Level Of Community Integration Research Articles

119 Satisfaction with Life and Community Integration Outcomes up to 20 Years after Burn Injury

Abstract Introduction Among the many challenges burn survivors face, community integration is often difficult and might affect overall satisfaction with life long-term. The purpose of this study is to examine quality of life, based on life satisfaction and community integration, at long-term follow-ups in the burn population. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and at 5, 10, 15, and 20 years after injury. The Satisfaction with Life Scale (SWLS) was used to measure participants’ satisfaction with life and the Community Integration Questionnaire (CIQ) measured level of community integration. A random intercept model was used to fit the data and generate a score trajectory with 95% confidence intervals to demonstrate the changes in scores over time and the impact of the demographic and clinical covariates on the model. SWLS trajectory is depicted in the Figure. Results The study population included 214 adult burn survivors with a mean age of 45.2 years. The population was mainly male (65.9%) and white (77.1%) with a mean burn size of 22.5% and average length of hospital stay of 34.7 days. This study found that SWLS scores decrease over time, but CIQ scores were relatively stable. The CIQ model with additional covariates were not statistically significant and did not improve the fit of the model. Conclusions Satisfaction with life was significantly worse over time. Community integration showed little or no change over the long term.

Return to work after spinal cord injury: a Singaporean pilot community-based rehabilitation program.

Retrospective analysis of data collected as part of a pilot program. The primary objective of our study was to document the return-to-work rate of individuals with SCI who participated in a community-based interdisciplinary vocational rehabilitation program. The secondary objectives were to assess changes in their levels of community integration and functional independence. A community-based rehabilitation center in Singapore. Participants were individuals with SCI between 21 and 55 years. They identified return to work as a rehabilitation goal, and were certified fit to undergo rehabilitation by their physicians. Primary outcome was the return-to-work rate at discharge from the program. Secondary outcomes were community integration and functional independence, measured by the Community Integration Questionnaire (CIQ) and the Spinal Cord Independence Measure III (SCIM-III), respectively. We summarized participants' clinical and socio-demographic characteristics descriptively, and used inferential statistics to compare pre- and postprogram scores for secondary outcome measures. Thirty-nine participants were included for this study. Thirty-two completed the program, of which 84% (n = 27) reported returning to work. Participants who completed the program had mean change in total CIQ and SCIM-III scores of 7 (95% CI, 5-8) and 11 (95% CI, 7-15), respectively. There were differences (p < 0.05) between pre- and postprogram scores for both secondary outcome measures. Our findings suggest that our vocational rehabilitation program facilitated participants with SCI in Singapore to return to work and was beneficial to enhance their levels of community integration and functional independence. Future interventional studies are recommended to estimate the efficacy of such programs.

Community Integration of Persons with Mental Disorders Compared with the General Population

Aims: Community integration is the catalyst for recovery that is provided by mental health services to persons with mental disorders. This study explores the impact of socio-demographic variables on the level of community integration in persons with mental disorders compared to the general population living in the same communities and the difference in community integration level between the two groups. Methods: A total of 224 persons with mental disorders (M age = 45.0, SD = 12.84, male 51.8%, female 48.2%) in communities and 247 individuals (M age = 44.6, SD = 11.41, male 50.6%, female 49.4%) of the general population in the same communities participated in the evaluation of levels of physical, psychological, and social integration. The effects of socio-demographic variables on the three types of community integration on both groups were evaluated using multiple regression analyses. Differences in the three types of community integration between the two groups were tested using multivariate analysis of covariance (MANCOVA) by controlling for socio-demographic variables as covariates. Results: The effects of socio-demographic variables on the three types of community integration differed between the two groups. In addition, the two groups differed significantly in terms of social rather than physical or psychological integration when the level of community integration was compared while controlling socio-demographic variables. The results also show that persons with mental disorders had smaller social networks and fewer social contacts than the general population. Conclusions: Based on the findings, we recommended that service providers provide incentives for consumers to strengthen social relationships and social skills training in order to maintain relationships.

