Transition from child to adult services for young people with cerebral palsy in Ireland: Influencing factors at multiple ecological levels

Abstract

AimTo explore the factors that influence the process of transitioning from child to adult services in Ireland among young people with cerebral palsy, their parents, and service providers.MethodThis study followed a qualitative descriptive approach. Semi‐structured interviews were conducted with 54 participants, including young people with cerebral palsy aged 16 to 22 years (n = 13), their parents (n = 14), and service providers (n = 27). Data were analysed using the Framework Method. Findings were categorized using an ecological model across four levels: individual, microsystem, mesosystem, and exosystem.ResultsLimited awareness, preparation, and access to information hindered successful transition. Microsystem factors such as family knowledge, readiness, resilience, and health professional expertise influenced transition experience. Mesosystem factors encompassed provider–family interaction, interprofessional partnerships, and interagency collaboration between child and adult services. Exosystem factors included inadequate availability and distribution of adult services, limited referral options, coordination challenges, absence of transition policies, staffing issues, and funding allocation challenges.InterpretationTransition is influenced by diverse factors at multiple ecological levels, including interactions within families, between health professionals, and larger systemic factors. Given the complexity of transition, a comprehensive multi‐level response is required, taking into account the interactions among individuals, services, and systems.

How transition from child to adult services for young people with disabilities is affected by limited perspectives: A parent's view

“…But what if all perspectives are not present? I have no direct experience of cerebral palsy or the care system in Ireland, 2 but there seems to be little difference between our own experience in the UK and the results of the study by Fortune et al 2 . The major difference is that, in our case, the central tenet of the Bronfenbrenner ecological diagram 3 – the individual's personal experience of the transition – is missing.…”

“…However, identifying a need in care or facilities is meaningless if there is nothing suitable to meet those needs, whether due to funding or availability, and I have to concur with Fortune et al. 's own conclusion that poor management of transition may contribute to poor health outcomes, decreased opportunities to participate in the community, and decreased quality of life 2 …”

“…Placing the microsystem at the centre of Bronfenbrenner's diagram makes it particularly important that all others involved in the process communicate fully. As highlighted by Fortune et al., transition in Ireland was characterized by a lack of information, preparation, and continuity; interpersonal interactions with family, peers, and health professionals supported knowledge development and preparation; coordination and communication challenges between services and agencies affected continuity; limited access to adult services, unclear pathways, and coordination gaps created care discontinuity; and policy gaps, staffing challenges, time constraints, funding, and service distribution impacted transition 2 . Our own experience of transition highlights all of Fortune et al.…”