Community Reintegration Program Research Articles

Goal-setting and personalization under the International Classification of Functioning, Disability, and Health framework: Community reintegration program for post-stroke patients.

Body functions and structures, activities, and participation are the core components in the International Classification of Functioning, Disability, and Health (ICF) to identify post-stroke patients' health conditions. The specification of health conditions enhances the outcomes of post-stroke rehabilitation. This study aimed to explore the extent and the processes in an ICF-based post-stroke rehabilitation program (ICF-PSRP) that could enhance patients' community reintegration level. Post-stroke patients who completed the ICF-PSRP participated in intake and pre-discharge individual face-to-face semi-structured interviews. In addition, case therapists were invited to a face-to-face semi-structured group interview. Clinician experts were invited to complete an interview with the same interview contents as case therapists but in an online format. All interview recordings were analyzed with the Framework analysis. Patients' treatment goals were mapped with the ICF Core Set for Stroke. Out of 37 invited post-stroke patients, thirty-three of them completed the interview. Three case therapists and five clinicians completed the interviews. The goals set by the patients and their caregivers showed a broadening of their scope over the course of the program. The changes in scope ranged from the activities to the participation and environmental components. Increases in patient-therapist interactions played an essential role in the goal-setting process, which were integral to personalizing the treatment content. These characteristics were perceived by all parties who contributed to the program outcomes. The application of ICF's principles and core components offers a useful framework for enhancing post-stroke patients' community reintegration level. Future studies should explore the way in which patient-therapist interaction, exposure to environmental factors, and personalized interventions maximize the benefits of applying this framework to the community integration of post-stroke patients.

Community reintegrating former child soldiers in Northern Uganda: A qualitative study on the road to recovery

This study aimed to profile the qualities of a holistic community reintegration program for former child soldiers (FCS) in the Lira region of Northern Uganda. Informants were a convenience sample of 37 FCS (age range 17 to 34, mean age 23.86, SD = 4.715 years; females = 29.73%). FCS completed semi-structured interviews on their current living situations and existing resources. This was aimed at assessing how they were transitioning back into the community and identifying gaps in resources. About 24% of FCS reported feeling unwelcome in their communities, suggesting a need for additional support and resources through the community integration models. Thematic analysis of the data suggests that the FCS would benefit from a holistic community reintegration program with the following qualities: psychosocial support, workforce development training, and job placement. FCS emphasised the need for skills training and employment opportunities over health and wellness; suggesting that mental health support and health care are not sufficient alone for them to successfully reintegrate into the community. FCS community integration policies and practices should prioritise holistic approaches.

PERBANDINGAN PELUANG PEKERJAAN OLEH MAJIKAN KEPADA BEKAS PENAGIH DADAH DI MALAYSIA (A COMPARATIVE STUDY OF JOB OPPORTUNITY BY EMPLOYEE TO THE FORMER DRUG USERS IN MALAYSIA)

The holistic recovery of drug users depends on total abstinence and a successful community re-integration program. Reintegration program opts for a holistic approach, and one of the indicators used is based on the former drug users ability to stay in long term employment. It is crucial for employers to give employment opportunities to former drug users after they have successfully completed a rehabilitation program. This article aims to discuss the comparison of employer support between groups of Persons under Supervision who have completed the rehabilitation within 6-11 months (K1) programme and those who have undergone a period of rehabilitation within 12-24 months (K2). This quantitative study was conducted using crosssectional design. The study selected 386 Person under Supervision (189 respondents in K1 programmes and 197 respondents in K2) from four main zones of Peninsular Malaysia. The employer support instrument (ESI) created and used in the study consists of 10 major items. Data was analyzed using descriptive analysis such as frequency, mean, mode, median, percentage and standard deviation. The analysis showed no significant difference between the level of employers support for K1 and K2 employees. A majority in both groups received moderate support from their employers (75.1%). Further comparative analysis revealed that K2 received slightly higher employer's support (75.6%) than K1 (74.6%) although no noticeable difference regarding supporting level. The findings also bring to light the need to establish Ezarina Zakaria, Fauziah Ibrahim, Salina Nen, Norjana Saim & Mohd Norahim Mohamed Sani 126 mechanisms of relapse prevention and complete recovery of OKP with a focus on reducing the constraints to find job opportunity due to long term “institutionalization,” providing a quality job opportunity and strengthening the components of employment offered by employers. The findings of this research provide insight into the potential for total recovery by providing employment with the expectation of former drug users’ success in community re-integration.