Community integration and life satisfaction among individuals with spinal cord injury living in the community after receiving institutional care in Bangladesh

Purpose: This study reports level of community integration and life satisfaction among individuals who sustained traumatic spinal cord injuries, received institutional rehabilitation care services, and went back to live in the community in Bangladesh. It examines the impact of type of injury, demographic characteristics, socio-economic profile, and secondary health conditions on community integration and life satisfaction and explores the association between these two measures.Method: Individuals with spinal cord injury were telephone interviewed by the Centre for the Rehabilitation of the Paralysed, Bangladesh from February to June of 2014. Data were collected from the subjects on type of injury, demographic and socio-economic profile, and secondary health conditions. The outcome measures were determined by using two validated tools – Community Integration Questionnaire and Life Satisfaction 9 Questionnaire.Results: Total community integration and life satisfaction scores were 15.09 and 3.69, respectively. A significant positive relationship between community integration and life satisfaction was revealed. Type of injury, gender, and age were found to be significant predictors of both community integration and life satisfaction scores. Higher education was significantly related to community integration and life satisfaction scores.Conclusion: Participants scored low in total community integration and life satisfaction, suggesting there is a great need to develop interventions by governmental and non-governmental organizations to better integrate individuals with spinal cord injury in the community.Implications for RehabilitationGovernment and non-government organizations should offer disability friendly public transportation facilities for individuals with spinal cord injury so that they can return to education, resume employment, and involve in social activities.Entrepreneurs and businesses should develop assistive devices featuring low technology, considering the rural structure and housing conditions in Bangladesh. Innovations being made in assistive technology should be supported by subsidies and grants.They should also plan to offer injury appropriate employment opportunities for individuals who suffer major injuries like spinal cord injury in Bangladesh.Housing facilities with accessible bathrooms, kitchens and stairs should be designed and offered for this population to improve their ability to self-care and decrease the dependence on caregivers for household tasks such as – cooking meals and taking care of children.

Community integration questionnaire: Outcomes of people with traumatic brain injury and high support needs compared with multiple matched controls

Objectives: To determine level of community integration in adults with traumatic brain injury and high support needs (TBI-HSN) compared with multiple matched controls.Setting: Community setting, Victoria, Australia.Participants: Adults with TBI-HSN living in the community (n = 61). Australian normative data (n = 1973) was used for matching purposes (1:4).Design: Matched analysis from people with and without TBI. Matching aimed to reduce variability expected from age, gender, metropolitan/rural residence and co-resident status.Main measures: Community Integration Questionnaire (CIQ): total and sub-scales of Home Integration, Social Integration and Productivity.Results: Matched analysis showed large effects favouring the general population, e.g. CIQ total scores were significantly different, F(1, 304) = 5.8, p < 0.0001. Conditional relative risk showed community-dwelling participants with TBI were 540-times more likely to report a poor CIQ total score compared to the general population.Conclusion: Normative CIQ data has enabled meaningful comparisons of the community integration of adults with chronic TBI to the general population in Australia. Evidence makes clear with numeric precision that individuals with TBI and high support needs are much less integrated than their non-TBI counterparts despite living in the community for many years.

Return to driving in the first 6 months of community integration after acquired brain injury

Return to driving is a goal and milestone in the recovery process following acquired brain injury (ABI). Knowledge of whether and when a person is likely to return to driving is important to people with ABI, family members and clinicians. To determine the rates, timing, correlates, and predictors of return to driving in the first 6 months after discharge from hospital following ABI. Survey of 212 participants with ABI and 121 family members at discharge and 3 and 6 months later. Participants with ABI were grouped according to driving status (not driving, returned within 3 months, returned within 6 months). Groups were compared on demographics, injury severity, quality of life, functioning, psychosocial integration, depression, and carer well-being. By 6 months post-discharge 62.3% had resumed driving. Between group differences existed on measures of injury severity, and psychosocial integration at 6 months, and carer depression and strain at discharge and 6 months. Whether and when someone returned to driving could be predicted by length of hospital stay, and level of community integration, and pain at discharge. Educating clients about their likelihood and timing of return to driving, and supporting non-drivers and their carers may improve psychosocial outcomes.

