Rural Units Research Articles

P27 - MGP - the answer to sustainable rural maternity services in Victoria. The Journey from a service perspective

For anyone with a knowledge and passion for Midwifery Group Practice (MGP) the answer to a sustainable rural maternity service seems simple. We know that continuity of care improves outcomes for birthing families but for smaller services it can also be the key to sustainability. Existing models of rural maternity care with the dual expectations of nurse/midwives are problematic, by changing the way midwives work to a caseload model of care through the implementation of MGP, rural maternity services are better able to recruit and retain midwives as well as respond to increased consumer demand for continuity of midwifery care. This presentation reflects on the experience of several health services in regional Victoria at different stages of their journey towards sustainable maternity care. These rural units are reinvigorating their maternity services by introducing MGP. This discussion looks at the journey towards MGP from the perspective of multiple services with the hope that sharing learnings will lay a better foundation for others to build on. As part of this discussion we will focus on the journey to change. The importance of collaborative partnerships with higher level services will be highlighted, not only for women with identified risk, but for improved quality, safety and governance. The value of midwives maintaining continued exposure to complex care for midwives working in low volume birthing units will also be discussed along with the industrial challenges that change brings. With the understanding that MGP offers greater sustainability for rural maternity services and the knowledge that continuity of carer is highly desired by women and has better outcomes for all women but particularly for some of the very vulnerable women and families in these disadvantaged rural communities is it time to look at the framework that surrounds the introduction of these models and for greater departmental and industrial support and reform?

Protocol: the complexity of informal caregiving for Alzheimer's disease and related dementias in rural South Africa.

With aging, many people develop Alzheimer's disease or related dementias (ADRD) as well as chronic physical health problems. The consequent care needs can be complicated, with heavy demands on families, households and communities, especially in resource-constrained settings with limited formal care services. However, research on ADRD caregiving is largely limited to primary caregivers and high-income countries. Our objectives are to analyse in a rural setting in South Africa: (1) how extended households provide care to people with ADRD; and (2) how the health and wellbeing of all caregivers are affected by care roles. The study will take place at the Agincourt health and socio-demographic surveillance system site of the MRC/Wits Rural Public Health and Health Transitions Research Unit in Mpumalanga Province, northeast South Africa. We will recruit 100 index individuals predicted to currently have ADRD or cognitive impairment using data from a recent dementia survey. Quantitative surveys will be conducted with each index person's nominated primary caregiver, all other household members aged over 12, and caregiving non-resident kin and non-kin to determine how care and health are patterned across household networks. Qualitative data will be generated through participant observation and in-depth interviews with caregivers, select community health workers and key informants. Combining epidemiological, demographic and anthropological methods, we will build a rich picture of households of people with ADRD, focused on caregiving demands and capacity, and of caregiving's effects on health. Our goal is to identify ways to mitigate the negative impacts of long-term informal caregiving for ADRD when formal supports are largely absent. We expect our findings to inform the development of locally relevant and community-oriented interventions to improve the health of caregivers and recipients, with implications for other resource-constrained settings in both higher- and lower-income countries.

Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study.

Dysphagia refers to swallowing difficulty, which impacts patients’ quality of life. Dysphagia influences clinical outcomes, including mortality rates and length of hospital stay of older hospitalized patients. Dysphagia may affect the current and future quality of life of these patients. However, its exact impact remains unclear. We aimed to clarify the impact of dysphagia on discharge to home in older patients in a rural rehabilitation unit. We conducted a secondary analysis using data from a retrospective cohort study including patients aged over 65 years who had been discharged from a community hospital rehabilitation unit in rural Japan. Data from the participants had been previously collected from April 2016 to March 2020. The primary outcome was home discharge. The average participant age was 82.1 (standard deviation, 10.8) years; 34.5% were men. Among medical conditions, brain stroke (44.3%) was the most frequent reason for admission; the most frequent orthopedic condition was femoral fracture (42.9%). The presence of dysphagia (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.20–0.73), polypharmacy (OR = 0.5, 95% CI: 0.32–0.90), and admission for internal medicine diseases (OR = 0.44, 95% CI: 0.26–0.77) were negatively associated with home discharge. High motor domain scores of the Functional Independence Measure were positively associated with home discharge (OR = 1.07, 95% CI: 1.05–1.08). Dysphagia was negatively associated with home discharge as were polypharmacy and admission for internal medicine diseases and conditions. By clarifying effective interventions through interventional studies, including approaches to managing multimorbidity and polypharmacy through interprofessional collaboration, the health conditions of older patients in rural areas may be improved.

