Six-week Program Research Articles

Developing a Spatial-Skills-Focused Music Program for Older Adults With Changes in Cognition

Older adults with cognitive changes need stimulating programming to maximize their cognitive abilities. One area to maximize includes spatial skills, its decline can lead to disorientation and wandering. Music has potential to maximize spatial skills: reading music’s notation is associated with enhanced spatial skills in children and professional musicians. It’s critical to understand the potential impact of a spatially focused music program for older adults with changing cognition; if successful, future music programs could support people staying orientated in their environments and living independently longer. We developed and assessed a six-week marimba program focused on reading music with 15 older adults ages 65-89 with changes in cognition. We compared their scores on the Orientation Test from the Test of Visual Perceptual Skills pre- and post-intervention and assessed if participants self-selected to read music notation. Participants scored an average Modified Mini Mental State Examination (3MSE) score of 81.3 (SD = 11.0). On average, participants’ scores on the Orientation Test moved from 13.4 (SD =1.9) to 14.1 (SD= 2.7), providing a cohen’s d effect size of 0.3. Over the six weeks, 11 out of the 15 participants selected to read music for at least one class, indicating a statistically significant change using the Wilcoxon signed-rank test (Z = -3.16, p < 0.01), suggesting that older adults with cognitive changes may be able to learn to read music. This is important, as a spatially focused music program may maximize spatial skills that older adults need to successfully navigate their world safely and independently.

Functional improvement related to enrolment in a Parkinson's disease rehabilitation program.

Parkinson's disease (PD) is a progressive neurodegenerative disorder with manifestations such as tremors, rigidity and bradykinesia. The objective of this study was to evaluate the efficacy of outpatient multidisciplinary rehabilitation. 179 patients participated in the six-week program. The following outcomes were measured: Timed Up and Go (TUG), sit to stand five times (STSx5) and in 30 seconds (STS30), six minute walk distance (6MWD) and gait velocity (6MWV), MOCA, bilateral grip strength, 360-degree turn (360 R, 360 L) and bilateral nine hole peg test. Pre- and post- data was analyzed via paired t-tests. Multiple regression was used to determine age- or gender-affected outcomes. Patients showed a statistically significant improvement (p < 0.05) in all outcomes. Mean TUG improved by 1.63 seconds (s), STSx5 by 4.19s, STS30 by 2.37 repetitions, 6MWD by 66.8 metres, 6MWV by 0.15 m/s, MOCA by 1.50 points, 360 R by 1.17s, 360 L by 1.60s, Grip R by 0.78 kg, Grip L by 0.95 kg, 9HP R by 1.71s and 9HP L by 1.58s. Gender had no influence. Age was a statistically significant predictor in STSx5 and 6MW. An outpatient multidisciplinary program successfully decreased motor impairment and increased overall functional independence in PD.

A Comparison of the Effects of a Six-Week Traditional Squat and Suspended Load Squat Program in Collegiate Baseball Players on Measures of Athletic Performance

Background: Acute studies suggest that resistance training with an unstable load suspended from the barbell increases core muscle activation with negligible detrimental effects on phasic muscle activation and force production compared to traditional barbell loading, but the effect of a suspended load program on athletic performance is unclear. Objective: The purpose of this study was to assess the effect of a six-week program where the back-squat was performed with a suspended load (SL) on vertical jump (VJ), change of direction ability (COD), single-leg balance, and one repetition maximum squat load (1RM). Methods: Thirty-two collegiate baseball players (20.4 ± 1.4 y, 86.0 ± 11.0 kg, 1.82 ± .065 m) were assigned to perform the back-squat with SL or traditional loading (CON). Additional exercises were done with traditional loading. Athletes completed VJ, T-tests to measure COD, star excursion balance test (SEBT) to measure single-leg balance, and 1RM PRE and POST program. A MANOVA was used to assess the dependent variables. Significance was set to p &lt; .05. Results: Effect of group × time (p = .152) and group (p = .095) were not significant, indicating CON and SL had similar performance. Effect of time (p &lt; .0001) was significant, suggesting POST performance improved relative to PRE. When groups were pooled, 1RM (p &lt; .0001) and T-test (p = .038) improved, but VJ (p = .255) and SEBT (p = .167) did not improve. Conclusion: Performing squats with SL does not appear to be detrimental to development during a six-week program.

