Search

Background: Social integration (i.e., reciprocal interactions with peers and community members) is a notable challenge for many homeless-experienced adults with serious mental illness (SMI). In this study, we examine a range of housing services offered to homeless-experienced adults with SMI and identify the impacts of supportive services on participants' social integration outcomes, with the goal of improving services in transitional and permanent housing settings for homeless-experienced adults with SMI. Methods: Through semi-structured interviews with homeless-experienced adults with SMI (n = 30), we examine the impacts of housing and service settings on participants' social integration. Participants received services in a variety of housing settings, including transitional housing with congregate/shared living (n = 10), transitional housing with individual quarters (n = 10), and permanent supportive housing (n = 10). Results: Participants expressed caution in developing social relationships, as these could pose barriers to recovery goals (e.g., substance use recovery). For many, social integration was secondary to mental and physical health and/or housing stability goals. Individual quarters gave individuals a place of respite and a sense of control regarding when and with whom they socialized. Meeting recovery goals was strongly related to connecting to and receiving a range of supportive services; interviews suggest that proximity to services was critical for engagement in these resources. Conclusions: Programs serving homeless experienced adults with SMI should seek to understand how individuals conceptualize social integration, and how social relationships can either support or hinder participants' recovery journey. [ABSTRACT FROM AUTHOR]

Purpose: The manual, user-operated Arise Standing Wheelchair (SWC) is the end result of multiple design iterations based on findings and feedback from user trials. The Arise SWC provides standing functionality, outdoor mobility, affordability, and customisability. This paper describes a long-term community integration study of the Arise SWC. Methods: All participants (N = 8; 7 Male, 1 Female) were persons with spinal cord injuries. During the study period (six months), the participants integrated the Arise SWC into their daily routines. To assess the impact of the Arise SWC on various outcome measures, participants' responses were captured using a Likert-scale questionnaire at the beginning of the study, after 30 days, and after 180 days of Arise SWC usage. Results: The long-term usage of the Arise SWC positively impacted the users' standing performance (ability to stand regularly, stand at different locations, and stand in community settings), productive ability (accessibility to environmental controls and ability to perform overhead reaches), and pathophysiology (spasticity and ability to get proper sleep). Furthermore, all the users were able to independently move using the Arise SWC over even and uneven terrain (some needed minimal assistance over uneven terrain). Conclusions: Overall, we believe that Arise SWC will benefit eligible users and improve their ability and performance in daily activities. IMPLICATIONS FOR REHABILITATION: Arise Standing Wheelchair (SWC) positively impacted users' standing performance, mobility over uneven terrain, ability to transfer between surfaces, and overhead reaches. Arise SWC positively impacted users' overall physical well-being. The study shows that Arise SWC improved the users' overall daily living activities. Arise SWC, an affordable solution, is anticipated to have a global impact, especially on low-income nations. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Recovery‐oriented practices in community‐based mental health services are of increasing importance. The recovery journey of individuals with mental illness starts with a sense of agency, and a therapeutic relationship with the providers who support them is a prerequisite.In Japan, the construction of community‐based integrated care systems for individuals with mental illness is positioned as a priority health issue, with communication with familiar individuals being particularly important for recovery in Japanese and Asian cultures. What the paper adds to existing knowledge?: This study is the first to examine effective communication factors for personal agency in the recovery of individuals with mental illness, focusing on addressing uncertainty about treatment choices and dissatisfaction with decision‐making, and considering the user's personal recovery journey.In recovery‐oriented practice, it is important to prioritize addressing the emotional aspects of decision‐making alongside the mental illness condition, supporting users' self‐determination in their unique recovery journeys. What are the implications for practice?: The findings emphasized the need to actively engage with users' perspectives and emotions, emphasize shared life planning, and foster a therapeutic relationship based on partnership. Providers should approach dialogue as carefully as medication prescriptions, prioritizing the establishment of an effective therapeutic relationship with the user.These characteristics are essential for developing a strong therapeutic relationship and effectively facilitating users' recovery. The findings are applicable not only to nurses but to all mental health service providers, contributing to the advancement of recovery‐oriented practice. Introduction: Recovery‐oriented practice in community‐based mental health services is crucial for individuals with mental illness, with communication with familiar individuals being important for recovery in Japanese and Asian cultures. Aim: This study aimed to examine effective communication factors for personal agency in recovery by investigating the association between perceived support provided through communication and personal agency of individuals with mental illness. Method: A cross‐sectional study was conducted among community‐dwelling Japanese mental health service users, assessing subjective agency, decisional conflict, staff support for personal recovery, activation for mental health self‐management, demographic variables and living difficulties. Multiple linear regression analysis identified factors predicting subjective agency, revealing characteristics of effective provider communication for recovery. Results: Data from 222 users were analysed, revealing negative correlations between uncertainty about treatment choices and ineffective decision‐making with higher subjective agency, while staff support for personal recovery positively correlated with higher subjective agency. Discussion: In recovery‐oriented practice, prioritizing users' emotional experiences during decision‐making and supporting their self‐determination in their unique recovery journeys is crucial. Implications for Practice: Providers should approach dialogue as carefully as medication prescriptions, prioritizing therapeutic partnerships with users. The findings extend beyond nursing to all mental health service providers, advancing the theory of recovery‐oriented practice. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject: Individuals with severe and enduring mental health challenges continued to consume mental health services for an average of 13 years as they needed multiple acute psychiatric admissions due to the challenges they experienced in their everyday activities.As caregivers of individuals with severe and enduring mental health challenges, they often bear the brunt of caregiving through their assistance with activities of daily living (ADL), providing emotional support and ensuring medication compliance for their loved ones.When caring for their loved ones, caregivers often reported psychological stress, social isolation and emotional exhaustion due to stressors such as uncertainty of the future, the lack of support from professional services and the isolation from their own social network and support mechanism. What the paper adds to existing knowledge: Insights from this study revealed that caregivers for individuals with severe and enduring mental health challenges went through a lonely and exhausting journey fraught with psychological, physical, social and financial challenges, echoing the caregiving needs and the prevalence of the caregiver burden. What are the implications for practice: Insights shared by the caregivers demonstrated the need for a centralised point of contact to navigate Singapore's fragmented mental healthcare sector.Peer‐support groups should be further promoted because they offer the benefits of information exchange, mutual support and a sense of empowerment and hopefulness, which may help ease the caregiver burden.Life skills training, such as teaching how to communicate empathetically with family members, resolve conflicts using open communication, maintain a structured daily routine and solve pragmatic problems in daily life, is more critical for individuals with severe and enduring mental health challenges. This will help them learn how to manage their well‐being, live independently, and stabilise their conditions.Lastly, public awareness campaigns should honour caregivers by highlighting their strength, resilience, and dedication. The state can provide financial assistance in the form of tax relief for their income per annum or caregiver allowance to alleviate the financial stress that caregivers are facing. Introduction: The progressive deinstitutionalisation of mental healthcare has increasingly shifted care responsibilities from healthcare professionals to family caregivers for individuals with severe mental illness. Caregivers must balance many obligations, which often compromise their overall health and well‐being, while helping their loved ones integrate into the community. Aim: To identify and understand caregivers' needs and challenges as they help individuals with severe and enduring mental health challenges integrate into the community. Methods: This study used a descriptive qualitative approach to explore the experiences and challenges of caregivers for individuals with severe and enduring mental health challenges when integrating back into the community. A semi‐structured guide was used during the video‐conferencing interviews conducted between December 2021 and November 2022. This study was reported according to the 32‐item Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Findings: Fourteen caregivers were individually interviewed by the primary author. Most caregivers were female, with an average of 15 years of experience caring for their loved ones. Using Braun and Clark's six‐phase thematic framework, we inductively generate the themes and subthemes from the data. The two themes were (i) challenges (whose subthemes included personal challenges in caregiving, the lack of awareness, and stigma and employment) and (ii) support (whose subthemes included the importance of socialisation for individuals with mental health conditions, existing avenues of support and potential areas for support). Discussion: Our findings informed the contemporary needs of caregivers caring for individuals with severe and enduring mental health challenges integrating into the community. Like the global challenges for people with mental health issues, psychosocial support and other supplementary support are still common themes in mental health settings. The findings further specifically highlighted the importance of accessible points of contact as resources and employment‐enabling and sustaining initiatives to help manage caregivers' emotional and system challenges, which addresses the gaps identified in the findings. Caregivers' peer‐support groups, life skills training and public mental health awareness are also necessitated by the caregivers' voices. Implications for Practice: Priority areas include having a centralised point of contact within the community for caregivers. Government or not‐for‐profit organisations can take the lead by initiating employment‐enabling initiatives for individuals with severe and enduring mental health challenges and their caregivers. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo explore the effects of the Personalized Citizen Assistance for Social Participation (APIC), an intervention adapted here for visual impairment, involving weekly stimulation sessions over six to twelve months, provided by trained and supervised attendants, on seven outcomes (social participation, leisure, independence, mobility, quality of life, health-related quality of life, and empowerment) in older adults with visual impairment, and to document its facilitators and barriers.A mixed-method design, which included a pre-experimental and an exploratory qualitative clinical research component, was used on 8 older adults (7 women) with visual impairment aged 70–86, and 8 attendants (5 women) aged 20–74. Before the intervention, directly after, and four months later, older adults completed questionnaires on the 7 outcomes. During the intervention, attendants completed diaries and participated in monthly meetings. Semi-structured interviews were administered to all participants after the intervention.Social participation, leisure, mobility, quality of life and empowerment had increased immediately after the APIC. These improvements were still generally observed four months later. Participants reported that the APIC improved older adults’ capabilities, social participation, and social environment.The APIC is a promising intervention which helps older adults with visual impairment to deal with social restrictions.In older adults, visual impairment has important consequences on active and healthy aging.Personalized citizen assistance for social participation (APIC) is an intervention that aims to foster the social participation.This study shows that APIC adapted to visual impairment influences social participation, leisure, mobility, quality of life and empowerment of older adults with visual impairment.Participants also reported improvements in their capabilities, social participation, and social environment.In older adults, visual impairment has important consequences on active and healthy aging.Personalized citizen assistance for social participation (APIC) is an intervention that aims to foster the social participation.This study shows that APIC adapted to visual impairment influences social participation, leisure, mobility, quality of life and empowerment of older adults with visual impairment.Participants also reported improvements in their capabilities, social participation, and social environment. [ABSTRACT FROM AUTHOR]

