Community Reintegration Research Articles

The challenges of leaving: Reintegration difficulties and negative mental health outcomes in UK Armed Forces Veterans residing in Northern Ireland

LAY SUMMARY Community reintegration refers to the period during which a person transitions from military service to civilian life. In the United Kingdom, understanding of the mental health impacts of community reintegration is limited because of the lack of research in this area. This study explored the extent to which a range of different aspects of community reintegration difficulties predicted the likelihood of experiencing several mental health disorders among 626 Northern Ireland Veterans. Results demonstrated that reintegration difficulties significantly predicted clinically relevant levels of anxiety, depression, posttraumatic stress disorder, and problematic alcohol use (even when other known risk factors for mental ill health among Veteran populations were considered). Reintegration difficulties in relation to interpersonal relationships was the most detrimental aspect of reintegration in terms of mental ill health. Findings demonstrated that difficulties reintegrating into civilian life after military service are a significant risk factor for a range of mental health disorders, underscoring the importance of interventions aimed at supporting military personnel during this time.

Traumatic atlanto‐occipital dislocation with successfully bystander resuscitation after cardiopulmonary arrest: A case report

Key Clinical MessageThis case report describes successful bystander cardiopulmonary resuscitation after a cardiopulmonary arrest due to a traffic accident, followed by early diagnosis and treatment of a traumatic atlanto‐occipital dislocation, resulting in successful community reintegration.

A Qualitative Systematic Review of the Barriers and Facilitators of the Reintegration of Men Convicted of a Sexual Offense From Prison or Secure Care into the Community.

This article is the first qualitative systematic review of studies examining the barriers and facilitators to male sex offenders reintegration from prison or secure care into the community. A search of 16 electronic databases produced 14,218 potential sources, which, after screening, resulted in 79 articles for inclusion. Papers were included if they used qualitative research methods about the barriers, facilitators, perceptions, experiences, and attitudes toward community reintegration from prison or secure care for men convicted of sexual offenses. Included papers were critically appraised and the findings were thematically synthesized. The findings identified that formal and cultural aspects of reintegration, such as probation services, stigmatization, and registration, were the three largest barriers that men faced upon their release, with stability aspects, such as positive relationships, religion, and support groups, being key facilitators to their successful reintegration. The implications for future research, and policy and practice, including prioritizing risk assessment and management, offering appropriate and timely treatment and rehabilitation, educating the community, better access to housing and employment, and services adopting a collaborative approach, are discussed.

Trunk control and acute-phase multifactorial predictors of community mobility after stroke: a longitudinal observational study.

Stroke is a detrimental condition associated with long-term functional impairments that restrict community reintegration, which is an indicator of successful post-stroke functional recovery and rehabilitation. Additionally, trunk control is an understudied factor that may contribute to community mobility and participation after stroke. This study aimed to identify predictors of community mobility among stroke survivors in the acute phase, with a primary focus on trunk control, in addition to exploring the mediating and moderating role of predictive factors. A longitudinal observational study included 61 participants with acute stroke. Trunk control test (TCT) during sitting, stroke severity, quality of life, fear of falls, depression, and age was assessed during the acute phase as potential predictors. The community mobility outcome measure was assessed 3 months after baseline using the Reintegration to Normal Living Index (RNLI). Statistical analyses included correlation, linear regression, mediation, and moderation analyses. Trunk control test was the strongest predictor of RNLI among all factors (β = 0.72; 95%CI = 0.004-0.007; p ≤ 0.0001). Stroke severity, quality of life, fear of falls, and age significantly predicted RNLI (p < 0.01). Higher age was a significant moderator of the relationship between TCT and RNLI (β = 0.002; p < 0.001; 95% CI = 0.0001-0.0003). The findings highlight sitting trunk control impairment during the acute stage as a crucial predictor of reduced community mobility after stroke, where age over 60 years can moderate this relationship. The study emphasizes that addressing trunk control during early stroke rehabilitation may enhance community reintegration prospects.

