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Objective To assess governmental and nongovernmental stakeholders' perceived impacts of a Medicaid home- and community-based services (HCBS) rebalancing initiative, the Balancing Incentive Program (BIP). Data sources Governmental stakeholders (Medicaid administrators) and nongovernmental stakeholders (service providers and consumer advocates) (n = 30) from eight states that participated in BIP. Study design We conducted key informant interviews. Data collection Interviews followed a semi-structured guide and were professionally transcribed. We thematically coded transcripts using an iterative codebook with a priori and emergent codes. Principal findings Stakeholders reported that BIP participation had a range of impacts on the HCBS ecosystem, often beyond the mandated structural reforms. BIP activities were believed to have changed the culture of HCBS in some states, for example, at the level of state administration or in the provision of HCBS to consumers. Stakeholders also described significant improvements in cross-stakeholder relationships and communication, for example, in the context of troubleshooting consumers' unmet needs or improvements in the states' responsiveness to providers' inquiries. Stakeholders believed that within-state data harmonization undertaken through Core Standardized Assessment (CSA) was a positive impact of BIP, particularly with regard to its utility for administrative data, care planning, and patient-centeredness. Two stakeholders also voiced concerns regarding the validity of spending-based rebalancing metrics. The impacts that stakeholders attributed to BIP may help create a more sustained rebalancing environment through their changes to the ecosystem, including infrastructure upgrades, data harmonization, collaboration across stakeholders and agencies, more patient-centeredness, and greater recognition of HCBS. Conclusions Our findings highlight additional BIP impacts to monitor over the longer term and to consider in evaluations of future rebalancing efforts. Some potential impacts of BIP are more readily quantified (e.g., HCBS spending), while others are less likely to be formally assessed (e.g., improved stakeholder cooperation). These latter impacts are likely instrumental to future rebalancing efforts.

Introduction Interprofessional education (IPE) offers relevant theoretical, conceptual and methodological approaches to the development of effective teamwork competencies. Objective To analyse an interprofessional experience of teaching-service-community integration carried out at a public university in the South of Brazil. Methods A case study with a qualitative approach was carried out. The study's participants were thirty-eight undergraduate dental students who attended the IPE activity between 2012 and 2019. Data collection was developed in two sequential steps that included the application of an online instrument and semi-structured interviews. The textual material was interpreted by content analysis, considering Kirkpatrick's evaluation levels (reaction, learning and behaviour). Results In the reaction level, students highlighted the contents provided by the National Curricular Guidelines regarding public health system and teamwork, as well as the pedagogical teaching proposal by tutoring groups, which stimulated students' autonomy. It was observed that the learning was geared towards the development of collaborative teamwork competencies and cultural competencies. In the behaviour level, students perceived positive changes in their attitudes and behaviours towards patients, focused on needs related to life conditions, realising that dentists may work within a team. The elective/optional nature of the experience allied with the absence of other IPE activities in the curricular grid showed to be challenging. Conclusion IPE in undergraduate education presented positive results related to the reaction, learning and behaviour of dental students. We recommend the inclusion of interprofessional activities of teaching-service-community integration in Dentistry curricular structure to complement uniprofessional education.

Loneliness is an important health issue facing older people due to its association with poor quality of life and poor health outcomes. This paper aimed to clarify key issues around loneliness among older adults and draw attention to innovative programs and the translation of emerging research into practice. Loneliness is a mismatch between a person's actual and desired social connections, experienced as negative emotions. Older adults are vulnerable to loneliness because of changes associated with ageing. As such, identifying as older is often seen as a burden, negatively impacting self-esteem, sense of purpose and relevance, culminating in loneliness. Interventions combatting loneliness can target individuals, relationships, communities or societies. We advocate for an intersectoral approach to support healthy ageing and reduce loneliness. This will require further research to evaluate new approaches with loneliness as the primary outcome, and additional funding to translate evidence into an integrated multi-level approach to addressing loneliness.

After being found not guilty by reason of insanity (NGRI), individuals are typically admitted to a secure forensic hospital for evaluation and treatment. This patient population can pose a challenge to clinicians in the hospital setting due to significant violence risk, complex psychiatric presentations, and scrutiny from oversight boards and the public. This article reviews the scientific literature around several key aspects of hospital-based treatment of insanity acquittees, including the management of inpatient aggression, the provision of specific treatments to acquittees, the assessment of violence risk and readiness for release, and the process of community transition. The authors conclude that the existing literature is heavily weighted toward the study of risk assessment and recidivism, with relatively little attention paid to the study of therapeutic modalities and recovery-oriented care in this population.

The Department of Forensic Psychiatry of Castle Peak Hospital is the only facility in Hong Kong that provides territory-wide forensic psychiatric services for patients with criminal involvement. This retrospective study aimed to explore whether the rehabilitation programs provided by the department could significantly reduce the risks of forensic psychiatric inpatients as measured by the Short-Term Assessment of Risk and Treatability (START). START ratings of inpatients who were hospitalized in the department for more than 3 months and were discharged to the community during the period from 11 April 2015 to 31 March 2019 were analyzed. A total of 79 patients were assessed, of whom 61 (77.2%) were males. Fifty-four (68.4%) patients suffered from schizophrenia. START scores upon admission (strength score = 5.67; vulnerability score = 17.43) and upon discharge (strength score = 6.87, vulnerability score = 11.18) indicated significant reduction of risks among inpatients (p < 0.05).

