Halfway House Research Articles

Factors Associated With Recovery Housing Availability for Individuals Involved in the Carceral System

Factors Associated With Recovery Housing Availability for Individuals Involved in the Carceral System

Implementation of an EMS-based naloxone distribution program: A qualitative evaluation.

We evaluated a novel leave-behind naloxone (LBN) program that allows Emergency Medical Services (EMS) personnel to distribute naloxone after an opioid overdose. Our objective was to explore EMS engagement and experiences with the program, as well as interest in education on addiction and harm reduction. We also assessed the acceptability of LBN programs among people who use drugs (PWUD). We conducted telephone interviews with EMS personnel and residents of substance use recovery housing between February and September 2023. EMS personnel described their direct experiences with the LBN program and perceived facilitating factors and barriers to naloxone distribution. First responder interactions and support for LBN were explored with PWUD. A rapid assessment method was used to analyze the interview data. Eighteen of the 23 EMS participants had distributed LBN; most agreed EMS agencies should have an LBN program. Barriers included forgetting, patient acuity, patients declining, and perceived liability. Facilitators included having a clear protocol, accessible kits, and minimal documentation burden. The majority expressed interest in harm reduction education. Eight of the 11 PWUD participants reported recent involvement in an opioid overdose. The majority supported LBN and felt comfortable receiving naloxone training from EMS. In this qualitative evaluation, we found broad support for EMS-based naloxone distribution among EMS personnel and PWUD. We identified several modifiable barriers to the success of such programs, which should be the subject of future investigation. EMS and harm reduction communities should support the expansion of LBN programs across the United States.

A qualitative investigation into the effectiveness of a housing navigator program linking justice-involved clients with recovery housing

BackgroundRoughly 24–36% of people who are incarcerated in the U.S. are formally diagnosed with opioid use disorder (OUD). Once released, individuals involved with the criminal legal system (CLS) face increased risks of return to use and fatality and are 129 times more likely to die from an overdose within the first two weeks of release compared to those without CLS involvement. People who are CLS-involved and who are seeking a recovery living environment can access temporary stable housing through recovery homes. However, entering a recovery home can be difficult due to fragmentation among recovery housing organizations and their non-uniform application and screening procedures. A navigation pilot program was implemented to provide clients with recovery home placement advice, pre-screening, and referrals in Cook County, IL. Existing research on recovery homes has rarely examined the importance of recovery housing navigation for enhancing service engagement among CLS-involved individuals receiving medications for OUD.MethodsSemi-structured qualitative interviews were conducted with 22 clients and three recovery housing navigators as part of a program evaluation of the navigation program pilot. Qualitative software was used to organize and qualitatively analyze transcripts through several rounds of coding producing emergent themes, which were then triangulated, and expanded using navigator data.ResultsClients seeking recovery home services reported multiple prior challenges securing safe and supportive recovery living environments. Despite low initial expectations, clients described their interactions with housing navigators in favorable terms and felt navigators worked with them effectively to identify and meet their housing and substance use needs in a timely manner. Clients also commented on their partnerships with the navigator throughout the process. Interactions with navigators also calmed fears of rejection many clients had previously experienced and still harbored about the process, which bolstered client-navigator relationships and client motivation to engage with additional services.ConclusionEvidence from this study suggests recovery home navigation can improve the speed and efficiency with which clients are connected to appropriate services that are tailored to their specific needs as well as increase client motivation to engage with a myriad of recovery services.

Retraction: Halfway Out: An Examination of the Effects of Halfway Houses on Criminal Recidivism.

Retraction: Halfway Out: An Examination of the Effects of Halfway Houses on Criminal Recidivism.