People who sustain a traumatic brain injury (TBI) may have to live with permanent sequelae such as mental health problems, cognitive impairments, and poor social participation. The strengths-based approach (SBA) of case management has a number of positive impacts such as greater community integration but it has never been implemented for persons with TBI. To support its successful implementation with this population, it is essential to gain understanding of how the key components of the intervention are perceived within the organization applying the approach. Documenting the barriers and facilitators in the implementation of the SBA as perceived by potential adopters. A qualitative pre-implementation study was conducted using semi-structured interviews with community workers and managers of the community organization where the SBA is to be implemented. Data were analyzed using a deductive approach based on the Consolidated Framework for Implementation Research (CFIR). The major barriers are associated with the intervention (e.g. adaptability of the intervention) and the external context (e.g. the impact of the pandemic). Perceived facilitators are mainly associated with the internal context (e.g. compatibility with current values). The barriers and facilitators identified will inform the research team's actions to maximize the likelihood of successful implementation. [ABSTRACT FROM AUTHOR]

To translate and cross-culturally adapt The Community Integration Measure into Turkish (CIM-T) and to assess its reliability and validity in patients with chronic stroke. Fifty participants completed the CIM-T, Community Integration Questionnaire (CIQ) and the London Handicap Scale (LHS). All participants completed the CIM-T questionnaire twice in 7 days. The internal consistency of the CIM-T was assessed using Cronbach's alpha, while the Intraclass Correlation Coefficient (ICC) was used to evaluate test-retest reliability. The convergent validity of CIM-T was determined with CIQ and LHS by using Pearson's and Spearman's correlation coefficient analysis. The CIM-T demonstrated high internal consistency (Cronbach's α = 0.955) and test-retest reliability (ICC= 0.992). The CIM-T showed a good correlation with CIQ (R = 0.727, p < 0.001) and LHS (R = 0.694, p < 0.001). The Turkish version of CIM is a valid and reliable instrument for assessing chronic stroke patients. It is a preferable scale for the clinical evaluation of Turkish-speaking patients with chronic stroke. The Community Integration Measure was successfully translated into Turkish and validated in a population with chronic stroke according to established guidelines. The Turkish version of the Community Integration Measure has very good internal consistency and test–retest reliability. The Turkish version of the Community Integration Measure is valid and reliable. [ABSTRACT FROM AUTHOR]

Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth‐related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth‐focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth‐related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods. Highlights: Participants in Housing First (HF) reported more distal supports (DS) than those in staircase services.More distal supports predicted stronger sense of community integration (CI).The link from Housiing First to well‐being indicators is indirect, through DS and CI.More research on the indirect effects of HF on important well‐being outcomes is needed.Future research should identify the specific mechanisms through whch HF programs promote DS. [ABSTRACT FROM AUTHOR]

Zambia is a low‐income country on the African continent which is facing a high rate of health inequalities. Although the government has made efforts to reform the organization of healthcare to reduce inequalities, the practical implementation of disability policies remains challenging. Specifically, people with intellectual disabilities (ID) face barriers to accessing healthcare services in Zambia, due to geographic or socioeconomic factors, stigma, and limited specialized health professionals. This perspective paper provides an overview of the current policy and organization on the healthcare provision for people with ID. It presents the key challenges people with ID face in Zambia to access quality healthcare services. Additionally, we provide examples of good practices with a community approach. We discuss policy implementation of disability rights, including access to healthcare, the impact of raising knowledge and awareness about people with ID, and how gathering contextual information through research can help to reduce inequalities. Community and culturally sensitive approaches to improve access to healthcare for people with ID in Zambia are crucial. We call for close collaboration between the fields of research and practice to combine expertise and strengthen the impact and possibilities of scaling good practices within Zambia. [ABSTRACT FROM AUTHOR]

Purpose. To characterize societal participation profiles after moderate-severe traumatic brain injury (TBI) along objective (Frequency) and subjective (Satisfaction, Importance, Enfranchisement) dimensions. Materials and Methods. We conducted secondary analyses of a TBI Model Systems sub-study (N = 408). Multiaxial assessment of participation included the Participation Assessment with Recombined Tools-Objective and -Subjective questionnaires (Participation Frequency and Importance/Satisfaction, respectively) and the Enfranchisement Scale. Participants provided responses via telephone interview 1–15 years post-injury. Multidimensional participation profiles (classes) were extracted using latent profile analysis. Results. A 4-class solution was identified as providing maximal statistical separation between profiles and being clinically meaningful based on profile demographic features. One profile group (48.5% of the sample) exhibited the "best" participation profile (High Frequency, Satisfaction, Importance, and Enfranchisement) and was also the most advantaged according to socioeconomic indicators. Other profile groups showed appreciable heterogeneity across participation dimensions. Age, race/ethnicity, education level, ability to drive, and urbanicity were features that varied between profiles. Conclusions. Societal participation is a critical, but inherently complex, TBI outcome that may not be adequately captured by a single index. Our data underscore the importance of a multidimensional approach to participation assessment and interpretation using profiles. The use of participation profiles may promote precision health interventions for community integration. Our study found unidimensional measures of societal participation in traumatic brain injury (TBI) populations that focus exclusively on frequency indicators may be overly simplistic and miss key subjective components of participation Taking a multidimensional perspective, we documented four meaningfully distinct participation subgroups (including both objective and subjective dimensions of societal participation) within the TBI rehabilitation population Multidimensional profiles of participation may be used to group individuals with TBI into target groups for intervention (e.g., deeper goal assessment for individuals who do not rate standard participation activities as important, but also do not participate and do not feel enfranchised). [ABSTRACT FROM AUTHOR]