Hexaconazole poisoning - An uncommon poisoning incidence in rural tertiary care and our experience

Acute pesticide poisoning is a very common in rural India. The pesticides used in the agriculture are major contributors in poisoning either intentiaonal or accidental. Poisoning itself is a major global concern. Hexaconazole is not as common poison in India and very few cases are reports. We report a rare case of hexaconazole poisoning and its successful management in rural tertiary care unit.

Pregnancy with COVID-19-related severe ARDS: A case report from rural critical care unit in India

Acute Respiratory Distress Syndrome (ARDS) can frequently occur as a complication of Coronavirus Disease 19 (COVID-19). As a result of the increasing number of COVID-19 cases around the world, it is inevitable that ARDS will complicate some pregnancies with COVID-19. At present, there are scarce data to guide decision-making on the timing of delivery for these patients. We present a case of a pregnant woman at 30 weeks gestation with COVID-19-related ARDS, who was successfully managed with lung protective strategies for mechanical ventilation and early delivery by cesarean section in the rural critical care setting.

Custo de um município do sul do Brasil com medicamentos de uso contínuo dispensados na Atenção Primária à Saúde

Objetivo: Avaliar o custo com medicamentos básicos de uso contínuo de usuários da Atenção Primária em Saúde de Santa Rosa-RS. Métodos: Estudo transversal e analítico realizado em um município do noroeste do Rio Grande do Sul. Foram incluídos usuários cadastrados nas 17 unidades de estratégia de saúde da família, das áreas urbana e rural, em uso de no mínimo um medicamento de uso contínuo. A coleta de dados foi realizada pelo acesso ao sistema informatizado de prescrição eletrônica. Resultados: Foram incluídos 642 usuários, com idade média de 60,40 anos, sendo 64,3% mulheres. Identificou-se média de 4,68 ± 2,82 medicamentos/prescrição e 47,4% ± 14,48 dos usuários em uso de cinco ou mais medicamentos. Dos medicamentos em uso, 87,9% pertencem ao componente básico da assistência farmacêutica. O custo anual do município por usuário de medicamento foi em média de R$ 250,60. O sistema cardiovascular foi o grupo anatômico com maior custo total. Verificou-se maior frequência de uso de medicamentos entre os idosos, que consequentemente representam o grupo etário com maior custo de tratamento. Conclusão: Evidenciou-se que a maioria dos medicamentos prescritos atua sobre os sistemas cardiovascular e nervoso, e pertence ao componente básico da assistência farmacêutica. O custo com medicamentos demonstrou investimento do município de valores 25 vezes maiores do que o mínimo estabelecido pela legislação vigente, com vistas a garantia de acesso ao tratamento e manutenção da qualidade de vida da população assistida.

Drug addiction in the academic performance of high school students in a rural educational unit

The impact of drug addiction on the academic performance of high school students from the Braulio Hidalgo Loor Educational Unit, Rio Venda-Chone site, is presented, a situation that occurs due to poor performance in the subjects, showing little interest because of their studies, and consequently low grades, which has generated learning problems, in this sense it is an investigation contextualized with reality, and that is added to what is happening in Ecuador. A quantitative study was carried out, and the use of scientific research methods such as inductive-deductive, analytical, and synthetic, for which interviews and surveys of parents, teachers and students were used, the sample being generalized. The result was that poor academic performance is because many young people consume narcotic substances, neglecting their studies and showing little interest in schoolwork, which has led to the concern of parents and teachers.

To study the incidences of needle stick injury among critical care nurses working in rural tertiary care hospital