Aims: This study explored community integration within a Moving On initiative that assisted individuals with the transition from permanent supportive housing (PSH) to more independent housing without service requirements. Methods: Participants completed baseline interviews while in PSH (n=90) and, for those who moved on, a follow-up one-year post-move (n=45). Bivariate analyses and OLS regression were used to examine community integration outcomes and potential correlates. Results: For participants who moved on, subjective social quality of life and sense of communitywere higher post-move, while physical integration decreased, and time spent at home increased. Gender, mastery, and housing quality were associated with community integration post-move. Conclusion: Moving on did not adversely impact most aspects of community integration, though PSH residents may need more support to facilitate participation in routine activities outside their home post-move. Findings also highlight the importance of supporting mastery given its potential role in community integration.

WHAT IS KNOWN ON THE SUBJECT?: Mental health treatments have become patient-centred. Evaluating recovery in people with mental health difficulties living in the community can help to develop better client-centred services. Community integration is critical to recovery in patients with mental health difficulties. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first study to use a single integrated measure of mental health recovery to evaluate the effect of community integration. Physical community integration was the easiest goal for most to reach. Developing independence/self-actualization was harder. In mental health recovery, most people were able to overcome stuckness. Developing abilities for basic functioning was harder. Participating in mental health centre day programmes promoted mental health recovery in people with mental health difficulties living in the community. Independence/self-actualization, psychological integration and social support improved mental health recovery in people with mental health difficulties living in the community. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need to develop and actively promote programmes that attract people with mental health difficulties living in the community so that they will actively use mental health centre services. Offering systematic social skills training and occupational rehabilitation therapy to people with mental health difficulties living in the community may help them function independently. Mental health service programmes should provide volunteer opportunities for people with mental health difficulties living in the community to facilitate a sense of belonging. Mental health nurses should serve as a social support resource for people with mental health difficulties living in the community by providing education to family and friends on how to support patients' recovery, and invigorating integration projects such as "making healthy friends." Abstract Introduction Although community integration of people with mental health difficulties and a consumer-centred recovery paradigm are of global importance, little research has been conducted on community integration factors that directly affect mental health recovery. Aim This study investigated the relationship between community integration and mental health recovery in people with mental health difficulties living in the community in South Korea. Method Data were collected from 155 people with mental health difficulties living in the community, using the Self-Reporting Scale of Community Integration and the Mental Health Recovery Measure (Korean version), and analysed using hierarchical regression analysis. Results Among the community integration subscales, independence/self-actualization, psychological integration and social support were significant factors in mental health recovery, explaining 47.3% of the variance. Discussion An effective intervention strategy for mental health recovery of people with mental health difficulties living in the community may reinforce community integration by carefully considering independence/self-actualization, psychological integration and social support. Implications for practice Mental health nurses should provide intervention to people with mental health difficulties living in the community to help them develop strategies for functioning independently, experiencing a sense of achievement and developing a sense belonging in the community.

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one-year post-implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four-step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes.

Community integration has emerged as a priority area among mental health advocates, policy makers, and researchers (Townley, Miller, & Kloos, 2013; Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007). Past research suggests that social support influences community integration for individuals with serious mental illnesses (Davidson, Haglund, Stayner, Rakfeldt, Chinman, & Tebes, 2001; Davidson, Stayner, Nickou, Styron, Rowe, & Chinman, 2001; Wong & Solomon, 2002), but there has not yet been a systematic review on this topic. Therefore, the purpose of this paper was to explore the influence of social support on community integration through a review of the existing literature. An extensive literature search was conducted, resulting in 32 articles that met the search criteria. These articles were organized into three categories: defining community integration, supportive relationships, and mental health services. The search results are analyzed according to the types of support being provided. Article strengths, limitations, implications, and future directions are also addressed. Overall, the findings of this review suggest that social support, which may be provided by a variety of individuals and services, plays an important role in promoting community integration for individuals with serious mental illnesses. Therefore, as community mental health research and practice continues to promote community integration for individuals with serious mental illnesses, the mental health field should emphasize the importance of social support as a key factor influencing community integration.

