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Abstract 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.

Objective: This review aims to highlight the effectiveness of various forms of cancer rehabilitation in improving physical, emotional, and social outcomes for patients with cancer. It evaluates the impact of cancer rehabilitation on physical function, psychological health, and social reintegration while identifying barriers and facilitators in the implementation of cancer rehabilitation programs. Methods: A literature search was conducted from December 2023 to February 2024, using two electronic databases: MEDLINE (via PubMed) and Google Scholar. After screening the titles and abstracts, the study selected 34 articles, including RCTs, clinical trials, observational studies, and systematic reviews. The study did not include letters to the editor, editorials, special and short communications, animal-based research, and non-English language publications. There were no restrictions on geographical distribution, age of the sample population, type, severity, duration, and outcome of cancer, or the year range from which the studies were selected. Results: Rehabilitation interventions were effective in different cancer types, including breast, prostate, lung, and colorectal cancers. These interventions addressed common treatment-related challenges such as fatigue, pain, lymphedema, incontinence, and psychological issues, improving patients' quality of life and physical functioning. However, challenges such as physical limitations, emotional distress, access to care, financial barriers, and coordination of services were frequently noted. This highlights the need for tailored, accessible, and well-coordinated rehabilitation programs. Conclusion: Multidisciplinary and coordinated cancer rehabilitation has the potential to improve mobility, quality of life and physical functioning across various cancer types, but challenges in accessibility and coordination must be addressed.

Abstract 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).

Objective: To investigate the community integration of patients following stroke and determine the predictors of their level of community integration at 1-year follow-up. Design: A multicenter, longitudinal, and observational study. Subjects: Sixty-five inpatients (41 men) with a mean age of 56.9 (standard deviation = 17.0) years, who had their first stroke at least 1 month prior to this study were recruited from 4 rehabilitation inpatient wards in China. Methods: In the initial assessment, the participants were evaluated using the Community Integration Questionnaire, the Fugl-Meyer Assessment, the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, and the Modified Ashworth Scale. In the follow-up assessments, which were conducted via telephone no less than 1 year after discharge, the participants were evaluated using the Community Integration Questionnaire and also assessed for other disease-related conditions. Results: The participants’ scores on the Community Integration Questionnaire in the follow-up assessment were significantly greater than those at the initial assessment (p

IntroductionThis article explores how systemic injustices and social inequalities affect refugee and asylum seeker integration, thriving, and mental health in London. This is pertinent as the United Kingdom currently operates a ‘broken’ asylum system with unfair policies and a ‘tough’ immigration rhetoric which makes it extraordinarily difficult for asylum seekers and refugees to achieve community integration, have a good quality of life, be able to thrive, and have good health including mental health. Paradoxically, the United Kingdom Home Office also features an Indicators for Integration Framework to provide practical ways to design more effective strategies, monitor services and evaluated integration interventions.MethodsThis study employed a qualitative research design including semi-structured interviews with 19 mental health and psychosocial support service providers working in third-sector organizations in London.ResultsThe study results show that the current asylum system severely undermines efforts to support asylum seekers and refugees with their integration. All participants highlighted that asylum seekers and refugees lacked experienced poor quality of life and faced structural challenges to build meaningful social connections; to have access education, fair employment and good work; to achieve good mental health and wellbeing; and to be able to thrive.DiscussionTo improve community integration, quality of life, thriving, and mental health for asylum seekers and refugees in London and, beyond, the United Kingdom, four recommendations are made on structural and service-levels: (1) reform of the current asylum system by centering human rights; (2) implement and carry out needs assessments among asylum seekers and refugees focussing on key social determinants; (3) ensure asylum seekers and refugees benefit from the NHS Inclusion Health framework; and (4) extend the NHS Patient and Carer Race Equality framework beyond England. To be effective, all four initiatives need to be grounded in a participatory approach that meaningfully involves diverse groups of stakeholders including asylum seekers and refugees.

Introduction: Community integration (CI) is recognised as an overarching goal for the rehabilitation of individuals with acquired brain injury (ABI). However, adults with less severe ABI often experience a lack of support when they return home after discharge from hospital or inpatient rehabilitation, despite having persistent impairments and ongoing needs. Individuals living in rural areas are even less likely to receive adequate support during this period, which is often marked by challenges and uncertainty. This review aims to map and explore the research literature to identify existing models for rehabilitation service provision aimed at promoting the CI of home-dwelling adults with ABI living in rural areas. Methods: A scoping review of the research literature was conducted. The study followed the Joanna Briggs Institute guidelines for scoping reviews and the PRISMA extension for scoping reviews. The databases searched were MEDLINE, Embase, AMED, CINAHL, Web of Science, Cochrane Library, PsycInfo, and Google Scholar. No limitations were set for the study design, time of publication, or country of origin, but only literature in English, Danish, Norwegian, or Swedish was considered for inclusion. Results: Twenty-seven articles were included. All of them originated from four Western and predominantly English-speaking countries: Australia, Canada, the UK, and the US. A thematic analysis identified six model categories that reflect different strategies for providing rehabilitation that promote CI in adults with ABI in rural areas. Sorting the model categories into micro (individual, interpersonal), meso (organisational, community), and macro (policy, society) levels highlighted that most of the included literature concentrates on microlevel issues at the individual or interpersonal level. Microlevel model categories encompass self-management and education, the use of navigators, and the incorporation of everyday life activities into rehabilitation. Far fewer articles addressed mesolevel issues such as service development in rural areas or the development of inclusive rural communities, and only a single article addressed policy development at the macro level. Conclusion: The relatively low number of included articles and limited geographical distribution of studies indicate that more research is needed on rehabilitation models aimed at promoting CI in adults with ABI in rural areas. Although we identified several existing approaches to rehabilitation service provision in rural areas, there is still a need to develop models that fully consider the complexity and long-term nature of CI after ABI. The results also demonstrate that CI in rural areas not only is dependent on professional service delivery aimed at the individual with ABI but also can be promoted by supporting significant others, developing inclusive communities, and improving policies. More knowledge on such issues may facilitate a wider reorganisation of care systems to enhance the CI of adults with ABI in rural areas. However, this will require more research with a wider scope than microlevel service delivery.

Abstract 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.

This study aimed to determine the perception of adapted physical education teachers perceptions on the effectiveness of the school-to-community transition process for students with disabilities in Puerto Rico. 71 teachers completed an open-ended questionnaire validated by a group of experts. Results showed that the majority of adapted physical education teachers in Puerto Rico do not plan for transition and they consider these services and processes to be inadequate. Data analysis uncovered three recurring themes: (a) lack of transitions services knowledge and training, (b) inadequate transition planning, and (c) ineffectiveness of transition services. It seems clear that there is a need to provide professional development opportunities and clearer guidelines on transition planning and implementation to all adapted physical education teachers in Puerto Rico.