Needle-stick injuries (NSIs) are a hazard for nursing staff and public health. Nursing workers are at high risk for occupational exposure to blood-borne pathogens via sharp injuries of the needle-stick. Needle-stick injuries (NSIs) are described as penetrating wounds caused by a device that is contaminated with another person’s body fluids. Needle-stick injuries are injuries acquired by needles like -scalp vein needles, hypodermic needles, blood sample collection needles, intracath stylets, lumbar puncture needles used to connect parts of IV delivery systems. Needle-stick injuries (NSIs) form a medium for the transmission of bloodborne infections. Strict use of personnel protective equipment while working in the hospital should be made compulsory. To study incidences of needle stick injury among nurses working in Rural tertiary care Unit, Loni. Ethical approval for this study was obtained from the Institutional Ethical Committee. Seventy-six nurses, who fulfilled inclusion criteria were included and data was obtained through survey. This study involves 76 nursing staff. Of them all, 27(35.5%) nursing staff experienced NSIsThe administration of medication was common action that caused most of needle-stick injuries mentioned by 14 (18.4%) nursing staff. IV cannula was the device that caused many needle-stick injuries reported by 17 (21.1%) nursing staff. Thenursing professionals are the main key players in both elective and emergency situations. There is a quite higher incidence of needle stick injury among critical care nurses. This might be due to handling of emergency cases and attempting to secure the intravenous line or to deliver the medications. Creating awareness and training appropriately is mandatory for critical care nurses.

Examining the Ratio of Obstetric Beds to Births, 2000-2019.

The number of U.S. births has been declining. There is also concern about rural obstetric units closing. To better understand the relationship between births and obstetric beds during 2000-2019, we examined changes over time in births, birth hospital distributions (i.e., hospital birth volume, ownership, and urban-rural designation), and the ratio of births to obstetric beds. We analyzed American Hospital Association Annual Survey data from 2000 to 2019. We included U.S. hospitals with at least 25 reported births during the year and at least 1 reported obstetric bed. We categorized birth volume to identify and describe hospitals with maternity services using seven categories. We calculated ratios of number of births to number of obstetric beds overall, by annual birth volume category, by three categories of hospital ownership, and by six urban-rural categories. The ratio of births to obstetric beds, which may represent need for maternity services, has stayed relatively consistent at 65 over the past two decades, despite the decline in births and changes in birth hospital distributions. The ratios were smallest in hospitals with < 250 annual births and largest in hospitals with ≥ 7000 annual births. The largest ratios of births to obstetric beds were in large metro areas and the smallest ratios were in noncore areas. At a societal level, the reduction in obstetric beds corresponds with the drop in the U.S. birth rate. However, consistency in the overall ratio can mask important differences that we could not discern, such as the impact of closures on distances to closest maternity care.

Self-efficacy, stress levels and daily style of living among older patients with type 2 diabetes in a rural primary care setting: a cross-sectional study.

AimsTo identify to what extent stress and self-efficacy may be associated with specific features in the elderly with type 2 diabetes, such as lifestyle habits, multi-morbidity, sleep quality and duration, and treatment regimen.MethodsA cross-sectional study of 92 out of 103 recruited patients ≥65 year old with a diagnosis of type 2 diabetes was conducted at a rural primary care unit in Northern Greece. The General Self-Efficacy Scale (GSES), the Short Anxiety Screening Test (SAST) and an original questionnaire to assess health habits and disease monitoring information were completed after structured personal interviews.ResultsIn the multiple linear regression analysis, patients with higher education, with more night sleeping hours and physical exercise weekly had a higher GSES score than their counterparts (p<0.05). Stress levels assessed with SAST were shown mostly associated with poor sleep quality, fewer days of meat and legumes consumption, increased body mass index and multi-morbidity (p<0.05), as emerged from the multiple linear regression analysis. Glycemic control in the elderly does not have a significant correlation with stress levels or general self-efficacy.ConclusionsSelf-efficacy and stress levels are not predictors for glycemic control, but can indirectly be seen as co-determinants, contributing to the overall daily life quality among patients with diabetes. Mental health well-being, expressed by higher self-efficacy and less stress scale rating, showed positive interferences with eating, sleep and daily life attitudes among elderly with diabetes.

Catching up with rapid technology implementation: mobilities, electronic medical records, and primary care work in the Philippines

ABSTRACT There is an increasing demand for the rapid implementation of technologies that can address persisting and evolving needs of the health sector. However, to make technologies work in local health settings, a mutual alignment between technologies and local context is needed. Despite existing scholarship on health technology implementation, few have examined how human and non-human actors move towards technology implementation. Using the mobilities lens, we explore how healthcare providers negotiated the varied and conflicting movements of human and non-human entities in health technology implementation. We draw our findings from the experiences of Filipino primary care workers in implementing electronic medical records (EMR) in rural health units. We argue that conflicting speeds of mobilities make visible the workarounds employed by healthcare providers. These workarounds provide spaces for technology users to perform their routine practices and spaces for technologies to perform its work. Furthermore, we show how attention to mobility and speed reveals how preoccupation with fast-tracked, rapid intervention implementation may undermine the value of technologies in the practice of their intended beneficiaries. We conclude this article by discussing how a focus on mobility can further complicate the discussion on health technology implementation.