Background: Neighbors are an important component of personal social network (PSN) and despite their peripheral role and being considered as familiar strangers, they typically provide instrumental support. For people who is discharged after long-term psychiatric hospitalizations, neighbors would offer other types of social support and play a different role fostering the process of becoming full member of a given community. Aims: To analyze the effects of neighboring on both, those who have had long-term psychiatric hospitalizations and their neighbors. Method: Data was collected between 2020 and 2021, including interviews with formal care staff of three housing support experiences in Argentina, and short testimonies from formerly discharged mental health service users living in the community and their neighbors. We analyzed the data using the Framework Method with a focus on the different aspects of social support and equity and reciprocity theories. Results: Results suggest that emotional support was a frequent function displayed by neighbors toward people with a history of long-term psychiatric hospitalizations, which differs from typical neighboring relationships. Conclusions: Despite reciprocity was observed, users and neighbors displayed an unbalanced helping relationship. [ABSTRACT FROM AUTHOR]

It is well known that the coronavirus disease 19 (COVID-19) epidemic had an adverse effect on the health-related quality of life (HRQOL) of patients with disabilities, or neurological or chronic conditions. The aim of this study was to examine the possible factors affecting HRQOL in patients with burn injuries during COVID-19 epidemic. The study included a total of 40 burns patients. The demographic and burn injury information of the patients were recorded. The active range of motion was measured with a goniometer. The HRQOL, community integration, scar tissue quality and anxiety level were evaluated using the Burn-Specific Health Scale (BSHS), the Community Integration Questionnaire Revised (CIQ-R), Patient and Observer Scar Assessment Scale, and the State-Trait Anxiety Inventory, respectively. The history of COVID-19 infection, total burn surface area (TBSA), community integration level, work-related burns, the presence of trunk burn injury, the presence of face burn injury, and the presence of a major burn injury were determined to be significantly associated with the HRQOL of burns patients (p < 0.05). The history of COVID-19 infection, community integration level, and burn-related parameters (TBSA, localization, severity etc.) were found to be factors associated with the HRQOL during the epidemic. The history of COVID-19 and community integration level should be evaluated in addition to the burn injury parameters to improve the quality of life of burn survivors. It can be recommended that these clinical parameters should be considered when planning the treatment program during and after the epidemic. • Burn patients with Covid-19 history have reduced HRQOL during pandemic. • Increased community integration level is associated with better HRQOL during Covid-19 pandemic. • It is important to follow-up HRQOL of burn survivors during/post the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration. 110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge. Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status. Experience of stigma in the first few months post-discharge may negatively impact individuals' community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community. Lower functional status and use of a power wheelchair after acquired neurological injury may increase the experience of stigma. Individuals with acquired brain injury or spinal cord injury who perceive high levels of stigma in the first few months post-discharge are more likely to experience poorer long-term community integration. The first few months post-discharge represent an important phase for health professionals to support individuals to explore their beliefs regarding disability and injury-related self-appraisals and enhance connection to their community. [ABSTRACT FROM AUTHOR]

Background: This paper describes the protocols for a randomized controlled trial using a parallel-group trial design that includes an intervention designed to address social isolation and loneliness among people experiencing homelessness known as Miracle Friends and an intervention that combines Miracles Friends with an economic poverty-reduction intervention known as Miracle Money. Miracle Friends pairs an unhoused person with a volunteer "phone buddy." Miracle Money provides guaranteed basic income of $750 per month for 1 year to Miracle Friends participants. The study will examine whether either intervention reduces social isolation or homelessness compared to a waitlist control group. Methods: Unhoused individuals who expressed interest in the Miracle Friends program were randomized to either receive the intervention or be placed on a waitlist for Miracle Friends. Among those randomized to receive the Miracle Friends intervention, randomization also determined whether they would be offered Miracle Money. The possibility of receiving basic income was only disclosed to study participants if they were randomly selected and participated in the Miracle Friends program. All study participants, regardless of assignment, were surveyed every 3 months for 15 months. Results: Of 760 unhoused individuals enrolled in the study, 256 were randomized to receive Miracle Friends, 267 were randomized to receive Miracle Money, and 237 were randomized to the waitlist control group. In the two intervention groups, 360 of 523 unhoused individuals were initially matched to a phone buddy. Of the 191 study participants in the Miracle Money group who had been initially matched to a volunteer phone buddy, 103 were deemed to be participating in the program and began receiving monthly income. Discussion: This randomized controlled trial will determine whether innovative interventions involving volunteer phone support and basic income reduce social isolation and improve housing outcomes for people experiencing homelessness. Although we enrolled unhoused individuals who initially expressed interest in the Miracle Friends program, the study team could not reach approximately 30% of individuals referred to the study. This may reflect the general lack of stability in the lives of people who are unhoused or limitations in the appeal of such a program to some portion of the unhoused population. Trial registration: ClinicalTrials.gov NCT05408884 (first submitted on May 26, 2022). [ABSTRACT FROM AUTHOR]

Community integration following the experience of chronic homelessness is a key principle of Housing First programming, yet it is scantily addressed or studied. Originally developed in New York, the Restorative Community Collaborative program shows promise in building meaningful community integration and improving outcomes among individuals who have experienced chronic homelessness. This convergent mixed-method study describes outcomes for this adapted program implemented in Houston, Texas by a social service agency in collaboration with local congregations. The program increased participant empowerment and beneficial community connection among all stakeholders (participants, volunteers and mentors). Lessons for future implementation of such programs is discussed. [ABSTRACT FROM AUTHOR]

The importance of community involvement for both older adults and individuals coping with mental illness is well documented. Yet, barriers to community integration for adults with mental illness such as social stigma, discrimination, and economic marginalization are often exacerbated by increased health and mobility challenges among older adults. Using photovoice, nine older adults with mental illness represented their views of community in photographs and group discussions over a six-week period. Participant themes of community life included physical spaces, valued social roles, and access to resources in the community. Themes were anchored by older adults' perceptions of historical and cultural time comparisons between 'how things used to be' and 'how things are now.' Barriers to community integration were often related to factors such as age, mobility, and resources rather than to mental health status. Program evaluation results suggest photovoice can promote self-reflection, learning, and collaboration among older adults with mental illness. [ABSTRACT FROM AUTHOR]

This study identified individual sociodemographic and clinical characteristics and service use patterns associated with quality of life (QoL) among 308 individuals living in permanent supportive housing (PSH) in Québec (Canada). Data were collected between 2020 and 2022, and linear multivariate analyses produced. Results demonstrated that better individual psychosocial conditions were positively associated with higher QoL. As well, living in PSH located in good neighborhoods for at least 5 years, higher self-esteem and community integration were positively associated with greater QoL. Met needs, satisfaction with housing support services, and no use of acute care were also linked with positive QoL. Comprehensive efforts to improve treatment for mental health disabilities responsive to the needs of PSH residents, and sustained long-term housing may reinforce QoL. Encouraging active participation in community-based activities, incorporating biophilic design into the neighborhoods around PSH, and promoting satisfaction with care may also enhance QoL. [ABSTRACT FROM AUTHOR]

Background: Individuals returning to the wider community from incarceration face many re‐entry barriers, including stigmatising beliefs regarding past criminal record, that have impact on health and re‐entry. Understanding the development and impact of self‐stigma on health can inform re‐entry and rehabilitation services. Aims: The two aims of this study were first, to evaluate a previously established model of self‐stigma applied to individuals who have experienced incarceration and, secondly, to study the impact of self‐stigma on physical and mental health as well as community integration on re‐entry. Methods: This is a cross‐sectional study of 129 formerly incarcerated adults recruited using an online platform and asked to complete online rating scales about self‐stigmatisation, health and sense of community integration. Repeated‐measures analysis of variance, correlation analysis, and path analyses were used to evaluate the model. Results: There was support for the four distinct stages of self‐stigmatisation apparent in mental health research. There was a relationship between self‐stigma harm and sense of community integration, mediated by mental but not physical health status scores. Conclusion: Our findings add to work on self‐stigmatisation in the field of mental health by showing that the concept appears relevant and appears in similar staging among formerly incarcerated individuals and that self‐stigmatisation is likely to be important for their community reintegration. Our sample was not typical of the wider prison population for race and gender distribution, in particular having fewer than expected those minority groups likely to be especially vulnerable to stigmatisation by others. Our findings nevertheless suggest that further, preferably, longitudinal research on self‐stigma to enable better understanding of pathways could substantially help treatment and rehabilitation of individuals after release from a correctional facility. [ABSTRACT FROM AUTHOR]