BACKGROUND AND OBJECTIVES Dementia is commonly associated with cognitive deficit, functional decline and societal participation restriction across multiple domains of functioning. The decline impacts not only on the individual, but also on their informal caregivers, healthcare and the social system. This clinical random controlled study investigated the efficacy of 12-week Progressive Task-oriented circuit training on cognition, physical functioning and societal participation of individuals with dementia. METHODS This study involved 31 individuals living with dementia recruited from a tertiary health institution in Lagos Nigeria. They were randomized into two groups: Progressive Task-oriented circuit training (involved in 12-week circuit training, two times a week for 70 min per session consisting of six workstations) and Control group (training with conventional treatment and home programmes). They were assessed at baseline, mid-intervention and post-intervention using Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognition (ADAS-Cog), Bristol ADLs, Community integration Questionnaire, 6-min walk test. Data analysed using the independent-samples t tests, paired t tests, Friedman two-way analysis of variance and Mann-Whitney U test (p ≤ .05). RESULTS Participants were aged 69.61 ± 3.44 years. There was significant improvement from baseline to post-intervention in cognition (30.77 ± 1.02 vs. 28.77 ± 3.30), physical functioning (28.19 ± 3.90 vs. 25.84 ± 6.26) and societal participation (3.64 ± 0.73 vs. 5.59 ± 2.76). However, the progressive Task-oriented circuit training had more significant improvement than the control group within the group in cognition (p = .000), physical functioning (p = .000), and societal participation (p = .000). There was no statistical difference within the Control group with cognition (p = .097), Physical functioning (p = 1.000). Meanwhile there was statistically significant effect between both groups on cognition, physical functioning and societal participation post-intervention (p

This paper explores the contribution of social identity change to international students' health and well-being. International students typically face a range of challenges from the time they leave their home country, including the need to adapt both to a new culture and norms and to a new educational landscape. Previous research informed by the Social Identity Model of Identity Change (SIMIC) suggests that during such life transitions, an individual's group memberships and associated social identities can provide a buffer against the threats to well-being that such transitions present. To examine the relevance of SIMIC for the transitions that international students' experience, semistructured interviews were conducted with 15 international students attending an Australian university. Thematic analysis provided support for the relevance of SIMIC's social identity gain and social identity maintenance pathways in the transition and revealed a number of associated factors that acted as either facilitators (e.g., a host family that supported community integration) or barriers (e.g., experiencing culture shock) to social identity change. These findings present the first qualitative support for SIMIC within an international student population and help to flesh out the specific ways in which social identity processes contribute to both positive and negative health and well-being outcomes.

There is still much to learn about how aspects of the ecology of homelessness shape homeless adults' recovery experiences. In the present mixed-methods study, the relationship of service providers' work-related values to their service users' recovery experiences in the microsystem of homelessness were examined. Service providers completed semi-structured qualitative interviews about their service users, daily work activities, and work-related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration. Service providers' interview transcripts were coded for three indicators of values: assumptions, actions, and end-states. Summative Content Analysis was used to transform qualitative codes into numeric data so they could be used to predict service users' recovery. In a series of growth curve models, the extent to which service providers' end-state values, as an indicator of consumer-led values, was shown to indirectly predict service users' recovery experiences, through their perceived choice and mastery. Findings confirm that providers' values are an important influence on service users' recovery. Results are discussed in terms of their implications for recovery-oriented theory and practice.

People with concealable stigmatized identities, such as a criminal record, often anticipate stigma from others. Anticipated stigma is thought to cause withdrawal from situations in which there is the potential for discrimination, which then negatively impacts behavior and functioning. This may have implications for offenders reentering the community, possibly hindering community integration and encouraging maladaptive behavior postrelease. Drawing upon a sample of 197 male jail inmates, we examine a theoretical model in which anticipated stigma during incarceration predicts behavioral outcomes 1 year after release from jail (i.e., recidivism, substance use disorder symptoms, mental health symptoms, community adjustment) through social withdrawal. Anticipated stigma during incarceration predicted social withdrawal three months postrelease, which then predicted more mental health problems 1 year postrelease. Stigma resistance and optimism buffered the effect of anticipated stigma on social withdrawal. Race moderated multiple paths in the model, suggesting that the relations between anticipated stigma, social withdrawal, and adjustment are more pronounced for White offenders.

Objective This study compares the effect of Housing First on older (≥50 years old) and younger (18–49 years old) homeless adults with mental illness participating in At Home/Chez Soi, a 24-month multisite randomized controlled trial of Housing First. Method At Home/Chez Soi, participants (n = 2148) were randomized to receive rent supplements with intensive case management or assertive community treatment, based on their need level for mental health services, or usual care in their respective communities. A subgroup analysis compared older (n = 470) and younger (n = 1678) homeless participants across baseline characteristics and 24-month outcomes including housing stability (primary outcome), generic and condition-specific quality of life, community functioning, physical and mental health status, mental health symptom severity, psychological community integration, recovery, and substance use (secondary outcomes). Results At 24 months, Housing First significantly improved the percentage of days stably housed among older (+43.9%, 95% confidence interval [CI]: 38.4% to 49.5%) and younger homeless adults (+39.7%, 95% CI: 36.8% to 42.6%), compared with usual care, with no significant differences between age groups (difference of differences = +4.2%, 95% CI: −2.1% to 10.5%, p = 0.188). Improvements from baseline to 24 months in mental health and condition-specific quality of life were significantly greater among older homeless adults than among younger homeless adults. Conclusion Housing First significantly improved housing stability among older and younger homeless adults with mental illness, resulting in superior mental health and quality of life outcomes in older homeless adults compared with younger homeless adults at 24 months. Copyright © 2017 John Wiley & Sons, Ltd.