Level of Implementation of Drug Rehabilitation Program, Treatment and Intervention for Persons Who Use Drugs (PWUD) in Basud, Camarines Norte, Philippines

The study specifically assessed the level of implementation of the Drug Rehabilitation Program, treatment and intervention for Persons Who Use Drugs (PWUD) in Basud, Camarines Norte. It employed descriptive research where 300 respondents participated as respondents. As to the findings, in terms of community preparation PNP Basud initiates advocacy programs on drug education in the community. The least implemented practice was initiating activities in organizing screening for person who use drugs. Meanwhile, in terms of screening, it was found that MHO Basud initiates accomplishing intake form during the screening process. The least practice was initiating schedule check-up by MHO Basud. In terms of assessment, the results showed that MHO Basud ensures other assessment of other mental health conditions using mhGAP IG. The least practice, however, was ensuring request for laboratory/diagnostic test by the MHO Basud. In terms of implementation of intervention, it was revealed that MHO Basud implements community-based treatment for person who uses drugs. The least practice was implements inpatient treatment for person who uses drugs by MHO Basud. Finally, in terms of aftercare program, it was revealed that DILG Basud undertakes community reintegration for person who formerly uses drugs. The least practice, however, was ensuring follow-up for person who formerly uses drugs by the DILG Basud. Comprehensive community-based training programs and educational orientation on drug-related treatment, rehabilitation and interventions may be continuously provided to the implementers of interventions to raise public awareness on the essence, objectives and processes involved in community-based drug rehabilitation.

Fostering Alignment and the Catalytic Potential of Community-Engaged Research With US Military Veterans and Advocates

This paper explores the concept of “community-engaged research” (CEnR) within the context of Veteran health care delivery and reintegration programs. A multi-sector expert panel (msExP) was formed to evaluate and make recommendations on Veteran community reintegration research and programs. The panel consisted of Veterans, care partners, clinical providers, researchers, community stakeholders, and subject matter experts. The paper examines the composition and lifecycle of the panel, highlighting the characteristics and experiences of the participants. Shifts in the panel’s purpose and engagement levels occurred in response to unanticipated disruptions, particularly the COVID-19 pandemic. The transformation of the panel emphasizes the importance of aligning individual and group needs and deepening intrapersonal relationships Findings based on observations, surveys, and interviews with panel members contribute to the field of community-engaged research by demonstrating the utility of catalytic validity that balances group and individual development. As part of a broader study on Veteran reintegration, the panel and its development over time allowed for various perspectives on Veteran experiences and reintegration within the community that shaped the overall project. Despite the challenges of developing and maintaining a panel alongside a research study, feedback from the panel members on their participation provides insight into the potential for future working alliances in community-engaged health research.

Factors impacting community living outcomes among former long-term nursing home residents using the interdependence-Human Activity Assistive Technology (i-HAAT) model

ABSTRACT Despite an increased application of social theory in assistive technology (AT) outcomes research, there continues to be a gap in integrating AT conceptual models in research design, data analysis, and results interpretation. This paper merged two preexisting AT models, the Human Activity Assistive Technology model (HAAT) and the interdependence frame for AT into a novel framework, the interdependence-HAAT model (i-HAAT). This model was used to examine the outcomes of former long-term nursing home residents using AT. The model was also used as a framework to facilitate quantitative variable identification and categorization, emphasize the interconnectivity between domain variables, and explore the infrastructural supports necessary for the successful community reintegration of deinstitutionalized AT users. Meaningful integration of theory into practice is the essential next step in generating socially responsive research that addresses AT consumer needs and moves the field forward.

Gait Function and its Association with Functional Independence, Quality of Life, and Community Reintegration in Stroke Survivors.

