The scoping review by Souto et al.¹ and the cross-sectional study by Brugnaro et al.² examined factors associated with the participation of young people with Down syndrome in home and community activities. This knowledge is essential for guiding healthcare professionals during the evaluation phase of the therapeutic process and for developing effective participation-focused interventions. One such factor associated with the participation of young people with Down syndrome is their family's behavior. For example, families of young people with Down syndrome can promote participation by providing opportunities for taking part in activities.^{1, 2} However, Souto et al.'s scoping review¹ also found that families can hinder a young person's participation by being overprotective. Therefore, the authors emphasized the importance of educating caregivers about their role in supporting participation in activities.

While education about the importance of providing opportunities for their child or youth to participate in activities may be effective for some families, it may also lead to a perceived increase in workload and a sense of being overwhelmed by environmental and personal barriers for others. According to a recent mixed-methods study on the role of caregiver strategies to support the community participation among young people with disabilities or those at-risk, caregivers often find themselves overwhelmed by the high workload involved in supporting participation, particularly in community settings where they reported experiencing little support from professionals.³ Furthermore, environmental and personal barriers such as experienced discrimination from other community members³ or lost trust in participation due to serious illness can result in parental overprotection. Thus, to foster the participation of young people, it is necessary for healthcare professionals to adopt a holistic approach and consider the full story of families.

Taken together, families' experienced workload and their reasons for being overprotective may require moving beyond educating these families. This may involve accompanying families in their real-world contexts. For out-of-home contexts it may also entail direct collaboration of healthcare professionals with community or school personnel to support a more inclusive and welcoming environment, as also described by occupational therapists when using the Pathway and Resources for Engagement and Participation (PREP) intervention.⁴ Direct collaboration with community and school personnel can not only foster a more inclusive and welcoming atmosphere for all, but it can also assist in shouldering some of the advocacy work currently undertaken by caregivers,³ thereby reducing their workload. However, such approaches require careful evaluation of priority activities, goals, and preferred goal-attainment strategies from the perspective of the young person and/or their families. This ensures that healthcare professionals know what to focus on for a successful outcome that matters to their clients (i.e. young people, families).

One way to support this careful evaluation might be by utilizing the Participation and Environment Measure Plus (PEM+),⁵ a participation-focused online tool designed to ensure that the perspectives of families are considered during the creation of a care plan for a child's rehabilitation services. The purpose of PEM+ is to provide families with a platform to share their priorities and goals for pediatric rehabilitation interventions and strategies for goal-attainment before meeting with healthcare professionals, thus preventing families from being ‘put on the spot’ when asked about their priorities. PEM+ is currently being developed for caregivers of young children,⁵ with the potential to expand to an older pediatric population.

Future research may benefit from combining ingredients of participation-focused approaches (e.g. aspects of PEM+ and PREP) with a focus on families' reasons for being overprotective and direct interventions with community and school personnel to remove encountered barriers, shoulder families' advocacy work, and thus, create more inclusive environments for all, facilitating participation of all young people.