The current longitudinal study used mixed methods to examine the relationship of housing and neighborhood characteristics and community integration among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada, and participated in 3 in-person interviews, each approximately 1 year apart. Participants were placed into either a “high” or a “low” integration group based on their community integration scores at Follow-up 1 and Follow-up 2. There were 14 high and 32 low integration participants at Follow-up 1, and 17 high and 35 low participants at Follow-up 2. A general inductive approach to analyzing qualitative data was used to code the data. The most salient themes that affected community integration involved substance use in one's housing and neighborhood, neighborhood safety and location, and housing quality. Implications for service provision and policy advancements to better address community integration are discussed.

Objective To describe the experience of Guinean Ebola virus disease (EVD) survivors in Guinea, up to ten months after discharge from the Ebola treatment unit. Methods Cross-sectional study using a standardised semistructured questionnaire among survivors from Conakry and Coyah districts in 2015 in Guinea. We used proportions, mean (standard deviation) and median (interquartile range) to summarise the variables. The McNemar chi-square test was used to compare proportions. Results The 121 EVD survivors interviewed had a median reintegration time from discharge of 18 weeks (IQR: 14–32 weeks). Most survivors were aged 15–44 years (87.6%) with secondary to higher level of education (68.6%), and 25.6% were healthcare workers. The majority reported a lower socio-economic status (90%), a less favourable work situation (79%) and psychological status (60%). About 31% reported physical health problems. Most survivors reported lower levels of reintegration with friends and at work place (72%) and lower acceptance by others in general (71%) in the period after the EVD as compared to the period before the EVD. Only 55 survivors (45.5%) were involved in one or more activities of the EVD response: participation in clinical studies on the EVD (44 survivors, 36.4%), community sensitisation (28 survivors, 23.1%) or work in Ebola treatment and/or transit centres (23 survivors, 21.7%). Conclusion There is a need for a long-term follow-up of EVD survivors in Guinea and more efforts to support their social, professional and economic reintegration, especially in rural areas.

Background/aim Australia's National Disability Insurance Scheme (NDIS) is designed to influence home, social and economic participation for Scheme participants. Given the major disability reform underway, this pilot study aimed to: (i) examine community integration outcomes of people with spinal cord injury (SCI); (ii) compare findings with multiple matched controls and (iii) consider findings within the context of Australia's NDIS. Methods Setting: Victoria, Australia. Design: Matched analysis (people with and without SCI). Instrumentation: Community Integration Questionnaire (CIQ). Participants: n = 40 adults with SCI (M age = 52.8 years; 61% male; 77% traumatic SCI). Analyses: Matched analyses from each SCI subject aged

This study examined predictors of physical and psychological integration in homeless adults with problematic substance use. Homeless adults with problematic substance use (n = 115) in Ottawa, Canada, completed questionnaires regarding their demographics (age, gender, Aboriginal ethnicity), health and social functioning (physical health, mental health, alcohol use problems, drug use problems, social skills), environmental factors (satisfaction with personal safety, social support), physical integration, and psychological integration. Participants reported low physical integration (i.e., participation in activities in the community) and did not feel strongly psychologically integrated (i.e., sense of belonging). The final models accounted for 36% and 19% of the variance in physical and psychological integration, respectively. Higher levels of social skills and social support were associated with greater physical integration. Higher levels of mental health functioning and satisfaction with safety were related to greater psychological integration. Implications of the findings for community support services are discussed.

American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre-existing interview data from 15 self-identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community's knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.

Accessible summaryWhat is known about the subject? Loneliness among people diagnosed with schizophrenia is a serious problem. Recent studies have focused on the loneliness; however, no study has examined the relationships between loneliness and both individual and environmental factors comprehensively. What this paper adds to existing knowledge? The main results indicated that the community-dwelling people diagnosed with schizophrenia in Japan as well as in other countries experienced higher levels of loneliness. Both individual and environmental factors were related to loneliness. Increasing the self-efficacy for community life and self-esteem of individual factors, and not being socially isolated and increasing community integration of environmental factors would improve their loneliness. What are the implications for practice? Health practitioners, in particular, public health nurses in mental health care, should work to develop a partnership with people diagnosed with schizophrenia, their family members, friends and other community-dwelling people in order to decrease and prevent loneliness. For individuals diagnosed with schizophrenia, interventions by cooperating with community resources and using the technique of nurses to assist them with continuous community activity could be useful. For environmental interventions, population approach such as developing daily programmes which family members can participate in, and cooperating with educational institutions and community events could have a positive effects. AbstractIntroduction Loneliness among people diagnosed with schizophrenia living in communities can decrease quality of life and may contribute to suicide. Aim The aim of this study was to examine the levels of loneliness among Japanese people diagnosed with schizophrenia and to identify individual and environmental factors related to their loneliness. Method A cross-sectional survey was conducted with 264 people diagnosed with schizophrenia who use local activity support centres in urban areas. The self-administered questionnaires included questions on loneliness, demographic characteristics, individual factors including self-efficacy for community life and self-esteem, and environmental factors including social isolation, community integration and service use. Results The study results indicated that people diagnosed with schizophrenia in Japan experience higher levels of loneliness, corroborating results from other countries. Multiple regression analysis showed that a lower level of self-efficacy for community life, self-esteem, community integration and social isolation predicted a higher level of loneliness, accounting for 55.3% of variance. Implications for Practice Public health nurses in mental health care in Japan can work with individuals diagnosed with schizophrenia and communities using the technique to assist them with continuous activity and cooperating with community resources and educational institutions in order to decrease and prevent loneliness.