Evaluation of a COVID-influenced Curriculum to Address Food Insecurity in a Detroit Family Medicine Residency Clinic

CONTEXTTo date, numerous projects have demonstrated that an ongoing limited access to nutritionally dense food (i.e., “food insecurity”) plays a key role in the overall health and wellbeing of lower income at-risk populations.METHODSFor this 2019-2020 pilot project, the resident physician authors first created and administered a simple five-item questionnaire screening process to systematically identify food insecure patients in their metropolitan Detroit residency clinic. A sample of patients who had been identified as food insecure and pre-diabetic were then provided improved access to healthy foods, supplemented by a six-week program of nutritional education classes using a nationally recognized “Cooking Matters’’ six-week long curriculum with a licensed chef and nutrition educatorRESULTSAfter institutional review board approval, the authors enrolled a sample of 10 adults. The authors successfully measured both pre- and post-program Hemoglobin A1c (HbA1C) levels for all participants who completed the required course and subsequent clinic follow up visits. Using a series of initial non-parametric Wilcoxon Signed Rank matched pair tests, post-program follow-up at three months revealed statistically significant reductions in documented HbA1c levels from baseline for six enrolled patients (W=1, Z = - 2.226, p = 0.026) and six-month follow up (i.e., more than four months after completion of the program) (W = 1, Z = - 2.060, p = 0.039). In post-program surveys, each respondent indicated that they found the class content to be generally beneficial to increase their nutritional knowledge.CONCLUSIONSIn the authors’ setting, this food insecurity program has subsequently led to a more formal screening process to evaluate and identify food insecure patients. The authors discuss the scheduling difficulties they experienced from the COVID-19 pandemic for their sample patients. However, these pilot results suggest that prolonged benefits may require ongoing “virtual” teaching sessions with pre-diabetic patients to address the complex factors influencing food insecurity levels identified in similar inner-city settings.

Effect of Bright Light Therapy on Depressive Symptoms in Middle-Aged and Older Patients Receiving Long-Term Hemodialysis.

Depressive symptoms are common psychiatric comorbidities among individuals receiving long-term hemodialysis. The aim of this two-arm parallel design study is to assess the effects of bright light therapy (BLT) on depressive symptoms among middle-aged and older adults receiving long-term hemodialysis. Study participants are recruited using convenient sampling from four dialysis clinics in eastern Taiwan. The eligible participants are block-randomized to either the BLT group (n = 30), with 30 min sessions of BLT five times a week for six weeks at their own home, or to the routine care control group (n = 30). The Beck Depression Inventory-II (BDI-II) scores and the salivary cortisol levels are obtained from the participants at three time points: baseline (T0), week 3 (T1), and week 6 (T2). The results, from the generalized estimating equations, indicate that the decline in the BDI-II scores over time is significant in the BLT group at T1 (β = −7.57, p < 0.001) and at T2 (β = −6.20, p = 0.002) compared to the control group. The decrease in salivary cortisol levels at each visit is also significant in the BLT group at T1 (β = −7.37, p = 0.017) and at T2 (β = −12.22, p = 0.005) compared to the control group. Our findings support the hypothesis that a six-week program of BLT is able to alleviate depressive symptoms in middle-aged and older patients who receive long-term hemodialysis.

Real-World Utilization and Outcomes of the Veterans Health Administration's Smoking Cessation Text Message Program.