Village‐level livelihood security: A case study on a wasteland‐dominated forest fringe region of rural India

AbstractThe majority of the Indian population lives in rural areas, and the livelihood security of a wasteland‐dominated and forest‐fringe region in rural India is mostly dependent on primary economic activities. Under this backdrop, understanding the spatial pattern of livelihood security is essential for reducing poverty (Sustainable Development Goal 01) and eradicating spatial inequality in socio‐economic conditions (SDG 10). The study focuses on estimating the magnitude of livelihood security by combining the availability of natural resources, housing, drinking water, and sanitation facilities, economic condition, socio‐cultural condition, and availability of assets using the Analytical Hierarchical Process (AHP) at the village level. The villages situated along the riverside (Shilabati River) of the north‐eastern part revealed a higher degree of livelihood security, whereas forest‐ and wasteland‐dominated central and south‐western parts exhibited a lower level of livelihood security. This demarcation of villages or rural units may help policymakers to frame adequate, sustainable, inclusive micro‐level policies, enhancing socio‐economic sustainability and livelihood security as well as reducing spatial inequality.

Regional estimates of noncommunicable diseases associated risk factors among adults in India: results from National Noncommunicable Disease Monitoring Survey

BackgroundThis study describes regional differences and determinants on key noncommunicable disease (NCD) risk factors in adults from the National NCD Monitoring Survey (NNMS) across six geographic regions of India.MethodsThe NNMS was a cross-sectional multistage cluster survey conducted in 2017–18, on a representative sample of 300 urban and 300 rural primary sampling units (PSU) covering 20 households per PSU. One adult aged 18–69 years per household was selected using the KISH grid. Globally standard survey tools were adapted for data collection. To arrive at regional estimates, the country was divided into six regions (south, north, central, west, east and northeast) based on the distribution of a national sample. The results are presented as proportion with 95% confidence intervals (CI). Univariable and multivariable logistic regression analyses were performed to identify NCD risk factor determinants significant in the regions. A p-value < 0.05 was considered for statistical significance.ResultsThe overall survey response rate was 96.3%. The prevalence of current tobacco (45.7%) and alcohol use (22.3%) was significantly high in the northeast region. The highest proportion of adults from northern India showed low levels of physical activity (49.6%). The prevalence of metabolic risk factors — obesity (12.5%), raised fasting blood glucose (21.2%) and raised blood pressure (35.6%) was highest in south India. The prevalence of raised blood pressure was high in north India (35.2%) similar in proportion to south India. Clustering of ≥3 risk factors (50.1%) and ten-year CVD risk of ≥30% or with existing CVD (18.1%) was highest in south India when compared to other regions. Older age, urban residents, alcohol consumption and overweight/obesity were significantly associated with higher odds of raised blood pressure and raised fasting blood glucose.ConclusionThe NNMS presents variations in NCD risk factors within the regions of India. It contributes to robust evidence for strengthening interventions and monitoring the progress in reducing NCDs and their associated risk factors.

Challenges Faced by Dialysis Unit Staff During COVID-19 Times: A Qualitative Study

Background: The Coronavirus has caused an epidemic affecting the whole world for the last two years and has been spreading steadily. The hemodialysis patients are at high risk because of their lowered immunity status. The dialysis staff is also at higher risk of contracting COVID-19 as these patients come for twice/thrice weekly treatment sessions. Objectives: This study was done to study the hardships and problems afflicting the dialysis staff during the infections caused by COVID-19 in a rural hemodialysis unit. Methods: This study setting was the hemodialysis unit located in a rural hospital in Pondicherry, India. Free listing and pile sorting were done to study the structure and salient problems as felt in the cognitive domain by the dialysis team. Smith's S value was calculated for a free listing. Multidimensional scaling and cluster analysis were conducted to do pile sorting of data. Data were analyzed using Anthropac 4.983/X. Group interviews were carried out to get in-depth information and validate the findings obtained from the free list and pile sorting exercise. Results: Twelve salient items were obtained from the free list. Three broad domains emerged: the absence of personal safety, shortage of personal safety equipment, and presence of logistical and operational problems. Surprisingly, RT-PCR testing was not perceived to be of importance for them. Conclusions: Accepting the true feelings, fears, and needs of the dialysis staff, helping to tackle the impediments to personal safety, and the lack of personal safety equipment in a dialysis unit during COVID-19 outbreak are vital in ensuring personal safety and improving working dynamics.