Traditional approaches to formal youth mentoring have focused primarily on improving the lives of "at-risk" youth through the assignment of individual mentors who are typically disconnected from youth's communities. Similarly, research in the field of formal mentoring has emphasized the dyadic relationship between the mentor and the mentee, with less attention paid to the broader relational contexts in which such relationships unfold. The current paper proposes a new framework that expands the scope of mentoring interventions to include approaches that build on and cultivate informal supports and empower youth to identify and reach out to networks of potential supportive adults, thus increasing the reach of youth mentoring.

This paper provides an overview of a conceptual model that integrates theories of social ecology, minority stress, and community readiness to better understand risk for and outcomes of intimate partner violence (IPV) among LGBTQ+ college students. Additionally, online survey data was collected from a sample of 202 LGBTQ+ students enrolled in 119 colleges across the United States to provide preliminary data on some aspects of the proposed model. Results suggested that students generally thought their campuses were low in readiness to address IPV; that is, students felt that their campuses could do more to address IPV and provide IPV services specific to LGBTQ+ college students. Perceptions of greater campus readiness to address IPV among LGBTQ+ college students was significantly and positively related to a more favorable LGBTQ+ campus climate and a greater sense of campus community. Additionally, IPV victims were more likely to perceive higher levels of campus community readiness than non-IPV victims. There was no association between IPV perpetration and perceptions of campus community readiness. Greater sense of community was marginally and inversely related to IPV victimization and perpetration. Sense of community and LGBTQ+ campus climate also varied to some extent as a function of region of the country and type of institution. Implications for further development and refinement of the conceptual model, as well as future research applying this model to better understand IPV among sexual minority students are discussed.

The current longitudinal study evaluated the individual, housing, and neighborhood characteristics predictive of feeling psychologically integrated within one's neighborhood among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada and participated in three in-person interviews, each approximately 1 year apart. Prospective and cross-sectional predictors of psychological integration at Follow-up 1 and Follow-up 2 were examined. There were 397 participants at baseline, 341 at Follow-up 1 and 320 at Follow-up 2. A hierarchical multiple regression uncovered several significant predictors of psychological integration. The most salient and common predictors were being older, having greater social support, living in high quality housing, and residing in a neighborhood with a positive impact. Implications for service provision and policy advancements are discussed.

An oil boom is a complex social and economic phenomenon. The socioeconomic system presented in this article represents a novel effort to explicate boom impacts and changes, within a systems framework, at the community level to enhance community planning and development efforts. Most boomtown studies focus on longitudinal changes of a boom-bust-recovery cycle or social-disruption-based approaches. This article is an effort to demonstrate that longitudinal changes or social disruptions of a boom manifest through the interactions and interrelationships between social entities and stakeholders acting within the boom conditions and surrounding conditions. The socioeconomic system approach in this article analyzes the boom as a system, which provides a useful lens for many other rural communities currently experiencing unconventional oil and gas development in the United States. The socioeconomic system highlights five main challenges or factors that need to be addressed through community development strategies: develop affordable housing, invest in community infrastructure, expand public services, attract new businesses to the area, and develop better community integration strategies to build trust and unity within the community. This article is qualitative and exploratory in nature. As a result, it explicates the functions, structure, and relationships between system entities to provide a broader understanding of coherence, conflicts, and synergies within a system.

The present study evaluates data from 116 forensic inpatients who underwent violent risk assessments, which included the Historical, Clinical, Risk-20 (HCR-20), from 2006 to 2013 as part of an opportunity to be conditionally discharged from state forensic facilities. Of the 116 inpatients, 58 were never released, 39 were released and returned to a hospital, and 19 were released and never returned. Results from analyses of variance and multinomial logistic regression found the risk management (R) scale of the HCR-20 successfully predicted group membership in that higher scores were associated with a greater likelihood of not being released from a forensic facility or returning to a forensic facility after release. The results of this study indicate that clinicians should consider community-based risk variables when evaluating forensic patients for potential return to the community. This research demonstrates that clinicians failing to fully consider dynamic risk factors associated with community integration jeopardize the quality and thoroughness of their violence risk assessment with regards to readiness for release. Copyright © 2016 John Wiley & Sons, Ltd.