Literacy learning and changing social practices in a community art project for women with experience of the criminal justice system

ABSTRACT This article seeks to understand what a group of women with experience of the criminal justice system learned through taking part in a community art project, particularly in terms of their literacy. It draws on an ethnographic study of a community art project carried out by the Collectif Art Entr’Elles which took place in a halfway house in Montreal (Canada) where prisoners can apply to complete their sentence and prepare for their social reintegration. Using a non-linear narrative structure, the collaborative sound work produced sought to break down prejudices by making these women’s voices heard in public space. Drawing on Lave’s (2019) theory of social practice, we explore in more detail the experience and learning journey of one of the women involved. Our analysis indicates that non-formal education, especially when it takes the form of community arts projects, can play a positive role in the diversification and enhancement of literacy practices that are key to the social reintegration and wellbeing of women with experience of the criminal justice system. As such, non-formal community arts education can be an important vehicle for social justice.

Implementing contingency management into rural recovery housing: recommendations of a professional advisory expert panel

ABSTRACT Background: Rural areas in the United States have been severely impacted by recent rises in substance use related mortality and psychosocial consequences. There is a dearth of treatment resources to address substance use disorder (SUD). Rural recovery houses (RRH) are important services that provide individuals with SUD with an environment where they can engage in recovery-oriented activities, but dropout rates are unacceptably high, and evidence-based interventions such as contingency management (CM) may reduce dropout and improve outcomes for RRH residents. In this paper, we describe the results of a national convening of experts that addressed important issues concerning the implementation of CM within the context of RRHs. Methods: Twelve experts (five female) in the areas of CM, RRH and rural health participated in a one-day facilitated meeting that used nominal group technique to identify expert consensus in three areas as they pertain to RRH: (a) facilitators and barriers to CM implementation, (b) elements necessary for successful program building based on group feedback, and (c) recommendations for future implementation of CM. Results: Several RRH- and system-level barriers and facilitators to implementing CM were identified by the panel, and these were categorized based on the level of importance for and ease of implementation. CM funding, staff and resident buy-in, set policies, education on CM, and consistent fidelity to CM procedures and tracking were identified as important requirements for implementing CM in RRH. Conclusions: We provide recommendations for the implementation of CM in RRH that may be useful in this context, as well as more broadly.

Barriers to re-reintegration: investigating families’ reluctance to welcome rehabilitated forensic mentally ill relatives back into their homes in Thulamela municipality, South Africa

ABSTRACT Reintegrating forensic mentally ill patients back into their families is difficult. This study explored the factors contributing to the reluctance of families to accept forensic mentally ill rehabilitated patients. The study engaged five families of rehabilitees who have undergone rehabilitation at Hayani Psychiatric Hospital. The findings highlighted the persistent trauma and anxiety among caregivers, leading to a preference for continued institutional care or halfway house placement. The study highlighted the significance of integrated service programs addressing caregivers’ specific challenges faced by family caregivers of mental relatives to facilitate successful family reunification and community integration.

Pendampingan Pasien Kanker Sistem Reproduksi Wanita Melalui Therapi Akupressure Sebagai Upaya Mengurangi Efek Kemotherapi Di Rumah Singgah Kanker Baiti Jannati Bengkulu

Cancer of the reproductive system is the most common type of cancer suffered with the highest order of breast cancer after cervical cancer. Kemotherapi is one of the therapies undertaken by cancer patients including patients with reproductive system cancers including breast cancer and mammal cancer, this motherfire uses chemicals that can cause side effects in patients including headaches (myalgia), nausea and vomiting, alopecia etc. Acupressure is one type / way of health care that is done through pressing techniques on the surface of the body on acupuncture points using fingers, or other body parts, or blunt-tipped aids with health purposes. The acupressure method prioritizes promotive and preventive., Acupressure can also reduce pain in cancer patients as a result of motherhood, besides that it can also reduce nausea and vomiting. The purpose of this service is to find out that acupressure carried out on cervical cancer patients and breast cancer who undergo mothership can reduce side effects due to motherhood that is adopted. The method of this study was to acupressure patients who treated motherfire at the Biati Jannati halfway house as much as 15 pasein, The results of this study showed that there was a decrease in maternal side effects after acupressure for 1 month with decreased side effects in the form of pain, nausea and vomiting

