Reintegration Outcomes Research Articles

The Effect of Masculinity on Community Reintegration Following TBI in Military Veterans

The present study examined the effect of level of traditional masculine gender role norms as well as the moderating effect of cognitive flexibility on community reintegration outcomes in a sample of 60 male military veterans who had sustained a traumatic brain injury during deployment. Data were collected through self-report measures and cognitive tests. Results suggested that greater endorsement of traditional masculine gender role beliefs, attitudes, and behaviors was significantly inversely related to the community integration domains of relationships and living skills and not significantly related to work and leisure. The effect of masculinity on healthy living skills was moderated by cognitive flexibility; the protective effect of low masculinity on living skills was only present if the veteran also had high cognitive flexibility skills. Results are discussed in the context of gender role strain, potential limiting aspects of stereotypy on recovery and reintegration, and the importance of cognitive flexibility in the recovery/reintegration process.

Coming home: the experiences and implication of reintegration for military families

Introduction: Although military families are typically resilient in the face of adversity, the current literature suggests that the aftermath of deployment involves numerous stressors and difficulties for these families for a long period. Method: Using a sample of 380 US service members, 295 partners of US service members, and 136 adolescents who experienced a full deployment cycle of a service member parent, this study addresses the gaps in knowledge by examining how factors identified in prior research (reintegration stress and coping, preparation and expectations, family functioning and parental satisfaction, perceived adolescent changes between deployment and reintegration, and adolescents’ perception of family functioning) affect reintegration stress and coping for US service members, partners of US service members (someone who identifies as being in a significant relationship with a service member), and adolescents. Results: Better service member coping, satisfaction with family deployment coping, better preparation, and accurate expectations were all found to be associated with lower reintegration stress. Discussion: Findings point to the need for a systemic approach throughout the deployment cycle for better reintegration outcomes for military individuals and families.

TBI Severity and Community Reintegration in Veterans of the Afghanistan and Iraq Wars

To compare community reintegration outcomes (CR) in Veterans with different trajectories of comorbidity including TBI.

Validation of the Community Integration Questionnaire in the adult burn injury population.

With improved survival, long-term effects of burn injuries on quality of life, particularly community integration, are important outcomes. This study aims to assess the Community Integration Questionnaire's psychometric properties in the adult burn population. Data were obtained from a multicenter longitudinal data set of burn survivors. The psychometric properties of the Community Integration Questionnaire (n = 492) were examined. The questionnaire items were evaluated for clinical and substantive relevance; validation procedures were conducted on different samples of the population; construct validity was assessed using exploratory factor analysis; internal consistency reliability was examined using Cronbach's α statistics; and item response theory was applied to the final models. The CIQ-15 was reduced by two questions to form the CIQ-13, with a two-factor structure, interpreted as self/family care and social integration. Item response theory testing suggests that Factor 2 captures a wider range of community integration levels. Cronbach's α was 0.80 for Factor 1, 0.77 for Factor 2, and 0.79 for the test as a whole. The CIQ-13 demonstrates validity and reliability in the adult burn survivor population addressing issues of self/family care and social integration. This instrument is useful in future research of community reintegration outcomes in the burn population.

2014 Canadian Stroke Congress Abstracts

d’Esterre, CD1, 3 Qazi, E1, 3 Patil, S1, 3 Almekhlafi, M3, 1 Lee, T2, 3 Demchuk, A1, 3 Goyal, M1, 3 Menon, B1, 3; 1. University of Calgary, Calgary, AB; 2. University of Western Ontario, London, ON; 3. Calgary Stroke Program, Calgary, AB Background : For ischemic stroke, CT Perfusion (CTP) may change thrombolytic/endovascular treatment decisions when compared to NCCT/CTA alone. Two distinct thresholds may be useful in this regard: separation of 1) non-salvageable tissue (infarct core) from salvageable electrically silent tissue (penumbra), and 2) penumbra from benign oligemia (hypoperfused, but will survive if clot persists). Methods : CTP (120s,8cm) was performed on 180 patients within 12hrs of ischemic stroke. Two patient cohorts were analyzed: (1) recanalization (TICI 2b,3) 6s. For group (2) CBF, CBV, and Tmax values were obtained from within the final infarct region, and total ipsilateral hemisphere, excluding infarction. CBF, CBV and Tmax were used in univariate regression models. Results : For group (1)[n=11], mean time from CTP to recanalization was 60±19min. CBF parameter (thresholds for gray and white matter 7.2 and 5.2 ml•min-1•(100g)-1) had the highest sensitivity (90.9%) and specificity (81.8%) for infarction. For group (2)[n=15], the Tmax parameter (thresholds for gray and white matter 11.3s and 11.8s) had the highest sensitivity (86.6%) and specificity (80.0%) for penumbra. Conclusion : Knowing the status of recanalization within 90mins of CTP allows for accurate delineation of infarct core, as …

