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/></a></div><div class="bkr_bib"><h1 id="_NBK579718_"><span itemprop="name">Evidence review for supporting participation in education and social activities</span></h1><div class="subtitle">Disabled children and young people up to 25 with severe complex needs: integrated service delivery and organisation across education, health and social care</div><p><b>Evidence review F</b></p><p><i>NICE Guideline, No. 213</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 Mar</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4460-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div><div class="bkr_clear"></div></div><div id="niceng213er6.s1"><h2 id="_niceng213er6_s1_">Supporting participation in education and social activities</h2><p>
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<b>Recommendations supported by this evidence review</b>
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</p><p>This evidence review supports recommendations 1.7.1 – 1.7.7, 1.17.14. Other evidence supporting these recommendations can be found in the evidence reviews on Views and experiences of service users (evidence report A), Barriers and facilitators of joined-up care (evidence report K), Views and experiences of service providers (evidence report M).</p><div id="niceng213er6.s1.1"><h3>Review question</h3><p>What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</p><div id="niceng213er6.s1.1.1"><h4>Introduction</h4><p>This review aims to determine effective combined approaches to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities.</p><p>At the time of scoping and developing the review protocols, documents referred to health, social care and education in accordance with NICE style. When discussing the evidence and making recommendations, these services will be referred to in the order of education, health and social care for consistency with education, health and care plans.</p></div><div id="niceng213er6.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK579718/table/niceng213er6.tab1/?report=objectonly" target="object" rid-figpopup="figniceng213er6tab1" rid-ob="figobniceng213er6tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng213er6tab1"><a href="/books/NBK579718/table/niceng213er6.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng213er6tab1" rid-ob="figobniceng213er6tab1"><img class="small-thumb" src="/books/NBK579718/table/niceng213er6.tab1/?report=thumb" src-large="/books/NBK579718/table/niceng213er6.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO table)." /></a><div class="icnblk_cntnt"><h4 id="niceng213er6.tab1"><a href="/books/NBK579718/table/niceng213er6.tab1/?report=objectonly" target="object" rid-ob="figobniceng213er6tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For further details see the review protocol in <a href="#niceng213er6.appa">appendix A</a>.</p></div><div id="niceng213er6.s1.1.3"><h4>Methods and processes</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng213er6.appa">appendix A</a> and the methods document (<a href="/books/NBK579718/bin/niceng213er6_bm1.pdf">Supplement A</a>).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng213er6.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng213er6.s1.1.4.1"><h5>1.1.1.1. Included studies</h5><p>Five studies were included for this review, 1 randomised controlled trial (RCT; <a class="bibr" href="#niceng213er6.ref1" rid="niceng213er6.ref1">Asmus 2017</a>), 2 cluster RCTs (<a class="bibr" href="#niceng213er6.ref3" rid="niceng213er6.ref3">George 2011</a> and <a class="bibr" href="#niceng213er6.ref5" rid="niceng213er6.ref5">Selanikyo 2017</a>), 1 retrospective cohort study (<a class="bibr" href="#niceng213er6.ref2" rid="niceng213er6.ref2">Bent 2002</a>), and 1 before and after study (<a class="bibr" href="#niceng213er6.ref4" rid="niceng213er6.ref4">Hoehne 2020</a>). One of the cluster RCTs (<a class="bibr" href="#niceng213er6.ref3" rid="niceng213er6.ref3">George 2011</a>) only reported outcome data of interest for the intervention group and, therefore, was treated as a before and after study.</p><p>The included studies are summarised in <a class="figpopup" href="/books/NBK579718/table/niceng213er6.tab2/?report=objectonly" target="object" rid-figpopup="figniceng213er6tab2" rid-ob="figobniceng213er6tab2">Table 2</a>.</p><p>Three studies looked at the effectiveness of 1:1 support (<a class="bibr" href="#niceng213er6.ref3" rid="niceng213er6.ref3">George 2011</a>, <a class="bibr" href="#niceng213er6.ref4" rid="niceng213er6.ref4">Hoehne 2020</a> and <a class="bibr" href="#niceng213er6.ref5" rid="niceng213er6.ref5">Selanikyo 2017</a>), 1 study compared a multidisciplinary team to ad-hoc services (<a class="bibr" href="#niceng213er6.ref2" rid="niceng213er6.ref2">Bent 2002</a>) and 1 study compared a peer support network with no peer-mediated intervention (<a class="bibr" href="#niceng213er6.ref1" rid="niceng213er6.ref1">Asmus 2017</a>).</p><p>See the literature search strategy in <a href="#niceng213er6.appb">appendix B</a> and study selection flow chart in <a href="#niceng213er6.appc">appendix C</a>.</p></div><div id="niceng213er6.s1.1.4.2"><h5>1.1.1.2. Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng213er6.appj">appendix J</a>.</p></div></div><div id="niceng213er6.s1.1.5"><h4>Summary of studies included in the effectiveness evidence</h4><p>Summaries of the studies that were included in this review are presented in <a class="figpopup" href="/books/NBK579718/table/niceng213er6.tab2/?report=objectonly" target="object" rid-figpopup="figniceng213er6tab2" rid-ob="figobniceng213er6tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng213er6tab2"><a href="/books/NBK579718/table/niceng213er6.