KUALITAS PELAYANAN KESEHATAN PADA PENYINTAS THALASEMIA DI KOTA SUKABUMI

This study aims to determine the quality of health services for Thalassemia survivors in Sukabumi City. This study uses a qualitative research method with a narrative approach. The results of this study indicate that the Quality of Health Services for Thalassemia Survivors in Sukabumi City, especially at Rs. Bhayangkara Setukpa Sukabumi already has the following improvements: 1) Already has a special room for Thalassemia Survivors; 2) The chelation medicine already has various types of iron syrup, tablets, and brewed chelation medicine; 3) Have a special Thalassemia officer. As for when viewed based on the assessment of the dimensions of Reliability (Reliability), Responsiviness (Response/responsiveness), and Empathy (Empathy) health services provided by the apparatus/officers for Thalassemia Survivors are of high quality, but the dimensions of Tangibles (Intangible) and Assurance (Guarantee) are not qualified. or still not optimal, because the quality of health services provided is still not in accordance with the medical standards as outlined in the Regulation of the Minister of Health of the Republic of Indonesia Number 1109/MENKES/PER/VI/2011 concerning Technical Instructions for Guaranteed Thalassemia Treatment Services, especially in facilities and infrastructure. . The Sukabumi City Health Office provides a policy regarding the Health Services for Thalassemia Survivors in Sukabumi City, namely Thalassemia survivors participating in the National Health Insurance for the Healthy Indonesia Card (JKN KIS) do not need to go to the First Level Health Facility (FKTP) again to get referrals, and Thalassemia Sukabumi City has a halfway house as form of local government attention.

정신장애 당사자의 주거서비스 경험 연구

The purpose of this study is to explore the experiences of individuals with mental illness who receive residential services during the process of community integration, and to propose practical measures in this field. To gain a better understanding of the context and significance of using residential services, eight participants who have utilized two or more types of such services, including halfway houses, living facilities, communal living families, and self-reliance experience housing, were selected. Data was collected through semi-structured in-depth interviews and analyzed using a continuous comparison method. The analysis resulted in the identification of 5 categories, 11 patterns, and 31 meanings: ① a vague desire for independence, ② finding a sense of daily life through practical preparation, ③ receiving empowerment from applicants, ④ enduring rewards and punishments, and ⑤ gaining confidence in independence. This study reveals that the experience of housing services for individuals with mental disabilities is a process of realizing the possibility of independence, starting from a vague desire, and driven by strong applicants, while also expanding voluntary housing options. Based on these findings, a housing service plan is proposed to support the community integration process for individuals with mental disabilities

Involuntary discharge from drug or alcohol treatment programs in Vancouver, Canada

BackgroundRetention in substance use treatment is essential to treatment success. While programmatic factors are known to influence retention, less is known about the role of involuntary discharges from drug or alcohol treatment programs. Therefore, we sought to identify the prevalence of and factors associated with involuntary discharge due to ongoing substance use.MethodsData were derived from two community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada. Generalized estimating equation (GEE) analyses were used to identify variables associated with involuntary discharge from treatment programs due to ongoing substance use.ResultsBetween June 2017 and March 2020, 1487 participants who accessed substance use treatment and completed at least one study interview were included in this study. Involuntary discharge from a treatment program due to ongoing substance use was reported by 41 (2.8%) participants throughout the study, with 23 instances reported at baseline and another 18 reported during study follow-up. In a multivariable GEE analysis, involuntary discharge was positively associated with homelessness (Adjusted Odds Ratio [AOR] = 3.22, 95% Confidence Interval [95% CI]: 1.59–6.52), daily injection drug use (AOR = 1.87, 95% CI 1.06–3.32) and recent overdose (AOR = 2.50, 95% CI 1.38–4.53), and negatively associated with age (AOR = 0.93, 95% CI 0.90–0.96). In sub-analyses, participants have most commonly been discharged from in-patient treatment centres (52.2%), recovery houses (28.3%) and detox programs (10.9%), and for using heroin (45.5%) and/or crystal methamphetamine (36.4%).ConclusionsWhile involuntary discharge was a relatively rare occurrence, those who were discharged due to active substance use possessed several markers of risk, including high-intensity injection drug use, homelessness, and recent non-fatal overdose. Our findings highlight the need for increased flexibility within treatment programs to account for those who re-initiate or continue to use substances during treatment.