Rasch Analysis of the Community Integration Measure in Persons With Traumatic Brain Injury

ObjectiveTo examine the measurement properties of the Community Integration Measure (CIM) in persons with traumatic brain injury (TBI). DesignRasch analysis was used to retrospectively evaluate the CIM. SettingRehabilitation hospital. ParticipantsPersons (N=279) 1 to 15 years after a TBI. InterventionsNone. Main Outcome MeasureCIM. ResultsThe CIM met Rasch expectations of unidimensionality and reliability (person separation ratio=2.01, item separation ratio=4.52). However, item endorsibility was poorly targeted to the participants' level of community integration. A ceiling effect was found with this sample. ConclusionsThe CIM is a relatively reliable and unidimensional scale. Future iterations might benefit from the addition of items that are more difficult to endorse (ie, improved targeting).

The Persian Version of Community Integration Questionnaire in persons with multiple sclerosis: translation, reliability, validity, and factor analysis

Purpose: To culturally translate and validate the Community Integration Questionnaire (CIQ) in persons with multiple sclerosis (MS). Methods: After a forward–backward translation, 105 persons with MS completed the Persian versions of the CIQ and MS Quality of Life (MSQOL) questionnaires in the first visit. The CIQ was re-administered to a sample of 45 persons with MS 7–10 days after the first session. Test–retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach’s α coefficient, respectively. Construct validity was assessed by measuring associations between subscales of the Persian CIQ (including Home Integration (HI), Social Integration (SI), and Productivity (P)) and MSQOL (including Physical and Mental Components). Dimensionality was assessed through two methods of corrected item-subscale correlation and factor analysis. Results: The acceptable level of test–retest reliability (ICC ≥0.70) was obtained for the Persian CIQ. However, Cronbach’s α coefficient of ≥0.70 was only seen for the HI. The correlations between the Persian CIQ and the Physical MSQOL were higher than those of Persian CIQ and the Mental MSQOL. The corrected item-subscale Spearman’s correlation coefficient of 0.40 was exceeded by most items of the HI and 2 items of P. A total of four factors were detected and similar to the results of item-subscale correlation, the most variability was seen for the items of SI which loaded on different factors. Conclusions: Persian CIQ seems to be a reliable and valid instrument for monitoring the level of community integration following rehabilitation in persons with MS. Some modifications need to be made in the SI of the Persian CIQ to improve extraction of information regarding community integration of persons with MS.Implications for RehabilitationThe results on psychometric properties of the Persian Community Integration Questionnaire (CIQ) are comparable with the English and Spanish versions.Persian version of the CIQ appears to be a reliable and valid instrument to assess community integration in “clinical” and “research” settings of Persian-speaking Iranians with definite diagnosis of multiple sclerosis (MS).

Deinstitutionalization? Where Have All the People Gone?

Although there is broad consensus that the state psychiatric hospital population drastically declined over the past five decades, the destination and well-being of people with serious mental illness (SMI) have been in greater doubt. In this article, we examine the aftermath of the deinstitutionalization movement. We begin with a brief historical overview of the move away from state hospitals, followed by an examination of where people with SMI currently reside and receive treatment. Next, we review recent trends reflecting access to treatment and level of community integration among this population. Evidence suggests the current decentralized mental health care system has generally benefited middle-class individuals with less severe disorders; those with serious and persistent mental illness, with the greatest need, often fare the worst. We conclude with several questions warranting further attention, including how deinstitutionalization can be defined and how barriers to community integration may be addressed.

Evaluation of an outpatient, peer group intervention for people with acquired brain injury based on the ICF ‘Environment’ dimension

Purpose. This study aimed to evaluate the effectiveness of an intervention based on the ICF ‘Environment’ dimension for enhancing the well-being and psychosocial outcomes of patients with acquired brain injury in an outpatient (day hospital) setting.Method. A mixed methodology cohort study comparing an intervention group with an historical non-intervention group using pre- and post-intervention and follow-up measures. The 6-week group intervention involved participants and their significant others. Pre- and post-intervention data from the intervention group and the non-intervention group were compared using 2 × 2 analyses of variance for five standardised outcome measures. Semi-structured interviews with intervention participants and significant others were used to provide qualitative feedback.Results. A significant group by time interaction was found for level of community integration on the Sydney Psychosocial Reintegration Scale and depression scores on the Hospital Anxiety and Depression Scale, with greater improvements for the intervention group compared with the non-intervention group. No other significant differences between groups were found. Gains in community integration were maintained by the intervention group at 1-month follow-up. Qualitative feedback from participants indicated the value of: sharing experiences, the group content, goal setting, comparing with others and the group processes.Conclusions. The Environment-focused intervention was useful in improving patient outcomes in terms of better self-reported community integration.