Background: Integration into a community after homelessness, while often difficult, can foster positive outcomes such as housing retention and improved health. However, research has understudied the roles of spiritual practices in community integration after homelessness. Methods: We conducted a grounded analysis of these processes using qualitative interviews with 27 supportive housing residents in Miami. Results: Even after moving into supportive housing, many of our interviewees grappled with long-term impacts of trauma, discrimination, and stigma, which oftentimes prevented them from joining conventional congregations. While some turned to solitary prayer, others used strategies such as joining alternative congregations, creating new locations of practice, and using technology to sustain social ties and a sense of belonging. Conclusion: We argue that researchers, supportive housing providers, congregation leaders, and administrators should pay more attention to barriers and strategies that impact residents' ability to practice spirituality in ways that meet existential, emotional, and social needs. [ABSTRACT FROM AUTHOR]

This paper describes a project exploring the viability in Australia of increasing the supply of small, affordable housing to those with limited income and wealth and a desire to live in homes that integrate with the community in meaningful ways and minimise consumption of building materials, land and energy. The research context is the increasing marketing and media coverage of tiny homes, which has prompted questions about whether such houses can offer an alternative affordable housing model. The project focused on four key issues: community integration, building and design, regulatory planning barriers, and financing and affordability. A combination of interviews, focus groups, and system thinking workshops was used to collect the views of stakeholders across the housing sector, including potential residents. Results indicate that a radical shift is needed from the planning authorities, housing supply and finance sector to enable the provision of affordable and sustainable compact homes that are adaptable to all stages of life. [ABSTRACT FROM AUTHOR]

To understand the applicability and unique contributions of global positioning system (GPS) and geographic information system (GIS) technologies to investigate individuals' participation in the community. A scoping review was conducted to summarize studies that employed GPS and/or GIS to assess community participation. Systematic literature searches were performed using nine electronic databases, up to April 2022. Two independent reviewers screened studies for eligibility and extracted data from the selected studies. The searches retrieved 628 articles, of which 36 met the inclusion criteria. In 31 studies, a GPS unit or GPS-enabled device monitored the community mobility of individuals with different health conditions. Tracking periods varied from five hours to 30 consecutive days. The spatiotemporal parameters obtained from satellite-based data provided information about individuals' presence in the community. Most studies combined GPS with other measuring tools (self-report diaries/questionnaires, qualitative interviews) to capture a broader description of community participation. GPS and GIS are viable approaches for advancing research as they provide unique information about community participation not easily captured by other methods. The combination of available methods comprehensively address the physical and social dimensions of this construct. Global positioning system (GPS) and geographic information system (GIS) technology allows direct and real-time quantification of patterns of individuals' community mobility. The geographic area where individuals participate in daily living activities complements information from self-report diaries/questionnaires. Combining GPS technology with self-report diaries/questionnaires allows a broader description of individuals' community participation, addressing respectively both its physical and social dimensions. Knowledge of individuals' access to and involvement in community locations/situations may help therapists design interventions to improve community participation. [ABSTRACT FROM AUTHOR]

Purpose: Strategies for preventing and ending homelessness are frequently measured by their effectiveness on indices of tenancy sustainment. To shift this narrative, we conducted research to identify what is needed to "thrive" following homelessness from the perspectives of persons with lived experience in Ontario, Canada. Methods: Conducted in the context of a community-based participatory research study aimed at informing the development of intervention strategies, we interviewed 46 persons living with mental illness and/or substance use disorder [n = 25 (54.3%) unhoused; n = 21 (45.7%) housed following homelessness] using qualitative interviews. A subsample of 14 participants agreed to engage in photovoice interviews. We analysed these data abductively using thematic analysis informed by health equity and social justice. Results: Participants described experiences of "living in a state of lack" following homelessness. This essence was expressed through four themes: 1) housing as part one of the journey to home; 2) finding and keeping "my people"; 3) meaningful activity as critical for thriving following homelessness; and 4) struggling to access mental health supports in the context of challenging circumstances. Conclusions: Individuals struggle to thrive following homelessness in the context of insufficient resources. There is a need to build on existing interventions to address outcomes beyond tenancy sustainment. [ABSTRACT FROM AUTHOR]

Background: Participation in leisure activities is significantly impacted following acquired brain injury (ABI). Despite this being a common community rehabilitation goal, re-engagement with leisure activities following ABI is poorly addressed within Australian community rehabilitation services, which often cater to a mixed-diagnostic group of both ABI and non-ABI clients. Objectives: To evaluate the feasibility and effect of a leisure reintegration group programme within a community rehabilitation service. Method: A single-site, pre- and post-test feasibility study was conducted. Three cohorts of a semi-structured leisure group programme were offered, each conducted over eight sessions within 4 weeks. The Nottingham Leisure Questionnaire (NLQ) and Leisure Satisfaction Measure (LSM) were used as primary outcome measures. Measures of acceptability, including adherence, and a post-intervention participant survey were also completed. Results: Of the 14 consenting participants, 9 completed all outcome measures. Mean change score for the NLQ was −3.63 (p = 0.11) and the LSM 4.25 (p = 0.46). The programme was well attended (79%), acceptable for ABI and non-ABI participants and able to be implemented within an existing community rehabilitation service. Conclusion: Providing a leisure reintegration group programme met an identified need, developed client and carer capacity and could be delivered within a community rehabilitation service for clients with mixed diagnoses including ABI. A larger trial is warranted to examine the effectiveness and cost-effectiveness of this intervention for people with ABI. [ABSTRACT FROM AUTHOR]

This research is an integrative review of the literature on social factors in TBI outcomes. It examines how such factors have been framed in TBI models, the social experience of people post-injury, and the evidence for effective social interventions. Evidence suggests that even when physical functioning has improved after injury, there is a lingering social distress that leaves individuals isolated and functionally impaired. A novel hypothesis is proposed to explain why these difficulties persist. This hypothesis draws from existing biopsychosocial models of TBI recovery, including those prominent in neuropsychology. It is argued that the social component of several TBI outcome models is too narrowly defined. This potentially has the effect of focusing efforts on the individual and their social skills or abilities as opposed to the seeking improvements at the level of the community. Evidence for and against this hypothesis is considered. This evaluation supports the idea that TBI outcomes are subject to a wider range of post injury social factors than is typically recognized, and that these factors are dynamic rather than static. Inspired by this hypothesis, this review proposes that social interventions for TBI should be adjusted to suit the stage of recovery. [ABSTRACT FROM AUTHOR]

Objectives: This research was aimed to ensure the validity and reliability of the Turkish version of the "Community Integration Scale for Adults with Psychiatric Disorders." Methods: This methodological study was conducted with 170 patients with psychiatric disorders. Data were collected between June 2019 and October 2019. Research data were analyzed with Kaiser-Meyer-Olkin (KMO) analysis, Barlett's sample size test, factor analysis, cronbach's α, correlation analysis, an independent t-test. Statistical analyses were made with IBM SPSS 22 and the Lisrel 8.8 program. Results: This study was conducted with 170 individuals with any of the diagnoses of schizophrenia and bipolar disorder. The KMO value of the scale was 0.864, and the Chi-square value was found as χ²: 5722.153. (p<0.001). As a result of explanatory factor analysis, it was determined that there was a five-factor structure. As a result of confirmatory factor analysis, fit indices (χ²/df: 2.013, root mean square errors: 0.077, comparative goodness of fit index: 0.96, goodness of fit index: 0.84, p=0.000) were found to be significant. The scale's Cronbach α=0.92, test-retest correlation of 0.84, and item-total score correlation were found to be high. Conclusion: The scale is a valid and reliable tool for measuring the community integration level of adults with psychiatric disorders in the Turkish community. [ABSTRACT FROM AUTHOR]