Solva in West Wales, UK, is a small community with about 700 people on the electoral roll. In 2013, Solva Community Council faced the fact that things were not going well for the elderly in our village. Many had to leave home and go “into care.” They didn’t want to go and we didn’t want to lose them. A community councillor at that time, author Mollie Roach, did some research and decided that the village could look after its own. A small working party including first author Frances Barker was set up to plan the way forward. The original idea was not a volunteer service. We wanted to set up a local domiciliary care service, where the carers would live locally and not have to spend their precious time travelling between wide-spread destinations. We soon found that there were several administrative and monetary barriers in the way of setting up such a scheme, especially for a small community. Registration needed money and qualified people. and the “rules” were such as to prevent rather than encourage individual response to individual circumstances. However, we could see that there was a need for a local volunteer service. It is disturbing when you discover you cannot go up a ladder and change a light bulb. It is devastating when you are told you cannot drive anymore because of an eye problem. It is worrying when you cannot take the dog for a good walk or collect your prescription because of arthritis. All these problems are under the radar of statutory services. This is a gap that can be alleviated by a local community-based volunteer scheme. Solva Care evolved with a paid co-ordinator to mediate between volunteers and those needing help. We are now getting closer to the original idea, doing our best to integrate domiciliary and social care, working with agencies, private carers, families, and individuals, as well as continuing to run the volunteer service.

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.

Objectives: The present cross-sectional study was done to acknowledge the level of resilience, its association with quality of life (QoL), community integration, and demographic/injury-related variables, and identify the determinants that affect resilience among spinal cord injury individuals living in the community. Methods: The data were collected from 108 participants using the convenience sampling method. A demographic/injury-related questionnaire was used to identify the characteristics of the participants. The CD-RISC10, World Health Organization quality of life-BREF (WHOQOL-BREF), and community integration questionnaire-revised (CIQ-R) were used to measure resilience, QoL, and community integration. Association between resilience and independent variables was examined through Pearson’s correlation and Point-Biserial correlation, whereas, univariate and multivariate linear regression analyses were applied to identify the influence of the demographic/injury-related factors that contribute to resilience, and independent t-test and ANOVA were employed to identify the determinants that affect resilience. Results: Almost 78% of participants had a moderate-to-high level of resilience. In multivariate analysis, gender, marital status, and profession were found to be statistically significant. Among these predictors, employment had a higher beta value (β=0.684, P=0.026), which signifies its importance in evaluating resilience. Significant associations were established between resilience, QoL domains, community integration, and demographic variables, which included marital status, duration since the injury, and frequency of going out. Discussion: The present research brings attention to the significance of using appropriate interventions, such as vocational rehabilitation support as well as awareness about the injury to help strengthen resilience and reintegration amongst SCI individuals into their communities. A further longitudinal study is recommended to determine predictive factors of the dynamic nature of resilience over time.

AimThis study aimed to evaluate the theoretical and practical skills acquired by nursing students and school students after the service-learning project.MethodsThis study promotes nursing students and school students working together to gain awareness and basic theoretical knowledge of first aid. The learning project was conducted with nursing students (n = 67) and school students (n = 131) from April to June 2022. The nursing students gave scores higher than 8 on the aspects linked to expectations, self-perception, overall assessment, and attainment of the goals, and these results are in line with the qualitative analysis.ResultsMoreover, 100% of the school students reported a satisfactory outcome about the service.ConclusionService-learning is a challenging and motivating methodology for nursing students, which results in greater engagement with theory and practice and the development of essential skills for future professionals.

IntroductionObjective and continuous monitoring of physical activity over the long-term in the community is perhaps the most important step in the paradigm shift toward evidence-based practice and personalized therapy for successful community integration. With the advancement in technology, physical activity monitors have become the go-to tools for objective and continuous monitoring of everyday physical activity in the community. While these devices are widely used in many patient populations, their use in individuals with acquired brain injury is slowly gaining traction. The first step before using activity monitors in this population is to understand the patient perspective on usability and ease of use of physical activity monitors at different wear locations. However, there are no studies that have looked at the feasibility and patient perspectives on long-term utilization of activity monitors in individuals with acquired brain injury.MethodsThis pilot study aims to fill this gap and understand patient-reported aspects of the feasibility of using physical activity monitors for long-term use in community-dwelling individuals with acquired brain injury.ResultsThis pilot study found that patients with acquired brain injury faced challenges specific to their functional limitations and that the activity monitors worn on the waist or wrist may be better suited in this population.DiscussionThe unique wear location-specific challenges faced by individuals with ABI need to be taken into account when selecting wearable activity monitors for long term use in this population.

Mental health problems still carry heavy stigma in rural communities. Sometimes a person suffering a mental, emotional, or behavioral health issue won't seek care for fear of others knowing about their personal issues. Historically, some rural communities created safe venues for emotional expression. One example is cowboy poetry, which allowed the cowboy poet to express sadness, disappointment and heartache in a safe environment. There is an opportunity for rural communities to imagine and reimagine safe venues for mental, emotional, and behavioral health; maybe cowboy poetry, maybe other ways to connect. Today, it is crucial for rural communities to do all they can to address mental health in the usual clinic settings, and by creating other safe venues for emotional expression.

Background Aphasia, the most common language disorder secondary to stroke, has been associated with increased mortality, longer hospitalization and rehabilitation times, worse performance in daily activities, increased financial burden, and short- and long-term complications. Aphasia can negatively impact functional communication skills, including social networks, social activities, relationships with other people and social support. Objective To evaluate patients with poststroke aphasia in their respective residences to investigate potential predictors of functional communication. Methods The prospective cohort included patients with poststroke aphasia aged 18 years or older who resided in the city of Salvador, Northeastern Brazil. Following discharge from the Stroke Unit (SU), the individuals themselves, or their guardians, were contacted by telephone to schedule a home visit no less than three months after discharge. At baseline, sociodemographic and clinical data were collected, in addition to the scores on the National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (mBI). The American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) was applied at the patients' homes. Multivariate linear regression was employed using the total score on the ASHA FACS as the outcome of interest. Results A multivariate analysis of the associated factors identified using the linear regression revealed that only functional capacity (as assessed by the mBI) upon discharge from the SU remained as an independent predictor of functional communication performance (β = 0.042; 95% confidence interval [95%CI] = 0.013–0.071; p = 0.002). Conclusion The functional capacity to perform daily activities, evaluated upon discharge from a stroke unit, was identified as a potential predictor of functional communication performance, regardless of the time elapsed after the stroke.

Abstract Background Earthquakes are global natural disasters and can cause loss of property, livelihood and affect human health. A 5.4 magnitude earthquake, the Pohang earthquake, occurred in South Korea in 2017. In this study, based on a health-related quality of life (HRQOL) conceptual model, we examined the HRQOL and its associated factors among older adults who had experienced the earthquake. Methods A cross-sectional study was conducted with a quota sample of 312 older adults living in eight villages of a district that was the most damaged area during the Pohang earthquake. Data were collected from January 15–March 19, 2019, via face-to-face interviews using structured questionnaires. Structural equation modeling was performed to explore the associations among depression, posttraumatic stress symptoms, community resilience, social support, disaster preparedness, and HRQOL. Results The mean age of the participants was 77.93 ± 6.11 years. HRQOL scores were 49.85 ± 18.07 (physical health), 50.16 ± 18.75 (psychological health), 61.93 ± 19.20 (social relations), and 49.53 ± 16.37 (environment). The structural equation modeling analysis showed a good fit. Depression had direct (β = − 2.21; p