Applying a Resiliency Model to Community Reintegration and Needs in Families with Traumatic Brain Injury: Implications for Rehabilitation Counselors

Traumatic Brain Injury (TBl) is complex and unique, encompassing a myriad of challenges for the person with the injury, rehabilitation counselors, and the survivor's family and friends. The challenges can affect work and family reintegration. Sustaining a TBI can result in familial strain as it affects the role and function of the individual with TBI in the family. Manifestations can include financial, psychological, and caregiver-related stress. Since individual andfamily coping mechanisms interrelate, it is important for rehabilitation counselors to appreciate theoretical constructs offamily resiliency. This article explores the rehabilitation counselor's need to assess the connectedness of family resiliency and community reintegration outcomes in persons with TBl; it also underscores the importance of evaluating family-inclusive rehabilitative interventions.

Assessing the Impact of Methadone Maintenance Treatment (MMT) on Post-release Recidivism among Male Federal Correctional Inmates in Canada

Methadone maintenance treatment (MMT) can benefit post-release outcomes for correctional populations with opioid dependence, yet few outcome data exist for Canada. This retrospective study examined return to custody (RTC) outcomes following correctional release among three samples of male federal offenders with problematic opioid use ( n = 856): offenders who continued MMT post-release (MMT-C) and offenders who discontinued MMT post-release (MMT-T) after being initiated on correctional MMT, and a non-MMT treated control group (MMT-N). MMT status was determined by community-based urinalysis; administrative data were used for outcomes. While the rate of continued MMT was lower, the MMT-C group had a 36% lower risk of RTC than the MMT-N group; RTC risk was not significantly different between the MMT-T and the MMT-N groups. Continuous MMT for correctional offenders with opioid dependence appears to be related to decreased post-release recidivism, and thus to social reintegration outcomes. Better understanding and improvement of corrections-to-community transition dynamics concerning MMT are required.

Fatherhood, Community Reintegration, and Successful Outcomes

Prior research indicates that assuming family roles, such as parent or spouse, can aid in the transition from prison to the community and has been linked to positive outcomes after a period of confinement. Using data from a longitudinal study of men returning to the community after incarceration, this study examines how the relationship between fathers and their children immediately after release may impact aspects of fathers' lives that are important to a successful reentry transition in the first year, such as employment, abstinence from substance abuse, and mental health. Analyses show that fathers who lived with children before incarceration and had regular contact with their children during their incarceration were more likely to be involved with their children after release. Moreover, fathers who were more involved with their children in the first few months after release, when interviewed again at 8 months out, worked more hours per week, were less likely to use illicit drugs, and were less likely to commit crime, get arrested, or violate conditions of their supervision.

A Theoretical Model of Co-worker Responses to Work Reintegration Processes

Emerging research has shown that co-workers have a significant influence on the return-to-work outcomes of partially fit ill or injured employees. By drawing on theoretical findings from the human resource and wider behavioral sciences literatures, our goal was to formulate a theoretical model of the influences on and outcomes of co-worker responses within work reintegration. From a search of 15 data bases covering the social sciences, business and medicine, we identified articles containing models of the factors that influence co-workers' responses to disability accommodations; and, the nature and impact of co-workers' behaviors on employee outcomes. To meet our goal, we combined identified models to form a comprehensive model of the relevant factors and relationships. Internal consistency and externally validity were assessed. The combined model illustrates four key findings: (1) co-workers' behaviors towards an accommodated employee are influenced by attributes of that employee, the illness or injury, the co-worker themselves, and the work environment; (2) the influences-behaviour relationship is mediated by perceptions of the fairness of the accommodation; (3) co-workers' behaviors affect all work reintegration outcomes; and (4) co-workers' behaviours can vary from support to antagonism and are moderated by type of support required, the social intensity of the job, and the level of antagonism. Theoretical models from the wider literature are useful for understanding the impact of co-workers on the work reintegration process. To achieve optimal outcomes, co-workers need to perceive the arrangements as fair. Perceptions of fairness might be supported by co-workers' collaborative engagement in the planning, monitoring and review of work reintegration activities.

Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street‐connected children and young people

AbstractBackgroundNumbers of street‐connected children and young people run into many millions worldwide and include children and young people who live or work in street environments. Whether or not they remain connected to their families of origin, and despite many strengths and resiliencies, they are vulnerable to a range of risks and are excluded from mainstream social structures and opportunities.ObjectivesTo summarise the effectiveness of interventions for street‐connected children and young people that promote inclusion and reintegration and reduce harms. To explore the processes of successful intervention and models of change in this area, and to understand how intervention effectiveness may vary in different contexts.Search methodsWe searched the following bibliographic databases, from inception to 2012, and various relevant non‐governmental and organisational websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and PreMEDLINE; EMBASE and EMBASE Classic; CINAHL; PsycINFO; ERIC; Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; LILACS; System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and IMF Libraries; BLDS (British Library for Development Studies); Google, Google Scholar.Selection criteriaThe review included data from harm reduction or reintegration promotion intervention studies that used a comparison group study design and were all randomised or quasi‐randomised studies. Studies were included if they evaluated interventions aimed to benefit street‐connected children and young people, aged 0 to 24 years, in all contexts.Data collection and analysisTwo review authors independently extracted data and assessed the risk of bias of included studies. Data were extracted on intervention delivery, context, process factors, equity and outcomes. Outcome measures were grouped according to whether they measured psychosocial outcomes, risky sexual behaviours or substance use. A meta‐analysis was conducted for some outcomes though it was not possible for all due to differences in measurements between studies. Other outcomes were evaluated narratively.Main resultsWe included 11 studies evaluating 12 interventions from high income countries. We did not find any sufficiently robust evaluations conducted in low and middle income countries (LMICs) despite the existence of many relevant programmes. Study quality overall was low to moderate and there was great variation in the measurement used by studies, making comparison difficult. Participants were drop‐in and shelter based. We found no consistent results on a range of relevant outcomes within domains of psychosocial health, substance misuse and sexual risky behaviours despite the many measurements collected in the studies. The interventions being evaluated consisted of time limited therapeutically based programmes which did not prove more effective than standard shelter or drop‐in services for most outcomes and in most studies. There were favourable changes from baseline in outcomes for most particpants in therapy interventions and also in standard services. There was considerable heterogeneity between studies and equity data were inconsistently reported. No study measured the primary outcome of reintegration or reported on adverse effects. The review discussion section included consideration of the relevance of the findings for LMIC settings.Authors' conclusionsAnalysis across the included studies found no consistently significant benefit for the ‘new’ interventions compared to standard services for street‐connected children and young people. These latter interventions, however, have not been rigorously evaluated, especially in the context of LMICs. Robustly evaluating the interventions would enable better recommendations to be made for service delivery. There is a need for future research in LMICs that includes children who are on the streets due to urbanisation, war or migration and who may be vulnerable to risks such as trafficking.Plain Language SummaryInterventions for reducing risks and promoting inclusion of street children and young peopleThere are millions of children and young people estimated to be living and working on the streets around the world. Many have become resilient but continue to be vulnerable to risks. To promote their best chances in life, services are needed to reduce risks and prevent marginalisation from mainstream society. Eleven studies evaluating 12 interventions have been rigorously conducted of services to support street‐connected children and youth, all in the developed world. They compared therapy‐based services with usual shelter and drop‐in services. The results of these studies were mixed but overall we found that participants receiving therapy or usual services benefitted to a similar level. There is a need for research which considers the benefit of usual drop‐in and shelter services, most particularly in low and middle income countries, and which includes participation of street‐connected children and young people. None of the studies included participants that were comparable to some street children in low income countries, who may be on the street primarily to earn a living or as a result of war, migration or urbanisation.