Occupational therapists support individuals experiencing homelessness in traditional roles, and occupational therapy positions focussed specifically on homelessness appear to be growing. To develop and refine a framework to guide occupational therapy practice and research in homelessness. We developed a framework and refined it through a stakeholder consultation process conducted with 17 international occupational therapy experts using an online survey. In this survey, we presented an initial framework and requested qualitative feedback. We analyzed this qualitative data using content analysis. Stakeholder feedback was categorized into eight recommendations: (1) Revision to the 'four processes'; (2) Emphasizing social justice and systems-level advocacy; (3) Reflecting intersectionality; (4) Emphasizing meaningful activity; (5) Emphasizing peer support; (6) Incorporating a focus on independent living skills; (7) Increasing a focus on an activity for addressing substance misuse; and (8) Acknowledging cognitive and physical health. Each of these recommendations was incorporated into a refined version of this framework. These recommendations and a refined version of the framework are presented in this paper. We have developed and refined a framework aimed at guiding practice and research in occupational therapy in homelessness that will be evaluated in future research. Though a range of frameworks exists for guiding the practice of occupational therapists more generally, this framework represents the first that is focussed specifically on guiding occupational therapy practice and research with individuals who experience homelessness. Research and practice implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Various factors affect the community integration (CI) of persons experiencing traumatic brain injury (TBI). To ensure positive outcomes in terms of life at home, social activities, and productive work among persons suffering TBI, it is necessary to understand the factors that facilitate or impede CI. Purpose: To compare CI by looking at demographic and clinical characteristics and determine significant predictors of CI among TBI Nepalese persons. Methods: 120 participants were selected using a stratified random sampling technique. A questionnaire was used to identify the participants' demographic and clinical characteristics, and the Community Integration Questionnaire was used to measure CI. Univariate and multivariate analyses were performed for demographic and clinical factors associated with community integration. Results: Using univariate analysis, male, employed, living with family, and independence in performing activities of daily living had significantly higher CI scores than female (t = −4.18, p<.000), unemployed (t = −10.52, p<.000), living with friends (t = −3.30, p<.001), and those with moderate to slight dependence (t = −2.83, p<.005). The multivariate analysis revealed that employment status, living with family, and length of hospital stay were significant predictors of CI among TBI Nepalese persons. Conclusion: Employment status, living with family, and length of hospital stay were significant predictors of CI. These findings suggest that rehabilitation efforts should focus on minimizing hospital stay and promoting both productive and social activities among people surviving TBI. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to identify factors that may predict community participation among adults with lower limb amputation. Design: This study is a secondary analysis of a cross-sectional data set, including 126 community-dwelling adults, ≥1 yr after unilateral transfemoral- (n = 44; mean age = 59 ± 14 yrs) or transtibial-level amputation (n = 82; mean age = 59 ± 14 yrs) seen in an outpatient limb loss clinic. Participation was assessed with the Community Integration Questionnaire. Factors, that is, demographics, comorbidities, prosthesis use per the Houghton Scale, Socket Comfort Score, assistive device use, falls history, and activity level per General Practice Physical Activity Questionnaire were evaluated. Moreover, balance confidence per the Activities-Specific Balance Confidence Scale, mobility per the Locomotor Capabilities Index, fast and self-selected gait speed per 10-meter walk tests, and functionalmobility via Timed Up and Go were also included. Results: Community participation was correlated with several factors (P ≤ 0.050). Stepwise regression of correlated factors found absence of peripheral neuropathy and greater self-reported physical activity, balance confidence, and prosthesis use, as the strongest correlates, collectively explaining 50.1% of the variance in community participation post-lower limb amputation. Conclusions: Findings identify key modifiable factors for consideration in future prospective research seeking to enhance community reintegration and participation among adults living with a unilateral transfemoral- or transtibial-level amputation. [ABSTRACT FROM AUTHOR]

Individuals who have experienced incarceration are an underserved population in need of career development to reduce barriers to employment. Given the high rates of disability and health concerns for individuals who have been previously incarcerated, this study explored the relationships between individual health functioning, vocational identity, core self‐evaluations, and community integration. Using structural equation modeling structural regression, results showed that functional difficulties negatively impact vocational identity and core self‐evaluations. Conversely, core self‐evaluations significantly improve community integration and mediate a positive relationship between vocational identity and community integration. Career development activities aimed at core self‐evaluations and increasing meaning in employment may reduce some of the barriers experienced by individuals post incarceration. [ABSTRACT FROM AUTHOR]

William (Bill) A. Anthony was a pioneer in the field of psychosocial/psychiatric rehabilitation and recovery. He established the Center for Psychiatric Rehabilitation at Boston University and served as the editor/coeditor of the Psychosocial Rehabilitation Journal (later Psychiatric Rehabilitation Journal). He helped to clarify ideas, principles, policies, and practices that promoted the right and ability of people living with psychiatric disabilities and mental health challenges to aspire to and achieve their own vision of a meaningful life. This introductory article briefly overviews Bill's contributions to psychiatric rehabilitation and recovery of people with mental health challenges and his influence on recent work in this field, a sample of which is presented in the current special section dedicated to him. To conclude, the article overviews this special section, which reports on studies in the United States and elsewhere, addressing supported education, recovery colleges, photovoice to promote community integration, and policy developments in Israel. Impact and Implications: This article summarizes the seminal impact of Bill Anthony's body of work on the field of psychiatric rehabilitation and recovery. Additionally, it traces the broad implications of his vision and contributions to the field, to the four articles presented in the special section, as examples of current work that will lead to future developments built upon his legacy. [ABSTRACT FROM AUTHOR]

Background: Supported accommodation intends to address challenges arising following release from prison; however, impact of services, and of specific service components, is unclear. We describe key characteristics of supported accommodation, including program components and outcomes/impact; and distil best-evidence components. Methods: We conducted a systematic review, searching relevant databases in November 2022. Data were synthesised via effect direction plots according to the Synthesis Without Meta-analysis guidelines. We assessed study quality using the McGill Mixed Methods Appraisal Tool, and certainty in evidence using the GRADE framework. Results: Twenty-eight studies were included; predominantly cross-sectional. Program components which address life skills, vocational training, AOD use, and mental health appear to positively impact criminal justice outcomes. Criminal justice outcomes were the most commonly reported, and while we identified a reduction in parole revocations and reincarceration, outcomes were otherwise mixed. Variable design, often lacking rigour, and inconsistent outcome reporting limited assessment of these outcomes, and subsequently certainty in findings was low. Conclusion: Post-release supported accommodation may reduce parole revocations and reincarceration. Despite limitations in the literature, the findings presented herein represent current best evidence. Future studies should clearly define program components and measure their impact; use analyses which reflect the high risk of adverse outcomes, such as time-to-event analyses; and consider outcomes which reflect the range of challenges faced by people leaving prison. Registration: PROSPERO registration CRD42020189821. [ABSTRACT FROM AUTHOR]

Background: Each individual with schizophrenia experiences life uniquely, despite the sameness in their diagnosis. Understanding their experiences is vital for their better community integration and social work practice. Method: We used the interpretative phenomenological approach. Persons with schizophrenia seeking outpatient services at a tertiary care institute in Bengaluru, India, were recruited through purposive sampling. In-depth interviews were conducted with six participants. Results: Some of the meta-themes and subthemes identified were as follows: (a) perception about self (struggling with the sense of self, desire for normalcy, wanting to be in control of self and desire to live independently), (b) relationship with others (feeling supported by others and feeling rejected by others), (c) coping with consequences of illness (coping with disruptions in personal life and coping with disruptions in family life), and (d) experience of seeking treatment (reasons for seeking treatment, being on medication, and behavior of mental health professionals). The participants tried to find meaning in their lives by making sense of their illness. Family and community can have a significant impact on how persons with schizophrenia perceive their lives. Conclusion: Mental health professionals need to encourage persons' and their families' greater participation in treatment planning and clinical interventions, which will enhance persons integration within the community and will help decrease the feeling of isolation commonly experienced when one lives with chronic mental illnesses. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify the associated factors with lower self-esteem and restriction in community reintegration in SpA patients. This study was a cross-sectional study including SpA patients (ASAS criteria) aged 18–50 years. The level of self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). The Reintegration to Normal Living Index (RNLI) evaluated the degree of reintegration to normal social activities. Anxiety, depression, and fibromyalgia were screened by the Hospital Anxiety and Depression Scale (HADS)-A, HADS-D, and FiRST, respectively. Statistical analysis was performed. A total of 72 patients were enrolled (sex-ratio = 1.88), with median (IQR) age of 39 years (28.25–46). Median (IQR) disease duration was 10 (6–14) years. Median (IQR) BASDAI and ASDAS were 3 (2.1–4.7) and 2.7 (1.9–3.48), respectively. Anxiety symptoms were screened in 10% of SpA patients, depression in 11%; and fibromyalgia in 10%. Median (IQR) RSES and RNLI scores were 30 (23.25–34), and 83 (53.25–93.25), respectively. Multivariate regression analysis identified the domain (work) of pain interference, VAS pain, HAD anxiety, PGA, marital status, and morning stiffness as factors associated with lower self-esteem. Restriction in the reintegration community was predicted by the presence of IBD, VAS pain, FIRST, deformity, enjoyment of life, and HAD depression. Pain intensity and interference, deformities, extra-articular manifestations, and deterioration of mental health were associated with low self-esteem and severe restriction in community reintegration among patients with SpA rather than inflammatory parameters. [ABSTRACT FROM AUTHOR]