Objective: Social participation in daily living the activities requires the maintenance of a variety of social relationships with others and engagement in various social activities. Proper social participation increases the feeling of attachment, provides a stable sense of identity, and increases one’s sense of worth, belonging, and dependence on society. Lack of social participation leads to anxiety, loneliness, depression, panic, mental disorders and many other mental problems and affects society in general. A new coronavirus, called COVID-19, was identified in late December 2019 in China. After just one year, it has been reportedly infected more than 85 million people (up to January 1, 2021) worldwide, and more than 1.8 million have died. Two public health measures to break the transmission chain include quarantine and social distancing. These measures restrict gatherings or separate individuals. Due to these measures in many countries, people’s participation in many social activities has been disrupted. The purpose of this study is to survey the negative effects of the COVID-19 pandemic on home integration, community integration and productive activities. Materials & Methods: This cross-sectional study was conducted in June 2020 by using the Community Integration Questionnaire (CIQ) which measures home integration, community integration, and productive activities, along with a demographic form which were sent to 461 participants in Iran (Mean ±SD age= 36.86±5.8 years) on WhatsApp or via email and completed online. Participants were selected from among college students, patients, people with disabilities, their families and relatives, and others who could use smartphones, computers, tablets, and laptops. The effects of Covid-19 were evaluated by analyzing the CIQ scores before and after the pandemic in SPSS v. 22 software. Results: Comparing the CIQ scores before and after the pandemic, results showed that it significantly reduced home integration (P

Resumen: Introducción: En 2011 se impulsó desde la Subdirección de Salud Pública de Gipuzkoa la iniciativa Ttipi-Ttapa para la promoción comunitaria del ejercicio físico en personas mayores mediante rutas saludables en colaboración con ayuntamientos, asociaciones ciudadanas y atención primaria. Objetivo: Evaluar desde la perspectiva de los participantes la experiencia Ttipi-Ttapa en el periodo 2012-2017 para identificar los principales aciertos y carencias y compartir propuestas de continuidad y mejora. Método: Diseño mixto con investigación cualitativa central y encuesta suplementaria a todos los caminantes en salidas en 13 localidades. Test de ji al cuadrado para comparación de porcentajes. En el estudio cualitativo, muestreo intencional con diferentes perfiles de participantes mediante nueve grupos focales y 10 entrevistas individuales. Grabación en audio previo consentimiento. Análisis temático con ayuda de mapas conceptuales y el programa MAXQDA. Triangulación entre investigadores en un contexto de investigación-aprendizaje. Resultados: Se analizaron 464 cuestionarios; 64% mujeres y 36% hombres. Edad media 69,8 años y 75% mayores de 65 años. Satisfacción general de 9,05/10, con diferencias significativas a favor de las mujeres, los grupos de mayor edad y las personas viudas. En el estudio cualitativo participaron 43 mujeres y 37 hombres. Se identifican tres áreas temáticas principales a partir de las categorías codificadas y sus solapamientos: a) no solo es caminar; b) organización, valores y personas; y c) claves colaborativas y retos de futuro. Conclusiones: Los beneficios percibidos en salud desbordan el ejercicio físico con implicaciones importantes en la interacción y la cohesión social. La complejidad de los procesos evaluados conlleva exigencias metodológicas, organizativas y colaborativas. Abstract: Introduction: In 2011 the Tipi-Tapa initiative was endorsed by the Public Health Department of Gipuzkoa to promote physical exercise through healthy walks in community-dwelling older adults, in collaboration with municipalities, citizens associations and primary care. Objective: To evaluate, from the participants’ perspective, the Tipi-Tapa experience during 2012-2017 to identify the main successes and failures and share proposals of continuity and improvement. Method: Mixed methods design with a qualitative core component and a supplementary questionnaire to all participants from 13 municipalities. The Chi-squared test was used to compare percentages. In the qualitative study, a purposive sampling was applied considering participants’ profiles through nine focus groups and 10 individual interviews. The interviews were audio recorded with previous consent. A thematic analysis was performed using conceptual maps and the MAXQDA software. Triangulation among researchers was done in a research-learning context. Results: We analysed 464 questionnaires; 64% from women and 36% from men. The participants’ mean age was 69.8 years; 75% were older than 65 years. The general satisfaction was 9.05/10 with significant differences in favour of women, older age groups and widows. In the qualitative study, 43 women and 37 men participated. Three main thematic areas were identified based on category coding and overlap: a) it is not just walking; b) organization, values and persons; and c) collaborative keystones and future challenges. Conclusions: The health benefits perceived by participants go beyond physical exercise, with important implications for social interaction and cohesion. The complexity of the processes assessed entails methodological, organizational and collaborative requirements.

Objective: The objective of the study is to evaluate functional outcomes and community reintegration of disaster survivors in Pakistan. Methods: This was a cross-sectional descriptive study of community-based participants at the Armed Forces Institute of Rehabilitation Medicine, Pakistan. The medical records were screened for eligibility of adults with disaster-related disability. Participants were interviewed in ambulatory clinics using validated measures: Neurological-Trauma Impairment Scale (NIS-Trauma), International Classification of Functioning, Disability, and Health-Generic Set, Community Integration Measure (CIM), Community Integration Questionnaire (CIQ), and EuroQol 5-Dimension 5-Level. Results: Participants were (n = 117, mean age = 35 years) with postdisaster injury up to 17 years; the majority had spinal cord injury (n = 62; 53%) and amputations (n = 44; 38%). At assessment, 80% were independent with mobility (with aids) and 29% with everyday living activities. They reported ongoing fatigue (54.7%), altered sensations (51.28%), and pain (50.43%), but fewer problems with mood and emotions. The impairment severity negatively impacted community activities (NIS-Trauma vs. CIQ: P < 0.001). As impairments improved with time (NIS-Trauma vs. time since injury: P = 0.003), so did community reintegration (time since injury vs. CIQ; P < 0.001) and perceived health status (time since injury vs. EuroQol; P = 0.001). Conclusion: Many participants reported various ongoing disability-related issues; however, majority were dependent with everyday living activities and well adapted in the community. Further robust studies are needed for evaluation of longer-term impact of the disability in disaster victims for the comprehensive healthcare in the community.

The interface of policy and legislation is crucial in making quality mental health care accessible in an effective manner. Shortage of psychiatrists and other mental health personnel in India poses a huge challenge in delivering mental health care. The social context is instrumental in subjecting the mentally ill to human rights violations and discriminations with low awareness, illiteracy, superstitions, denial, and the prevailing social perception of mental illness in India. The enormity of problem requires a multipronged approach supported by a robust policy with specific achievable goals. Mental health policy relies on the legal framework to achieve its goals, and ameliorate the lives of persons with mental disorders. Policy and legislation are two complementary approaches for improving mental health care and services. International developments in mental health care have brought a paradigm shift from “charity-” to “rights-” based approach which is very much reflected in India's first-ever Mental Health Policy, 2014, and the newly enacted Mental Healthcare Act, 2017. This shift entails a “participatory” approach for developing community-based facilities, services, and rehabilitation provisions. An analytical approach has been adopted to gauge the likely outcome of the combined role of this ambitious policy and law in light of existing mental health-care infrastructure and “social context.” An attempt has been made to highlight the main concerns and challenges in effective implementation of new law while putting forth feasible solutions to attain the policy goals. The paper concludes on a note that legal and health measures should work in tandem and eventual convergence be directed toward the best interest of mentally ill persons.

