Mental health practices in rehabilitation for youth with physical disabilities: a chart review study

Abstract

Purpose

Evidence on co-occurring mental health problems in youth with physical disabilities is growing, however how services are provided remains unclear. This study examined current interprofessional rehabilitation practices for physical and mental health services.

Methods

Youth (aged 15–24) followed for a physical disability that had mental health problems were identified. Chart reviews were used to identify practices. Mental health-related diagnoses/symptoms, assessments, goals, interventions, and referrals were extracted for inductive content analysis.

Results

Sixty charts were reviewed. Mental health problems included anxiety (n = 53), depression (n = 25), neurodevelopmental (n = 19) and personality disorders (n = 8), often (n = 36) citing more than one. No mental health assessments were found, and in 43%, no goals or interventions were evident. Relevant goals (n = 98) targeted emotional management, autonomy/communication of needs, acceptance of physical condition, socialization, routines/energy levels, school/work supports, and leisure/calming environments. Interventions (n = 104) included emotional management, formal individual/group therapy, links with external supports, routines/activities, reflection/acceptance, and school/work support. Mental health services were received in-house (n = 24) and/or externally (n = 30), plus 18 referrals pending and 14 not referred.

Conclusion

Many had more than one mental health problem, suggesting the complexity of their condition. While some mental health goals/interventions are documented, problems may often not be reported or addressed in this context.

IMPLICATIONS FOR REHABILITATION

• Further attention can be directed to the needs of youth with physical disabilities and co-occurring mental health problems as they are not fully addressed by current interdisciplinary rehabilitation practices.

• Follow-up (services and referrals) should be adapted to the holistic needs of youth and their goals within the rehabilitation context.

• Rehabilitation professionals can be provided with training to build workforce capacity in mental health screening and have access to guidance when addressing situations related to mental health or referring to external services.

Keywords:

• Rehabilitation
• mental health
• interdisciplinary practices
• integrated care
• co-occurrence
• chart review

Acknowledgements

We extend our thanks to the research coordinators, managers, and clinicians for recruitment assistance.

Conflicts of interest and sources of funding

No conflicts of interest were declared. SMT received a training award from the Fonds de recherche du Québec - Santé (FRQS; #313915). SL is supported by a Canada Research Chair in Innovations for Youth Mental Health. MAF is supported by a Canada Research Chair in Youth Mental Health. DRA is supported by the FRQS Research Scholar Award.