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng213er6tab2" rid-ob="figobniceng213er6tab2"><img class="small-thumb" src="/books/NBK579718/table/niceng213er6.tab2/?report=thumb" src-large="/books/NBK579718/table/niceng213er6.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng213er6.tab2"><a href="/books/NBK579718/table/niceng213er6.tab2/?report=objectonly" target="object" rid-ob="figobniceng213er6tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng213er6.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng213er6.appe">appendix E</a>).</p></div><div id="niceng213er6.s1.1.6"><h4>Summary of the effectiveness evidence</h4><p>Overall, the 1:1 support interventions either showed an important benefit for participation and social interaction or showed no important difference in these outcomes. Specifically, there was evidence that the Pathways and Resources for Engagement and Participation intervention possibly increased frequency and diversity of participation in the community. There was some evidence of an important reduction in frequency of participation at home following this intervention but this was viewed as being due to an important increase in time spent within community settings. There was no important difference in other measures of participation and inclusion across the community, home and school settings before and after the intervention. The Collaborative Consultation Participation of Students with Intellectual and Developmental Disabilities intervention showed important improvements on scores of communication and choosing behaviours in the classroom, but no differences in scores for initiating. An adapted fitness programme showed an important increase in the number of positive social interactions occurring during group activity between the first and second half of this programme, but there were no differences in the number of social interactions outside of group activities. There was evidence of important increases in participation restriction scores (with higher scores representing better outcomes) with young adult teams compared with an ad-hoc service approach.</p><p>Peer support networks showed important increases in the number of social contact and friendship gains relative to standard practice with no peer-mediated interventions. However, there were no important differences in social skills between groups or the number of school activities children and young people were involved in.</p><p>Five studies were identified for this review question but the evidence was very low to low quality, from single studies and seriously imprecise. Further, none of the included studies reported progress in learning or educational achievement or attainment.</p><p>See <a href="#niceng213er6.appf">appendix F</a> for full GRADE tables.</p></div><div id="niceng213er6.s1.1.7"><h4>Economic evidence</h4><div id="niceng213er6.s1.1.7.1"><h5>1.1.1.3. Included studies</h5><p>A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.</p><p>A single economic search was undertaken for all topics included in the scope of this guideline. See <a href="/books/NBK579718/bin/niceng213er6_bm2.pdf">Supplement B</a> for details.</p></div><div id="niceng213er6.s1.1.7.2"><h5>1.1.1.4. Excluded studies</h5><p>Economic studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng213er6.appj">appendix J</a>.</p></div></div><div id="niceng213er6.s1.1.8"><h4>Summary of included economic evidence</h4><p>No economic studies were identified which were applicable to this review question.</p></div><div id="niceng213er6.s1.1.9"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="niceng213er6.s1.1.10"><h4>Evidence statements</h4><div id="niceng213er6.s1.1.10.1"><h5>1.1.1.5. Economic</h5><p>No economic studies were identified which were applicable to this review question.</p></div></div><div id="niceng213er6.s1.1.11"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="niceng213er6.s1.1.11.1"><h5>1.1.1.6. The outcomes that matter most</h5><p>Participation and inclusion, progress in learning and positive social relationships were selected as critical outcomes by the committee. Participation and inclusion was prioritised because identifying joint-working practices to support participation was the primary focus of this review. Progress in learning and positive social relationships were selected as critical outcomes because they represent benefits of education and social activities, respectively. Educational achievement or attainment and developmental progress were included as important outcomes. Educational achievement or attainment was included as an outcome for the same reason as progress in learning, but was not considered as high priority as it may be applicable to a narrower population of disabled children and young people with severe complex needs. Developmental progress was included as an outcome as this may both improve as a result of practices to support participation and increase the likelihood of participation.</p><p>No evidence was found that reported progress in learning or educational achievement or attainment.</p></div><div id="niceng213er6.s1.1.11.2"><h5>1.1.1.7. The quality of the evidence</h5><p>The quality of the evidence was assessed with GRADE and was rated as very low to low. Concerns about risk of bias were “very serious” for all outcomes. The most serious concerns for the randomised controlled trials were bias in measurement of the outcome, whereas the most serious concerns for the cohort study were biases arising from selection of participants, classification of interventions and confounding. The most serious concerns for the before and after studies were biases arising from random sequence generation, allocation concealment, knowledge of allocated interventions and lack of a separate control group. There was “no serious inconsistency” for all outcomes due to only one study reporting each outcome of interest. Indirectness ranged from “very serious” to “no serious indirectness”. Indirectness was due to differences between the population and outcomes of interest and those included in and reported by studies. Concerns about imprecision ranged from “very serious” to “no serious imprecision”. Imprecision was due to 95% confidence intervals crossing boundaries for minimally important differences.