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

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

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

The independent predictive power of fatigue for community integration has not been investigated, although there is an increasing amount of literature that recognizes the importance of fatigue in people with stroke. To examine the correlation between community integration and fatigue, walking endurance, and fear of falling; and to quantify the relative contribution of fatigue to community integration in people with stroke. This was a cross-sectional study with 75 community-dwelling people with stroke. Data were collected using the Community Integration Measure (CIM), Fatigue Assessment Scale (FAS), 6-minute walk test (6MWT), and Survey of Activities and Fear of Falling in the Elderly (SAFE). Multiple linear regressions (forced entry method) were used to quantify the relative power of the FAS score to predict community integration in a model covering distance in the 6MWT and the SAFE score. After controlling for age, the CIM score significantly correlated with the scores for FAS (r=-0.48, p < 0.001), 6MWT distance (r = 0.24, p = 0.039), and SAFE (r=-0.39, p = 0.001). The entire model, including age, FAS score, 6MWT distance, and SAFE score, explained 26.1% of the variance in the CIM scores (F [4, 70] = 7.52, p < 0.001). The FAS scores independently explained 10.6% of the variance in the CIM scores. This study suggests that fatigue is an independent predictor of community integration among people with stroke, taking into account walking endurance and fear of falling. [ABSTRACT FROM AUTHOR]

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).

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

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

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

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

This study investigated the impact of recovery capital (RC) on community integration (CI) among a sample of adults formerly incarcerated. A sample of 78 participants who identified as being in recovery from substance use disorder and having been previously incarcerated completed a survey asking about their RC and CI. Results of a hierarchical regression model investigating the relationship between RC and CI revealed a significant model, accounting for 27% of the variance in CI. Results provide support for considering aspects of RC, particularly social support, when facilitating reentry and reintegration for individuals who have experienced incarceration. Results also reveal that people who identified as multiracial reported significantly lower levels of CI. [ABSTRACT FROM AUTHOR]

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

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

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

Several systematic reviews have synthesized studies exploring the experience of homelessness. No known reviews have synthesized findings of studies exploring experiences of transitioning to housing following homelessness. To address this gap, we conducted a systematic review and meta-aggregation of qualitative evidence using the methodology developed by the Joanna Briggs Institute (JBI) following PRISMA guidelines. Of 8559 titles and abstracts screened, we included 57 studies in our meta-aggregation, and generated six synthesized findings: 1) trying to move on but facing ongoing individual and structural barriers; 2) home as a launching pad for self-discovery and emotional and spiritual growth; 3) social connection as a fundamental and often unmet need; 4) having housing that is the right fit and enables a sense of safety and avoidance of trauma; 5) meaningful activity as facilitating community integration and the journey home; and 6) the meaning of having services that are effective, caring, and responsive to the person. Our findings suggest that leaving homelessness is a complex process that does not immediately end with attaining a tenancy. Future research designed to understand the experiences of leaving homelessness for racialized and Indigenous persons, women leaving domestic violence, and persons identifying as 2SLGBTQ2 + are needed. [ABSTRACT FROM AUTHOR]

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

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

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

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.

This study presents an analysis of the experiences of 15 men convicted of sexual offences, from England and Wales, who have completed the Horizon treatment programme in the community, facilitated by The Probation Service. We found that whilst men felt initially coerced into the programme, finishing the programme was experienced as a significant loss of support. Beyond the programme, the men described the constraints on their citizenship, difficulty accessing support, and rejection in society due to their offence. We conclude by discussing the limitations of personal rehabilitation, the need for social rehabilitation, including tailored support beyond the programme, the importance of user voice and a 'community integration paradox'. [ABSTRACT FROM AUTHOR]

Background: The strengths-based approach (SBA) was initially developed for people living with mental health issues but may represent a promising support option for community participation of people living with a traumatic brain injury (TBI). A community-based organisation working with people living with TBI is in the process of adapting this approach to implement it in their organisation. No studies explored an SBA implementation with this population. This study explores the implementation of key components of the SBA in a community-based organisation dedicated to people living with TBI. Methods: A qualitative descriptive design using semi-structured interviews (n = 10) with community workers, before and during implementation, was used. Transcripts were analysed inductively and deductively. Deductive coding was informed by the SBA fidelity scale. Results: Group supervision and mobilisation of personal strengths are key SBA components that were reported as being integrated within practice. These changes led to improved team communication and cohesiveness in and across services, more structured interventions, and greater engagement of clients. No changes were reported regarding the mobilisation of environmental strengths and the provision of individual supervision. Conclusion: The implementation of the SBA had positive impacts on the community-based organisation. This suggests that it is valuable to implement an adaptation of the SBA for people living with TBI. This descriptive qualitative study explores the perceived changes within a community-based organisation following the implementation of a strength-based approach for people living with the sequela of a traumatic brain injury. Positive changes resulting from the implementation process were revealed through semi-structured interviews with community support workers of the organisation. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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.