The demographic transition is also a kinship transition. This insight is obvious for certain types of kin-as fertility falls parents have fewer children for instance-but its broader implications for communities remain unexplored. Prior work on this topic has focused on how the demographic transition reshapes the availability of living kin within a society over time to the neglect of how differences in the demographic transition lead to differences in kinship networks between communities. In this article I examine survey data (for rural Thailand) and use microsimulation methods to test how different pathways through the demographic transition affect kinship networks in communities. My results show that different routes through the demographic transition can substantially alter kinship network size and entirely through the mechanism of demographic change have indirect effects on community integration. These effects persist long after the demographic transition has ended. I theorize reasons that community-level differentiation in kinship networks owing to the demographic transition are an important mechanism linking the demographic transition to modernity.

Purpose To examine community reintegration following a hip or knee total joint replacement (TJR) from the perspective of rehabilitation clients. Methods A phenomenological frame of reference guided the present study. Ten participants who received inpatient rehabilitation completed semi-structured qualitative interviews to explore their experiences with reintegrating back into their chosen communities and the meanings that they ascribed to their reintegration. Interview data were analysed using thematic analysis. Demographic data, and information regarding participants’ living situation and supports were extracted from existing databases and used to characterize the sample. Results Participants revealed that reintegration after a TJR encompassed two key elements of meaning: i) engagement in meaningful activities; and ii) satisfaction levels. Additionally, the following five factors were identified as facilitators or barriers to community reintegration following a TJR: i) ongoing preparation and education; ii) confounding health issues; iii) driving and transportation; iv) personal facilitators; v) access to supports from professionals, family and friends, and community programmes. Conclusions The present study highlights the significance of engaging in meaningful activities and being satisfied in one's level of engagement to achieving a sense of community reintegration following a TJR. This suggests that reintegration post-TJR has broader meanings than just improvements in functional abilities. Practitioners are encouraged to inquire about patients’ meaningful activities, support their preparedness throughout the rehabilitation process, to identify confounding health issues that may limit reintegration, consider patients’ fears and anxieties and establish supports to enhance their feelings of self-efficacy and abilities to cope following a TJR. Copyright © 2014 John Wiley & Sons, Ltd.

In this paper data was collected in 2012 for a study concerning the employment of skilled workers on temporary 457 visas in the Western Australian resources sector. While workers came from numerous countries in order to meet the sector’s skill shortages, issues relating to workers from the Philippines were prominent due to the difficulties they reported. These difficulties included: skill recognition; workplace and community integration challenges, and deficiencies in their family members’ English language ability. The experiences of workers on 457 visas from other countries are compared with those of workers from the Philippines. Interviews with key stakeholders from a sample of resource sector firms that employ Filipino workers on 457 visas and agencies that support their integration are also reported. The purpose of the paper is to highlight the HRM implications of employing migrant workers on 457 visas, especially Filipino workers, to facilitate successfully adaption to Australian workplace culture.

Persons with cognitive disabilities such as intellectual disability, borderline intellectual disability, and acquired brain injury are overrepresented in Australian criminal justice systems both as victims and as offenders. Data obtained in Australia and internationally indicate that up to 12% of the prison population has an intelligence quotient (IQ) of less than 70, with up to 30% having an IQ of between 70 and 80, indicating substantially higher representation of intellectual disability and borderline intellectual disability than in the general population. Indigenous Australian adults in prison are significantly more likely to have intellectual disability than their non-Indigenous counterparts. Points of intervention throughout individuals' trajectories into and through the criminal justice and human service system are investigated, allowing new ways of understanding how persons with intellectual and other cognitive disabilities are vulnerable to the harms of control-and-punishment systems. Using an innovative data-linking and data-merging method, the authors compiled longitudinal administrative data from all criminal justice and human service agencies in New South Wales, Australia, to create life-course pathways for 2,731 persons who had served time in prison in New South Wales and whose mental health and cognitive disability diagnoses were available. Mapping service agency responses and institutional trajectories of these persons from an early age reveal a picture of early police contact and enmeshment in juvenile and adult corrections with high frequency, but often of low duration. Poor recognition of cognitive disability coupled with the presence of mental disorders and substance use disorders is associated with multiple and compounding social disadvantage and vulnerability to harm. This group is subject to multiple, simultaneous, and continuing human service agency interventions, which have only limited impact on their offending and (re) incarceration. Provision of appropriate support before, during, and after imprisonment is likely to reduce these individuals' vulnerability to harm and improve their experiences of community integration. Language: en

Aim To report on an Israeli academic nursing project, aimed at supporting the integration of Ethiopian immigrants into nursing studies. Background The representation of ethnic minorities within nursing is crucial for the provision of efficient care in diverse societies. Nevertheless, successful integration of minority students in nursing programs is not a simple task and needs developing support systems that will attract and retain students from minorities. Ethiopian Jewish immigrants and their descendants in Israel form a community of 120 000 people. Their participation in the national workforce is low, as well as their average income. Methods The paper is based on formative evaluation, using action research, of an academic nursing program in Israel. Findings Four main strategies identify this project: (1) a policy of institutional commitment, (2) personal relations with staff, (3) personal tutoring, and (4) cultural safety education. The project has reached success in terms of attraction, retention and students' satisfactions. The project's two main challenges, which need further concern, are: (1) giving support without labelling and (2) supporting without creating dependency. Conclusions and International Policy Implications Appropriate strategies can enable success of minority students. Nevertheless, the amount of support needed for such programs raises two major questions: (1) To what extent should individual nursing departments be expected to bear solutions to this widely experienced problem? (2) How does focusing on one minority affect cultural safety of the overall group?

