Community Integration Of People Research Articles

Transportation for people with intellectual and developmental disabilities in Home- and Community-Based Services

BackgroundTransportation can help improve the health, quality of life, and community integration of people with intellectual and developmental disabilities (IDD). Yet, transportation is one of people with IDD's most common unmet needs. ObjectiveThe aim of this study was to examine if, and, how, states provide non-medical transportation to people with IDD in their Medicaid HCBS programs. MethodsUsing content analysis and descriptive statistics, this study analyzed fiscal year (FY) 2021 Medicaid HCBS 1915(c) waivers for people with IDD from across the nation to examine how they allocated transportation. ResultsIn FY 2021, all 44 states and the District of Columbia with HCBS waivers for people with IDD provided transportation services. Transportation was included either by providing a stand-alone service that exclusively provided transportation, or by being embedded within another service. Transportation was embedded within 896 different HCBS services for people with IDD, most commonly within residential habilitation services (26.70 %), supported employment services (19.44 %), and day habilitation (18.44 %). Thirty-three states (73.33 %) also provided 145 different stand-alone transportation services in their programs for people with IDD, to increase community integration and help people gain access to waiver services. A total of $781.78 million of spending was projected for stand-alone transportation services for 261,109 people with IDD (30.32 % of waiver recipients). ConclusionsHCBS waivers are an important resource for providing transportation for people with IDD. However, significant variation in how states do so may result in disparities or unmet needs.

Assistive technology for people with intellectual and developmental disabilities in the United States in Home- and Community-Based Services

Purpose Unmet needs for assistive technology (AT) contribute to health and quality of life disparities among people with intellectual and developmental disabilities (IDD) [1–4]. The biggest barrier people with IDD face accessing technology is affordability and a lack of funding [1,3–6]. The purpose of this study was to examine how AT were provided to people with IDD in Medicaid Home- and Community-Based Services (HCBS) in the United States, the largest funding source for Long-Term Services and Supports for people with IDD. Materials and methods We analysed Medicaid HCBS 1915(c) waivers for people with IDD from across the USA in fiscal year (FY) 2021 using content analysis and descriptive statistics. Results and conclusions In FY2021, 31 states and the District of Columbia provided AT (stand-alone and combined services) through 68 waivers for people with IDD to improve functioning, communication, independence, and community integration. In total, $63.3 million was projected for the AT services for 23,753 people with IDD. Average spending per person on AT services was $2,663. We found significant variability in terms of how states allocated AT to people with IDD in their HCBS programs. Not only were less than 3% of people with IDD with HCBS projected to receive assistive technology services, there was also large variance across services and states. Assistive technology promotes the health, safety, quality of life, independence, and community integration of people with IDD – they align with the very aims of HCBS, and thus, should be expanded.

Mental Health After Spinal Cord Injury: Findings from Focus Groups with People with SCI

<h3>Research Objectives</h3> Spinal Cord Injury (SCI) affects social roles and community integration of people with SCI across the lifespan. In combination with environmental and attitudinal barriers to equitable outcomes, these challenges can have an adverse effect on mental health. Unfortunately, there are limited resources tailored to support the mental health needs of people with SCI. This study seeks to identify the informational needs related to mental health of people with SCI. <h3>Design</h3> We conducted three focus groups with people with SCI regarding experiences and opinions on mental health needs following SCI. We used a deductive approach to analyze themes from focus groups. Pairs of coders independently coded each transcript, and a third coder reconciled disagreements. <h3>Setting</h3> People with SCI living in the community. <h3>Participants</h3> The focus group sample was 16 people with SCI, 10 females, 6 males. The average age of participants was 50 years (range: 24-79yrs). Participants came from eight states, primarily in the Midwest. The majority of participants sustained paraplegia (69%), and 50% of the sample lived with SCI for more than 5 years. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Experiences of mental health conditions and symptoms described by people with SCI in the focus groups. <h3>Results</h3> A number of mental health disorders and challenges were mentioned by participants: anxiety, depression, post-traumatic stress disorder, substance abuse disorders, pain, loneliness/social isolation, guilt, anger/frustration, and denial. Participants also frequently described their identity and how their sense of self changed. <h3>Conclusions</h3> Results from this study can inform education and training of rehabilitation professionals to improve mental health outcomes and access to supports for people with SCI. Resources from this work are also expected to promote greater participation in community life. <h3>Author(s) Disclosures</h3> The authors have no conflicts to disclose.