Environmental Factors and Their Role in Community Integration after Spinal Cord Injury

Background. The International Classification of Functioning, Disability and Health (ICF) model presents an opportunity to better understand previously neglected longterm social outcomes after traumatic spinal cord injury (SCI), especially the experience of participation. Purpose. The study explored the relationship between perceived environmental barriers and perceived community integration (a participation proxy) in a sample of adults with traumatic SCI. Methods. The study interviewed African American and White women and men (n=136) who had lived with SCI for an average of 11.5 years. Results. Participants reported environmental barriers at twice the level indicated by previous studies; the natural environment and the policies of government were the most problematic. Levels of community integration were also high. Data suggest a significant relationship (p&lt;.01) between perceived environmental barriers and community integration for adults with SCI, providing support for the ICF model. Implications. Improved measures and more sophisticated concepts and theories are needed to explicate the relationship between environmental factors and participation concepts in the ICF. With respect to practice, occupational therapists need to be aware that removal of environmental barriers is only a first step in the more complex effort to facilitate optimal community integration after SCI.

Environmental Factors and Their Role in Community Integration after Spinal Cord Injury

The International Classification of Functioning, Disability and Health (ICF) model presents an opportunity to better understand previously neglected longterm social outcomes after traumatic spinal cord injury (SCI), especially the experience of participation. The study explored the relationship between perceived environmental barriers and perceived community integration (a participation proxy) in a sample of adults with traumatic SCI. The study interviewed African American and White women and men (n = 136) who had lived with SCI for an average of 11.5 years. Participants reported environmental barriers at twice the level indicated by previous studies; the natural environment and the policies of government were the most problematic. Levels of community integration were also high. Data suggest a significant relationship (p < .01) between perceived environmental barriers and community integration for adults with SCI, providing support for the ICF model. Improved measures and more sophisticated concepts and theories are needed to explicate the relationship between environmental factors and participation concepts in the ICE With respect to practice, occupational therapists need to be aware that removal of environmental barriers is only a first step in the more complex effort to facilitate optimal community integration after SCI.

A Tale of Two Towns: Social Structure, Integration and Crime in Rural New South Wales

AbstractThis paper examines social factors that are associated with crime in two rural Australian communities with high proportions of Aboriginal people. It draws upon the theoretical contributions of Braithwaite (1989) to explain how levels of community integration and cohesion affect the presence of crime. Data for the case studies are derived from secondary statistics, surveys, observation and in‐depth interviews. Existing literature on crime in Australia emphasises the disproportionate representation of Aboriginal people within the criminal justice system. Yet, by comparing and contrasting the two communities, the analysis demonstrated that social structural and perceptual characteristics, rather than Indigenous status, account for high levels of crime in one community and low levels in the other. The analyses demonstrate that communities with high levels of social cohesion can ameliorate the affects of social disorganisation, division, and disadvantage in communities with high Aboriginal populations. It further demonstrates that rural crime is a complex and multi‐faceted phenomenon.

Reduced community integration in persons following traumatic brain injury, as measured on the community integration measure: An exploratory analysis

Purpose. To explore the community integration of individuals who had suffered a Traumatic Brain Injury (TBI) and compare this to members of the general public.Method. An independent groups design explored differences in three groups' levels of community integration. These groups consisted of ten survivors of TBI, ten male and ten female controls and were measured using The Community Integration Measure (CIM). All participants were resident in Northern Ireland (NI). The brain injured participants were drawn from a Belfast-based social skills programme.Results. Mann-Whitney U tests showed a statistically significant difference between female controls and brain-injured individuals (U = 26.50, N1 = 10, N2 = 10, p = 0.037, one-tailed).Conclusion. Females were more integrated into their communities than males, who were, in turn, more integrated than brain injured individuals. It would appear that brain injury survivors are doubly disadvantaged. Their gender (mainly male), and the injury itself, conspire to reduce their integration within the wider community.