Interventions for Promoting Reintegration and Reducing Harmful Behaviour and Lifestyles in Street‐connected Children and Young People: A Systematic Review

Interventions for Promoting Reintegration and Reducing Harmful Behaviour and Lifestyles in Street‐connected Children and Young People: A Systematic Review

Diminished Brain Functional Magnetic Resonance Imaging Activation in Patients on Opiate Maintenance Despite Normal Spatial Working Memory Task Performance

Despite the beneficial impact on the reduction of addictive behavior, opiate maintenance therapy has been associated with negative effects on cognitive and psychomotor functioning. This may limit the outcome of behavioral strategies, rehabilitation, and reintegration into society. The objective of the study at hand was to investigate the effect of buprenorphine and methadone maintenance therapy on visuospatial working memory performance. Visuospatial working memory performance of 13 patients, receiving either methadone or buprenorphine, was investigated and compared to 13 control participants using functional magnetic resonance imaging. Altered neuronal activation was found in the patients, including brain areas associated with working memory performance and addiction. Behavioral performance on the visuospatial working memory task was similar across groups. Results indicate that there are no robust impairments of visuospatial capabilities in patients on opiate maintenance, but altered neuronal activation in working memory-related brain areas-due to chronic presence of opiates-may limit cognitive performance on complex cognitive tasks. Factors in therapeutic strategies that may support rehabilitation of patients' cognitive performance are discussed.

Issues in defining and measuring veteran community reintegration: Proceedings of the Working Group on Community Reintegration,VA Rehabilitation Outcomes Conference, Miami, Florida

In January 2010, the Department of Veterans Affairs (VA) Rehabilitation Research and Development Service convened a State of the Art (SOTA) conference to advance the field of outcome measurement for rehabilitation-related studies. This article reports on the proceedings of the SOTA Working Group on Community Reintegration. We explored the use of the International Classification of Health, Disability, and Functioning as a theoretical framework for measuring community reintegration; identified key dimensions of community reintegration that could and/or should be measured; discussed challenges in measuring community reintegration; suggested steps to enhance community reintegration measurement; proposed future research that focuses on outcomes measures for community reintegration and the study of community reintegration outcomes; and made policy recommendations that would facilitate community reintegration research within the VA.

Disarming Youth Combatants: Mitigating Youth Radicalization and Violent Extremism

In the complex of motivating variables that define the push and pull factors behind recruitment and participation in civil conflict, "radicalization"—or "violent extremism"—is not conceived as a very strong motive, as is the case with studies on terrorism. As part of disarming youth combatants,the linkages between reintegration outcomes and possible rerecruitment into radical and extremist violence must be better understood to mitigate such risks. In our analysis, the policies guiding reintegration of child soldiers and youth should be better attuned to the relationship between recruitment motivations and reintegration outcomes, and must be approached from a political lens rather than a purely technical one. The risk of radicalization and involvement in violent extremism is ultimately a structural challenge, which needs to address root causes of recruitment rather than trying to find a solution through a band-aid approach of stopgap reintegration assistance.

On selecting emotional outcomes in a rehabilitation program for persons with traumatic brain injury in Brazil.

Traumatic brain injury (TBI) is an important health problem in Brazil. It frequently results in a variety of sequelae, including cognitive, behavioral, and physical impairments that are frequently related to difficulties in community reintegration and successful rehabilitation outcomes. The literature shows that several variables are involved in positive outcomes, including neuropsychological deficits, services received, and social support. Brazil has a paucity of rehabilitation programs for persons with TBI. Intervention outcomes are underreported, and culturally adapted rehabilitation strategies are rarely found. The present study describes a rehabilitation program, presents emotional factors as an important outcome, and discusses a case that illustrates the major points debated.

Identity, Ideology and Child Soldiering: Community and Youth Participation in Civil Conflict – A Study on the Moro Islamic Liberation Front in Mindanao, Philippines

The cessation of the governmental offensive to eliminate key figures of the separatist Moro Islamic Liberation Front (MILF) in 2009 imparted fresh impetus to the peace process in Mindanao, Philippines. Recent clashes have resulted in large-scale and ongoing displacement. This stalemate, together with the end of Gloria Macapagal Arroyo's Presidential term, has revived concerns about the future dynamics of the Bangsamoro struggle. An important dimension in this is the ‘voluntary’ nature of the participation of children and young people in the ranks of the MILF, sanctioned and often encouraged by their families and community. This presents an interesting contrast to the predominant literature on child soldiering that seems overly aligned with the coercive recruitment and related trauma-healing axis. In this article we examine the role of identity, ideology, the family and community in this presumed voluntary participation of children and youth in the MILF, in order to refine the linkage between recruitment experience of children and youth and their reintegration outcomes, and prescribe more appropriate reintegration interventions for youth in scenarios of participation sanctioned by family and community.

