Beyond Functional Limitations: Unique Contribution of the Environment in Predicting Participation of Transition-Aged Youth With and Without Disabilities Across Settings.

Abstract

To investigate the extent to which environmental supports predict participation indicators of youth with and without disabilities in the presence of functional limitations and age across 4 settings: home, educational setting, community, and workplace. Cross-sectional study. Youth completed the self-reported measures. Youth with disabilities without cognitive impairments (n=112) and youth without disabilities (n=57), aged 12-31 years (x̄=21.8; interquartile range, 18-25y). Not applicable. The Youth, young-adult Participation and Environment Measure assessed 3 participation indicators (eg, frequency, involvement, and desire for change) and environmental supports within each setting. Youth's functional limitations were evaluated using a self-reported 11-item checklist. Hierarchical multiple regression modeling revealed that environmental supports exhibited a unique contribution (R² change up to 9%) and consistently predicted participation scores on ≥2 of 3 participation indicators across all 4 settings. Greater environmental support was significantly associated with fewer activities wherein youth desired change in participation across all settings (standardized β=-0.306 to -0.186; 95% confidence interval [CI], -0.117 to -0.010). Environmental support demonstrated the most consistent contribution to home participation in terms of frequency (standardized β=0.255; 95% CI, 0.008-0.029), involvement (standardized β=0.172; 95% CI, 0.001-0.019), and desire for change (standardized β=-0.272; 95% CI, -0.116 to -0.034). Findings underscore the unique contribution of environmental supports in predicting variation in subjective and objective participation across settings beyond the variance predicted by youth-related factors (age and number of functional limitations). These findings support environment-based interventions to enhance participation during this challenging transition phase, particularly focusing on those activities where youth desire change. Moreover, our findings can inform service providers and policymakers in promoting environmental supports that enhance multiple dimensions of participation for youth with disabilities.