Background and Aims: The major outcome of stroke rehabilitation is the recovery of the ability to walk. However, a large proportion of stroke survivors are discharged to the community with gait deficiency which impairs their functional independence, and quality of life increasing the burden of care on caregivers especially their lack of functioning in the community. This study assessed the gait functional performance in community-dwelling stroke survivors and explored its association with functional independence, quality of life, and community reintegration in community-dwelling stroke survivors. Materials and methods: This study involved 115(59 males and 56 females) community-dwelling stroke survivors. Their gait functional performance was assessed using the 10-meter walk test (10MWT) while their functional independence was assessed with the functional independence measure (FIM). Their quality of life (QoL) was assessed using the Stroke-specific QoL scale while community functioning and productivity were assessed using the community integration questionnaire (CIQ). Their scores on the assessments were compared with the normative data of their age and sex-matched healthy individuals. Data was analysed using Spearman’s correlation coefficient and Chi-Square at p&lt;.05. Results: Participants’ ages ranged between 27 to 78 years (mean=60.48±37.84 years). More participants (56.7%) had right hemispheric lesions and 43.3% had lesions in the left hemisphere. Their gait function, functional independence performance, QoL, and community reintegration functions were significantly (p&lt;0.05) lower than their age and sex-matched normative data. There was a significant (p&lt;0.05) association and relationship between their gait functional performance and each of the functional independence performance, QoL, community reintegration, and productivity. Conclusion: Gait functional performance in community-dwelling stroke survivors is significantly lower than in age and sex-matched healthy individuals and it is significantly associated with low functional independence performance, low quality of life, poor community functioning, and lack of productivity in stroke survivors, Abnormal gait pattern is related to poor functional independence, poor quality of life and low productivity.

Transitioning to home and beyond following stroke: a prospective cohort study of outcomes and needs

IntroductionUnderstanding of the needs of people with stroke at hospital discharge and in the first six-months is limited. This study aim was to profile and document the needs of people with stroke at hospital discharge to home and thereafter.MethodsA prospective cohort study recruiting individuals with stroke, from three hospitals, who transitioned home, either directly, through rehabilitation, or with early supported discharge teams. Their outcomes (global-health, cognition, function, quality of life, needs) were described using validated questionnaires and a needs survey, at 7–10 days, and at 3-, and 6-months, post-discharge.Results72 patients were available at hospital discharge; mean age 70 (SD 13); 61% female; median NIHSS score of 4 (IQR 0–20). 62 (86%), 54 (75%), and 45 (63%) individuals were available respectively at each data collection time-point. Perceived disability was considerable at hospital discharge (51% with mRS ≥ 3), and while it improved at 3-months, it increased thereafter (35% with mRS ≥ 3 at 6-months). Mean physical health and social functioning were “fair” at hospital discharge and ongoing; while HR-QOL, although improved over time, remained impaired at 6-months (0.69+/-0.28). At 6-months cognitive impairment was present in 40%. Unmet needs included involvement in transition planning and care decisions, with ongoing rehabilitation, information, and support needs. The median number of unmet needs at discharge to home was four (range:1–9), and three (range:1–7) at 6-months.ConclusionStroke community reintegration is challenging for people with stroke and their families, with high levels of unmet need. Profiling outcomes and unmet needs for people with stroke at hospital-to-home transition and onwards are crucial for shaping the development of effective support interventions to be delivered at this juncture.ISRCTN registration02/08/2022; ISRCTN44633579.

Staff supported community outings among forensic mental health patients: patient characteristics, rehabilitative goals, and (the absence of) adverse outcomes.

Mental health professionals are tasked with making difficult clinical decisions in treatment settings. In the forensic system, decision making regarding staff supervised community outings (SSCOs) provides a significant challenge due to the need to balance patient liberties, mental health recovery, and public safety. This study explored the characteristics and rehabilitative nature of SSCOs, characteristics of patients attending SSCOs, and any adverse events that occurred during the outings. Employing a cross-sectional design, 110 patients who participated in SSCOs over a one-year period from a Canadian Forensic Psychiatric Hospital were included. Clinical records were reviewed to capture patient and SSCO variables. Descriptive analyses were used to calculate participant, risk, SSCO, and adverse event characteristics. Qualitative analysis was used to explore the purpose of SSCOs and rehabilitative progress that occurred during the outings. Patients attending SSCOs were comprised of long-stay patients with over half having committed a violent index offence. Almost 75% of patients had a moderate/high risk for violence and 50% of the patients had a moderate/high risk of absconding. During the study period, 463 SSCOs were completed. Most outings focused on developing skills for daily living and staff comments suggested many patients developed skills in these areas. Despite considerable risk profiles and public concern regarding forensic patients having community access, there was a single occurrence of unauthorized leave and no instances of violence or substance use. This research can disrupt stigma, demonstrating that SSCOs support a specific rehabilitative intent, promote community reintegration, and maintain public safety.