Modeling Recovery Housing Retention and Program Outcomes by Justice Involvement among Residents in Virginia, USA: An Observational Study.

Living in recovery housing can improve addiction recovery and desistance outcomes. This study examined whether retention in recovery housing and types of discharge outcomes (completed, "neutral," and "negative" outcomes) differed for clients with recent criminal legal system (CLS) involvement. Using data from 101 recovery residences certified by the Virginia Association of Recovery Residences based on 1,978 individuals completing the REC-CAP assessment, competing risk analyses (cumulative incidence function, restricted mean survival time, and restricted mean time lost) followed by the marginalization of effects were implemented to examine program outcomes at final discharge. Residents with recent CLS involvement were more likely to be discharged for positive reasons (successful completion of their goals) and premature/negative reasons (e.g., disciplinary releases) than for neutral reasons. Findings indicate that retention for 6-18 months is essential to establish and maintain positive discharge outcomes, and interventions should be developed to enhance retention in recovery residents with recent justice involvement.

"And Now that I Feel Safe…I'm Coming Out of Fight or Flight": A Qualitative Exploration of Challenges and Opportunities for Residents' Mental Health in Substance Use Recovery Housing.

Co-occurring mental health concerns are prevalent among substance use recovery housing residents. We sought to explore how residents with co-occurring mental health and substance use needs experience recovery housing. We conducted semi-structured interviews with residents (N = 92) in recovery homes across Texas and developed themes through thematic analysis. Residents note that living in a group home can exacerbate anxiety and paranoia, especially during periods of high turnover. Overwhelmingly, however, residents believe recovery housing improves their mental health. Residents use their shared lived experiences to support one another. Residents also express appreciation for the transition period offered by recovery housing, allowing them to solidify their recoveries before fully re-entering society. Participants describe recovery homes as a critical support for their co-occurring mental health and substance use concerns. These results provide key insights on how to better support mental health in recovery housing.

The impact of specialized referral services on recidivism and length of stay among halfway house residents

Individualized case management services that identify and provide support for treatment, housing, and employment may improve opportunities for success for those housed in community residential facilities (CRFs) upon release, particularly when evaluated against the goals of reducing the length of stay in the CRF and reducing the rate of return to prison among a targeted parole population with severe mental health needs and moderate-to-high criminogenic risk. Following an experimental design with random assignment design, this study evaluated 349 participants who were eligible for specialized case management services while housed and released from a CRF between January 2018 and June 2019. Findings reveal that participants who received specialized service referrals significantly decreased their length of stay in the CRF compared to the control group. Successful program completion was further related to a reduced length of stay and a significant reduction in the likelihood of returning to prison.

Justifying the need for a recovery related surveillance system: Exploratory focused interviews.

No recovery related surveillance system exists but given the evidence of effectiveness and growing supply, a house- and resident- level recovery house (RH) surveillance system could be beneficial for data collection on recovery support service (RSS) engagement, and retention; for improved standardization of RH programs and services; and for identification of outcomes associated with long-term recovery. This study aimed to explore current data collection practices at the resident- and house- level through qualitative focus interviews of RH representatives. The 13 RH interviews were scheduled with 16 RH representative respondents. The most frequently collected resident data was at entry (92%) and departure (85%) and included demographics (n = 5), substance use history (n = 6), treatment and recovery history (n = 5), legal and correctional history (n = 6) and mental health information (n = 7). Recovery support data was collected by 85% of houses. Post-stay data was only collected by four RHs (31%). These results indicate that there is a lack of standardized systematic collection, analysis, and reporting of recovery related data in the RH field. A recovery related surveillance system has the potential to fill this gap and inform and improve standard of resident care to support long-term recovery from substance use disorder.