Research and Services Partnerships: A Partnership to Develop a Utilization-Focused Evaluation Plan for a Criminal Justice Diversion Program

More than 100,000 offenders in the Texas correctional system have a mental illness, which represents about 19% of the state's correctional population, including offenders in prison and under community correctional supervision. To reduce these numbers, a leading mental health service provider established the Community Reintegration Program (CRP) to divert misdemeanor offenders with mental illness to community-based treatment. This column describes a collaborative process between the University of Texas at San Antonio and community partners to develop a utilization-focused evaluation plan for the CRP that would benefit all stakeholders. The evaluation used data collected as part of routine clinical work.

Three-Year Follow-Up Results of a Residential Community Reintegration Program for Patients With Chronic Acquired Brain Injury

Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. Three-year follow-up results of a residential community reintegration program for patients with chronic acquired brain injury. ObjectiveTo evaluate outcomes of a residential community reintegration program 3 years after treatment on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. DesignA follow-up assessment 3 years after treatment was compared with the 1-year follow-up assessment in a prospective cohort study. SettingA tertiary rehabilitation center for acquired brain injury. ParticipantsOf the 67 patients assessed at the 1-year follow-up, 63 subjects (94%; 42 men; mean age at admission to treatment 24.7y; mean time postonset 5.1y) were available at the 3-year follow-up and taken into account in the analyses. InterventionA structured residential treatment program directed at improving independence in domestic life, work, leisure time, and social interactions. Main Outcome MeasuresCommunity Integration Questionnaire, Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies-Depression scale, and the World Health Organization Quality of Life Scale Abbreviated (5 scales). ResultsThere were no significant differences for any of the outcome measures between the 1-year and 3-year follow-up assessment. ConclusionsThese results indicate that the established significant and clinically relevant improvements after a residential community reintegration program remain stable in the long term.

A Prospective Study to Evaluate a Residential Community Reintegration Program for Patients With Chronic Acquired Brain Injury

Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. A prospective study to evaluate a residential community reintegration program for patients with chronic acquired brain injury. Objective To examine the effects of a residential community reintegration program on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. Design A prospective cohort study with a 3-month waiting list control period and 1-year follow up. Setting A tertiary rehabilitation center for acquired brain injury. Participants Patients (N=70) with acquired brain injury (46 men; mean age, 25.1y; mean time postonset, 5.2y; at follow up n=67). Intervention A structured residential treatment program was offered directed at improving independence in domestic life, work, leisure time, and social interactions. Main Outcome Measures Community Integration Questionnaire (CIQ), Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale, EuroQOL quality of life scale (2 scales), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales), and the Global Assessment of Functioning (GAF) scale. Results There was an overall significant time effect for all outcome measures (multiple analysis of variance T 2=26.16; F 36,557 134.9; P=.000). There was no spontaneous recovery during the waiting-list period. The effect sizes for the CIQ, Employability Rating Scale, work hours, and GAF were large (partial η 2=0.25, 0.35, 0.22, and 0.72, respectively). The effect sizes were moderate for 7 of the 8 emotional well-being and quality of life (sub)scales (partial η 2=0.11–0.20). The WHOQOL-BREF environment subscale showed a small effect size (partial η 2=0.05). Living independently rose from 25.4% before treatment to 72.4% after treatment and was still 65.7% at follow up. Conclusions This study shows that a residential community reintegration program leads to significant and relevant improvements of independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation.