</p></div><div id="niceng213er6.s1.1.11.3"><h5>1.1.1.8. Benefits and harms</h5><p>There was low quality evidence that a fitness programme, adapted to meet the individual needs of the participants, increased the number of positive social interactions occurring during group activities. Although the evidence was specific to a fitness programme, the committee agreed that increases in positive social interactions would likely be seen in other adapted group social activities and that a range of activities should be considered as part of short break services, as not all children and young people will be interested in fitness activities. Further, they were aware of examples of inclusive drama and choir groups [1.7.2]. In the committee’s experience, short breaks are normally provided either in a 1:1 setting or very specialist settings – there are limited opportunities for children and young people to engage in group social activities, develop friendships and participate in their community. Therefore, even though the evidence was very low quality, the committee based a recommendation on it to consider group social activities as social inclusion is a preparation for adulthood outcome. In addition, the committee agreed that the intervention included in this evidence was more general and less niche than interventions in other very low quality evidence and so it could be applied to the whole population of this guideline. This recommendation was also supported by qualitative evidence that short breaks benefit the child or young person and the whole family (see evidence report A, sub-theme 13.1 and evidence reports M, sub-theme 9.1). The committee were aware that the local authority has a duty to ensure short breaks are provided as part of the SEND Local Offer but agreed that collaboration with voluntary and community organisations would be required to develop and fund a range of group activities [1.7.2]. They also noted there needs to be a range of options within these group activities to accommodate different mobility, learning and communication needs, behaviour, cultural backgrounds and family circumstances. Also there needs to be specific consideration of options for those living in rural areas and consideration of what equipment will be needed to make the activity accessible to prevent inequalities in accessing these social activities [1.7.3]. The committee also discussed that some children and young people would prefer individual activities over group activities. However, they did not make a recommendation supporting individual activities as the evidence of benefit was only shown during group activities. The committee agreed that the adaptations included in the fitness programme were an important part of the intervention and, therefore, recommended that providers adapt activities as required [1.7.4]. This would be particularly relevant for children and young people with physical disabilities, communication needs and disorders, learning disabilities and sensory impairments. It could also be relevant for those where English is not their first language.</p><p>The committee were aware that some families do not know where to find information about services and support available, and that this causes inequality in access as some people will find the information themselves more easily than others. Therefore, the committee recommended that the leisure activities (including social activities) available should be specified in the SEND Local Offer [1.17.14]. The committee agreed that short break services may be the only way that such activities can be delivered due to the support and care required by children and young people with severe complex needs. However, there was evidence from one of the qualitative reviews (see evidence report K, sub-theme 5.7) that opportunities to engage in activities at short break services can be limited. Therefore, the committee made a recommendation in support of short break services being used for the benefit of the child or young person, as well as providing a break for families [1.7.6]. The importance of using short breaks for the benefit of the child or young person was highlighted by the qualitative evidence mentioned above (see evidence report A, sub-theme 13.1 and evidence report M, sub-theme 9.1).</p><p>The committee wanted to raise awareness that social inclusion is likely to be more difficult for children and young people who are not in education, employment or training as this removes some of the opportunities for participation. The committee were aware that the likelihood of completing a course can be a barrier to children and young people with severe complex needs being able to engage education, so made a recommendation highlighting that social participation gains may may justify a young person with progressive or fluctuating illness in participating in school or college, even if their attendance may be interrupted. [1.7.1].