Mental health legislation: a defect in Cameroon's health system

Mental health legislation has a crucial role in community integration of people with mental disorders, integration of mental health in primary health care, provision of high-quality mental health services, and improvement of access to mental health care at the community level. Mental disorders are increasing in importance in Africa. In the past two decades (2000–20), the continent's population increased by 49% and the person-years lost to disability as a result of mental and substance use disorders increased by 52%.

The Contribution of a Music and Arts Rehabilitation Program to the Creative Identity, Well-Being, and Community Integration of People With Mental Health Conditions

The United Nations highlighted the importance of promoting the rights of people with mental health conditions (MHC) to education, employment, and citizenship. One related initiative in Israel is the Garage pre-academic music and arts school for individuals with musical and artistic abilities coping with MHC. This process–outcome study examined whether and how the Garage contributes to participants’ creative self-concept, mental health, alleviates loneliness, and promotes postsecondary education and work integration. It also probed the participants’ initial expectations and the extent to which these were fulfilled. Using a single-group pretest–posttest design, quantitative data on the outcome variables were collected, along with mid-test data on process variables from the Garage students ( N = 44). Supplementary qualitative data were collected at pretest on the students’ expectations. The results suggest a significant increase in creative personal identity and mental health, a decrease in loneliness, and promotion of postsecondary education and work integration. These findings were associated with persistent attendance, basic psychological needs satisfaction, and expectation fulfillment. A merged analysis indicated that the students’ qualitative expectations were generally congruent with the quantitative results. Overall, the findings show how the program corresponds to humanistic values, targets service users’ needs and rights, and promotes personal recovery and community integration.

Social Isolation and Psychosis: Perspectives from People with Psychosis, Family Caregivers and Mental Health Professionals

This paper explores the subjective experiences of mental health practitioners, people with psychosis and carers, on social isolation and community integration of people with psychosis. Focus groups and one-to-one interviews with 80 adult participants across three sites in the UK were conducted. Audio recordings were transcribed and analysed using thematic analysis. Participants commented on various aspects that may cause social isolation or enable community integration, including institutional factors (lack of resources, hospitalisation impact), illness symptoms (e.g., paranoia; over-pathologising vs individual choice), stigma (particularly the psychosis label), and the importance of communities that foster agency and embrace change. Hospitalisation maybe be a cause for isolation and psychiatric wards should consider allowing for socialisation as a therapeutic tool. Initiatives should consider the social fabric of our communities, socioeconomic inequalities and stigmatisation. Building communities that are accepting, kind and flexible can create opportunities that could lead to independence from mental health services.

Psychosocial rehabilitation for severe mental illness: A community project adjustable to the needs and resources of the population

IntroductionPsychosocial rehabilitation is a challenge in a society with demands unsuitable for those with severe mental illness (SMI). The Mental Health Department of Matosinhos Local Health Unity (MHD-MLHU) has developed a solidarity project aiming to evaluate and elaborate individualized rehabilitative responses with people with SMI, including people from the community motivated for solidarity initiatives.ObjectivesTo describe a psychosocial rehabilitation project focused on community integration of people with SMI, considering needs and resources of the population, and to present the individualized rehabilitation plans carried out for people with SMI.MethodsIn January 2019, we began the home evaluation of people with SMI monitored in the MHD-MLHU. To develop solidary based play-occupational groups, we interviewed people from the community and from the common mental pathology outpatient clinic willing to participate.ResultsWe present the description and evaluation of the psychosocial responses developed by the project. These responses include recreational-occupational groups, tailored to interests of each person with SMI, and using the community support group built for the purpose. These responses promote face-to-face activities, and enhance the destigmatization of SMI. The constraints resulting from the COVID-19 pandemic led to the creation of digital responses aimed at people with SMI and the community in general.ConclusionsThis experience has revealed the great potential of rehabilitating the community context of people with SMI, rather than just contemplating pre-existing structured responses. The pandemic created specific challenges but made the initiative even more relevant for SMI people and for promoting the mental health of the general population.