Competency of Psychiatric Residents in the Treatment of People With Severe Mental Illness Before and After a Community Psychiatry Rotation

psychiatric rehabilitation is an evidence-based service with the goal of recovery for people with severe mental illness. Psychiatric residents should understand the services and learn the principles of psychiatric rehabilitation. This study assessed whether a 3-month rotation in a psychiatric rehabilitation center changes the competency level of second-year psychiatric residents in evidence-based treatment of severe mental illness. the study is a prospective, case-control comparison using the validated Competency Assessment Instrument (CAI), which measures 15 provider competencies critical to recovery, rehabilitation, and empowerment for people with severe mental illness, providing a score for each competency. Participants were second-year psychiatric residents attending a 3-month rotation at the Community Reintegration Program, a psychiatric rehabilitation day program. The authors administered the CAI at the beginning and the end of the residents' 3-month rotation in order to assess change in their competency in psychiatric rehabilitation. The authors also administered the CAI to a comparison group of second-year psychiatric residents who did not rotate through the Community Reintegration Program, and therefore had no formal training in psychiatric rehabilitation. a 3-month rotation in psychiatric rehabilitation significantly improved residents' competency in the domains of goal functioning, client preferences, holistic approach, skills, and team value relative to nonrotating residents. a brief community psychiatry rotation in the second year of residency likely improves some skills in the treatment of people with severe mental illness. Future research should evaluate year-long electives and public psychiatry fellowships.

Community reintegration: Therapeutic dining program for older adult following stroke

Therapeutic dining programs are part of the community reintegration process for clients recovering from a stroke. It is a supervised program performed in social settings that consists of a combination of techniques to improve the eating situation. Therapeutic dining programs are a beneficial form of therapy for many rehabilitative groups. This specific program has been tailored to older adults who are recovering from a stroke. Its main goals, aside from improving the eating situation, are to prevent another stroke from happening and decrease depression symptoms and increase self-esteem by reintegrating clients back into the community. I looked into several different community reintegration program and nutrition and eating after stroke studies in which positive outcomes were found for post-stroke clients. All studies and research used has provided a strong support for the specific proposed intervention program for my client Kelly, who is an older adult female recovering from a stroke. Assessments selected: The Barthel Index, Nutritional Status, and Geriatric Depression Scale (GDS). Plan: Small group therapeutic dining program with other older adults in the afternoon. Intervention: Therapeutic Dining Program three times a week for eight weeks to improve eating situation, promote healthy eating, decrease symptoms of depression, and increase self esteem and social activity. Evaluation: The Barthel Index, Nutritional Status, Geriatric Depression Scale plus a Stroke Recovery Scorecard. Clients Goals: 1) Client will lower the risks of having another stroke. 2) Client will increase their eating situation experience and self-esteem while decreasing their depression symptoms. 3) Client will get involved in one support group or leisure activity outside of recreational therapy (RT) dining program for community reintegrated leisure pursuits.

Treatment for the Service Member: A Description of Innovative Interventions

This article describes advances to the rehabilitation programs at major military medical centers since the onset of operations in Iraq and Afghanistan. The demands on military health care in times of war produce advances in the various rehabilitation professions. This article describes two programs that use new technologies for the care of military patients with devastating injuries to the upper extremity. One project relates to the application of voice-sensitive technology. The other project describes the utilization of virtual reality technology through a Firearm Training System. The article also explains an adaptive sports program and how recreation is part of a robust community reintegration program. Lastly, this article discusses the Center for the Intrepid, which is one of two new amputee care centers built to support the advanced rehabilitation of war-wounded amputees.