</p><p>There was evidence that a coaching intervention, working with children and young people and their parents, possibly improved frequency and diversity of participation in the community. However, minimal information was provided about the goals set as part of this intervention so the committee did not make a recommendation about it. Social inclusion is a preparation for adulthood outcome that must be included in all EHC plans/reviews from year 9 onwards. However the SEND Code of Practice (2015) talks about doing this from the earliest years. The committee agreed that helping children and young people to volunteer in the community, use the internet and social media, make friends and access local community facilities would help them to participate in social activities. These examples were chosen as they are aspects of social participation that may be taken for granted as most children and young people would be able to access social media, for example [1.7.5]. However, assistance and adaptations may be required to enable disabled children and young people to engage in these activities and these would not typically be covered by existing service specifications [1.7.4].</p><p>The evidence showed that collaboration between health and education services can improve communication in classroom settings. This was supported by evidence from one of the qualitative reviews (see evidence report K, sub-theme 11.4) that showed education practitioners valued the opportunity to learn from, observe and model health professionals. The committee agreed that this collaboration between health and education services is important to ensure that health needs are met, so that unaddressed needs do not form a barrier to participation in education settings, and approaches can be developed to enable student participation. The committee agreed that similar benefits may be seen in other settings if health services collaborate with social care services to better address the health needs of children and young people and so broadened the recommendation to encompass social care. However, the committee also had experience that the way in which health needs are addressed, including where and when appointments are scheduled, can act as a barrier to participation if it conflicts with other activities that children and young people like to participate in or if it isolates them from other children and young people. Therefore, the committee agreed it was important that needs are addressed flexibly to enable participation which should have a consequential positive effect on quality of life [1.7.7].</p><p>Based on their experience, the committee agreed with the evidence that having peer networks confers benefits on positive social relationships. However, they noted that whilst this approach may have some benefits, it could be perceived as discriminatory as it is creating networks based on the presence or absence of a disability. The committee thought that the recommendations made throughout the guideline would be likely to achieve the same benefits more naturally by facilitating the formation of friendships and networks and therefore did not make a recommendation based on this evidence.</p></div><div id="niceng213er6.s1.1.11.4"><h5>1.1.1.9. Cost effectiveness and resource use</h5><p>There was no existing economic evidence in this area and no economic analysis was undertaken.</p><p>The committee explained that the recommendation on interagency teams helping children and young people to participate in social activities and working together to find ways to address the health needs of children and young people, without preventing them from participating in social activities might require services to be more imaginative. However, it was not anticipated to result in a need for additional resources. The recommendation for interagency teams to plan support to help children and young people participate in social activities was not expected to have significant resource implications because this already happens. However, focussing this support on the areas identified in the recommendation may be a change in practice for some teams.</p><p>The committee discussed the recommendation on developing and funding group social activities. The committee explained that such activities would fall under short break services, the provision of which is a statutory requirement, so there should not be a significant resource impact, i.e. there may be a change in the composition of short break services on offer depending on local needs, but this should happen within existing funding. Also, group social activities, e.g. sports or theatre, are already provided by some services.</p><p>The committee considered that there would not be any resource implications or change in practice associated with the recommendation to adapt activities, communication formats, the physical environment and participation methods. This was because there is already a legal duty to make reasonable adjustments.</p><p>The committee discussed the benefits of social participation, including substantial improvements in quality of life and wider wellbeing and that in this population, social participation might be an end in itself. Due to these benefits, the committee considered that promotion of social inclusion would represent a cost-effective use of resources.</p></div></div><div id="niceng213er6.s1.1.12"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.7.1 – 1.7.7, 1.17.14. Other evidence supporting these recommendations can be found in the evidence reviews on Views and experiences of service users (evidence report A), Barriers and facilitators of joined-up care (evidence report K), Views and experiences of service providers (evidence report M).</p></div></div></div><div id="niceng213er6.rl.r1"><h2 id="_niceng213er6_rl_r1_">References – included studies</h2><ul class="simple-list"><div id="niceng213er6.rl.r2"><h3>Effectiveness</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng213er6.ref1"><p id="p-109">
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<strong>Asmus 2017</strong>
