Multifaceted interventions show limited impact on community participation among adults with disabilities
Multifaceted interventions combine different intervention components, such as social skills training and work experience, to improve community participation outcomes for people with disabilities. The evidence shows limited support for the approach. More and better evidence is needed.
What is this review about?
Multifaceted interventions are interventions which target two or more individual or environmental characteristics in different domains. For example, many factors affect the outcome of integrated, competitive employment in the community for people with disabilities. Among those factors, there are points of intervention related to the individual (e.g., work experience, social skills, level of support needs, education/training), the employer or workplace (e.g., disability awareness, provision of accommodations, accessibility), and the community (e.g., access to transport, proximity to workplace).
This review examines multifaceted interventions that measure outcomes relevant to community participation for adults with disabilities.
What is the aim of this review?
This Campbell systematic review and meta-analysis examines the impact of multifaceted interventions on community participation outcomes for adults with disabilities, and aims to find effective components of the interventions. The review summarizes the findings from 15 reports of multifaceted interventions in five countries.
What studies are included?
Included studies employ at least two interventions designed to address two or more participant characteristics (e.g., skill enhancement, behavior/attitude change) and/or environmental characteristics (e.g., participant interactions with people, places, or things) resulting in outcomes that provide direct access to the community (e.g., competitive employment, adult learning, housing) or are a dimension of community participation (e.g., self-determination, quality of life, social networking).
A total of 15 studies using a multifaceted intervention were included in this review. Of these, nine were randomized and six were quasi-experimental. Study participants were adults, 18 years or older, with a disability, who had exited secondary school services. Participants identified as having the following disabilities: intellectual disability, mental illness, traumatic brain injury, aging-related disabilities (e.g., dementia, Alzheimer’s, reduction in activities of daily living), or combinations of two or more classifications.
What are the main findings of this review?
Individual studies of multifaceted interventions focus on increasing community participation of adults with disabilities. These studies show evidence of positive effects for some outcomes (employment, quality of life, and adult learning). However, there are no significant effects on other outcomes (activities of daily living, mental health, autonomy, independent living, social skills, community activities, and housing).
The evidence supporting multifaceted interventions is hampered by (1) lack of design quality in the studies and (2) the small number of studies represented in each multifaceted intervention and the associated outcome.
What do the findings of this review mean?
Implications for research
Limited support for the effectiveness of multifaceted over single-faceted interventions suggests the need for more substantial research to determine effectiveness broadly as well as specifically in relation to community participation of adults with disabilities. Future research should narrow the focus to more specific outcomes for targeted groups of adults with similar disabilities, which may yield greater insight into the potential effectiveness of multifaceted interventions.
Disability populations that are most frequently the target of multifaceted interventions tend to need greater support for executive functioning. Further, the multifaceted interventions for these populations tend to include cognitive coaching as one of the facets of the intervention. Therefore, more research on multifaceted interventions targeting these populations may provide greater insight into the effectiveness of multifaceted interventions across specific outcomes of interest (e.g., competitive employment).
Implications for policy
The studies included in this systematic review did not directly address policy. However, employment and community living for people with disabilities are important policy areas. As such, continued research is needed to more effectively inform and guide future policies that will support community participation for adults with disabilities. More research evidence from high-quality studies is needed before policy implications can be formed.
How up-to-date is this review?
The review authors searched for studies up to the end of 2016.