Community-Based Psychiatric Care Provision in Hungary: Trends and Steps towards Progress.

Psychiatric care has undergone several cycles of profound changes in the past centuries all over the world. In Hungary, community-based outpatient care has been showing signs of evolution since the 1950s. Initially, the system centered on assertive outreach and family involvement, especially for those with serious mental health problems. Such services remain available throughout the country, but the emphasis in the past decades has shifted towards mass care provision. In many places, community-based services are no longer provided, and where they are the approach is biomedical and less asuming of recovery. In other centers, the services provided are conceived with the eventuality of rehabilitation in mind and in close cooperation with community-based care providers. Community-based services providers, as part of the social fabric, offer as many psychiatric and rehabilitation services as possible for those with mental disorders within their communities. The main objective of community-based care is to achieve community re-integration and recovery from mental disorders. Today in Hungary, deinstitutionalisation and the introduction of community-based psychiatric care have been adopted even by large inpatient institutions. The replacement of institutional bed space and the provision of subsidised housing further underscore the importance of community-based psychiatric care provision. There is the opinion that, as a further course of development, the emphasis needs to now shift towards the nurturing of a community of experienced experts and creastion of user-led programs. In this new paradigm, the ability of a person with a mental disorder to make decisions and the bolstering of that ability are seen as vital. In order to achieve these objectives, it is essential that health and social seervices professionals cooperate. Hands-on experience is key in the provision and development of such services.

Comorbidities, healthcare use, and contact with healthcare transition services in older veterans after incarceration.

The Health Care for Reentry Veterans (HCRV) program was established to support community reintegration for veterans after incarceration. Yet, it is unclear how those with and without HCRV contact differ. We sought to evaluate differences in medical and psychiatric conditions and healthcare utilization among mid-to late-life reentry veterans who did and did not receive HCRV outreach. Study participants were veterans aged ≥50 years who qualified for Medicare fee-for-service, had experienced incarceration for ≥1 year, and were released from incarceration between October 1, 2006, and September 30, 2018 (N = 9733). Using VA and Medicare claims data, we compared prevalence of medical and psychiatric diagnoses, and use of emergency, inpatient, and outpatient medical and mental health services up to 12 months after release between those with and without HCRV contact. Veterans with HCRV contact (35.5%) had significantly higher rates of psychiatric conditions and medical conditions related to substance use (e.g., liver disease) compared to veterans without HCRV contact. Average time between release and first healthcare service use was significantly lower for HCRV veterans (36.5 ± SD 59.5 days) versus non-HCRV veterans (58.9 ± SD 77.5 days) and HCRV veterans were more likely to utilize the emergency department, inpatient and outpatient mental health services, and inpatient medical services. HCRV reaches older reentry veterans with a large burden of mental health and substance use disorders. However, levels of multimorbidity were high among all older reentry veterans, pointing to a need to develop specialized geriatric models of care for this reentry population.

Overcoming barriers in the implementation of stroke care rehabilitation in a public hospital in Costa Rica

Stroke is a major public health concern in developing countries, where the burden of the disease is high and resources for care are often limited. While progress has been made in improving stroke care, many barriers still exist in providing adequate rehabilitation care for stroke survivors. In this paper we study the case of Costa Rica and how stroke care has been addressed in recent years. It is important to consider the particularities of Costa Rica when working on stroke rehabilitation. The existence of a socialized healthcare system, along with the consolidation of acute stroke management protocols, allows for the adequate management of the early stages. In addition to this, families play a key role in rehabilitation, particularly for a country where there is a lack of medium stay and long-stay rehabilitation centers. Therefore, providing training and education for families is essential in stroke case management. Looking toward the future, there is still a pending need to generate homogeneous stroke rehabilitation protocols throughout the national healthcare system, to ensure equitable access to health care, and to consolidate multidisciplinary groups. At the same time, the implementation of technologies is urgent, particularly considering their potential to help reduce waiting lists. Another goal is enhancing coordination with other state entities and NGOs to advance community, labor or educational reintegration of stroke patients.