BackgroundGreater understanding of the influences on participation in life after spinal cord injury (SCI) can inform rehabilitation theory and practice. Careful qualitative inquiry can reveal subjective meanings associated with the relevant experiences, strategies, and perceptions of those with lived experience of SCI. A search of literature, followed by a thematic synthesis of qualitative studies, was undertaken to bring together these insights in a meaningful way.MethodsThe research question guiding the literature review and synthesis was, What do people with SCI perceive to be the influences on their participation in life? Three critical databases were searched for qualitative studies examining influences on participation in life after SCI. Peer-reviewed studies published after 2006, involving adults with SCI living in countries with advanced economies, were included. Data were extracted from 24 articles and subjected to three-level thematic synthesis—the coding of primary data from the studies, the development of descriptive themes based on an organization of those codes, and the generation of analytical themes.ResultsThe synthesis yielded five analytical themes, supported by 17 descriptive themes. The analytical themes were (1) external contextual influences, (2) personal physical context, (3) personal psychological context, (4) potential moderators of participation outcomes, and (5) temporal dimensions of participating in life after SCI.InterpretationThese themes highlight the complex interactions that shape participation from the perspective of people with SCI. Closer examination of the potential moderators may provide insights into effective rehabilitation interventions.ConclusionsSynthesis of qualitative inquiry provides valuable insights into the perceptions of influences on participation in life from the point of view of people with SCI. The findings of this synthesis are instructive for rehabilitation theory and practice. It can complement what we learn from using the ICF to understand participation.

Abstract Aim This study aimed to investigate changes in mental health among young adults participating in an integrated mental health and vocational support intervention according to the Södertälje Supported Employment and Education model. Design A prospective longitudinal pre–post intervention study of 12 months. Methods Instruments on depressive symptoms, quality of life, empowerment, engagement in activities and sociodemographic characteristics were administered to 42 young adults aged 19–28 years with mood disorders. Wilcoxon signed rank tests were used to assess changes in mental health. Results Statistically significant positive changes between baseline and 12 months were noted for quality of life and engagement in activities. Difference in empowerment scores neared significance and a statistical trend towards lower depression scores was seen, corresponding to moderate depression at baseline and less severe depression at 12 months. Conclusions Integrated mental health and vocational services may support young adults' mental health and is suggested to be linked to their personal recovery and clinical recovery.

Abstract Background Over the last three decades, there has been worldwide recognition of peer support contributions to improve mental healthcare provision. However, in the current literature, little attention has been paid to exploring perspectives of peer supporters on their involvement in mental health services provision. The purpose of the present study was to examine peer supporters’ perspectives on the implementation of a transitional discharge model (TDM), an intervention for the community integration of people with mental illness. Methods This paper represents ethnographic qualitative data collected as part of a study that used mixed methods to evaluate the implementation of TDM across nine hospitals from the Province of Ontario, in Canada. The study involved a sample of 66 peer supporters, who were recruited from participating Consumer/Survivor Initiative Organizations and Peer Support Programs. The study collected data using two sets of focus groups, which were held at 6 months and 1-year post implementation. Data analysis used an ethnography model of qualitative analysis. Results Peer supporters expressed that their involvement in mental healthcare enhanced clients’ autonomy and hope about their recovery, as well as established a safety net and reduced hospital readmissions. Peer supporters articulated that they assumed several roles to facilitate clients’ transition from hospital to the community. These roles included: assisting clients in building their capacity and developing healthy routines; attending regular on-ward and community meetings; accompanying clients to their appointments; and working with clients to set goals for their recovery. The study showed hindrances to effective implementation of peer support programs, such as a lack of understanding and appreciation of peer supporter roles, lack of careful allocation of peer supporters to clients, and an absence of appropriate protocols for ensuring the safety and supervision of the peer supporters. Conclusions Results of the TDM implementation demonstrated that involving peer supporters in mental healthcare delivery may benefit clients by enhancing autonomy and hope about their recovery, as well as establishing a safety net and reducing hospital readmissions. Results from the study have the potential to inform healthcare professionals and managers of strategies for developing effective peer support programs.

ABSTRACT Introduction The Centro Universitário de Votuporanga (UNIFEV) medicine course was implemented in 2012 according to the 2001 National Curricular Guidelines for Undergraduate Medical Courses. The practical module of Community Service Education Integration is the curricular unit that places students into Primary Health Care (PHC) scenarios from the first period of the course until the internship period, breaking with the traditional model of hospital-centered training, which is segmented into specialties. The module of medical skills and attitudes training also leads the student, in some cases, to PHC services, but with focus on the basic clinical procedures in controlled scenarios, which may be those from typical clinical practice, simulations or even those performed in laboratories. During internship, the student continues in PHC as an intern in general, family and community medicine. In this context, the integration of community-education-service plays a major role in the transformations undergone in undergraduate training in health, which are also aimed at modifying the current healthcare model. Objectives To understand the perception of professionals from the Family Health Care Units regarding medical student work placement and to interpret the results of this integration as far as the service, the community and the medical training are concerned. Methodology Qualitative research carried out with health professionals who work in three Family Health Care Units of Votuporanga, São Paulo, Brazil. They were invited to participate in focus groups to express their opinions about thought-provoking questions. The recorded material was transcribed, organized and analyzed according to Bardin’s content analysis, which allowed categories of analysis to emerge based on what the participants said. Results and discussion: The opinions that have emerged allow to identify the following aspects: teaching-service-community integration contributes to medical education; student presence promotes team integration and self-learning and promotes the work process; student integration has impact on the community. Among the student’s contributions, participants highlighted the academic and health care reflective practices, health education actions and complementary activities that support the health team in solving local problems. Participants also identified some situations of difficulty, such as: students in the early periods of the course need to acquire affective domains for an adequate professional posture at PHC units; the embarrassment of patients in the medical consultation with the presence of students; and the short length of stay of the students for the necessary bond building. Conclusion For PHC professionals, the inclusion of students in these scenarios contributes to the development of the service, medical training and community support. Due to the solidary relations existing between the educational institution and the PHC management, this research may contribute to promote the necessary adaptations and prepare the community and professionals for the presence of students in PHC.

Abstract Background Low balance confidence is a prevalent yet overlooked issue among people who use lower limb prostheses (LLP) that can diminish community integration and quality of life. There is a critical need to develop rehabilitation programs that specifically target balance confidence in people who use LLP. Previous research has shown that multicomponent interventions including cognitive-behavioral therapy (CBT) techniques and exercise are feasible and effective for improving balance confidence in older adults. Therefore, a cognitive behavioral–physical therapy (CBPT) intervention was developed to target balance confidence and increase community integration in people who use LLP. Methods/design This randomized control trial will recruit 60 people who use LLP with low balance confidence. Participants will be randomized to the CBPT intervention condition or control condition. Discussion The trial is designed to test the effects of the CBPT intervention on balance confidence and functional mobility in lower limb prosthesis users by examining self-reported and objective measures of community integration and quality of life. The trial will also examine the relationship between changes in balance confidence and changes in community integration following participation in CBPT intervention. Additionally, through participant feedback, researchers will identify opportunities to improve intervention efficacy. Trial registration ClinicalTrials.gov, NCT03411148. Registration date: January 26, 2018.

This research promotes the implementation of a specialised Learning Management System (LMS) for doctoral schools by identifying the required information, features, qualities, and actors and their specific roles. An extended literature assessment informs the structuring of information regarding the expected returned benefits; while the related findings are analysed using the graph and concept algebra. Five major components are identified as having a significant impact on the doctoral programme. One of them, namely social behaviour, poses a lack of connectivity with the rest of the identified components. The present research also looks at the expected impact created by the community of social behaviour as induced by the implementation of a specialised LMS for doctoral school. Cooperation, collaboration and professional socialisation enhance the overall effect of process improvement. Compliance and conformity is the main engine involved in strengthening the connectivity between LMS and Cross-disciplinarity. To study the proposed LMS structure, a conceptual design framework, along with a possible configuration, supply the proper description of how the LMS can be present within the doctoral school.

