. With the long term goal to create ICF-CY codesets, EDLs were identified by a systematic literature search for measures of performance or participation andby collecting professional opinions on EDL and participation. Information was linked to the ICF-CY andtriangulated with research exploring family opinions. Most items in measures were linked to moving around,play, and recreation and leisure. The six measures of performance and six of participation differed regardingcontent and content dependent on age group.Descriptions on EDLs from 297 professionals were linked to ICF-CY codes. Frequent linkages were Self-care,such as eating and hygiene; Major life areas, such as play and education; and Relationships, but also sleep. Byrelating EDLs directly to predefined ICF-CY categories in the ICF-CY component Activities and Participation,five EDLs across categories were identified based on responses from 207 professionals. These concernedsleep, communication, dressing, family relationships and play. Some differences emerged dependent onparticipants’ culture and on age group. A triangulation between professional and family opinions concerningEDL’s revealed relatively high agreement. As a final result, a set of approximately 12-15 everyday lifesituations is expected to be identified in this study to be used for development of code sets.

Background: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs.

Objective: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs.

Methods: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses.

Results: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken.

Conclusions: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons.

Implications for Rehabilitation: The users should have access to specially trained prescribers. There is a need for development of user-friendly and manageable products to function in any climate. Knowledge is lacking on how to implement the users in all stages of the prescribing process. Prescribers should increase knowledge in the use of EPDs to influence the attitudes of the social environment.

BACKGROUND:

Individuals diagnosed with autism spectrum disorder (ASD) experience impairing challenges in social communication and interaction across multiple contexts. While social skills group training (SSGT) has shown moderate effects on various sociability outcomes in ASD, there is a need for (1) replication of effects in additional clinical and cultural contexts, (2) designs that employ active control groups, (3) calculation of health economic benefits, (4) identification of the optimal training duration, and (5) measurement of individual goals and quality of life outcomes.

METHOD/DESIGN:

With the aim of investigating the efficacy and cost-effectiveness of a SSGT, KONTAKT©, a two-armed randomized control trial with adolescents aged 12-17 years (N = 90) with ASD and an intelligence quotient (IQ) of over 70 will be undertaken. Following stratification for centre and gender, participants will be randomly assigned to either KONTAKT© or to an active control group, a group-based cooking programme. Participants will attend both programmes in groups of 6-8 adolescents, over 16 one-and-a-half-hour sessions. The primary outcome examined is adolescent self-rated achievement of personally meaningful social goals as assessed via the Goal Attainment Scaling during an interview with a blinded clinician. Secondary outcomes include adolescent self-reported interpersonal efficacy, quality of life, social anxiety, loneliness, face emotion recognition performance and associated gaze behaviour, and parent proxy reports of autistic traits, quality of life, social functioning, and emotion recognition and expression. Cost-effectiveness will be investigated in relation to direct and indirect societal and healthcare costs.

DISCUSSION:

The primary outcomes of this study will be evidenced in the anticipated achievement of adolescents' personally meaningful social goals following participation in KONTAKT© as compared to the active control group. This design will enable rigorous evaluation of the efficacy of KONTAKT©, exercising control over the possibly confounding effect of exposure to a social context of peers with a diagnosis of ASD.

TRIAL REGISTRATION:

Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12617001117303. Registered on 31 July 2017. anzctr.org.au ClinicalTrials.gov, NCT03294668. Registered on 22 September 2017. https://clinicaltrials.gov.

This study examines how children report abuse, neglect and behavioural problems and what authorities they claim to have had contact with that are legally mandated to report to the Child Welfare Services, e.g. health services and police. It draws data from a longitudinal research programme, LoRDIA, in which four data collections followed adolescents’ development from 12 to 15 years (n = 1884). A total of 61 indicators of self-reported child abuse, neglect and behavioural problems were constructed to identify children with severe exposure so that each indicator would have prompted referral. The main finding is that 445 (25.3%) of the study population reported severe exposure of this magnitude. Among these self-reported severely exposed children (SSE), boys reported higher rates of child neglect and of overall behavioural problems, specifically criminal and other socially destructive behaviour. Poverty and living in single-parent households significantly increase the risk of abuse, neglect, and behavioural problems. Increased risk of neglect and criminal behaviour were found for children studying Swedish as second language. The SSE children more than other children report contact with all authorities with mandatory reporting. Odds ratios of contact were higher in the case of behavioural problems compared to the odds ratios for abuse and neglect.

OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.

METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.

RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.

CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.

Facial recognition is a complex skill necessary for successful human interpersonal and social interactions. Given that the most prevalent disorder of social interaction is autism spectrum disorder (ASD), a number of studies have investigated and found impaired facial recognition abilities in people with ASD. Further, this impairment may be critically involved in mediating the deficits in interpersonal and social interactions in people with ASD. We sought to address the question of whether face processing is impaired in children with ASD in the current study. While there were a number of differences in visual search behaviours between the 19 children with ASD and the 15 controls, this did not manifest in deficits in facial recognition accuracy. In addition, there were notable differences with respect to eye fixation behaviours and recognition accuracy in this study compared to the findings in a previous similar study conducted in adults with ASD. These differences suggest a performance enhancing developmental trajectory in facial processing in controls that may not be present in individuals with ASD.

Recently, there has been heightened interest in suggestions of enhanced visual acuity in autism spectrum disorders (ASD) which was sparked by evidence that was later accepted to be methodologically flawed. However, a recent study that claimed children with ASD have enhanced visual acuity (Brosnan et al. in J Autism Dev Disord 42:2491–2497, 2012) repeated a critical methodological flaw by using an inappropriate viewing distance for a computerised acuity test, placing the findings in doubt. We examined visual acuity in 31 children with ASD and 33 controls using the 2 m 2000 Series Revised Early Treatment Diabetic Retinopathy Study chart placed at twice the conventional distance to better evaluate possible enhanced acuity. Children with ASD did not demonstrate superior acuity. The current findings strengthen the argument that reports of enhanced acuity in ASD are due to methodological flaws and challenges the reported association between visual acuity and systemising type behaviours.

In Sweden, Early Childhood Education and Care is a right for every child and children in need of special support have access to these provisions in inclusive mainstream settings. National evaluations show great quality variations in special educational support in preschools and schools across the country. A Multicenter Research School with 10 PhD students from four Universities and international partners has been funded (2018- 2021) by the Swedish Research Council to develop knowledge in early intervention. Preschool/school environments are assessed and tailored interventions at unit or child level are developed. The projects are built on previous research and identified needs in research and practice. The theoretical framework for the Research School will be described, results from a systematic review of previous research and specific plans for various topics (engagement, early literacy, expressive language development, socio- emotional development, self-regulation) will be presented and linked to the theoretical framework.

Background: Little is known about whether individuals with autism spectrum disorder (ASD) or attention deficit hyperactive disorder (ADHD) experience any specific facilitators or barriers to driving education.

Objective: To explore the facilitators or barriers to driving education experienced by individuals with ASD or ADHD who obtained a learner’s permit, from the perspective of the learner drivers and their driving instructors.

Methods: Data were collected from 33 participants with ASD or ADHD, and nine of their driving instructors.

Results: Participants with ASD required twice as many driving lessons and more on-road tests than those with ADHD. Participants with ADHD repeated the written tests more than those with ASD. Driving license theory was more challenging for individuals with ADHD, whilst individuals with ASD found translating theory into practice and adjusting to “unfamiliar” driving situations to be the greatest challenges.

Conclusion: Obtaining a driving license was associated with stressful training experience.

BACKGROUND

Feeling accepted by peers is important for young people's health but few studies have examined the overall degree of acceptance in school and its health consequences. The purpose of the study was to investigate whether health complaints among Swedish students can be attributed to the acceptance climate in their school class even when the health effects of their own (individual) acceptance score have been taken into account.

METHODS

The data used were from the Health Behaviour in School-aged Children (HBSC) study for the years 2001 to 2002, 2005 to 2006, and 2009 to 2010, consisting of 13,902 5th-, 7th-, and 9th-grade Swedish students nested into 742 school classes. The statistical analyses were performed by means of linear regression multilevel analysis.