Seeking sufficient and appropriate care during the first year after spinal cord injury: a qualitative study

Study designLongitudinal qualitative study, based on a constructivist grounded theory and transformative approach.ObjectivesThis study investigated experiences of individuals with spinal cord injury (SCI) while navigating rehabilitation, resources for recovery, and community reintegration during the first year after injury.SettingAn acute inpatient rehabilitation facility in the Midwest United States.MethodsIn-depth, semi-structured interviews were conducted with 20 individuals with newly-acquired SCI. Interviews were conducted approximately every other month for one year, beginning at acute inpatient rehabilitation. Data were analyzed and interpreted using a constructivist grounded theory approach and transformative paradigm, which examines power and social structures within and across institutions and gives voice to people at risk for marginalization.ResultsParticipants experienced variable post-injury trajectories, with an average of four transitions within and across healthcare institutions in the first three months. Half of the cohort was discharged to a skilled nursing facility (SNF). Emergent themes included discharge (un)readiness; length of stay uncertainty and insurance impacts; challenges choosing a SNF including time-sensitive decisions; and early cessation of therapy in the SNF. Participants experienced resource navigation challenges such as communication/information access barriers and contending with many concerns at once.ConclusionsThe experiences of this cohort reveal significant challenges to attaining sufficient and appropriate rehabilitation. Acute inpatient rehabilitation is a critical aspect of recovery, but does not ensure sufficient intervention for maximization of functional skills and community reintegration. Innovative rehabilitation models need to be developed for positive impacts on successful transition to independent living in the community.

Unlocking Second Chances: Scoping review of the parole system and the path to successful community reintegration in Malaysia

Unlocking Second Chances: Scoping review of the parole system and the path to successful community reintegration in Malaysia

Psychiatric rehabilitation in routine Indian mental health practice: A review of social protections for persons with mental health conditions.

An estimated 200 million Indians have mental health conditions - a sizeable proportion of them requiring psychiatric rehabilitation services. The numbers of mental health professionals are abysmally low. Early psycho-social rehabilitation interventions can improve functional outcomes, reducing disability. Psycho-social interventions have been made possible with the shift away from medical and charity models of disability to the establishment of social protections for vulnerable groups. The authors have undertaken a narrative review of all the social protection measures that can be explained to persons affected by mental health conditions and their family members. A larger tabulation is provided as an appendix to this article that has details of all the social protection measures across the states and union territories of India. This tabulation can be useful as a one-stop reference for every mental health practitioner in India toward informing persons affected by mental health conditions and their family members about how recovery journeys can be advanced. The data have been compiled after extensive searches of official government websites, information brochures, and even relevant legal provisions. For almost all the social protection measures provided by the central or state government, a disability certificate is a prerequisite. Rehabilitation today is a collaborative process aimed at community re-integration. In the absence of specialized services like those of clinical psychologists, vocational trainers, and psychiatric social workers, the psychiatrist becomes the sole point of contact. Motivated community members, recovered services users, and family members can aid mental health professionals by disseminating this knowledge further.

Psychosocial reintegration post-traumatic spinal cord injury in Rwanda: An exploratory study.