Android Application For Handcrafts Goods

The goal of this project is just to create a model that will assist craftsmen in selling their services. Our app gives a platform to the sellers that they can give their information about product details and their delivery service. The main goal of our app is to help sellers as Handicraft’s people face many issues to sell their products. Indian artisans, typically manufactured by rural craftsmen, exude a certain charm of their own handiwork that has always been praised around the world for its vibrant colour schemes and fine craftsmanship. Rural units, often known as cottage industries, create 78.2percent of all crafts grown in the country. They represent the artistic representation of the producers, both women and men, and are grounded in India's traditions and social history. Around 77percent of artisans are self-employed, with the rest 23% working as daily workers. They must rely on exhibitions, tourism seasons, and the weather to make a living. But based on present pandemic situations one should follow the safety precautions as well as government guidelines so, it is impossible to run the exhibitions in large crowds. so that handicrafts men face several issues to sell their products. so by using our app they can sell their goods in a friendly way. It is a platform where a seller can sell his products on his own and there is no third-party involvement directly; the profit will be taken by the seller.

Emergency care of sepsis in sub-Saharan Africa: Mortality and non-physician clinician management of sepsis in rural Uganda from 2010 to 2019.

IntroductionLittle data exists from sub-Saharan Africa describing incidence and outcomes of sepsis in emergency units and uncertainty exists surrounding optimal management of sepsis in low-income settings. There exists limited data regarding quality care metrics for non-physician clinicians trained in emergency care. The objective of this study was to describe changes in septic patients over time and evaluate associations between sepsis care and mortality.MethodsSecondary analysis of a prospective cohort of all consecutive patients seen from 2010–2019 in a rural Ugandan emergency unit staffed by non-physician clinicians was performed using an electronic database based on paper charts. Sepsis was defined as suspected infection with a quick Sequential Organ Failure Assessment score (qSOFA)≥1. Multi-variable logistic regression was used to analyze three-day mortality.ResultsOverall, 48,653 patient visits from 2010–2019 yielded 17,490 encounters for patients age≥18 who had suspected infection, including 10,437 with sepsis. The annual proportion of patients with sepsis decreased from 45.0%% to 21.3% and the proportion with malarial sepsis decreased from 17.7% to 2.1% during the study period. Rates of septic patients receiving quality care (“both fluids and anti-infectives”) increased over time (21.2% in 2012 to 32.0% in 2019, p<0.001), but mortality did not significantly improve (4.5% in 2012 to 6.4% in 2019, p = 0.50). The increasing quality of non-physician clinician care was not associated with reduced mortality, and treatment with “both fluids and antibiotics” was associated with increased mortality (RR = 1.55, 95%CI 1.10–2.00).ConclusionThe largest study of sepsis management and outcomes ever published in both Uganda and sub-Saharan Africa showed sepsis and malarial sepsis decreasing from 2010 to 2019. The increasing quality of non-physician clinician care did not significantly reduce mortality and treatment with “both fluids and antibiotics” increased mortality. With causal associations between antibiotics and mortality deemed implausible, associations between sepsis mortality and interventions likely represent confounding by indication. Defining optimal sepsis care regionally will likely require randomized controlled trials.

IsiPAN (Isinusulong ang Psychiatry At Neurology): Kalusugan ng Diwa, Utak at Kaisipan tungo sa malusog na Pamayanan at Kinabukasan. A Community-Based Mental Health Program

Currently, mental health issues are of greatest importance to society as it is considered to be a growing invisible pandemic. It is strongly suggested to address concerns in the field of neurology and psychiatry, especially at the community level. One of the most popular interventions that the World Health Organization (WHO) recommends is to bring health promotion to the periphery. With this in mind, a public health campaign in one of the University of Santo Tomas Simbahayan partner communities, Kasiglahan Village Rodriguez, Rizal was born. This project aims to bring health awareness to the community, especially at the grassroots levels involving the municipal rural health unit, barangay health care workers and allied specialist stakeholders. They were taught symptom recognition, proper referral to specialists and prevention measures that the community may benefit from, which is much needed at this day and age. Further, this program can serve as a precursor to more public health initiatives regarding mental health in the community to spread awareness and aid in the prevention of mental health illnesses. Keywords: mental health community-based program, public health program

Association Between Medicaid Expansion And Closure Of Hospital-Based Obstetric Services.