The relationship between community integration and mental health recovery in people with mental health issues living in the community: A quantitative study

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.

Impact of an Instrumental Activities of Daily Living (IADL) Group on Perceived Quality of Life and Community Integration for People With Aphasia

Abstract Date Presented 04/04/19 This study, exploring the effects of an eight-week IADL group for people living with aphasia, identified statistically significant improvements in physical and communication skills and overall quality of life, as measured by the Stroke and Aphasia Quality of Life Scale and Community Integration Questionnaire. Positive trends were noted in home integration, social activities, and community integration. This research supports the unique value of OT and occupation-based groups for people with aphasia. Primary Author and Speaker: Lynne Murphy Additional Authors and Speakers: Lorelei Feeny, Danielle Matos Contributing Authors: Nicole Falkenstein, Hanna Terry

Community integration of people with nonheterosexual identities in Indian society: An integrated and intersectional approach

This article adopts a multidisciplinary approach to community integration (CI). We concentrate on CI programs for sexual minorities. Stakeholders are those nonheterosexual individuals who experience psychological distress when confronted by social prejudice and nonacceptance. The majority of Indian citizens identify as heterosexuals. We argue however that sexual orientation is only one form of selfhood and that people have multiple identities, with multiple belongings. CI programs we propose should make use of such diversity in Indian society and aim at strategic partnerships between Indian citizens with hetero and nonheterosexual orientations. The integrated and intersectional approach we put forward aims at social empowerment of stakeholders.

Community Integration of People with Disabilities: Can Olmstead Protect Against Retrenchment?

Since the passage of the Americans with Disabilities Act (ADA) in 1990, states have made significant progress in enabling Americans with disabilities to live in their communities, rather than institutions. That progress reflects the combined effect of the Supreme Court’s holding in Olmstead v. L.C. ex rel. Zimring, that states’ failure to provide services to disabled persons in the community may violate the ADA, and amendments to Medicaid that permit states to devote funding to home and community-based services (HCBS). This article considers whether Olmstead and its progeny could act as a check on a potential retrenchment of states’ support for HCBS in the event that states face severe reductions in federal funding for Medicaid, as was threatened by Republican efforts in 2017 to “repeal and replace” the Affordable Care Act and to restructure Medicaid. The article concludes that Olmstead provides a strong basis for challenging a state’s elimination or severe curtailment of existing HCBS programs, but that the fact-specific nature of a state’s likely “fundamental alteration” defense precludes predicting the outcome of such a challenge. Despite this legal uncertainty, protests mounted by people with disabilities, in which they demanded freedom from institutionalization, may have helped cement the idea that community integration is a civil right in the public’s mind.

Community integration of people with intellectual and developmental disabilities: A national longitudinal analysis

BackgroundMedicaid Home and Community Based Services (HCBS) 1915(c) waivers are the largest providers of long-term supports and services (LTSS) for people with intellectual and developmental disabilities (IDD) in the United States. National and longitudinal analyses of HCBS 1915(c) waivers for people with IDD are critical because of changes in the fiscal landscape, the variability produced by states ability to flexibly customize their programs, and the significant changes required by the HCBS final settings rule. Objective/HypothesisThe aim of this study was to determine spending allocations and state priorities for LTSS for people with IDD through Medicaid HCBS waivers over a five-year period (fiscal year 2011 to fiscal year 2015). MethodsMedicaid HCBS 1915(c) waivers for people with IDD from fiscal year (FY) 2011 to FY 2015 were analyzed to determine total projected spending, unduplicated participants, and average spending per participant across fiscal years and states. Over 10,000 services from the five years were also analyzed to determine service priorities. ResultsThis longitudinal analysis of HCBS IDD waiver allocation revealed large fluctuation across five years in terms of total participants, total spending, and average spending per participant. Trends also revealed a shifting away from residential habilitation settings towards supports for living in one's own home. ConclusionsWhen revising waivers to meet the Final Settings Rule, states should utilize our findings to determine areas of need and how to best apply limited funding.