Direct adjusted comparison of expressed emotion towards patients with schizophrenia between halfway houses and family settings

IntroductionRates of high expressed emotion (EE) towards patients with schizophrenia have only indirectly been compared between families and community residential facilities, since studies including patients in both settings are unfortunately lacking. High EE rates in staff-patient studies are typically lower than in families, with negligible rates of high emotional overinvolvement (EOI). However, indirect comparisons can suffer from many biases.ObjectivesThis study directly compared patients with schizophrenia living in halfway houses or with their families on the EE of their caregivers, adjusting for patient- and caregiver-related confounders.MethodsWe included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the EE of the caring staff (N=22 nurses) or parents (N=56), respectively, through Five Minutes Speech Sample interviews. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses, totaling 155 nurse ratings. Each outpatient was rated by one or both parents. Due to the multilevel structure of EE ratings, generalized linear mixed models were fitted. We first adjusted only for differences in patient-related confounders between groups and then added basic caregiver-related demographics.ResultsCompared to outpatients, inpatients were older (p=0.001), less well educated (p=0.002), had a longer disease duration (p=0.047), more hospitalizations (p=0.012), lower severity of psychotic (p=0.027) and, specifically, negative symptoms (p=0.015), and lower perceived criticism (p=0.001). Nurses were younger (p<0.001) and better educated (p=0.001) than parents. After adjusting for patient-related confounders only, EOI was significantly higher in parents (p=0.027) while criticism did not significantly differ between groups. However, after also adjusting for caregiver demographics (age, gender and education), criticism was significantly higher in nurses (p=0.027) while differences in EOI became non-significant.ConclusionsDifferences in EE, when directly compared between parents and professional caregivers, may be explained by differences in patient-related characteristics, caregiver demographics as well as other caregiver characteristics to be investigated in future studies.Disclosure of InterestNone Declared

Addressing rural and non-rural substance use disorder stigma: Evidence from a national randomized controlled trial

BackgroundIndividuals with substance use disorder (SUD) and recovery support services often face significant social stigma, especially in rural areas. One method of addressing stigma is through education and personal recovery stories. It is unclear if such messages will work similarly across rural and non-rural areas. MethodsWe conduct an exploratory analysis of data from a national randomized controlled trial (N = 2,721) to determine if there are differences in the effectiveness of messages at reducing stigma across rurality. Specifically, we test four interventions to reduce stigma: education about the effectiveness of recovery housing and three versions of a personal recovery story that varied social distance and delivery medium (identified written story, anonymous written story, and video). ResultsWe find that messages may not have the same effect across rurality, with non-rural participants in the identified and anonymous written recovery story groups having lower stigma scores and only rural participants exposed to the anonymous written story having lower stigma scores compared to their counterparts in the control group. Further, non-rural participants exposed to both written story treatments had higher positive feelings towards those in recovery compared to the control group, but only rural participants in the anonymous written story group had higher positive feelings compared to the control group. ConclusionOur results suggest that messages may have different effects on stigma across rurality and that rural participants’ beliefs may be particularly hard to change. Future research should examine what types of stigma reduction interventions are most effective in rural areas.

Differential predictors of expressed emotion toward individuals with schizophrenia between families and halfway houses.