Background: Many individuals with cerebral palsy (CP) or acquired brain injury (ABI) are at higher risk of lowered psychosocial functioning, poor mental health outcomes and decreased opportunities for community integration (CI) as they transition to adulthood. It is imperative to understand the characteristics of those at highest risk of dysfunction so that targeted interventions can be developed to reduce the impact.Methods: This quantitative, cross-sectional study examines current patients of the Living Independently Fully Engaged [(LIFEspan) Service], a tertiary outpatient hospital-based clinic. The Patient Health Questionnaire-4 (PHQ-4) and the Community Integration Questionnaire (CIQ) were administered to participants. Personal health information was also collected from participants' health charts, and participant interviews. Associations of sex and condition with the outcomes of screening for further assessment of depression, screening for further assessment of anxiety, and CI were calculated using t-tests and Chi-square tests.Results: 285 participants completed standardized screening tools for depression and anxiety (PHQ-4) and 283 completed the Community Integration Questionnaire (CIQ). Mean age was 23.4 (4.2) years; 59% were diagnosed with CP, 41% diagnosed with ABI, and 56% were male. A moderate proportion of the sample screened positive for further assessment of anxiety (28%) and depression (16%), and the overall mean score on the CIQ for the sample was 15.8 (SD 5.1). Participants that screened positive for further assessment of depression and anxiety on the PHQ-4 had lower scores on the Social Integration subscale of the CIQ (p = 0.04 and p = 0.036, respectively). Females were found to have significantly higher community integration than males (p = 0.0011) and those diagnosed with ABI were found to have significantly higher community integration than those with CP (p = 0.009), respectively. A weak negative association was found between age for the total sample and overall PHQ-4 score (p = 0.0417). Presence of an intellectual or learning disability/challenge was associated with a lower CIQ score (p = 0.0026).Conclusions: This current study, highlights the need for further research to explore the unique needs and barriers faced by this population. This study may inform assessments and interventions to support the mental health and community integration of this population.

In Canada and the USA, about 30% of people with HIV are uninsured or not covered by government-subsidized health insurance. This paper presents a patient’s narrative of his experience being diagnosed with HIV and accessing care in the midst of his process of immigrating to and studying in Canada. The narrative explores how Vincent Croft (pseudonym) has coped with the chronicity of the infection and its associated social stigma, and the temporary solutions he found to access treatment. Engaging with healthcare providers, researchers, and other people living with HIV has allowed Croft to share his experience, including the barriers he encountered and the solutions he envisioned or attempted, resulting in self-empowerment and reinterpretations of Croft’s own trajectory. Patrick Keeler, a community-based intervener, reflects on Croft’s narrative as symptomatic of systemic issues in access to care of people living with HIV in Canada. He also illustrates how the experiential knowledge of people with similar lived experiences can trigger simple, innovative, and cost-efficient initiatives with Le Cercle Orange, which connects and mobilizes existing resources for people with HIV with no or limited access to care and treatment. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Abstract Background Social participation is a modifiable health determinant influenced by physical and social aspects of the environment. Little is known about aging women’s and men’s community activities and barriers according to region and population size. This study compared social participation, desire to participate more, and perceived barriers of aging women and men by Canadian region and population size. Methods A secondary analysis of the 2008–2009 cross-sectional Canadian Community Health Survey - Healthy Aging was done with 16,274 respondents aged 65+. Respondents were grouped into five regions [Atlantic, Quebec, Ontario, Prairies and British Columbia] and five population size groups [rural (

Abstract Background Neurological disorders may negatively impact community integration and/or quality of life. Peer support has emerged as a potential strategy to enhance patients’ efficacy in managing their own health. This review examines the key characteristics and impact of peer support interventions for adults with acquired brain injury, cerebral palsy, and spina bifida on community integration and quality of life. Methods Eligible studies reported on peer support interventions for adults (16 years of age or older) with acquired brain injury, cerebral palsy, or spina bifida. Only randomized controlled trials published in English in the last 10 years were included. MEDLINE, EMBASE, PsycINFO, and CINAHL were used to conduct the literature search. Two reviewers independently screened studies, abstracted data, and evaluated the risk of bias (for individual study elements and overall) using the Cochrane Risk of Bias Tool. Results The systematic review included 6 trials reporting on acquired brain injury only. Of these studies, 4 reported on stroke and 2 reported on traumatic brain injury. Two studies found significant improvements in quality of life following peer support. No studies reported significant results on community integration. Considerable heterogeneity existed in the key characteristics of interventions. Conclusions There are a limited number of studies on the impact of peer support interventions for adults with acquired brain injury, cerebral palsy, or spina bifida on community integration and quality of life. Standardization of key intervention characteristics may aid the global adoption of peer support as a formalized, evidence-based practice.

The present article first presents a critique about the current status of the CMH field; and second based in theoretical and empirical literature it presents a perspective inspired by the inception of community psychology, namely the empowerment and community integration principles to offer a challenging framework to inspire reforms in CMH field. The article also discusses two major promising CMH practices: supported employment and independent housing with support, determinant for the transformation of the life conditions of the people experiencing mental illness while promoting people’s empowerment and integration in the community. Concluding authors argue that CMH programs and practices focused on integration, together with self-representation movements, organizations or networks, aligned with the community psychology acting principles, have the potential to inform a renovated partnership within CMH stakeholders, and bring about sustainable change focused on the active citizenship for the people who experience mental illness.

Este estudio tuvo como objetivo verificar la asociación de la participación comunitaria, el apoyo familiar y las variables sociodemográficas con la integración comunitaria. Los participantes fueron 201 personas del estado brasileño de Rio Grande do Sul, residentes en las ciudades de Porto Alegre y Esteio, asistidos por un programa de protección social básica, PAIF (Proteção e Atendimento Integral à Família). La muestra fue no probabilística, compuesta principalmente por mujeres de baja condición socioeconómica, bajo nivel educativo y beneficiarias de programas sociales de apoyo financiero. El protocolo de la encuesta incluía el Inventario de Percepción de Apoyo Familiar, el Cuestionario de Apoyo Social Comunitario y preguntas sobre características sociodemográficas. La correlación de la duración de la participación de PAIF con la integración comunitaria fue débil (r = 0,145, p < 0,05). Los predictores en el modelo de regresión lineal fueron la edad (β = 0,323, p < 0,001), el valor del beneficio (β = 0,224, p = 0,002) y la participación comunitaria (β = 0,234, p = 0,002), los cuales representaron el 30,5% de la variación en la integración comunitaria. Los resultados indican que, a medida que las personas envejecen en la comunidad, aumentan su integración. Probablemente los valores de beneficio recibidos afectan la integración

