Social participation to support good mental health in neurodisability

Background: Young people with neurodisability experience lower levels of mental wellbeing and are at increased risk of mental illness compared to their non-disabled peers. Social participation is recognised as a protective factor against mental illness and a potential pathway to support better mental wellbeing in neurodisability. Method: This co-design study involved young people, parents, and clinicians. First, possible interventions were identified through a rapid systematic evidence review. Any study designs were considered that included people with a neurodisability aged 0-18 years that evaluated a therapy intervention with social participation and mental health outcomes. Titles and abstracts were screened by two reviewers, from the included studies data were extracted and then presented using written summaries. Second, the summaries were discussed and prioritised in stakeholder groups with young people, parents, and clinicians. Groups were audio recorded and framework analysis was used to identify and specify intervention elements and their delivery. Results: The evidence review identified 13870 records, from which 43 were included. These records were published 1994-2017 and reported studies with 4-249 participants aged 16 months – 18 years with a range of neurodisabilities. Five intervention approaches (social skills training, arts, sports, technology, and play) were identified from the review. Two themes emerged from the stakeholder groups: intervention in the real world, feeling judged and feeling safe. The groups prioritised an intervention in real-world social leisure contexts (i.e. existing clubs and groups) using nine key intervention elements (e.g. feedback, positive verbal reinforcement) delivered by club leaders trained by healthcare professionals using five intervention procedures (e.g. a manual, video training). Conclusion: This study has identified core elements of social participation interventions that may improve mental health outcomes in young people with neurodisability, which should now be tested.