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</p>Asmus, J. M., Carter, E. W., Moss, C. K., Biggs, E. E., Bolt, D. M., Bom, T. L., Bottema-Beutel, K., Brock, M. E., Cattey, G. N., Cooney, M., Fesperman, E. S., Hochman, J. M., Huber, H. B., Lequia, J. L., Lyons, G. L., Vincent, L. B., Weir, K., Efficacy and social validity of peer network interventions for high school students with severe disabilities, American Journal on Intellectual and Developmental Disabilities, 122, 118–137, 2017 [<a href="https://pubmed.ncbi.nlm.nih.gov/28257242" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28257242</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng213er6.ref2"><p id="p-110">
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<strong>Bent 2002</strong>
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</p>Bent, N., Tennant, A., Swift, T., Posnett, J., Scuffham, P., Chamberlain, M. A., Team approach versus ad hoc health services for young people with physical disabilities: a retrospective cohort study, Lancet (London, England), 360, 1280–6, 2002 [<a href="https://pubmed.ncbi.nlm.nih.gov/12414202" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12414202</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng213er6.ref3"><p id="p-111">
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<strong>George 2011</strong>
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</p>George, C. L., Oriel, K. N., Blatt, P. J., Marchese, V., Impact of a community-based exercise program on children and adolescents with disabilities, Journal of allied health, 40, e55–60, 2011 [<a href="https://pubmed.ncbi.nlm.nih.gov/22138879" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22138879</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng213er6.ref4"><p id="p-112">
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<strong>Hoehne 2020</strong>
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</p>Hoehne, C., Baranski, B., Benmohammed, L., Bienstock, L., Menezes, N., Margolese, N., Anaby, D., Changes in overall participation profile of youth with physical disabilities following the prep intervention, International Journal of Environmental Research and Public Health, 17, 1–18, 2020 [<a href="/pmc/articles/PMC7312643/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7312643</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32512815" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32512815</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng213er6.ref5"><p id="p-113">
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<strong>Selanikyo 2017</strong>
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</p>Selanikyo, E., Yalon-Chamovitz, S., Weintraub, N., Enhancing classroom participation of students with intellectual and developmental disabilities, Canadian journal of occupational therapy. Revue canadienne d’ergotherapie, 84, 76–86, 2017 [<a href="https://pubmed.ncbi.nlm.nih.gov/27624813" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27624813</span></a>]</div></p></li></ul></div></ul></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng213er6.appa"><h3>Appendix A. Review protocol</h3><div id="niceng213er6.appa.s1"><h4>Review protocol for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p id="niceng213er6.appa.et1"><a href="/books/NBK579718/bin/niceng213er6-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 3. Review protocol</a><span class="small"> (PDF, 213K)</span></p></div></div><div id="niceng213er6.appb"><h3>Appendix B. Literature search strategies</h3><div id="niceng213er6.appb.s1"><h4>Literature search strategies for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><div id="niceng213er6.appb.s1.1"><h5>Databases: Medline; Medline EPub Ahead of Print; and Medline In-Process & Other Non-Indexed Citations</h5><p id="niceng213er6.appb.et1"><a href="/books/NBK579718/bin/niceng213er6-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (133K)</span></p></div><div id="niceng213er6.appb.s1.2"><h5>Databases: Embase; and Embase Classic</h5><p id="niceng213er6.appb.et2"><a href="/books/NBK579718/bin/niceng213er6-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (133K)</span></p></div><div id="niceng213er6.appb.s1.3"><h5>Database: Health Management Information Consortium (HMIC)</h5><p id="niceng213er6.appb.et3"><a href="/books/NBK579718/bin/niceng213er6-appb-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (129K)</span></p></div><div id="niceng213er6.appb.s1.4"><h5>Database: Social Policy and Practice</h5><p id="niceng213er6.appb.et4"><a href="/books/NBK579718/bin/niceng213er6-appb-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (123K)</span></p></div><div id="niceng213er6.appb.s1.5"><h5>Database: PsycInfo</h5><p id="niceng213er6.appb.et5"><a href="/books/NBK579718/bin/niceng213er6-appb-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (130K)</span></p></div><div id="niceng213er6.appb.s1.6"><h5>Database: Emcare</h5><p id="niceng213er6.appb.et6"><a href="/books/NBK579718/bin/niceng213er6-appb-et6.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (134K)</span></p></div><div id="niceng213er6.appb.s1.7"><h5>Databases: Cochrane Central Register of Controlled Trials (CCTR); and Cochrane Database of Systematic Reviews (CDSR)</h5><p id="niceng213er6.appb.et7"><a href="/books/NBK579718/bin/niceng213er6-appb-et7.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (133K)</span></p></div><div id="niceng213er6.appb.s1.8"><h5>Database: Database of Abstracts of Reviews of Effects (DARE)</h5><p id="niceng213er6.appb.et8"><a href="/books/NBK579718/bin/niceng213er6-appb-et8.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (112K)</span></p></div><div id="niceng213er6.appb.s1.9"><h5>Database: Health Technology Abstracts (HTA)</h5><p id="niceng213er6.appb.et9"><a href="/books/NBK579718/bin/niceng213er6-appb-et9.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (109K)</span></p></div><div id="niceng213er6.appb.s1.10"><h5>Databases: Applied Social Sciences Index & Abstracts (ASSIA); Social Services Abstracts; Sociological Abstracts; and ERIC (Education Resources Information Centre)</h5><p id="niceng213er6.appb.et10"><a href="/books/NBK579718/bin/niceng213er6-appb-et10.