Introduction: Qualitative knowledge in health education is increasingly essential for critical, reflective and interdisciplinary training for graduates of the health field, as well as the necessary articulation of the use of qualitative research methodology grounded in the concepts of human and social sciences. Objective: to expose the importance of knowledge and qualitative methodological elements in health training in the Brazilian Amazon scenario. Method: This is an experience report with the use of qualitative research methodology, which took as reference the curricular component of Interaction on a Real Basis (IBR), of the three undergraduate courses in the area of health (collective health, pharmacy and interdisciplinary), taught during the first four semesters by the Institute of Collective Health (ISCO) of the Federal University of Western Pará (UFOPA), in the Brazilian Amazon region. Results: The experience produced through the use of qualitative research methodology in this curriculum component, occurred in activities developed in the classroom space and in the field of practice (Amazonian communities). Among the methodological elements of qualitative research used are: observation, ethnography for the production of listening, bonding with people from the community investigated, recognition of culture and identity, ethnic and linguistic diversity in scenarios of socioeconomic inequality that coexist in these territories, urban and rural spaces, indigenous communities, quilombolas and riverine communities. The use of the methodological elements of qualitative research enabled the development of qualitative scientific knowledge in health education, through conceptual, textual and contextual construction. In addition, the experiences produced with the communities of the Brazilian Amazon region, unveil the multiplicity of ways of living and doing health, allowing a broad field for qualitative teaching in health. Conclusions: The knowledge of qualitative research is essential to support the teaching-learning process articulated with the field practice, aiming at the construction of new perspectives and methodological paths that go beyond the disciplinary boundaries of the health field. [ABSTRACT FROM AUTHOR]

Objectives The United States has seen increasing shifts toward home- and community-based services (HCBS) in place of institutional care for long-term services and supports. However, research has neglected to assess whether these shifts have improved access to HCBS for persons with dementia. This paper identifies HCBS access barriers and facilitators, and discusses how barriers contribute to disparities for persons with dementia living in rural areas and exacerbate disparities for minoritized populations. Methods We analyzed qualitative data from 35 in-depth interviews. Interviews were held with stakeholders in the HCBS ecosystem, including Medicaid administrators, advocates for persons with dementia and caregivers, and HCBS providers. Results Barriers to HCBS access for persons with dementia range from community and infrastructure barriers (e.g. clinicians and cultural differences), to interpersonal and individual-level barriers (e.g. caregivers, awareness, and attitudes). These barriers affect the health and quality of life for persons with dementia and may affect whether individuals can remain in their home or community. Facilitators included a range of more comprehensive and dementia-attuned practices and services in health care, technology, recognition and support for family caregivers, and culturally competent and linguistically accessible education and services. Discussion System refinements, such as incentivizing cognitive screening, can improve detection and increase access to HCBS. Disparities in HCBS access experienced by minoritized persons with dementia may be addressed through culturally competent awareness campaigns and policies that recognize the necessity of familial caregivers in supporting persons with dementia. These findings can inform efforts to ensure more equitable access to HCBS, improve dementia competence, and reduce disparities. [ABSTRACT FROM AUTHOR]

Background: Recovery-oriented programs provide individuals with opportunities for well-being through community integration processes that enhance the degree to which individuals could live, work, and recreate in their community. The current evaluation assessed how tenants experience their home environment after the modernization of Homes for Special Care (HSC) to Community Homes for Opportunity (CHO) in Southwest Ontario, Canada. Our study identifies existing policies and practices that could interfere with or promote the modernization process. Methods: We applied ethnographic qualitative techniques to purposefully recruit 188 participants with severe mental illness from 28 group homes. Focus groups were conducted at three time points, i.e., at pre-implementation/Baseline/Time I – spring 2018; Transition/Time II – fall 2018, and Final/Time III – winter 2019. Results: Study findings suggest that the transition of HSC to CHO supports activities that empower tenants towards personal growth and development. Participants were largely satisfied with the support they were getting in relation to the program-related services. Tenants disclosed that their quality of life and well-being had been enhanced through participating in the program, and that their social interaction and support for each other had also improved. Most tenants demonstrated autonomy in terms of personal and financial independence. The enhanced financial support for tenants did not only improve their quality of life, but also helped to raise their purchasing power, decision making, sense of responsibility and accountability towards healthy spending of their resources. Despite tenants' good impression about the CHO, some still encountered problems and provided suggestions to further improve the program. Conclusion: It is expected that a more effective and expanded CHO will lead to tenant empowerment and successful social integration. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of baseline injury characteristics and one-year functional level on the 10-year community integration outcomes for working-age patients with moderate-to-severe traumatic brain injury (TBI). Patients aged 16–55 and diagnosed with moderate-to-severe TBI within 24 h of injury were eligible for the study. Multivariable hierarchical linear regression was utilized to assess the impact of baseline characteristics and one-year functional measures on the mean Community Integration Questionnaire (CIQ) scores 10 years after injury. Of 133 original study participants, 97 survived 10 years, and 75 were available for this study. The mean total CIQ score changed positively from one to 10 years post-injury, from 18.7 (±5.5) to 19.8 (±4.8) (p = 0.04). The results suggested that age (β = −0.260, p = 0.013), FIM-Cognitive subscale (β = 0.608, p = 0.002), and the bodily pain subscale (BP) (β = 0.277, p = 0.017) of the SF-36 were significantly associated with the mean CIQ scores. In conclusion, this study demonstrated improved community integration from one to 10 years in a sample of working-age patients with moderate-to-severe TBI. The findings also showed that age, cognitive function, and bodily pain were significant predictors of long-term community integration, suggesting post-acute rehabilitation should focus on factors related to long-term risk and protective factors to improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Mobile sensing applications that collect active, Ecological Momentary Assessment data, and passive, Global Positioning System data provide reliable, longitudinal assessments of community integration. Ensuring their acceptability by vulnerable populations is warranted. Acceptability‐related perceptions of a mobile sensing application were gathered via focus groups with homeless‐experienced Veterans with serious mental illness (n = 19) and individual interviews with providers (n = 5) to inform subsequent application tailoring and testing. Rapid assessment generated structured summaries and matrix analyses integrated participant data. Active data collection was deemed noninvasive, with more concerns of passive data "ending up in the wrong hands." Providers recommended clear descriptions and promotion of choice to navigate privacy concerns and guardedness. Participants felt the application possessed clinical value for enhancing patient‐provider interactions and community integration efforts. Overall, participants found application features acceptable and expressed Veterans' willingness to engage in research using mobile sensing technology. Recommendations to enhance acceptability are discussed. [ABSTRACT FROM AUTHOR]

Objective: To understand barriers and facilitators to engaging in community activities for increasing social connectedness among recently psychiatrically hospitalized veterans, a population at elevated risk for suicide. Method: We completed 30 semistructured qualitative interviews with veterans within 1 week of discharge from inpatient psychiatric hospitalization. Our interviews focused on understanding past and current barriers, facilitators, and needs for engaging in community activities after psychiatric hospitalization. Data were analyzed using a modified grounded theory approach. Results: Veterans shared feeling a lack of belonging and discussed several barriers to community engagement including lack of self-confidence, limited knowledge of opportunities, and negative expectations. Veterans identified several ways to facilitate engagement in community activities such as centralizing information on community activities and providing active support posthospitalization. Conclusions and Implications for Practice: Veterans by and large valued community and the role of community activities for increasing social connectedness. However, more active intervention for supporting engagement in community activities appears necessary to facilitate connection posthospitalization. Impact and Implications: Engaging in community activities may be a helpful strategy to help veterans increase social connectedness after psychiatric hospitalization, a critical period for suicide risk. Veterans shared several barriers and facilitators that impact their future and current engagement in community activities. Clinicians may wish to pay special attention to historical challenges to connection and negative expectations as well as the need for active support for engaging in community activities. [ABSTRACT FROM AUTHOR]