This study investigated patient- and caregiver-related predictors of expressed emotion (EE) toward individuals with schizophrenia in families and halfway houses and yet understudied differential effects across settings. We included 40 individuals with schizophrenia living with their families ("outpatients") and 40 "inpatients" in halfway houses and recorded the EE of 56 parents or 22 psychiatric nurses, respectively, through Five Minutes Speech Sample. Each outpatient was rated by one to two parents; each inpatient was rated by two to five nurses. As EE ratings had a multilevel structure, EE predictors were investigated in backward stepwise generalized linear mixed models using the "buildmer" R package. We first fitted models including either caregiver- or patient-related predictors in each setting and finally included both types of predictors. Setting-specific patient-related effects were investigated in interaction analyses. Adjustment for multiple tests identified the most robust associations. In multivariate models including either caregiver- or patient-related predictors, nurses' higher age, shorter work experience and lower inpatients' negative symptoms robustly predicted higher emotional overinvolvement (EOI). In the final models including both types of predictors, nurses robustly displayed lower EOI (i.e., reduced concern and disengagement) toward inpatients with higher negative symptoms. Several other features were nominally associated with criticism and EOI in each setting. However, no feature robustly predicted criticism in inpatients and criticism/EOI in outpatients after adjustment for multiple tests. In interaction analyses, higher negative symptoms differentially predicted lower EOI in nurses only. Our findings suggest setting-specific pathogenetic pathways of EOI and might help customize psychoeducational interventions to staff in halfway houses.

Family in Crisis: Do Halfway Houses Perform Better Than Families with Expressed Emotion toward Patients with Schizophrenia? A Direct Adjusted Comparison

Expressed emotion (EE) toward patients with schizophrenia is typically reported to be lower in psychiatric halfway houses than in families. This is the first study directly comparing EE between these settings and investigating the pathways mediating EE differences. We included 40 inpatients in halfway houses and 40 outpatients living with their families and recorded 22 psychiatric nurses’ and 56 parents’ EE, respectively, through Five Minutes Speech Samples. Each inpatient was rated by 2–5 nurses and each outpatient by 1–2 parents. As EE ratings had a multilevel structure, generalized linear mixed models were fitted, adjusting for patient-related confounders and caregiver demographics. Mediatory effects were investigated in multilevel structural equation models. Outpatients were younger, less chronic, and better educated, with higher negative symptoms and perceived criticism than inpatients. Nurses were younger and better educated than parents. Before adjustment, EE rates were equally high across settings. After adjusting for patient-related confounders, emotional overinvolvement was significantly higher in parents. However, after also adjusting for caregiver demographics, only criticism was significantly higher in nurses. Patients’ age, negative symptoms, and perceived criticism and caregivers’ age and sex significantly mediated EE group differences. Our findings highlight pathways underlying EE differences between halfway houses and families and underscore the importance of staff and family psychoeducation.

Differential correlates of criticism versus emotional overinvolvement towards patients with schizophrenia living in halfway houses or with their families

PurposeThis study systematically searched for differential correlates of criticism vs. emotional overinvolvement (EOI) towards patients with schizophrenia in families and halfway houses, which have only incidentally been reported in previous research. Identified patterns were compared across settings.MethodsWe included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the expressed emotion (EE) of 22 psychiatric nurses or 56 parents, respectively, through Five Minutes Speech Samples. Each nurse rated 1–12 inpatients and each inpatient was rated by 2–5 nurses. Each outpatient was rated by one or both parents. As EE ratings had a multilevel structure, weighted Spearman correlations of criticism and EOI with various patient- and caregiver-related characteristics were calculated and compared with Meng’s z-test.ResultsCriticism was weakly negatively correlated with EOI in nurses but negligibly in parents. Distinct patterns of significant differential correlates arose across settings. Outpatients’ aggressive behavior and parents’ related burden were mainly associated with higher criticism. Inpatients’ symptoms (agitation/aggression, negative and other psychotic symptoms) and nurses’ burnout (Depersonalization) were mainly associated with lower EOI. Inpatients’ perceived criticism and outpatients’ previous suicide attempts were equally associated with higher criticism and lower EOI (mirror correlations). Finally, various inpatient attributes (older age, chronicity, unemployment and smoking) triggered higher EOI only. Inpatients’ age, psychopathology (esp. agitation/aggression and negative symptoms) and perceived criticism survived adjustment for multiple comparisons.ConclusionOur findings suggest setting-specific pathogenetic pathways of criticism and EOI and might help customize psychoeducational interventions to staff and families.