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (98K)</span></p></div><div id="niceng213er6.appb.s1.11"><h5>Database: British Education Index</h5><p id="niceng213er6.appb.et11"><a href="/books/NBK579718/bin/niceng213er6-appb-et11.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (102K)</span></p></div><div id="niceng213er6.appb.s1.12"><h5>Database: CINAHL Plus (Cumulative Index to Nursing and Allied Health Literature)</h5><p id="niceng213er6.appb.et12"><a href="/books/NBK579718/bin/niceng213er6-appb-et12.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (98K)</span></p></div><div id="niceng213er6.appb.s1.13"><h5>Database: Social Sciences Citation Index (SSCI)</h5><p id="niceng213er6.appb.et13"><a href="/books/NBK579718/bin/niceng213er6-appb-et13.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (103K)</span></p></div><div id="niceng213er6.appb.s1.14"><h5>Database: Social Care Online</h5><p id="niceng213er6.appb.et14"><a href="/books/NBK579718/bin/niceng213er6-appb-et14.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (95K)</span></p></div></div></div><div id="niceng213er6.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><div id="niceng213er6.appc.s1"><h4>Study selection for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p id="niceng213er6.appc.et1"><a href="/books/NBK579718/bin/niceng213er6-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Study selection flow chart</a><span class="small"> (PDF, 109K)</span></p></div></div><div id="niceng213er6.appd"><h3>Appendix D. Effectiveness evidence</h3><div id="niceng213er6.appd.s1"><h4>Evidence tables for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p id="niceng213er6.appd.et1"><a href="/books/NBK579718/bin/niceng213er6-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 4. Evidence tables</a><span class="small"> (PDF, 185K)</span></p></div></div><div id="niceng213er6.appe"><h3>Appendix E. Forest plots</h3><div id="niceng213er6.appe.s1"><h4>Forest plots for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng213er6.appf"><h3>Appendix F. GRADE tables</h3><div id="niceng213er6.appf.s1"><h4>GRADE tables for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p id="niceng213er6.appf.et1"><a href="/books/NBK579718/bin/niceng213er6-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 5. Evidence profile for comparison 1: 1:1 support versus control</a><span class="small"> (PDF, 177K)</span></p><p id="niceng213er6.appf.et2"><a href="/books/NBK579718/bin/niceng213er6-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 6. Evidence profile for comparison 2: Young adult teams versus ad-hoc services</a><span class="small"> (PDF, 126K)</span></p><p id="niceng213er6.appf.et3"><a href="/books/NBK579718/bin/niceng213er6-appf-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 7. Evidence profile for comparison 3: Peer support network versus standard practice (no peer-mediated intervention)</a><span class="small"> (PDF, 134K)</span></p></div></div><div id="niceng213er6.appg"><h3>Appendix G. Economic evidence study selection</h3><div id="niceng213er6.appg.s1"><h4>Economic evidence study selection for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p>One global search was undertaken – please see <a href="/books/NBK579718/bin/niceng213er6_bm2.pdf">Supplement B</a> for details on study selection.</p></div></div><div id="niceng213er6.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng213er6.apph.s1"><h4>Economic evidence tables for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng213er6.appi"><h3>Appendix I. Economic model</h3><div id="niceng213er6.appi.s1"><h4>Economic model for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng213er6.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng213er6.appj.s1"><h4>Excluded studies for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><div id="niceng213er6.appj.s1.1"><h5>1.1.1.10. Effectiveness studies</h5><p id="niceng213er6.appj.et1"><a href="/books/NBK579718/bin/niceng213er6-appj-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 8. Excluded studies and reasons for their exclusion</a><span class="small"> (PDF, 172K)</span></p></div><div id="niceng213er6.appj.s1.2"><h5>1.1.1.11. Economic studies</h5><p>No economic evidence was identified for this review. See <a href="/books/NBK579718/bin/niceng213er6_bm2.pdf">Supplement B</a> for further information.</p></div></div></div><div id="niceng213er6.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng213er6.appk.s1"><h4>Research recommendations for review question: What are the most effective ways that health, social care and education services can work together to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities?</h4><p>No research recommendations were made for this review question.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews</p><p>These evidence reviews were developed by the National Guideline Alliance which is a part of the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK579718</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35471795" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35471795</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng213er6tab1"><div id="niceng213er6.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK579718/table/niceng213er6.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng213er6.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_niceng213er6.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng213er6.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Disabled children and young people from birth to 25 years with severe complex needs who require health, social care and education support.</td></tr><tr><th id="hd_b_niceng213er6.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng213er6.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Any joint-working practices to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities.</p>