RESULTS

The results indicated that the variation in subjective health complaints could be ascribed partly to the school-class level (boys: 5.0%; girls: 13.5%). Peer acceptance at the individual level demonstrated a clear association with health: the lower the acceptance, the higher the complaint scores. For girls, but not for boys, the overall degree of peer acceptance in the school class demonstrated a contextual effect on health, net of acceptance at the student level. Interaction analyses also revealed an increasingly favorable health among poorly accepted girls as the acceptance climate in the school class declined.

CONCLUSIONS

A lower overall degree of peer acceptance in the school class is associated with poorer health among girls. However, girls who themselves feel poorly accepted are not as negatively affected health-wise by a poor acceptance climate, as are well-accepted girls.

This study investigated patterns of interrelated positive subject and environmental factors related to participation in school activities of pupils with different kinds of disabilities. Questionnaires concerning participation were collected from 472 pupils with disabilities and their teachers, parents and special education consultants. A person-oriented approach with the aim to identify patterns of variables related to a high degree of participation of pupils with disabilities was used. Cluster-groups were formed based on scores for individual subjects on factors identified as important for participation. Groups with a high degree of participation were characterized by high scores in autonomy and perceived interaction with peers and teachers and an internal locus of control. Type and degree of disability did not predict cluster group membership. A conclusion is that the outcome participation is better predicted by patterns of interrelated positive subject and environmental factors than by type of disability or any other single factor.

It is of concern that some children, even at a young age, are less engaged than others. Findings indicate that children of other ethnicities are less engaged in preschool activities than their Swedish peers. They also more commonly display behaviour difficulties. Such negative patterns tend to be stable over time. Provision of special support in preschool could change this; however children of other ethnicities have been found to be less supported in preschool, compared to Swedish children. This study aimed to explore longitudinal typical patterns of engagement and behaviour of children of Swedish and other ethnicities in Swedish preschools and the association with special support provision. Data were collected at three time points (n=197; 110 boys; 48 of other ethnicities; 15-57 months). A longitudinal pattern analysis revealed five stable types, examined regarding the influence of provision of support and proportion of children with other ethnicities.

Health is today viewed as a multi-dimensional concept partly conceptualized independent from not being ill. The aim of this study was to gain knowledge of how young children perceive health. Interviews were conducted with 68 children (4–5 years), within their pre-school setting, with the help of a semi-structured interview guide. A multi-dimensional perspective represented by the health dimensions of the International Classification of Functioning, Disability and Health (ICF) was used in a manifest deductive content analysis. The children's statements were categorized and placed under one of the four health dimensions, body, activity, participation and environment. A latent content analysis was applied to identify underlying themes in the manifest categories. The results revealed that young children perceive health as a multi-dimensional construct, largely related to being engaged, i.e. to be able to perform wanted activities and participate in a supportive every-day context. This implies that improvements of child engagement should be emphasized in health promotion and to a greater extent be the central focus of health interventions for young children

The Swedish preschool curriculum stipulates that all children independent of support needs should attend mainstream preschool groups, with equal opportunities for learning and engagement. Preschool teachers are responsible for paying attention to children in need of special support to achieve this. How support is provided for children in need of special support due to behavior difficulties in Swedish preschools varies, however. Some children, often formally identified as in need of special support, are supported by preschool staff supervised by external services. Other children receive support initiated and implemented by preschool staff, without supervision from external services. A further number of children receive no support for behavior difficulties, on top of what is provided to all children. This study investigated associations between support format (i.e. supervised support, staff-initiated support or no additional support), support content (i.e. implementation of support), behavior difficulties, socio-demographics and engagement. A mixed methods approach was used with a sample of 232 preschool children 15 to 71 months with assessed behavior difficulties. Preschool staff reported on the children's engagement, behavior difficulties, socio-demographics and support provision. Logistic regression models were used to analyze the probability of children receiving either support format. Content analysis was used to categorize the support content, reported by preschool staff through open-ended questions. Point-biserial correlations were used to test associations between support content, behavior, socio-demographics and engagement. All children receiving supervised support for behavior difficulties were formally identified by external services as in need of special support. Supervised support was also more common if children disturbed the free play in the preschool group, with the most frequent support being collaboration with external teams. Staff-initiated support was most commonly given to children with high engagement, and for children who are not early second language learners. These children were most frequently supported by staff paying attention to negative behavior. Children who were not perceived as a burden to the group were less likely to receive any form of additional support. Ways of managing the preschool group seem to guide support strategies for children with behavior difficulties, rather than child-focused strategies emphasizing engagement in everyday activities.