To assess whether meeting criteria for community ambulation and ambulatory self-confidence on discharge from inpatient rehabilitation are associated with participation in community activities. Prospective longitudinal observational study design. Participants were assessed within 48-hours of discharge on ability to complete tasks reflective of community ambulation (walking 315 m, ascending/descending three stairs, a ramp, and a street curb and walking at 0.44 m/s) and ambulatory self-confidence. At 8 weeks post-discharge frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Multivariable regression analysis determined factors associated with total and outdoor FAI score. Seventy-four of 79 participants were followed up at 8 weeks post-discharge. Meeting all ambulation criteria was positively associated with FAI outdoor score (β = 1.85, 95%CI 0.01–3.69, p = 0.049). Ambulatory self-confidence was positively associated with FAI outdoor score (β = 0.03, 95%CI 0–0.05, p = 0.032) and FAI total score (β = 0.05, 95%CI 0–0.1, p = 0.040). Age (β= −0.22, 95%CI −0.36 to −0.08, p = 0.003) and living alone (β = 3.36, 95%CI 0.10–6.61, p = 0.044) were associated with FAI total score. Capacity to meet ambulation criteria and ambulatory self-confidence are modifiable factors that could be targeted during rehabilitation to improve participation in community activities. Meeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation are positively associated with performance of outdoor community activities 8 weeks after discharge. Capacity to meet community ambulation criteria and ambulatory confidence may be useful measures for rehabilitation teams to consider when discharging patients home. Meeting ambulation criteria and ambulatory confidence are modifiable factors that could be addressed through targeted therapy to improve community integration following hospitalisation. [ABSTRACT FROM AUTHOR]

Minimal general knowledge of the quality of life (QoL) of people with intellectual disabilities and mental health problems (ID/MHP) in Serbia exists at present. The outcomes of the deinstitutionalisation process of these groups, which began in 2015, are very questionable—many individuals have faced challenges, and very few have been deinstitutionalised to date. The purpose of this study was to determine the level of quality of life in the domain of social belonging/community integration, the differences in this domain between persons with ID/MHP living together in institutional residential arrangements and community settings, particularly in supported housing, and the differences in the same domain relating to the service provider (governmental/state‐run or non‐governmental sector). The results of the study indicate that the level of social belonging for this specific population is low, especially on indicators such as belonging to civic or community clubs or organisations, participating in events in the local community, and establishing friendships and emotional relationships. Users of services provided by the non‐governmental sector show slightly higher scores in this domain compared to institutionalised users and users in supported housing. The organisational culture based on institutionalism is transferred to community services, leading to an inability to fulfil the basic principles of proclaimed deinstitutionalisation. The recommendations provided should enable the basing of support services for persons with ID/MHP on the principles of deinstitutionalisation while respecting their rights and facilitating their participation in local communities. [ABSTRACT FROM AUTHOR]

This qualitative study explored ex-offender's community reintegration experiences following a prison sentence. Fourteen ex-offenders from the Offender Alumni Association participated in an in-person in-depth individual interview regarding their current roles, daily routines, living situation, activity participation, and current and future plans. A phenomenological approach using thematic analysis was employed for data collection and interpretation. The emerged themes were categorized under facilitators and barriers that influence healthy community reintegration. The facilitators included visualizing and committing to an ideal future, establishing a daily routine, upholding life balance, and discovering and connecting to external supports. The barriers included impediments to employment opportunities, lack of financial resources, social stigma, regulations imposed by the judicial system, disconnection from social advancements, and addiction to drugs and alcohol. The themes identified from the interviews suggest that current reintegration strategies and programs need to be improved in order to benefit ex-offenders seeking these services. [ABSTRACT FROM AUTHOR]

To further understand social and leisure (SL) participation after stroke and how it can be supported in a long-term perspective, this study aims to deepen the understanding of strategies used by long-term stroke survivors in relation to SL activities. The study has a qualitative design, using a grounded theory approach, and is based on in-depth interviews with 10 persons who had a stroke 15 years ago and four of their family members. The findings comprise nine different strategies used by the participants. These had two overarching purposes; to protect and re-construct the post-stroke self and to enable participation in valued SL activities despite challenges. The findings are summarized in one overarching theme: "Employing different strategies to balance costs and rewards of engagement in social and leisure activities". Strategies for SL participation involves balancing different priorities in life and can change over time as they are continuously influenced by various personal and environmental conditions. These findings contribute to an improved understanding of why and how people hold on to activities, give up activities and find new activities after a stroke. It also highlights the need for a long-term perspective on stroke rehabilitation and support. Re-engagement in social and leisure activities after stroke is a long-term process and various types of support may be needed during different stages of recovery and adaptation. Successful rehabilitation interventions build on an understanding of each individual's priorities, goals and strategies and how these may change or manifest over time. Special attention should be given to the individual's perception of costs and benefits in relation to engagement in activities, and the role that it has for the person's identity. By providing knowledge and supporting the use of adequate coping strategies, rehabilitation professionals can help patients find a new and accepted post-stroke identity. [ABSTRACT FROM AUTHOR]

To examine return to school outcomes 1 year after traumatic brain injury (TBI) rehabilitation discharge. Longitudinal observational study using Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) data at 1-year post-TBI. Inpatient rehabilitation centers using follow-up telephone calls. Individuals (n = 237) enrolled in the TBIMS-NDB since 2001 between the ages of 18 and 59 years who were engaged in postsecondary education (full or part-time) before recorded TBI. Return to school, categorized as in a postsecondary setting at first follow-up (reported hours in school greater than zero at one-year follow-up). Using an alpha level of 0.05 binary logistic regression analysis identified four predictive variables. Significant predictors of return to school include being of lower age, possessing a higher level of functioning at discharge, reporting lower ratings of disability at discharge, and being able to use a vehicle independently for transportation. Pursuit of higher education is a viable means of community reintegration after TBI. Some individuals with TBI face a myriad of barriers and challenges when returning to school. Study findings may facilitate understanding of how TBI affects return to school and community reintegration outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Due to medical advances, care for patients that experience burns has shifted from saving life to improving quality of life. Reintegrating into the community and maintain body image satisfaction may be difficult after a severe burn. Several studies have analyzed these two variables independently, but none have addressed a potential interrelationship.Aim: To investigate the indirect or direct relationship of body image and community integration, potentially mediated or moderated by social stigma, symptoms of depression, symptoms of post-traumatic stress disorder (PTSD), or posttraumatic growth.Methods: Data from the Burn Models Systems (BMS) Database between the years 2014 and 2020, patients who were at least 18 years of age and who had completed questionnaires that measured body image satisfaction, attitudes of community integration, perceived social stigma, and symptoms of depression, symptoms of PTSD, and posttraumatic growth were used to analyze potential mediators and moderators of the relationship between body image and community integration using multivariable linear regression models and structural equation modeling.Results: Social stigma, symptoms of depression, and symptoms of PTSD were determined to completely mediate the association of body image and community integration. Posttraumatic growth did not mediate this association. Social stigma, symptoms of depression, symptoms of PTSD, and posttraumatic growth did not moderate the relationship between body image and community integration.Conclusion: The finding that symptoms of distress and social stigma account for the relationship between body image satisfaction and community integration support the potential for interventions that ameliorate distress to improve community integration and quality of life in people recovering from burn injuries. [ABSTRACT FROM AUTHOR]

Community integration is preferred by people with intellectual and developmental disabilities; community integration is also associated with positive outcomes. Yet, many people with intellectual and developmental disabilities, especially with higher support needs, remain isolated. This exploratory study examined the relationship between community integration, significant support needs, and emergency department utilization of people with intellectual and developmental disabilities (n = 251) by analyzing secondary Personal Outcome Measures® interview data. We found an interaction between community integration and comprehensive behavior support needs, wherein people with intellectual and developmental disabilities with comprehensive behavior support needs who participated in the life of the community had 78% fewer emergency department visits than those people with comprehensive behavior support needs who did not participate in the community. Not only is community integration preferred by people with intellectual and developmental disabilities, our research suggests it can also produce improved health outcomes for those with comprehensive behavior support needs. [ABSTRACT FROM AUTHOR]