Moderatorsʼ Summary: Amputee Care

Moderatorsʼ Summary: Amputee Care

The Community Reintegration Project: Occupational Therapy at Work in a County Jail

The incarcerated population in U.S jails has more than doubled in the last thirty years while prison populations have quintupled. Over half of those released from incarceration return to correctional systems within one year of release. One of the reasons for these high rates of recidivism is that many inmates lack the community living skills necessary for community reintegration. Successful community reintegration for ex-offenders requires a skill set that occupational therapists have long addressed in their domain of practice. Compared to practitioners in the United Kingdom and Australia, U.S. practitioners have been slow to develop occupational therapy programming in correctional settings. This article describes a community reintegration program for jail inmates built through a collaborative partnership between a university occupational therapy program, community non-profit organizations and a county jail.

An Educator's Dilemma

Every day I enter a world of hierarchy that I cannot fully comprehend--a world in which I am expected to teach, transform, and rehabilitate incarcerated women into productive citizens. It is a world where political forces blow powerfully on anyone that challenges the status quo. I work with a population that most Americans wish would disappear. For most people, they exist on fictional television shows and the occasional jaunt in the Sunday news. I work with the women inmates at a correctional facility's Community Reintegration Program located in an urban area of the Midwestern United States. As with most correctional facilities, it's a place of crisis and control; it's an environment with conditions suitable for radical change, but rarely used as such. As a result of incarceration, the women that I work with become mechanical in their responses. They are trained to say what they think their judge, jury, counselor, probation officer, attorney, or teacher wants to hear. This mechanical response spills over into the classroom where they respond to questions in ways that appear scripted. Most do not take any interest in the Basic Adult Education curriculum that is being taught, but rather sit and stare with empty eyes. I attribute the lack of interest in the learners' inability to see the relevance in this curriculum. Sure, she wants to move forward with her life, get her high school diploma or equivalent, but this incentive doesn't seem to be enough motivation to get her to a point of taking steps in the right direction. I have found that when teaching, the only thing that provokes genuine questions and answers are things pertinent to their current situation, such as lessons on affordable housing, learning about their Constitutional Rights, and the science behind the effects of drugs on the brain. Lately, my teachings have been led by their desire to learn about things that matter to them. However, I am painfully aware of the potential consequences of teaching a somewhat radical curriculum. You see, I am taking basic adult education principles to the extreme. I am meeting the learner where she is (a criminal), and hooking into her experiences (criminal behavior) to derive the content of the curriculum (Taylor, Marienau, & Fiddler, 2000). In doing so, I am constantly questioning whether or not I am teaching criminals how to be better criminals. Needless to say, teaching this population of women can be a daunting task. I often leave work feeling inadequate and unsuccessful because I wasn't able to get through to them. I have found that the most challenging part of my job is to bridge the gap between what they need to know and what inmates want to know. That is, they need to understand what behaviors led them to incarceration in the first place, how to change these behaviors, and what new learning or unlearning is required to get them to a place where they will not recidivate. There is value in what they already know. For example, the majority of the women have learned to survive without legal employment. They steal, cheat, hustle, sell drugs, and manipulate government welfare systems. But as a society, we demonize and shun them for this knowledge because it is knowledge. Rather than using this knowledge as a basis for new learning, we attempt to present other new information in an unfamiliar context. Until the laws regarding felon status are changed, the opportunity for advancement of ex-offenders in our society is minimal. Once a person has a criminal background, she will find it difficult if not impossible to find employment. As a result, I have looked at models and theories that create opportunities for ex-offenders, and a lot of times it means teaching ex-offenders entrepreneurial skills so that they can create employment for themselves. The Delancey Street Project in San Francisco is exemplary of this type of model (The Delancey Street Foundation, 2008). The project assists ex-offenders in creating small businesses to become self-sufficient. …

The Community Reintegration Project: Occupational Therapy at Work in a County Jail

The incarcerated population in U.S jails has more than doubled in the last thirty years while prison populations have quintupled. Over half of those released from incarceration return to correctional systems within one year of release. One of the reasons for these high rates of recidivism is that many inmates lack the community living skills necessary for community reintegration. Successful community reintegration for ex-offenders requires a skill set that occupational therapists have long addressed in their domain of practice. Compared to practitioners in the United Kingdom and Australia, U.S. practitioners have been slow to develop occupational therapy programming in correctional settings. This article describes a community reintegration program for jail inmates built through a collaborative partnership between a university occupational therapy program, community non-profit organizations and a county jail.