The Power of Theater to Promote Individual Recovery and Social Change

Although theatrical activities are used in a variety of therapeutic settings, little attention has been paid to the ways that theater can enhance the recovery process and community integration for people living with psychiatric disabilities. Community-based theater involving people with psychiatric disabilities offers unique opportunities for personal growth, social connection, and advocacy efforts. This Open Forum posits that theater has the power to both facilitate individual recovery and improve the social conditions of people living with mental illness. Critical elements of theatrical activities that relate to processes of recovery and community integration are examined. Implications for future research and program development are discussed.

The Power of Theater to Promote Individual Recovery and Social Change

The Power of Theater to Promote Individual Recovery and Social Change

Review of a Home and Community Integration Programme for People With Spinal Cord Injuries in Hong Kong and its Relevance to Sri Lanka

A community occupational therapy programme is essential to home and community integration for people with spinal cord injury. This paper reviews the community integration programme for patients with spinal cord injury in the in-hospital rehabilitation stage, and recommends a programme for service development in countries like Sri Lanka. References are made with the published literature and with experience in Hong Kong. The programme should consider not only the patients but also the culture, the attitude of the people, and resources available in that particular country.

Schizophrenia, Community Integration, and Recovery

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.

Asset-Building, Financial Self-Management Service Model: Piecing Together Consumer Financial Independence

This program represents an innovative approach to traditional money-management services. This asset-building, financial self-management service model has the potential to positively affect recovery, self-sufficiency, and community integration for people with mental illnesses. It is hoped this program will be replicated by other providers in a way that may effect systems change.

Community integration of people with traumatic brain injury: introduction

Gordon WA. Community integration of people with traumatic brain injury: introduction. 2004;85(4 Suppl 2):S1–2. This introduction discusses the philosophy of the Rehabilitation Research and Training Center (RRTC) on Community Integration of Individuals with Traumatic Brain Injury (TBI) at Mount Sinai School of Medicine. This approach places the perspective, values, and preferences of the person with a disability at the center of our work. Seven of the 9 articles in the supplement are based on the research of the RRTC. The articles address the following: methods of implementing a research program within a Participatory Action Research framework, insider-outsider power relationships within measurement, a review of quality of life research on individuals with TBI, 2 articles summarizing research on depression, an evaluation of a method for identifying TBI in schoolchildren, a study of aging in people with TBI, an evaluation of an innovative community-based vocational rehabilitation program, and a description of findings from the Colorado Traumatic Brain Injury Registry and Follow-Up System.

Outside Looking In? Studies of the Community Integration of People with Learning Disabilities

The paper reviews research exploring the degree of community integration of people with learning disabilities. In the majority of studies reviewed 'integration' is measured in terms of the activities undertaken within the community and/or the character of personal and social relationships. Although in much of the work the focus on these indicators of outcome is informed by the value assumptions embodied in the principle of normalisation, the paper begins by drawing attention to the potentially contested nature of these assumptions. This is followed by a description and a critique of studies of community integration. The picture which emerges is of the apparently continued gap between being physically within and socially a part of the community. The paper highlights some of the issues this raises for service provision and draws attention to issues of research practice.

Ethnography as narrative discourse

Quality of life is recognized as a critical variable in community integration of people with developmental disabilities. A major concern expressed in the literature is to establish a measure of congruence between the perception and experiences of these people and their social environment. In response to this concern, this study presents a framework of analysis based on ethnography as narrative of the old and the new. The old narrative is that of segregation, leading to confined form of space and time. The new narrative is that of interdependence achieved through cyclical form of space and time. It is argued that community integration of people with developmental disabilities has taken place in relation to linear form of time and space, perpetuating the old narrative of isolation and segregation. The new narrative of interdependence requires the accommodation of differences by the non-disabled. The quality of life for people with disabilities is then a function of accommodation of differences.