Defining community integration of persons with brain injuries as acculturation: A Canadian perspective

In this study, the AIMS, a measure of community integration developed from acculturation theory, was used to explore the various ways that people with brain injuries, a smaller cultural or minority group, are involved with the larger cultural group and to evaluate rehabilitation outcome (i.e., reintegration into the community). Specifically, the AIMS assesses whether the needs of individuals with brain injuries in a number of areas are identified and supported in a way that supports community participation. In addition, the opinions of persons with a brain injury regarding their level of community integration were compared to the opinions of individuals who knew them well. The results of this study indicate that while a large proportion of the participants with brain injuries were integrated in traditional areas of service delivery such as medical services, housing and social activity, their disability-related needs were not being identified and supported adequately in the areas of spirituality and productive activity.

9th Annual Rotman Research Institute Conference ”Traumatic Brain Injury: Diagnosis, Outcome, and Rehabilitation“ March 24–26, 1999

The aim of this study was to investigate the association between measures of cognition and level of community integration 7 to 24 years after moderate/severe traumatic brain injury (TBI). Subjects were recruited from in-patient health records of a large rehabilitation hospital in Pennsylvania. Eligible subjects were traced and then invited to participate in a face-to-face interview which included the Community Integration Scale (CIQ), and cognitive tests such as Trails A & B, the Rivermead Story Recall subtest, and the Neurobehavioral Cognitive Status Exam (NCSE). Linear regression analyses on 207 subjects showed that Trails A, Trails B, and story recall measure were significantly associated with CIQ scores (p < .0005) controlling for age and education. Results with other cognitive measures are discussed.

Représentations de la communauté linguistique dans une famille francophone de Suisse romande

Representations of speakers cannot be reduced to categories pre-established by the researcher, whether these correspond to the norm, theory or common sens. The representational content is organized and works within the interview. Its analysis can allow us to trace different levels of community integration of the speakers which do not necessarily coincide with geopolitical limits. Thus, while the definition of the French speaking part of Switzerland is necessarily in reference to the Germanic world on the one hand, it also brings into play the whole European French-speaking community, and not only France. In terms of system, the existence of a regional French is valid as a symbol, but the notion does not seem to have real significance. Finally, the linguistic border with the German speaking part of Switzerland is not clear-cut: it seems rather to be characterized by a zone of transition.

Community Integration of Women with Spinal Cord Injuries: An Examination of Psychological, Social, Vocational, and Environmental Factors

This study examines four aspects of community integration--relationships, productive occupation, personal and environmental resources, and psychological resources--to determine the extent to which women with spinal cord injury (SCI) are able to achieve the same levels of community integration as women without disabilities. Data were collected using a mailed questionnaire that was completed by 946 women with and without physical disabilities. A subsample of 120 women with SCI and 406 women without disabilities met the inclusion criteria. The impact of SCI on the community integration of women can be seen primarily in lower rates of employment, environmental barriers to socializing, and unmet needs for personal assistance services. There was no significant difference between the groups on measures of marital status, living arrangement, satisfaction with relationships with friends and family members, personal and household income, self-esteem, or perceived control. There is discussion of new perspectives on ...

Plymouth and West Devon mental handicap strategy: AN EVALUATION APPROACH

Plymouth and West Devon have enjoyed a coherent Joint Strategic Plan for the development of services for adults with mental handicaps since 1984. A multi‐agency group of professionals and parents was formed in 1985 to undertake an evaluation of the strategy. This article reports on the form and function of the group, and the scope of the evaluations under way: for example, resettlement from hospital; levels of community integration; contrasting models of day care; psychiatric treatment; and the use of buildings. It also comments on the benefits and pitfalls of service personnel designing and executing an evaluation of the service they themselves plan and deliver.