Reintegration Success and Failure: Factors Impacting Reintegration Among Incarcerated and Formerly Incarcerated Women

Criminologists have explored the reentry experience of formerly incarcerated adults, documented the pressing challenges of reentry, the correlates of recidivism, and the causes of desistance. Given scholars' focus on reentry to explain what factors impact criminal outcome, this raises the interesting question of whether and how such factors shape the process and outcome of reintegration. The current study uses official records and survey and in-depth interviews of 50 current and formerly incarcerated women to assess their accounts of what shapes reintegration success and failure. Results highlight the utility of an intragender approach and have import for policy aimed at women.

An Exploration of Factors Reducing Recidivism Rates of Formerly Incarcerated Youth with Disabilities Participating in a Re-Entry Intervention

Juvenile offenders are costly to our society in terms of the monetary and social expenditures from the legal system, victims’ person costs, and incarceration. The re-entry and community reintegration outcomes for formerly incarcerated youth with a disabling condition are bleak compared to peers without disabilities. In this study, we examined the factors––both static and intervention-related––that reduce recidivism rates for project participants possessing a mental health and/or special education diagnosis and were served by a facility-to-community re-entry intervention. Our sample was comprised of a total of 320 youth formerly incarcerated who received project services between August of 1999 through June of 2004. Project services include a transition specialist whose role is service coordination to youth from the facility to the community. Kaplan–Meier survival functions were calculated for participants on the outcome measure of the rates of recidivism. Additionally, Cox regression modeling was used to identify factors for the prediction of time to recidivate. Our findings indicate that the intervention may contribute to reduced recidivism rates but that a set of static demographic and pre-incarceration risks contribute more to the prediction of recidivism than community adjustment factors (e.g., employment or enrollment). With these findings, the intervention seems promising yet it remains unclear about which programmatic features contribute to reduced recidivism rates. Implications for research and practice are shared.

Community Reintegration Outcomes for Formerly Incarcerated Adolescent Fathers and Nonfathers

This article examines the community reintegration outcomes for adolescents with co-existing behaviors associated with juvenile offending and fatherhood. Data were gathered from the Transition Research on Adjudicated Youth in Community Settings (TRACS) research project, a 5-year prospective, longitudinal examination of outcomes for incarcerated juvenile offenders as they transitioned from youth correctional facilities back into the community. Of the TRACS sample, 125 (28.3%) of the participants reported that they had become fathers before their 20th birthday. Juvenile offenders who were fathers were found to return to the juvenile correctional system at a higher rate than nonfathers (59.4% to 47.5%) within 12 months of initially leaving that system. Fathers who remained in the community were (a) more than 3 times more likely to be employed within 6 months of exit and (b) more than 2.5 times more likely to use community resources over an 18-month period as compared with fathers who returned to custody. The results provide support for the development of interventions connecting these high-risk individuals with employment and community services immediately upon exit from the youth correctional system.

Influences on the Process of Work Integration: The Consumer Perspective

Despite evidence confirming the value of employment in promoting and maintaining mental health, efforts aimed at work integration of mental health consumers have met with limited success. Using qualitative research methods, this study explores the consumer perspective on factors influencing the process of employment integration. A sample of five consumers of the mental health system who were employed at the time of the study was used. Two data collection instruments, a semi-structured interview and demographic questionnaire, were utilized. The study draws on grounded theory (i.e., the constant comparative method of analysis) including unitizing, categorizing, and forming themes to process the data. Descriptive statistics were used to analyze demographic information. Four themes emerged from the data: (a) the importance of recognizing the mind-body connection, (b) the relationship of personal empowerment to work reintegration, (c) the need for skills and supports, and (d) the relationship of the work environment to the outcome of work reintegration.