Under 2015 genomfördes nationella lärandeseminarier för att stärka implementeringen av den lag som ger barn rätt till information, råd och stöd när en förälder plötsligt avlider, är svårt sjuk eller skadad (HSL 2g §). Satsningen var ett förbättringsarbete som omfattade sex landsting som med hjälp av en projektledning träffades vid fyra tillfällen från januari till september. Två av träffarna skedde i Stockholm och två var digitala. Under våren 2015 knöts följeforskning till arbetet med frågeställningar om vilka resultat förbättringsarbetet gav och hur deltagarna upplevde arbetssättet. Syftet var att lyfta fram vad satsningen gav samt att lära inför framtida satsningar – är lärandeseminarier ett användbart arbetssätt för nationella implementeringssatsningar?

Rapporten visar att lärandeseminarier tycks vara en användbar form. Teamen kan redovisa att de uppnått många av de mål som de föresatte sig under projekttiden. Det handlade om kartläggning av kunskapsläge och strukturer, kompetensutveckling samt utveckling av rutiner och material. Teamen uppskattade också att få delta i ett nationellt sammanhang som gav inspiration. Samtidigt framkom det önskemål om fortsatt och ännu mer handfast stöd i fortsatt implementering i klinisk verksamhet.

Breakthrough Collaborative (BC) aims at learning through networking, mainly at micro level, and is used as a tool to improve care and welfare organizations. The aim of this study was to explore and illuminate the challenges when applying BC model at meso and macro level. In 2010, the Swedish Health and Medical Services Act stated the responsibility of healthcare professionals to consider children’s needs as relatives. This study uses an interactive collaborative research model. To support healthcare organizations in the implementation of the regulation, county councils/regions in Sweden were invited to take part in a BC during 2015. Six teams from different county councils/regions participated. Team members were interviewed several times during the project time. Data were analyzed with an explorative and descriptive qualitative content analysis. The result illuminates the challenges faced when applying BC at meso and macro level. Most challenges concern preparation, support structures and system connections. There are similarities with the challenges met at micro level when BC is used at meso and macro level. But it seems even more important to consider how the team is constituted at meso and macro level to make use of the learnings and achieve long-term impact in the home organization.

The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.

Aim/Introduction: An 18F-FDG-PET/CT examination requires the patient to follow instructions before and during the examination procedure to ensure a high image quality. There is thus a need to develop ways to ensure that patients absorb the information given in connection with the examination. Aim To develop communication support for information sharing related to an18F-FDG-PET/CT examination. Materials and Methods: The study has a qualitative design adapting a multiphase structure. A prototype of the communication support consisting of illustrations and text related to an 18F-FDG-PET/CT examination was developed. Interviews were conducted with patients scheduled for an 18F-FDG-PET/CT examination for the frst time and questionnaires were collected from health care professionalswith experience of 18F-FDG-PET/CT. The communication support was revised until consensus about the material. Results: The results are based on interviews with patients (n=10) and questionnaires collected from health care professionals (n=9).The overall theme revealed that information in conjunction with the 18F-FDG-PET/CT examination is a balancing act betweentext and illustrations. The analysis showed two categories;“illustrations as a complement” and “easy to understand lay-out”. Conclusion: The participants strengthened the development of the communication-support by bringing in valuable viewpoints from various perspectives. The results support a person-centered approach, where the information in conjunction with an 18F-FDGPET/CT examination can be adapted to each patient’s needs as a balancing act between text and illustrations.

Our aim was to develop communication support material for information sharing related to an ¹⁸F-FDG PET/CT examination.

Methods: The study had a qualitative design adapting a multiphase structure. A prototype of communication support material consisting of illustrations and text related to an ¹⁸F-FDG PET/CT examination was developed. Interviews were conducted with patients scheduled for an ¹⁸F-FDG PET/CT examination for the first time, and questionnaires were collected from health care professionals with experience in ¹⁸F-FDG PET/CT. The communication support material was revised until consensus was reached about it.