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

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

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

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

A high level of resilience is positively related to successful aging. However, interventions to increase resilience in older adults are not yet available. This study aimed to examine the mediating role of community participation in the relationship between resilience and successful aging. Data from 284 individuals aged 60 years and above were analyzed in this cross-sectional study. The pathways among resilience, community participation, and successful aging were statistically significant after controlling for sociodemographic characteristics, depression, disability, and chronic disease. The analysis revealed a partial mediating effect of community participation (unstandardized estimate =.01, p <.01), explaining 16.4% of the total effect of resilience on successful aging. Promoting community participation may be beneficial for enhancing successful aging in community-dwelling older adults. Further studies to examine the causal relationship between community participation and successful aging and to develop community services are recommended to use community resources as means to support successful aging. [ABSTRACT FROM AUTHOR]

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

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

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

Community integration (CI) is often regarded as the foundation of rehabilitation endeavors after stroke; nevertheless, few studies have investigated the relationship between inpatient rehabilitation (clinical and demographic) variables and long-term CI. To identify novel classes of patients having similar temporal patterns in CI and relate them to baseline features. Retrospective observational cohort study analyzing (n = 287) adult patients with stroke admitted to rehabilitation between 2003 and 2018, including baseline Functional Independence Measure (FIM) at discharge, follow-ups (m = 1264) of Community Integration Questionnaire (CIQ) between 2006 and 2022. Growth mixture models (GMMs) were fitted to identify CI trajectories, and baseline predictors were identified using multivariate logistic regression (reporting AUC) with 10-fold cross validation. Each patient was assessed at 2.7 (2.2–3.7), 4.4 (3.7–5.6), and 6.2 (5.4–7.4) years after injury, 66% had a fourth assessment at 7.9 (6.8–8.9) years. GMM identified three classes of trajectories: Lowest CI (n=105, 36.6%): The lowest mean total CIQ; highest proportion of dysphagia (47.6%) and aphasia (46.7%), oldest at injury, largest length of stay (LOS), largest time to admission, and lowest FIM. Highest CI (n=63, 21.9%): The highest mean total CIQ, youngest, shortest LOS, highest education (27% university) highest FIM, and Intermediate CI (n=119, 41.5%): Intermediate mean total CIQ and FIM scores. Age at injury OR: 0.89 (0.85–0.93), FIM OR: 1.04 (1.02–1.07), hypertension OR: 2.86 (1.25–6.87), LOS OR: 0.98 (0.97–0.99), and high education OR: 3.05 (1.22–7.65) predicted highest CI, and AUC was 0.84 (0.76–0.93). Novel clinical (e.g. hypertension) and demographic (e.g. education) variables characterized and predicted long-term CI trajectories. [ABSTRACT FROM AUTHOR]

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.

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.

Community integration is important to address among homeless-experienced individuals. Little is known about helping veteran families (families with a parent who is a veteran) integrate into the community after homelessness. We sought to understand the experiences of community integration among homeless-experienced veteran families. We used a two-stage, community-partnered approach. First, we analysed 16 interviews with homeless-experienced veteran parents (parents who served in the military; n = 9) living in permanent housing and providers of homeless services (n = 7), conducted from February to September 2016, for themes of community integration. Second, we developed a workgroup of nine homeless-experienced veteran parents living in a permanent housing facility, who met four times from December 2016 to July 2017 to further understand community integration. We audio-recorded, transcribed and analysed the interviews and workgroups for community integration themes. For the analysis, we developed community integration categories based on interactions outside of the household and built a codebook describing each topic. We used the codebook to code the individual interviews and parent workgroup sessions after concluding that the workgroup and interview topics were consistent. Findings were shared with the workgroup. We describe our findings across three stages of community integration: (a) first housed, (b) adjusting to housing and the community, and (c) housing maintenance and community integration. We found that parents tended to isolate after transitioning into permanent housing. After this, families encountered new challenges and were guarded about losing housing. One facilitator to community integration was connecting through children to other parents and community institutions (e.g. schools). Although parents felt safe around other veterans, many felt judged by non-veterans. Parents and providers reported a need for resources and advocacy after obtaining housing. We share implications for improving community integration among homeless-experienced veteran families, including providing resources after obtaining housing, involving schools in facilitating social connections, and combating stigma.

Black Americans are overrepresented in Veteran and non-Veteran homeless populations. Community integration remains a problem for many Veterans after they obtain housing, and Black Veterans may encounter additional difficulties due to systemic racism. However, no prior study has specifically examined whether there are racial differences in community integration; similarly, no study has considered racial differences in psychosocial correlates of community integration in homeless Veterans. Knowledge of these factors could inform the development of culturally congruent rehabilitative interventions for Black Veterans. Semi-structured clinical interviews were administered to Black (N = 99) and White (N = 49) homeless Veterans to examine relations among psychiatric symptoms, motivation, and community integration domains (e.g., social integration, work productivity, and independent living). There were no significant racial differences in independent living or work productivity. Black Veterans had better social integration with family compared to White Veterans. In addition, psychiatric symptoms were more strongly correlated with social integration for Black than White Veterans. The association between motivation and work productivity was also stronger for Black Veterans. Recovery-oriented interventions could harness family connections and better target psychiatric symptoms to improve community integration for Black Veterans. Work productivity may improve from interventions aimed at enhancing motivation for Black Veterans.

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.