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<p>For example:
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<ul><li class="half_rhythm"><div>1:1 support</div></li><li class="half_rhythm"><div>Personalised budgets</div></li><li class="half_rhythm"><div>Visual support hierarchy recommendations (or total communication guidance)</div></li><li class="half_rhythm"><div>Short breaks/respite and holiday clubs</div></li><li class="half_rhythm"><div>EHC plans</div></li><li class="half_rhythm"><div>Named responsible practitioners (e.g., keyworker, single point of contact, lead professional, named coordinator, transition worker)</div></li><li class="half_rhythm"><div>Arrangements/links with third sector/community organisations (e.g., football clubs, theatre groups)</div></li></ul></p></td></tr><tr><th id="hd_b_niceng213er6.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng213er6.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any other practices to support disabled children and young people with severe complex needs to participate in and benefit from education and social activities</td></tr><tr><th id="hd_b_niceng213er6.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_niceng213er6.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Critical</b>
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<ul><li class="half_rhythm"><div>Participation and inclusion</div></li><li class="half_rhythm"><div>Progress in learning (e.g., measured by progress towards outcomes/goals specific in EHC plans)</div></li><li class="half_rhythm"><div>Positive social relationships (e.g., friends)</div></li></ul></p>
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<p><b>Important</b>
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<ul><li class="half_rhythm"><div>Educational achievement or attainment</div></li><li class="half_rhythm"><div>Developmental progress (including social and emotional development)</div></li></ul></p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">EHC: education, health and care</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng213er6tab2"><div id="niceng213er6.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK579718/table/niceng213er6.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng213er6.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng213er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng213er6.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng213er6.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng213er6.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_niceng213er6.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng213er6.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng213er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng213er6.ref1" rid="niceng213er6.ref1">Asmus 2017</a>
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</p>
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<p>RCT</p>
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<p>USA</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CYP who qualified for state’s alternate assessment for significant cognitive impairment and/or receiving special education for intellectual disability or autism; enrolled in at least one general education class.</td><td headers="hd_h_niceng213er6.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Peer networks (n=47):</u>
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</p>
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<p>Group of peers without disabilities formed a social network for each student. Network meetings included social interactions around a shared activity and planning for other social contact between meetings.</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Standard practice (n=48):</u>
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</p>
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<p>Special education services were provided as stated in individualised education programs. No peer-mediated interventions were introduced.</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Participation and inclusion</div></li><li class="half_rhythm"><div>Positive social relationships</div></li><li class="half_rhythm"><div>Developmental progress</div></li></ul></td><td headers="hd_h_niceng213er6.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Could not include parent-reported outcomes as the number of people with data in each arm was not reported.</td></tr><tr><td headers="hd_h_niceng213er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng213er6.ref2" rid="niceng213er6.ref2">Bent 2002</a>
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</p>
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<p>Cohort study</p>
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<p>UK</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with cerebral palsy, spina bifida, traumatic brain injury or degenerative neuromuscular disease born between 1978 and 1982.</td><td headers="hd_h_niceng213er6.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Young Adult Team services (YAT) (n=119):</u>
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</p>
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<p>Authors only report a definition of YATs (Multidisciplinary specialist teams developed to facilitate transition from child to adults services).</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Ad-hoc services (n=135):</u>
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</p>