Traumatic spinal cord injury (TSCI) survivors are confronted by both physical and psychosocial barriers when returning to their communities. Therefore, reintegration is an important aspect of their journey back into social life. To assess psychosocial reintegration after TSCI in Rwanda. All community-dwelling adults who were registered in the previous epidemiological study were recruited and injury characteristics questionnaire and the Sydney Psychosocial Reintegration Scale version 2 (SPRS-2) were used to collect data through a telephone interview. The study traced 58 participants, 77.6% (n = 45) were male and 56.9% (n = 33) were categorised with paraplegia. Overall, the results show poor community reintegration. The SPRS-2 and domain mean (SD) scores were: overall SPRS-2 of 20.95 (11.56), occupational activity (OA) of 3.68 (4.31), interpersonal relationship (IR) of 7.11(4.31) and living skills (LS) of 7.43 (5.32). Gender significantly influenced overall SPRS-2 (p = 0.011) and two domains: OA (p = 0.005) and LS (p = 0.012). Level of injury was significantly associated with an OA domain score of SPRS-2 (p = 0.002). Gender explained 29% of the variance in the LS domain of SPRS-2, with males reporting better psychosocial reintegration. Gender strongly predicted psychosocial reintegration following a TSCI, which is an indication of the role of social support. Traumatic SCI rehabilitation should be holistic to help prepare the person to return to the community. There should be an assessment of an individual's readiness to return to the community before discharge from the hospital.

Examining the Role of Third Sector Organization Volunteers in Facilitating Hospital-to-Home Transitions for Older Adults - a Collective Case Study.

With increasing attention to models of transitional support delivered through multisectoral approaches, third-sector organizations (TSOs) have supported community reintegration and independent living post-hospitalization. This study aimed to identify the core elements of these types of programs, the facilitators, and barriers to service implementation and to understand the perspectives of providers and recipients of their experiences with the programs. A collective case study collected data from two UK-based 'Home from Hospital' programs. An inductive thematic analysis generated rich descriptions of each program, and analytical activities generated insights across the cases. Programs provided a range of personalized support for older adults and addressed many post-discharge needs, including well-being assessments, support for instrumental activities of daily living, psychosocial support, and other individualized services directed by the needs and preferences of the service user. Results suggest that these programs can act as a 'safety net' and promote independent living. Skilled volunteers can positively impact older adults' experience returning home. When the programs under study are considered in tandem with existing evidence, it facilitates a discussion of how TSO services could be made available more widely to support older adults in their transition experiences.

The world's most remote community service? Partnership working and building community capacity on the British Overseas Territory Island of St Helena

Measuring just 47 square miles and 1950 km from its nearest neighbour, St Helena is a British Overseas Territory in the South Atlantic with a population of approximately 4500. Working in this remote setting is one of the world's smallest probation services delivering a range of interventions including community service. In this practice note the authors explore the sustained, successful partnership between St Helena Island Probation Service and the St Helena National Trust. This partnership not only provides meaningful community service placements which support vital conservation work, but simultaneously contributes to an individual's journey towards desistance through enhancing employability and supporting positive community reintegration.

Definitions of recovery and reintegration across the first year: A qualitative study of perspectives of persons with spinal cord injury and caregivers.

Longitudinal, qualitative cohort study. To understand how people with newly acquired spinal cord injury (PWS) and their support person (SP) define recovery and successful community reintegration (CR) across the first 12 months post-injury (mpi) and their satisfaction with the rate of recovery and reintegration experienced. Academic and Veterans hospitals in Midwest USA. In-depth, semi-structured interviews were conducted in two cohorts of PWS and SP during the initial inpatient rehabilitation stay, at 6 mpi, and at 12 mpi. Recordings were transcribed; four authors independently undertook line-by-line coding. The team discussed codes to reach consensus and synthesize into broader themes within the International Classification of Function, Disability, and Health and Transformative frameworks. Data are reported on 23 PWS and 21 SP. PWS and SP are similar in defining recovery as gaining motor function and achieving independence. However, SP more frequently define recovery in terms of maintaining positivity and emotional recovery. At 12 mpi both groups shift to define recovery according to progress. Social roles, being active, and employment are persistent themes of how PWS and SP define successful CR. However, SP also frequently define successful CR as reestablishing identity and emotional adjustment. Veterans with SCI less frequently defined successful CR as employment. This study is the first to reveal how PWS and SP define recovery and reintegration during the first 12 mpi. Given decreasing lengths of stay, this information can be used to tailor rehabilitation strategies during the critical first year of injury to optimize recovery.