Education and Practice Collaborations: A Pilot Case Study Between a University Faculty and County Jail Practitioners

SUMMARYThe purpose of this case study is to present a partnership between faculty and practitioners that initiated a systematic evaluation data collection approach to support program development and study practice in a newly developing occupational therapy program. The Department of Occupational Therapy at Duquesne University collaborated with Goodwill Industries of Pittsburgh to introduce occupational therapy as part of a grant-supported community re-integration program at the Allegheny County Jail. In developing the program, the absence of published data regarding the occupational needs among jail inmates was evident.This paper is presented as a case study to demonstrate that faculty-practitioner collaborations can promote the implementation of a viable, systematic evaluation process when implemented as soon as possible in the practice setting. The community-university partnership ensured that a wide variety of knowledge and resource applied to the development of an evaluation process that generated relevant data for each of the partners. The intent of providing systematic evidence for practice can enhance the intervention process and provide valuable professional information.This paper also presents pilot descriptive results from the Occupational Self Assessment (2002) from the initial 67 (61 men & 6 women) inmates in the local Allegheny County Jail Community regarding perceptions of their own occupational competence and of the impact of their environment on their overall occupational adaptation. Using OSA responses, a difference score between reported occupational competence in an activity (rated low) and the correlated importance of the occupation (rated high), the top eight occupational performance areas of concern were identified for the total group, men only and women only. Caution in using the woman data due to the small n is advised. The top eight occupational performance areas of concern for this population included managing my finances, handling my responsibilities, working towards my goals, accomplishing what I set out to do, a place to live and take care of myself, basic things I need to live and take care of myself, things I need to be productive, and a place where I can be productive. Notably, four of these eight items captured the inmates' perceptions of the impact of the environment on their occupational adaptation. This study demonstrates the viability of the academic-practice partnership to support the scholarship of practice and provide a model to embed evidence-gathering through systematic evaluation processes.

Traumatic Brain Injury

Traumatic Brain Injury

A pragmatic approach to parole aftercare: Evaluation of a community reintegration program for high-risk youthful offenders*

We evaluated the parole reentry program “Lifeskills'95” to determine the initial success of individuals released from secure facilities. We collected and analyzed data on experimental and control groups of California Youth Authority offenders released to parole in 1995. The program was successful in several areas of parole performance, especially in reducing recidivism rates during the period of program participation. This study is relevant to rethinking the role of juvenile justice agencies in the United States. The long-term goal is to substantially alter the traditional way in which juvenile offender aftercare and community reintegration have been designed and managed in this country.

Assessment and treatment of impaired awareness after brain injury: implications for community re-integration

Impaired self-awareness of deficits is a common finding in patients who have suffered traumatic brain injury. Impaired awareness can limit motivation for treatment and contribute to poor outcome. Consequently, it is important for brain injury rehabilitation professionals to understand this phenomenon and utilize treatment approaches that may improve patient awareness. The present article reviews the existing literature on measurement of impaired awareness, characteristics of impaired awareness, the relationship of impaired awareness to functional outcome, possible treatment approaches for impaired awareness and empirical investigations of interventions to improve awareness. The treatment strategies we use to address impaired awareness in our community re-integration program for brain injury survivors are described in detail. These approaches include: establishment of the therapeutic alliance, family interventions, peer feedback, education, roleplaying, videotape feedback, real world experiences, therapeutic milieu and psychotherapy.

Responding to Current Needs—A Community Reintegration Program

The 1980s were a time of fiscal tightening in the health care system in the United States. As the costs of medical care soared, the prospective payment system was introduced which limited the amount of money second- or third-party payers would contribute toward a particular illness or person.