Original Title: État des connaissances - Caractéristiques et besoins des clientèles visées par la réadaptation pour les jeunes en difficulté d’adaptation âgés de 10 ans et plus

Authors' objectives: In the early 2010s, an in-depth reflection on the rehabilitation of young people with adjustment problems in Quebec led to the publication of the Cadre de référence pour une pratique rigoureuse de l’intervention en réadaptation auprès des enfants, des jeunes et de leurs parents en CSSS et en CJ [Reference framework for a rigorous practice of rehabilitation intervention with children, young people and their parents in Health and Social Services Centres and Youth Centres]. This document put forward a definition of rehabilitation and its main components (e.g., targeted client groups, fundamental principles, intervention targets, clinical approaches). However, since its publication, a number of changes have been observed in the field, such as the increasing diversification among youth client groups and the growing challenges that rehabilitation services must cope with to meet these heterogeneous needs. Consequently, certain components of rehabilitation are being called into question by a number of key players who also stress the importance of a new in-depth reflection on rehabilitation to support the Ministry of Health and Social Services in reviewing and harmonizing the service offer for young people with adjustment problems. This is the context in which the Institut national d’excellence en santé et en services sociaux (INESSS) is working towards an updated definition of rehabilitation. The purpose of this report is to define the characteristics and needs of targeted rehabilitation clienteles for young people with adjustment problems aged 10 or older. Other INESSS works will complement this definition and will be pooled as part of an upcoming production supporting clinical and organizational practice.

Authors' results and conclusions: RESULTS: The topics covered in this report are documented by a total of 24 scientific publications that focus primarily on the characteristics of the targeted rehabilitation clienteles rather than on their actual needs. The results are organized into four domains (and 11 dimensions) related to youth development and functioning: behavioural, health, socialization and education. The results show that young people with adjustment problems present highly varied characteristics and heterogeneous needs. Data associated with the behavioral domain indicates that young people are using alcohol or drugs for recreational purposes; however, some young people also have substance use problems. Many recognize the impact of substance use on their lives, but far fewer see this as a need that must be addressed in the context of rehabilitation services for young people with adjustment problems. Selfdestructive behaviours (e.g., self-harm, suicidal behaviours) and externalized behaviours (e.g., delinquent behaviours, aggressive behaviours, externalized behaviour problems) also appear to be prevalent. Nevertheless, no needs related to these characteristics are clearly reported in the selected publications. Health is also an important issue. Although young people appear to rate their overall health positively, many exhibit varied signs of health problems (e.g., diagnoses, medications, hospitalizations, functional limitations). Many of them have mental health issues (mainly anxiety or emotional) or physical health problems, but young people seem to be more limited in their daily lives mainly because of mental health problems, which are quite widespread. The sexual health of all young people appears to be related to experiences associated with the typical developmental trajectory of adolescence, but risky sexual activity and sexual difficulties were also reported among some young people. In addition, some of them stressed the need to be better informed about health matters. Data in the domain of socialization indicates that many young people have limited social skills. Interactions with the people around them, whether outside or inside the substitute living environment, are also marked by relational difficulties, relationships of limited quality and a breakdown of social ties. Young people further reported the need to improve their social skills and their interactions with their peers and service workers, along with the need to maintain social ties with those around them during the placement. The data relating to the domain of education also appears to be of concern, indicating that the educational path of the majority of young people does not follow the expected educational progression and that their educational and professional aspirations are rather limited. Some young people nevertheless expressed the need to develop training skills within the context of rehabilitation services, particularly to facilitate their transition to adult life. CONCLUSION: In conclusion of this report, it is now possible to establish several characteristics of young people with adjustment problems, as well as a certain number of their needs. The majority of the characteristics analyzed in this report raise clinical concerns, which have been highlighted by screening or diagnostic tools. However, some of the characteristics presented are a reflection of the personal and social development associated with adolescence. Thus, rehabilitation services must promote flexible support, i.e., support that is consistent with the varied clinical portraits of young people and the typical exploratory behaviours they exhibit. As is the case with some of the characteristics mentioned in this report, the few needs that were identified match those reported among young people with adjustment problems in Quebec by the project’s working committee and by the Special Commission on the Rights of the Child and Youth Protection. However, this systematic review does not capture the full range of youth needs: the characteristics identified underlie needs that are not clearly articulated here. This underscores the importance of conducting research that addresses the specific needs of young people with adjustment problems, while also considering problems related to typical adolescent development. Such studies should also address the needs arising from the distinct characteristics of these young people (e.g., ethnocultural/religious/identity, mental health issues) to support individualization of care. Moreover, it is important to note that the results presented are not based on a formal assessment of scientific evidence; the characteristics and needs of young people are therefore not ranked according to their importance and all are considered important, regardless of their prevalence, the number of publications in which they are addressed or, again, the methodological quality of the specifications used to document them. Nevertheless, the varied characteristics and heterogeneous needs presented in this report suggest that the supply of rehabilitation services needs to be diversified so that all young people with adjustment problems can find meaning in their lives, realize their full potential and be better equipped to face the challenges they encounter daily as adolescents. Finally, the contribution of this report will be enhanced by the results of complementary works, including a report already published on the effectiveness of the models and approaches used in a rehabilitation context and the consultations with key players aimed at better contextualizing the data collected thus far. This work will provide rigorous input into the discussion on the rehabilitation service offer for young people with adjustment problems aged 10 years and older. The result will be a product that will support clinical and organizational practice.

Authors' methods: To meet this objective, a systematic review was conducted using publications listed in several targeted bibliographic databases and the grey literature. The literature search was limited to publications that presented empirical data. Predefined inclusion criteria were used to select these publications. Relevant information was extracted and analyzed. The analysis results are presented in the form of an analytical synthesis. Finally, a working committee and a panel of users and relatives support the validity of the results described herein or the concordance of those results with the needs of the community and young people with adjustment problems.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/soutien-a-la-revision-et-a-lharmonisation-de-loffre-de-service-en-readaptation-pour-les-jeunes-en-difficulte-dadaptation.html

Year Published: 2023

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/soutien-a-la-revision-et-a-lharmonisation-de-loffre-de-service-en-readaptation-pour-les-jeunes-en-difficulte-dadaptation.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Gouvernement du Québec