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<p>Authors only report a definition of ad-hoc services (Individual professionals working in isolation with ad-hoc links between professionals/services).</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Participation and inclusion</div></li></ul></td><td headers="hd_h_niceng213er6.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Population is indirect as it included people aged up to 28 years.</div></li><li class="half_rhythm"><div>Outcome is indirect as participation is not limited to education and social activities.</div></li></ul></td></tr><tr><td headers="hd_h_niceng213er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng213er6.ref3" rid="niceng213er6.ref3">George 2011</a>
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</p>
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<p>Before and after study*†</p>
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<p>USA</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Children and young people with disabilities aged 5 to 21 years who could move about with or without an assistive device.</td><td headers="hd_h_niceng213er6.tab2_1_1_1_3 hd_h_niceng213er6.tab2_1_1_1_4" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Fitness program (n=10)</u>
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</p>
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<p>8-week fitness program involving: 1) supervised exercise ran by physical therapy and special education students; 2) home exercise program to occur on the nights when supervised exercise was not happening; and 3) parent education about exercise and nutrition. All activities were adapted to the individual needs of the participants.</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Positive social relationships</div></li></ul></td><td headers="hd_h_niceng213er6.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Overall study design was a quasi-cluster RCT. However, data for outcome of interest (positive social interactions) was only available for the intervention group. †Comparison between first and second half of intervention rather than before and after intervention</td></tr><tr><td headers="hd_h_niceng213er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng213er6.ref4" rid="niceng213er6.ref4">Hoehne 2020</a>
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</p>
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<p>Before and after study</p>
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<p>Canada</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Youth with mobility restrictions (with or without cognitive and/or communication impairments).</td><td headers="hd_h_niceng213er6.tab2_1_1_1_3 hd_h_niceng213er6.tab2_1_1_1_4" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Pathways and Resources for Engagement and Participation (PREP) (n=20):</u>
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</p>
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<p>12-week intervention led by occupational therapist with the aim of improving participation by changing aspects of the environment and engaging/coaching youth and their parents. A participation team, comprising family members, teachers, community instructors and volunteers, assisted in execution of the plan.</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Participation and inclusion</div></li></ul></td><td headers="hd_h_niceng213er6.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Youth were excluded if they were within the first year after a severe brain injury or within the first 4 months following orthopaedic surgery</td></tr><tr><td headers="hd_h_niceng213er6.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng213er6.ref5" rid="niceng213er6.ref5">Selanikyo 2017</a>
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</p>
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<p>Cluster RCT</p>
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<p>Israel</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Students with moderate intellectual and developmental disability (IDD) who had been attending one of two special education schools for at least a year.</td><td headers="hd_h_niceng213er6.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Co-PID* (n=35)</u>
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</p>
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<p>20-week collaborative consultation model which included joint formulation of classroom goals for each student and activities that could enable students to meet these goals.</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>In-service (n=34)</u>
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</p>
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<p>3-hour workshop that aimed to expand teachers’ knowledge and awareness of participation of students with moderate IDD and brainstorm ways of implementing knowledge in the classroom.</p>
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</td><td headers="hd_h_niceng213er6.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Participation and inclusion</div></li></ul></td><td headers="hd_h_niceng213er6.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*In addition to in-service
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<ul><li class="half_rhythm"><div>Population is indirect as those with moderate IDD may not have severe, complex needs in all three areas.</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Co-PID: Collaborative Consultation Participation of Students With Intellectual and Developmental Disabilities; CYP: children and young people; IDD: intellectual and developmental disability; PREP: Pathways and Resources for Engagement and Participation; RCT: randomised controlled trial; YAT: young adult team</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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