Objective: To examine the association of fatigue with long-term participation in aneurysmal subarachnoid haemorrhage survivors. Design: Cohort study, 4 years post-onset. Subjects: A total of 59 patients with aneurysmal subarachnoid haemorrhage. Methods: Participation performance was assessed with the Sickness Impact Profile-68, participation autonomy and problem experience with the Impact on Participation and Autonomy questionnaire, and community integration with the Community Integration Questionnaire. Fatigue was assessed with the Fatigue Severity Scale and depression with the Center for Epidemiologic Studies-Depression scale. Multivariable linear regression analyses were performed. Results: Fifty-nine survivors (mean age 53.0 years, standard deviation (SD) 10.8 years) were included, of which 59.3% was fatigued. Fatigued patients had significantly worse participation scores than non-fatigued patients regarding performance (p

This work sought to adapt the Perceived Community Support Questionnaire (PCSQ) to the Brazilian context, gathering evidence of its factorial structure and internal consistency. Two studies were performed. The first comprised 119 individuals aged between 21 and 85 years (M = 41.59, SD = 15.33) with incomplete elementary education (52.1%). An exploratory factor analysis was conducted and indicated a three-factor structure, explaining 42.3% of the total variance. The second study comprised 203 participants aged between 19 and 84 years (M = 42.99, SD = 12.70) with higher education (17.2%). The three-factor structure was corroborated by a confirmatory factor analysis (CFI = 0.944, TLI = 0.931, RMSEA = 0.088, 90%CI: 0.072; 0.103), and Cronbach’s alpha was adequate. Questionnaire dimensions were named Community Integration, Community Participation, and Community Organizations. Despite the issues involving inverted items, the instrument gathered evidence of factorial validity and internal consistency, showing applicability to further studies.

Abstract Background Transition from prison to community is a challenging time for all people who have been incarcerated. It is particularly challenging for those also living with serious and persistent mental illness. This study explored staff experiences and perspectives of what helped and hindered them in their work to support that transition. Methods Semi-structured interviews were conducted with 12 mental health staff working across three service sectors directly engaged in the process of supporting people with mental illness transitioning from prison to community; the forensic mental health provider Justice Health, Community Mental Health and a non-government delivered community-based service called Partners in Recovery. Data were analysed using constant comparative analysis. Results Five main themes were identified through the analysis. All five themes were key practices that, when occurring, supported staff to work in a way that they felt would maximise positive outcomes for people transitioning from prison to community. These included: housing secured before release; clearly defined and effective communication pathways; shared understanding of systems and roles; in-reach and continuity of contact, and consumers’ pre-release preparation and knowledge. All staff participants described barriers to good transition to community outcomes when some or all of these practices could not, or did not, occur. Conclusions Staff experiences highlight the complexity but importance of getting multi-sectorial partnerships and practices right for good prison to community transitions for people living with serious and persistent mental illness. Currently fragmented and disparate systems and practices need to align and clear expectations and understandings need to be shared across the whole. These changes, along with prioritised housing are likely to lead to better long-term outcomes for people.

Abstract Background To address the challenges of the global aging population, the World Health Organization promoted age-friendly communities as a way to foster the development of active aging community initiatives. Accordingly, key components (i.e., policies, services and structures related to the communities’ physical and social environments) should be designed to be age-friendly and help all aging adults to live safely, enjoy good health and stay involved in their communities. Although age-friendly communities are believed to be a promising way to help aging Canadians lead healthy and active lives, little is known about which key components best foster positive health, social participation and health equity, and their underlying mechanisms. This study aims to better understand which and how key components of age-friendly communities best foster positive health, social participation and health equity in aging Canadians. Specifically, the research objectives are to: 1) Describe and compare age-friendly key components of communities across Canada 2) Identify key components best associated with positive health, social participation and health equity of aging adults 3) Explore how these key components foster positive health, social participation and health equity Methods A mixed-method sequential explanatory design will be used. The quantitative part will involve a survey of Canadian communities and secondary analysis of cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA). The survey will include an age-friendly questionnaire targeting key components in seven domains: physical environment, housing options, social environment, opportunities for participation, community supports and healthcare services, transportation options, communication and information. The CLSA is a large, national prospective study representative of the Canadian aging population designed to examine health transitions and trajectories of adults as they age. In the qualitative part, a multiple case study will be conducted in five Canadian communities performing best on positive health, social participation and health equity. Discussion Building on new and existing collaborations and generating evidence from real-world interventions, the results of this project will help communities to promote age-friendly policies, services and structures which foster positive health, social participation and health equity at a population level.

Abstract Background Community integration is an essential right for people with schizophrenia that affects their well-being and quality of life, but no valid instrument exists to measure it in Japan. The aim of the present study is to develop and evaluate the reliability and validity of the Japanese version of the Community Integration Measure (CIM) for people with schizophrenia. Methods The Japanese version of the CIM was developed as a self-administered questionnaire based on the original version of the CIM, which was developed by McColl et al. This study of the Japanese CIM had a cross-sectional design. Construct validity was determined using a confirmatory factor analysis (CFA) and data from 291 community-dwelling people with schizophrenia in Japan. Internal consistency was calculated using Cronbach’s alpha. The Lubben Social Network Scale (LSNS-6), the Rosenberg Self-Esteem Scale (RSE) and the UCLA Loneliness Scale, version 3 (UCLALS) were administered to assess the criterion-related validity of the Japanese version of the CIM. Results The participants were 263 people with schizophrenia who provided valid responses. The Cronbach’s alpha was 0.87, and CFA identified one domain with ten items that demonstrated the following values: goodness of fit index = 0.924, adjusted goodness of fit index = 0.881, comparative fit index = 0.925, and root mean square error of approximation = 0.085. The correlation coefficients were 0.43 (p

Participation is a primary goal of neurorehabilitation; however, most individuals post stroke experience significant restrictions in participation as they attempt to resume their everyday roles and routines. Despite this emphasis on participation, there is a paucity of evidence-based interventions for optimizing this outcome and a limited understanding of factors that contribute to poor participation outcomes. Caregiver support at discharge from inpatient rehabilitation positively influences physical and psychological outcomes after stroke but more research is needed to understand the association between social support and participation. This study aimed to examine the independent contribution of perceived social support to participation 3 months post discharge from inpatient stroke rehabilitation. This study was a secondary analysis of the Stroke Recovery in Underserved Populations 2005–2006 data. Participants were adults ≥55 years old, living in the community 3 months post discharge from inpatient rehabilitation for ischemic stroke (n = 422). Hierarchical linear regressions were performed. The primary variables of interest were the PAR-PRO Measure of Home and Community Participation and the Duke–University of North Carolina Functional Social Support Questionnaire. Perceived social support at discharge from inpatient rehabilitation for ischemic stroke contributed uniquely to the variance in participation 3 months later (β = 0.396, P < 0.001) after controlling for race, sex, age, years of education, comorbidities, stroke symptoms, depression, FIM Motor, and FIM Cognitive. Social support accounted for 12.2% of the variance in participation and was the strongest predictor of participation relative to the other independently significant predictors in the model including FIM Motor and depression. There is already a focus on caregiver training during inpatient rehabilitation related to basic self-care, transfers, and medical management. These findings suggest the need for rehabilitation professionals to also address social support during discharge planning in the context of promoting participation. Given the findings, expanding caregiver training is necessary but novel interventions and programs must be carefully developed to avoid increasing caregiver burden.