Background Public attitudes towards persons with intellectual disabilities (IDs) have a significant effect on potential community integration. A better understanding of these can help target service provision and public awareness programmes. Objective The objective of the present study is threefold: (1) describe public attitudes towards persons with ID along affective, cognitive and behavioural dimensions; (2) compare and contrast attitudes according to sex, age, education and income, as well as frequency and quality of contacts with persons with ID; and (3) ascertain whether the level of functioning has an effect on attitudes. Methods The Attitudes Toward Intellectual Disability Questionnaire (ATTID) was administered by phone to 1605 randomly selected adult men and women, stratified by region in the province of Quebec, Canada. The ATTID uses a multidimensional perspective of attitudes that reflect affective, cognitive and behavioural dimensions. Results The results showed that public attitudes were generally positive regarding all three attitudinal dimensions. Public attitudes towards persons with ID are presented in terms of the five factors meas

The policy of deinstitutionalization was based on the proposition that quality of life (QoL) of individuals with intellectual disabilities (ID) will improve as a result of being moved from institutions to community-based care settings. The aim of this literature review was to evaluate whether this assumption has become a reality now that the social policy of deinstitutionalization has progressed in many countries across the globe. A total of 15 studies were examined that assessed QoL as an outcome of community living following deinstitutionalization. Results indicated that relocation had a general positive impact on life quality of participants. However, many of the studies found that improvements were most prominent shortly after the move and plateaued after a year. Also, participants continued to have low levels of community integration. There was some evidence that healthcare needs might not be adequately met in the community. The role of service providers was indicated as vital in the continued development of participants' life quality. Common limitations of the studies reviewed included lack of subjective assessments of QoL and limited use of standardized measures of QoL. The authors note that the directions for future research should include examining whether QoL outcomes after deinstitutionalization are affected by level of ID and age of participants. Overall, additional empirical research is needed to identify the factors that are critical in enhancing QoL of participants in community-based care following deinstitutionalization.

In response to national policy directives, all residents of long-stay hospitals for adults with an intellectual disability (ID) in England are now living in the community. The success of community integration can be assessed by measures of relevant factors, such as quality of life and mortality, in those adults who move out of hospital and into community settings. The authors used the Questionnaire on Quality of Life to measure quality of life at baseline (i.e., 6 months prior to moving) and at 6 months and 1 year postrelocation in 51 adults with ID with complex health problems who had moved from a long-stay hospital into various community supported living accommodations, group residential homes, or nursing homes. Mortality and causes of death were investigated in those who died within 2 years of relocation. Overall, it was found that quality of life (in all domains investigated) improved between baseline and 6 months follow-up but leveled off at 1 year follow-up. Three adults died during the first 2 years of moving to the community; all had complex problems (two died from complications associated with seizures). The findings suggest the need for careful and considered planning when relocating people with ID who have complex health problems irrespective of their current residence. They also suggest that adults with ID and epilepsy may be particularly vulnerable to the move process and require particular attention.

This study examined individual and neighborhood predictors of the psychological community integration of people with psychiatric disabilities and nondisabled community members. One hundred twenty-three adults (60 psychiatrically disabled, 63 general community residents), completed measures of sense of community, life satisfaction, psychiatric symptoms, and perceptions of neighborhood. Mental health consumers living in independent scatter-site apartments did not differ from other community members in either sense of community or life satisfaction. Among mental health consumers, neither symptoms nor demographic variables predicted sense of community, whereas objective neighborhood characteristics did. Conversely, among community members, age and symptoms predicted sense of community while objective neighborhood characteristics did not; perceived neighborhood characteristics predicted sense of community in both samples. Findings suggest that consumers living in independent housing may achieve levels of psychological community integration comparable to other community members, and that neighborhood factors impact degree of community integration in this population. © 2011 Wiley Periodicals, Inc.

Aim To advance understanding of the interrelationships of sex, level of lesion (LOL), self-management, community integration (employment, independent living), and quality of life (QOL) in young adults with myelomeningocele. Method A multicenter convenience sample of 50 individuals with myelomeningocele, 18 to 25 years of age (mean age 21y 5mo, SD 2y), participated in a structured clinical interview on self-management (Adolescent Self-Management and Independence Scale II [AMIS II]) and completed a self-report questionnaire comprising standardized measures. QOL was assessed using the World Health Organization Quality of Life (WHOQOL)-BREF instrument. A chart review yielded clinical data. Results Most participants were Caucasian (78%), female (56%: 28 females, 22 males), unemployed (58%), and in supervised living environments (74%). Eighty per cent had a history of hydrocephalus requiring shunt placement. A lumbar LOL was most frequently reported (64%), followed by a sacral LOL (22%), and thoracic LOL (7%). Males were more likely to report employment (p=0.008), but females had greater success in transitioning into independent living settings (p=0.015). LOL was a significant predictor of specific dimensions of self-management, employment, and QOL (p