Individuals with serious mental illnesses (SMIs) face safety risks related to their mental health conditions that are often compounded by experiences of trauma, victimization, residence in impoverished neighborhoods, and histories of homelessness. Stigma and safety challenges significantly impact community integration for individuals with SMIs, particularly women, who often bear a disproportionate burden of vulnerability, gender-based stigma, violence, and other inequalities. This study investigates how women with SMIs engage in the meaning-making of their safety and stigma experiences that, in turn, influence their community integration. From a large multi-site study exploring community experiences of racially/ethnically diverse participants with SMIs, a subsample of 28 cis and trans-gender women, who reported experiencing gendered stigma and a lack of safety, were chosen for the current study. The interviews were analyzed using modified principles of Interpretive Phenomenological Analysis (IPA) to understand how women with SMIs made meaning of their safety and stigma encounters in their families, communities, and neighborhoods. IPA analysis resulted in the emergence of themes within a broad category of safety that represented participants’ meaning-making about their physical safety and stigma experiences. Specifically, we used the broad themes from an existing framework of safety called ‘Navigating Safety’ model as sensitizing concepts for our analysis. Physical and psychological aspects of safety for this study were experienced in tandem whereby the women made sense of how their experiences of a lack of physical safety in multiple contexts shaped their sense of self, internalized stigma, and their social relationships. Within the broad theme of physical safety, participants described unsafe neighborhoods, exposure to domestic and intimate partner violence, and vulnerability to sexual violence. Additionally, under psychological safety, we identified how gender-based norms, race and ethnicity, sources of stigma (internalized, familial, and societal), and social isolation contributed to their mental health and social relationships (particularly with family). These findings highlight how the compounding influence of the intersection of multiple stigmatized identities exerts safety challenges on the lives and community experiences of women with SMIs. Focusing on access and affordability of appropriate gender-responsive resources for women, including trauma-informed care, could reduce hospitalizations, mental health symptoms, and stigma so they can safely integrate into their communities. [ABSTRACT FROM AUTHOR]

Despite an estimated population of 10 million autistic individuals, there is still a significant lack of research on autistic adults in China. This study aimed to investigate the extent and factors influencing community integration (employment, independent living and friendship) and life satisfaction among young autistic adults in China, and compare them with an autistic adult sample with similar characteristics (58%–63% with a reported IQ below 70) from the Netherlands. Data were collected via online surveys to the caregivers of 99 young autistic adults (18–30 years) in China and 109 in the Netherlands, because the autistic adults were not able to fill in the survey independently. Autistic adults in both countries were reported to have limited community integration, as indicated by low rates of employment, limited independent living and few close friendships. Proxy-reported life satisfaction of autistic adults seemed relatively low in both countries, but even lower in Chinese adults, possibly due to limited awareness and acceptance of autism in China, inadequate or inaccessible support services, higher parenting stress, or general cross-country differences in well-being. In general, the findings indicate a common challenge faced by autistic adults with high support needs in both China and the Netherlands.Even though there are about 10 million Chinese autistic individuals, we know little about autistic adults in China. This study examined how well young autistic adults in China integrate into their communities (such as having a job, living independently and having friends) and how satisfied they are with their lives as reported by their caregivers. We compared them to autistic adults with similar characteristics (such as high support needs) from the Netherlands. We included 99 autistic adults in China and 109 in the Netherlands (18–30 years). In both countries, autistic adults were reported to have a hard time fitting into their communities. They often had no work, did not live on their own and had few close friends. Also, in both countries, caregivers reported that autistic adults felt low satisfaction with their life. Chinese adults were less satisfied with their life than Dutch adults, as indicated by their caregivers. This could be because of a lack of support for autistic adults in China, higher parental stress in Chinese caregivers, or general cross-country differences in happiness. Only in the Dutch group, younger compared with older adults fitted better into their communities, and adults without additional psychiatric conditions were reported to have higher life satisfaction. Country was a significant predictor of independent living only, with Dutch participants more likely living in care facilities than Chinese participants. In conclusion, our study shows that autistic adults with high support needs generally face similar challenges in both China and the Netherlands. [ABSTRACT FROM AUTHOR]

In the post-poverty alleviation era, multi-dimensionalrelative poverty governance and community integration offarmersin relo⁃ cation and resettlement areas have become serious challenges to consolidating and expanding the key achievements of poverty alleviation and effectively connecting with rural revitalization. Based on the spatial multi-dimensional poverty theory, by constructing the 'SEE-MAR􀆳 index system of multi-dimensional relative poverty coupling between poverty alleviation resettlement areas and farmers, this study ana⁃ lyzed the impact mechanism of their spatial coupling synergy on farmers􀆳 community integration, and used the evaluation report data of 38 poverty alleviation resettlement areas in Wumeng Mountain Area from 2014 to 2019. Using the entropy method and spatial econometric model, this study tested the spatial coupling mechanism of multi-dimensional relative poverty between resettlement areas and farmers, and revealed the spatial effect of multi-dimensional relative poverty coupling synergy between different resettlement areas and farmers on farm⁃ ers􀆳 community integration. The results showed that: ① The spatial coupling synergy between the poverty alleviation resettlement areas and farmers􀆳 multidimensional relative poverty was affected by systematic factors such as 'human-industry-land􀆳, and the integration of the geo⁃ graphical spatial transformation of the resettlement areas and the spatial reconstruction of farmers􀆳 livelihood presented the development trend of 'spatial differentiation→spatial coupling→spatial reconstruction→spatial integration􀆳 due to the differences of location condi⁃ tions and resource endowments. ② In terms of spatial coupling and synergy, the agricultural industrial base oriented and poverty allevia⁃ tion workshop employment oriented resettlement areas brought strong spatial coupling and synergy. In particular, the coupling synergy of small and medium-sized and large-scale farmers􀆳 resettlement areas was high, which was reflected in a pattern that small and medium⁃sized resettlement areas > large resettlement areas > super large resettlement areas > micro resettlement areas. However, the spatial coupling synergy of multi-dimensional relative poverty between resettlement areas and farmers showed a downward trend with the growth of per capi⁃ ta GDP. ③ The spatial effect of community integration of relocated farmers showed a certain spatial agglomeration and Matthew effect. The higher the degree of spatial integration, the more obvious the weakening trend of CO agglomeration and the strengthening trend of negative agglomeration. Reducing the degree of multi-dimensional relative poverty spatial agglomeration and spatial inequality between resettle⁃ ment areas and farmers could strengthen farmers􀆳 sense of community integration. Therefore, more follow-up support for relocation should be implemented to strengthen the reconstruction of farmers􀆳 livelihood space, geographical space, social space and cultural and psychologi⁃ calspace, and improve the sense of community integration of relocated farmers. [ABSTRACT FROM AUTHOR]

Objective: To understand and explore the traumatic brain injury (TBI) outcomes for people returning to urban versus rural communities post‐injury, and if geographical location plays a role in those outcomes. Design: Cross‐sectional mail‐out survey of TBI patients, using standardised, quantitative measures. Setting: Data were drawn from three Accessibility Remoteness Index of Australia (ARIA) areas in Queensland to model the contribution of these areas and other factors to TBI outcomes. Participants: Using hospital records, 662 people with mild to severe TBI were identified. These people were sent a survey, postdischarge. Usable surveys were returned by 91 individuals, 6‐ to 18‐months post‐injury. Location was coded using the ARIA (urban n = 22, rural n = 43, remote n = 26). Main Outcome Measures: TBI‐related symptoms, quality of life, service obstacles, unmet needs, mental health and community integration. Results: No group differences in TBI outcomes due to location were found. While the participant's gender, age, and injury severity were significant independent predictors of five of the six outcomes, location did not play a role. Conclusion: Consistent with previous findings, geographical remoteness did not affect self‐reported TBI outcomes. Older people, women and those with severe TBI had worse outcomes and required additional supports, and men require community integration assistance. An Australia‐wide study with regular follow‐ups is strongly recommended to support direct regional comparisons and improve service planning. [ABSTRACT FROM AUTHOR]