Results: The results are based on interviews with patients (n = 10) and questionnaires collected from health care professionals (n = 9). The overall theme revealed that patient information about an ¹⁸F-FDG PET/CT examination is a balancing act between text and illustrations. The analysis showed 2 categories: "illustrations as a complement" and "easy-to-understand layout."

Conclusion: The participants strengthened the development of the communication support material by bringing in valuable viewpoints from various perspectives. The results support a person-centered approach in which information about an ¹⁸F-FDG PET/CT examination can be adapted to each patient's needs as a balancing act between text and illustrations.

Introduction

Nonsuicidal self-injury (NSSI) is a common and concerning behavior in adolescents. However, most adolescents cease NSSI as they transition into adulthood. Increased knowledge of the cessation process is needed. This study aimed to qualitatively explore the factors contributing to NSSI cessation in individuals with lived experience of NSSI, providing valuable insights for treatment strategies.

Methods

Twenty-six individuals assigned female sex at birth, between ages 20-22 years, from Sweden were interviewed between 2021 and 2023 in Linköping, Sweden. Of these, 21 individuals perceived themselves as having ceased NSSI and were included in the analysis. Thematic analysis and Hooley and Franklins' Benefits and Barriers Model of NSSI were used to analyze the transcripts.

Results

Three overarching themes were generated: "Something inside me changed", "Something in my close relationships changed", and "Something in my life context changed". The cessation of NSSI was associated with several key factors. Improved well-being and envisioning a different future were pivotal in initiating the cessation process. Additionally, interpersonal relationships and support from others were interpreted as powerful motivators for change. Transitioning to a new social context and leaving behind a destructive environment provided opportunities for personal growth and enhanced well-being, interpreted as initiators in the participants' broader life context.

Conclusion

This study underscores the complexity of the NSSI cessation process and highlights the need for a comprehensive understanding of the underlying factors. Access to emotion regulation skills was perceived as a significant barrier to NSSI engagement. Clinical implications and different interventions to support NSSI cessation are discussed.

PURPOSE: To describe how parents with deafblindness experience parenting and family life.

MATERIALS AND METHODS: This a qualitative interview study. Fourteen parents with deafblindness were interviewed. Most were mothers (n = 10), with ages ranging between 33 and 57 years (mean 46 years). Interviews were transcribed, and the analysis was done using inductive qualitative content analysis.

RESULTS: The analysis resulted in the overarching theme, 'Living family life as a parent with deafblindness is not a walk in the park, but it is rewarding', and three subthemes, 'Being a competent parent despite having deafblindness', 'Needing support to fulfil my parental obligations' and 'Parenting is a struggle due to my deafblindness'. The results encompass many experiences and feelings and illustrate the complex reality of these parents in their parental role and family life.

CONCLUSION: The parents expressed their joy in being parents, but these feelings were intertwined with negative aspects of being unable to take on the desired responsibility or not receiving the necessary support. When requested, tailored support should be offered from social services, health care and rehabilitation services in order for parents with deafblindness to take on the parental responsibility they want and to be able to actively participate in family life.

AIM: To investigate strategies used by professionals in pediatric rehabilitation to engage children in every step of the intervention process, including assessment, goal setting, planning and implementation of the intervention, and results evaluation.

METHODS: A scoping literature review was conducted, and seven databases were searched, including CINAHL and MEDLINE, ProQuest Central, PsycINFO, Social Science Premium Collection, PubMed, and Web of Science. A citation search of included articles was completed. Predetermined criteria, quality standards, and PIO framework guided the selection process. Results were presented in relation to Self-Determination Theory (SDT) and the contextual model of therapeutic change.

RESULTS: In total, 20 studies were included in the review. Pediatric professionals reported that therapeutic use of self and their own engagement in the intervention facilitated the establishment of a supportive relationship. Providing clear explanations about their role and therapy rationale developed positive expectations. By making the child feel successful within-session and outside-session activities, professionals enhanced child mastery. Professionals' strategies were abstractly described.

CONCLUSIONS: Further research is needed to investigate strategies that are effective in the different steps of the intervention. More observational, longitudinal studies are required to capture fluctuations in in-session engagement.