Background: A definition of recovery drawn from qualitative literature and the ‘consumer/survivor’ movement suggests that recovery should be seen as a way of developing satisfaction and purpose in life, whether or not symptoms of mental illness are present. A qualitative review suggested that meaningful activity may facilitate recovery by providing a sense of purpose in life. Social firms may be well placed to offer this activity due to their ethos of empowerment, their community integration and their similarity to ‘recovery-oriented services’. Aims: The aim of this study was to explore experiences of recovery from mental illness in the context of two emerging social firms. Method: A social constructionist version of grounded theory was used to develop a model of recovery through participation in the emerging social firms. Multiple coding, triangulation and respondent validation were used to increase the rigour of study findings. Findings: A model of recovery in the context of the emerging social firms was constructed. This was influenced by characteristics such as a flexible structure, a meaningful and diverse activity, an accepting social group and an inclusive leadership. Conclusion: Social firms may provide an important model for ‘recovery-oriented services’. Clinical, research and policy implications of findings are discussed. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: Social firms are a form of enterprise that employs people who are disadvantaged in the labour market by their disability. Social firms promote a model of community integration and empowerment for their employees. We found that individuals recovering from a mental illness experience social firms as providing a flexible environment which promotes feelings of belonging, success, competence and individuality. We interpret these findings as social firms providing secure base for recovery.

In this paper the author examines the role of the occupational therapist as a consultant to a local government agency. A Community Integration Policy Project conducted in Melbourne, Victoria, is described. This project was an action research project, aimed at improving one agency's response to the needs of people with a disability, in the areas of access to physical facilities, programmes, employment opportunities and decision making processes. Results of the project include improved access in all areas mentioned above, as well as the adoption and implementation of a comprehensive policy on access for the disabled. It is concluded that the occupational therapist has a legitimate role to play in creating social change.

This study examined whether occupational therapists write treatment goals relevant to community integration for adults with developmental disabilities. One hundred and twenty one occupational therapy records from 23 NSW therapists were reviewed to ascertain the focus of their treatment goals. Results indicated that adaptive goals significantly outnumbered remedial goals. Within adaptive goals, community living skills significantly outnumbered basic self care goals. A number of therapists goals addressed equipment prescription and alternative environments or services. Implications of therapist goal preferences for adults with developmental disabilities are discussed.

To investigate the relationship between driving versus not driving and community integration after stroke. Much research on patients who drive after experiencing a stroke has focused on driving assessment protocols; little attention has been given to the implications of assessment outcomes.Prospective study.Six driving evaluation centers in Ontario, Canada.Fifty-three community-dwelling patients who were referred for a driving assessment after they experienced a stroke.Data on demographics, living circumstances, health status, driving habits, and driving history were gathered via a semistructured interview and various questionnaires administered on 3 occasions: study entry (or =1 month after stroke; n = 53), 3 months (n = 44), and 1 year (n = 43).Reintegration into the community at 1 year, as evaluated with the Reintegration to Normal Living Index (RNLI).The participants had sustained a stroke an average of 12.3 months before study entry. Two subjects were driving at study entry. At 1 year, 28 (65%) of 43 subjects had passed their driving test and had resumed/continued driving. Nondrivers had a significantly lower mean RNLI score than drivers. Subjects who were not driving at study entry but had resumed driving by 1 year had a significant increase in RNLI score (P = .011). Driving was significantly associated with community integration after adjustment for concomitant health status (P.001). Driving and health status were associated with community integration at 1 year, accounting for 32% of the variance in RNLI score.Driving after stroke was significantly associated with community integration in patients after adjustment for health status (P.001). Community decision-makers may decide to use the study results when determining the transportation needs of stroke survivors who self-limit their driving because of weather, time of day, or distance concerns.

Aim: Children with a disability are reliant on a capable, healthy and well-resourced carer. Most often the child’s mother provides the care that ensures the child’s health, service access and community integration are attended to successfully. Through in-depth interviews with mothers and professionals, this study explores issues that challenge the mother’s performance in her very important role as a caregiver. Method: Qualitative methodology(n = 8)resulted in verbatim transcriptions that were analysed and categorised, and common themes were derived. Results: Participants identified a multitude of challenges related to issues surrounding the child, maternal characteristics, the family, services and the community. Emotional distress and mental health issues were reported. Conclusion: Many aspects of caregiving can be relentless and challenging. Occupational therapy clinical implications aimed at supporting mothers and their children are discussed.

The deinstitutionalisation of people with mental handicaps has given rise to a considerable literature regarding the effects of this policy on service users. This review describes the major findings in relation to changes in adaptive behaviour, activity levels, social interaction, community integration, disruptive behaviour, and quality of life. Individual and environmental influences are discussed, together with possible foci for future research.