Moderate-severe traumatic brain injury (TBI) may result in difficulty with emotion recognition, which has negative implications for social functioning. As aspects of social cognition have been linked to resting-state functional connectivity (RSFC) in the default mode network (DMN), we sought to determine whether DMN connectivity strength predicts emotion recognition and level of social integration in TBI. To this end, we examined emotion recognition ability of 21 individuals with TBI and 27 healthy controls in relation to RSFC between DMN regions. Across all participants, decreased emotion recognition ability was related to increased connectivity between dorsomedial prefrontal cortex (dmPFC) and temporal regions (temporal pole and parahippocampal gyrus). Furthermore, within the TBI group, connectivity between dmPFC and parahippocampal gyrus predicted level of social integration on the Community Integration Questionnaire, an important index of post-injury social functioning in TBI. This finding was not explained by emotion recognition ability, indicating that DMN connectivity predicts social functioning independent of emotion recognition. These results advance our understanding of the neural underpinnings of emotional and social processes in both healthy and injured brains, and suggest that RSFC may be an important marker of social outcomes in individuals with TBI.

Community integration is recognized as a meaningful goal that is highly relevant to the long-term success of supportive housing programs. Research to date highlights concerns that some individuals in permanent supportive housing remain socially isolated and have limited success in other domains of community integration. However, we know little about what factors impact formerly homeless veterans’ ability to achieve community integration. To identify factors associated with community integration among homeless veterans housed through the Department of Veterans Affairs’ (VA’s) Supportive Housing program (HUD-VASH), we performed secondary database analyses of Veterans (n = 560) housed via HUD-VASH in the VA Greater Los Angeles Healthcare System from 10/1/14–9/30/15. We conducted ordinal and logit regressions to examine associations between baseline HUD-VASH participant characteristics, supportive housing voucher type, health service utilization in the year post-housing, and three types of community integration outcomes (i.e., change in community adjustment, status of housing stability, and change in employment). Data were obtained from HOMES (VA’s homeless registry) and Corporate Data Warehouse (CDW) (VA’s a national administrative dataset of VA inpatient and outpatient care). Mental health service utilization was negatively associated with community adjustment, housing stability, and employment. Employment at baseline was positively associated with housing stability and employment. Also, substance use disorder visits was positively associated with employment, and combined medical and substance use disorder diagnoses was positively associated with change in community adjustment. We considered 29 variables and found relatively few were associated with community integration. Consistent with previous research, our study highlights the importance of mental health needs, and suggests that utilization of mental health services is an important indicator of improvements in community adjustment, housing stability, and employment.

Introduction: Community integration is an important outcome of rehabilitation, because the ultimate focus of rehabilitation is to enable people to participate in their life roles. Aim: To determine community integration scores achieved by adults with disabilities post discharge from an in-patient rehabilitation centre in the Western Cape Province. Method: Fifty-nine individuals participated in this cross-sectional study. Community integration was determined using the Reintegration to Normal Living Index (RNLI). Descriptive analysis of age, gender, medical diagnosis and RNLI scores was performed. Kruskal–Wallis test and t-tests were used to determine whether there exists any relationship between age, gender, medical diagnosis and RNLI scores (p < 0.05). Results: Participants’ mean age was 45 (± 15.9) years. Of the study participants, 54% were women. The most common diagnosis was stroke (41%), followed by spinal cord injury (30%). The mean overall RNLI score was 66.3 (± 25.5). Persons with brain trauma (stroke or head injury) had a mean of 60.9 (±20.3); those with spinal cord injury had a mean of 75.2 (± 25.8) and those with peripheral impairments had a mean of 65.5 (± 30.5). The RNLI domains ‘personal relationships’ 73.45 (± 31.6) and ‘presentation of self’ 72.13 (± 35.4) recorded the highest mean scores. The domain ‘work or meaningful activities’ had the lowest mean score 52.54 (± 35.3). ‘Community mobility’ (59.9; ± 34.6) and ‘recreation’ (57.3; ± 37.2) also had mean scores below 60. No statistically significant relationships were found between age, gender and medical diagnosis and RNLI scores. Conclusion: The relatively low mean scores indicate that participants achieved poor community reintegration.

Today, due to ever-increasing knowledge and large volumes of information, educational planners of various fields around the world, have been seeking to establish a better and faster refresh for learning. Integration can be a good educational strategy by blending different subjects and contents when presented to students. The aim of this study is to evaluate the medical literature about integration in the curriculum; its process, importance, necessity and different types of it. This review article was prepared by searching the PubMed database, Google Scholar and science direct websites, national and international journals in the field of medical education curricula. The keywords were educational planning, curriculum integration, and medical education with integration and incorporation. Integration and its eleven steps can be an important strategy in educational planning. According to various studies, integration can enhance the students’ learning and skills in medicinal and pharmaceutical care. It also improves the satisfaction of faculty and students, the quality of education and increases the students’ grades at their examinations. Considering the proper planning, cooperation and co-teaching of faculty members, focus on the desired performance of students and correct assessment of the fundamental principles of integration are crucial to this strategy.

Individuals with serious mental illness are often forced to live in institutional settings which limit their freedom and rights to become fully integrated into the community. The Olmstead v. L.C., 527 U.S. 581 (1999) decision ruled that states must provide individuals with disabilities the opportunity to live in the most integrated settings based on their needs. Since that time several lawsuits have been filed on behalf of individuals with disabilities against states for failing to comply with the Olmstead decision. New York State is one such state. The purpose of this paper is to describe the lawsuit which was brought against the state of New York by the Department of Justice on behalf of several individuals with severe mental illness who lived in “adult homes.” The lawsuit was filed against New York State in 2013 for failing to fulfill the promise of the Olmstead decision by not providing these individuals access to housing that would allow them to be fully integrated into communities so as to live productive lives. A brief discussion is provided as to how the case was finally settled and the changes New York State made to ensure that the Olmstead decision would be fully implemented in the future.

Objectives: This paper reviews the current literature on acquired brain injury (ABI) with a focus on ABI burden, importance of community integration, and community integration definitions suggested by the literature. Methods: Literature review Results: Acquired brain injury (ABI) is referred to a diverse range of disabilities resulted of injury in different parts of the brain. People with ABI are in face with different aspects of individual, family and social concerns or burdens which directly affect their lives. Although community integration as an ultimate aim of rehabilitation is optimal approach to overcome their consequences, a comprehensive concept of it is always challenging. There are several different definitions for community integration including various aspects of life with ABI. Discussion: Living with brain injury constitutes an expanded experience of community isolation and consequences which reduces participation and social integration. Community integration is aimed to condense concerns of people with ABI with returning them to community.

El objetivo es describir las características clínicas y de dependencia de un grupo de ancianos con enfermedad mental, institucionalizados con el fin de conocer la posibilidad de integrarse en residencias de ancianos de la comunidad. Es un estudio descriptivo, transversal y cuantitativo llevado a cabo en el Centro Psiquiátrico de Rehabilitación (CPR) de Sádaba, con personas mayores de 65 de edad. Los datos recogidos fueron: historias clínicas, entrevista que valora el comportamiento actual, índice de Barthel y escalas de evolución HoNOS y criterios de cronicidad. Según este estudio, hay un perfil clínico y de rendimiento en AVD que permite a pacientes con enfermedad mental grave y crónica el que sean derivados a recursos normalizados comunitarios.Objetive is to describe the clinical and dependency characteristics of a group of institutionalised elderly persons suffering from mental diseases, in order to determine the feasibility of their integration into local residential homes. A descriptive, transversal and quantitative study conducted at the Centro Psiquiátrico de Rehabilitación de Sádaba (Psychiatric Rehabilitation Centre of Sádaba) with people aged 65 years or over. Data was collected through medical records, interviews which assessed the current behaviour of the person, the Barthel Index, and the Evolution Scales HoNOS and Chronicity. According to this study, there is a clinical and performance profile in ADL that allows for patients with serious and chronic mental illness to be referred to standard resources within the local community.