Access to obstetric services has declined steadily during the past decade, driven by the closure of hospital-based obstetric units and of entire hospitals. A fundamental challenge to maintaining obstetric services is that they are frequently unprofitable for hospitals to operate, threatening hospital viability. Medicaid expansion has emerged as a possible remedy for obstetric service closure because it reduces uncompensated care and improves hospital finances. Using national hospital data from the period 2010-18, we assessed the relationship between Medicaid expansion and obstetric service closure in rural and urban communities. We found that expansion led to a large reduction in hospital closures; however, this effect was concentrated among hospitals that did not have obstetric units. Considering closure of obstetric units, we found that rural obstetric units were less likely to close immediately after expansion, but this effect faded within two years. Overall, our findings suggest that Medicaid expansion had little effect on the closure of obstetric services. Policies supporting access to obstetric care may need to directly address the financial challenges specific to this service line.

Formation of System of Medical Institutions in Tobolsk North in XIX — Early XX Centuries

The history of the creation and development of the system of medical institutions on the territory of the Tobolsk North (within the modern borders — the Khanty-Mansiysk and Yamalo-Nenets Autonomous Okrugs) in the pre-revolutionary period is studied. It is noted that since the mid-1830s, a network of medical centers has been organized in the region: three hospitals, up to a dozen paramedical stations, medical barracks in fishing fields and steamship piers. The state played the main role in this. It financed medical institutions, provided personnel, necessary equipment and medicines, regulated activities through legislation and by-laws, and controlled the organization of medical care by entrepreneurs. Particularly rapid growth in the network of hospitals and feldsher stations was observed at the end of the 19th and beginning of the 20th centuries, which was facilitated by the involvement of the region in market relations, the intensification of the resettlement process, and the implementation of the legislative act of May 10, 1888 “On the arrangement of a rural medical unit in the provinces of Tobolsk and Tomsk”. It is indicated that in matters of providing medical care, the indigenous population was in a privileged position in comparison with the Russians, since they received it free of charge. Difficulties in creating a system of modern medical institutions in the Tobolsk North were noted: a shortage of personnel not only for doctors, but also for paramedical personnel, especially in rural areas; the extreme dispersion and rarity of villages, which made it difficult to regularly monitor the health of local residents, the slow pace of modernization. It is concluded that the opinion about the extremely low level of development of medicine in the region is not fully fair.

An implementation and effectiveness study evaluating Conflict Analysis in VA residential substance abuse services: Whole Health informed self-guided online care

ContextWhole Health is an emerging healthcare framework that emphasizes wellbeing in place of illness. Conflict Analysis (CA), an online self-guided assessment, leverages innovative diagnostic and therapeutic resources that shares Whole Health objectives, including helping users explore their identity and develop a personalized health plan and helping users develop resources to optimize their health. ObjectivesPaper presents CA implementation-effectiveness study in a Veteran Affairs inpatient substance recovery care. DesignPatients were randomized to CA or mindfulness control. Patients completed Whole Health outcomes measures at baseline, completion (post), and three-week follow-up. Interventions took 2.5 h. Attending psychologist assessed CA protocols and completed outcome evaluation. Due to Coronavirus, recruitment and follow-up were curtailed. SettingStudy took place in a rural northern New England Veteran Affairs inpatient substance recovery unit. Outcome MeasuresMeasures include The Personal Growth Initiative Scale, The Beck Cognitive Insight Scale, Perceived Stress Scale, The Patient Health Questionnaire, Perceived Psychological Wellbeing, and Perceived Therapeutic and Diagnostic Benefit. Results12 patients were randomized, 11 completed post measures (CA=5; Mindfulness = 6), and 7 completed follow-up measures (CA=3; Mindfulness=4). CA offered significant Whole Health benefits when compared to control. Additionally, participant and clinician evaluations indicated that CA can be personally relevant, meaningful, and motivate therapeutic growth. Implications include extending CA research and expanding Whole Health related interventions. Although initial results suggest implementation feasibility and Whole Health benefit, more research is necessary to establish CA's utility within inpatient substance recovery care in particular and psychiatric rehabilitation in general.