The contemporary scene of European social policies identifies two precise lines of development. The first is the convergence with the tendency of national contexts towards a unitary system, the European welfare, that comes from the Europeanization process and from the rules of subsidiarity and activation rules concerning the elaborations of the social sciences. As for the second, if we could penetrate deeply into the micro-dimension we could recognize the need to observe the welfare conformations in their local connotation. A European welfare scission, as a unitary system, is what occurs, under the pressure of autonomy and the push to a locally governed welfare system, the local net welfare. The purpose of the work is to outline a new welfare system typology, macro-oriented, but without underestimating the micro dimension, which continues to be very important as concerns the tendency toward communitary integration and the different forms that it wears assumes in different countries and in the local contests of the 27 countries of Europe. We talk about a new model that does not diminish the classifying ability of traditional ones, but attempts to reveal their hard to detect details.

Bąk Jadwiga, Chrzan Agnieszka, Świrszcz Anna, Pietraszek Agata, Kachaniuk Hanna, Charzyńska-Gula Marianna, Łuczyk Marta. Integracja międzypokoleniowa przedszkolaków z seniorami cz. I. Opinie osób starszych = Intergenerational integration between preschool children and elderly people Part I. Opinions of the elderly. Journal of Education, Health and Sport. 2016;6(9):498-505. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.154157 http://ojs.ukw.edu.pl/index.php/johs/article/view/3857 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.08.2016. Revised 25.08.2016. Accepted: 16.09.2016. Integracja międzypokoleniowa przedszkolaków z seniorami cz. I. Opinie osób starszych Intergenerational integration between preschool children and elderly people Part I. Opinions of the elderly Jadwiga Bąk1, Agnieszka Chrzan1, Anna Świrszcz1, Agata Pietraszek2, Hanna Kachaniuk3, Marianna Charzyńska-Gula4, Marta Łuczyk2 • SKN przy Katedrze Onkologii i Środowiskowej Opieki Zdrowotnej, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie • Zakład Onkologii, Katedra Onkologii i Środowiskowej Opieki Zdrowotnej, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie • Zakład Medycyny Rodzinnej i Pielęgniarstwa Środowiskowego, Onkologii i Środowiskowej Opieki Zdrowotnej, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie • Wydział Nauk Społecznych i Humanistycznych, Państwowa Wyższa Szkoła Zawodowa im. prof. Stanisława Tarnowskiego w Tarnobrzegu Streszczenie Cel pracy. Celem pracy było poznanie i opisanie opinii seniorów na temat organizowania wspólnych zajęć przedszkolaków z seniorami, których byliby potencjalnymi uczestnikami. Materiał i metody. Metodą badawczą był sondaż diagnostyczny z techniką ankiety. Badania przeprowadzono wśród 135 seniorów w wieku do 90 r.ż. uczestniczących w zajęciach Uniwersytetów Trzeciego Wieku w Lublinie i Wadowicach. Wyniki: Ponad 80% ankietowanych przyznało, że lubi dzieci w wieku przedszkolnym. Większość badanych seniorów przyznało (81,5%), że chciałoby, aby organizowano wspólne spotkania dla dzieci w wieku przedszkolnym oraz osób starszych. Zdecydowana większość, bo nawet 90% badanych, którzy odpowiedzieli pozytywnie na to pytanie spotykałoby się z dziećmi nieodpłatnie. Rodzaje aktywności, które seniorzy chętnie realizowaliby razem z dziećmi to przede wszystkim czytanie książek i spacery. Jeden na ośmiu (12,7%) seniorów mógłby poświęcić czas przedszkolakom do 30 min. dziennie, a ponad połowa (58,1%) mogłaby poświęcić od 1-2 godzin dziennie. Głównym powodem chęci spotykania się z dziećmi byłoby dla badanych seniorów spełnienie poczucia bycia potrzebnym. Wnioski: Badani seniorzy w większości deklarują chęć uczestnictwa w spotkaniach integracyjnych z młodym pokoleniem. Może być to wyraźny sygnał wskazujący na potrzebę organizacji tego typu przedsięwzięć. Osoby starsze posiadają mądrość życiową oraz doświadczenie, z którego społeczeństwo powinno korzystać i przekazywać ją młodym pokoleniom. Słowa kluczowe: starzenie się, integracja społeczna, rozwój dziecka Abstract Objective. The objective of the study was to identify and describe the opinions of seniors on organising activities for preschool children with the elderly as potential participants. Material and methods. The diagnostic survey method was applied, together with the questionnaire technique. The survey was carried out among 135 seniors aged up to 90 years taking courses at the Universities of the Third Age in Lublin and Wadowice. Results. Over 80% of the surveyed stated that they were fond of preschool children. Most of the seniors (81.5%) admitted that they would gladly participate in meetings with children at this age. A considerable majority, i.e. 90% of the respondents who were willing to take part in such activities would do so free of charge. The types of activities that the seniors would like to carry out together with the children were mostly reading books and going for walks. One in seven (12.7%) of seniors would be able to spend up to 30 minutes per day with preschool children, and over a half (58.1%) - 1-2 hours per day. The main reason why the surveyed elderly people were willing to meet with children was to satisfy the need to be useful. Conclusions. Most of the surveyed seniors declared their readiness to participate in integration meetings with the young generation. This may be a clear indication that such activities are needed. Elderly people have experience and worldly wisdom which society should use and share with younger generations. Key words: aging, community integration, child development

Purpose: This study analyzed the time and space use of adults with intellectual disabilities (ID) in order to better understand the occupational patterns of this population. Methods: Time and space use data were collected through observation of 15 adults with ID during 4-hour periods on typical weekdays and weekend days. Data were coded into 12 time and 10 space use descriptive categories. Results: The participants used a greater variety of locations during weekdays that contributed to greater amounts of weekday time spent in a wider variety of activity categories. In contrast, the participants spent a majority of the observed weekend day time in the group home with less activity variety. Although the participants in this study lived in group homes and participated in day habilitation programs or supported employment, a majority of their midday time use occurred in passive activity categories in a minimum variety of locations. These results may be due to the types of activities offered by structured day habilitation programs and group homes. Conclusion: Occupational therapists may be key players to enhance the environments of people with ID by providing direct service and staff training to facilitate more diversity of active use of time and space for adults with ID.

Despite preference for community-based living, large numbers of people with psychiatric disabilities live in nursing homes throughout the US. Community-based services for this population are limited by public policy and service system barriers. This paper summarizes these barriers and presents the second phase of a participatory action research project jointly developed by university-based researchers and two Centers for Independent Living. A qualitative case study methodology was used to understand the experiences of three individuals with psychiatric disabilities reintegrating into the community from nursing homes. Findings revealed themes of social isolation, participation in virtual communities, variability of impairment experiences and unmet needs for community supports. In addition to thematic findings, action products were generated for the benefit of community partners. These products included national best practice resources and a needs assessment survey tool. Study findings and products point to specific systems change and policy recommendations to better support community reintegration for this population. These recommendations are discussed in light of U.S. healthcare reform and broader disability advocacy efforts.