Smoking cessation mobile health (mHealth) programs are effective and have been recommended for integration into health care services but have not been evaluated in real-world health care settings. The Veterans Health Administration, a safety net health care provider, provides health care for 9 million US military veterans. Veterans Health Administration implemented the SmokefreeVET text message program in 2013. A retrospective evaluation of 6153 SmokefreeVET subscribers was conducted. The primary outcome was 30-day self-reported abstinence at 6 months. Secondary outcomes included percentage of opt outs, program completers, and 30-day self-reported abstinence at 3 months. SmokefreeVET subscribers were on average 47.5 years old and 71.4% male. Smoking cessation medication use was reported by 11.5% of subscribers at the start of their quit attempt and subscribers enrolled in the program for an average of 29 days. Subscribers who were younger, female, and heavier smokers were more likely to opt out of the six-week program early. The abstinence rate for the primary outcome, self-reported 30-day abstinence at 6 months among all subscribers was 3.7%. SmokefreeVET enrolled a younger and more female population of subscribers than other studies of veterans interested in tobacco treatment. The mHealth program was generally acceptable to veterans, yet strategies to increase retention may improve completion rates and outcomes. In this real-world setting, nearly half of the mHealth program subscribers combined use of the text program with smoking cessation medication. Further study of the optimal combination of mHealth with smoking cessation treatments is needed. mHealth smoking cessation programs can be effectively implemented within real-world health care settings, even in those serving disadvantaged populations. Further research to improve mHealth program efficacy and integration into clinical settings will increase the population-level impact of these effective smoking cessation programs.

Formal Stroke Education Program Effects on OTs’ Competence &amp; Confidence

Abstract Date Presented 03/27/20 This poster presentation will review the methodology and results of a six-week online educational program focused on evidence-based practice in stroke rehabilitation to improve clinical competence and confidence in OT practitioners. Primary Author and Speaker: Michelle Buccinna

Forever-Fit Summer Camp: The Impact of a Six-Week Summer Healthy Lifestyle Day Camp on Anthropometric, Cardiovascular, and Physical Fitness Measures in Youth with Obesity

Purpose: Pediatric obesity is a grave public health concern with both genetic and environmental risk factors. The first line treatment for obesity in youth is lifestyle intervention, which has proven to be challenging. Forever-Fit Summer Camp (FFSC) is a six-week summer day program that offers physical activity and nutrition education, as well as well-balanced meals and snacks, to youth at low cost. The aim of the study was to assess the impact of FFSC on BMI, cardiovascular and …

A feasibility study of an exercise intervention to educate and promote health and well-being among medical students: the \u2018MED-WELL\u2019 programme

BackgroundMedical School programme workloads challenge the physical and mental health of students particularly in compressed graduate entry programmes. There is evidence that physical activity (PA) can improve holistic care and help maintain wellness among medical students. We tested the feasibility of introducing an exercise programme to the medical school curriculum which would educate and promote health and well-being among its students.MethodsThis study was conducted in a single graduate entry medical school at the University of Limerick (UL). The ‘MED-WELL’ programme was a six-week programme of 1 hour-long weekly sessions, each involving a different type of PA (45 min). These sessions were prefaced by an interactive lecture about how to incorporate exercise theory into daily medical practice (15 min). The study was conducted in a single graduate entry medical school at UL and involved year one and year two graduate entry medical students. Three parameters were used to test feasibility: 1. Recruitment and retention of participants, 2. Acceptability of the programme and 3. Efficacy in terms of health and well-being. The latter was assessed by administering questionnaires pre and post the intervention. The questionnaires used the following validated measurement scales: EQ-VAS; WHO-5 Well-Being Index; 3-item Loneliness Scale; Social Support Measure 3-item scale. Free text boxes also encouraged participants to discuss the merits of the programme.ResultsIn total, 26% (74/286 students) participated in the programme. Of those who participated, 69 students (93%) attended one or more sessions of the programme and completed questionnaires at baseline and at follow-up. Significant improvements were seen in scores after the programme in the WHO-5 Well-Being Index which increased from 63.2 (95%CI: 48–78.4) to 67.5 (95%CI: 55.1–79.9); (P < 0.01), the sleep scale which increased from 3.1 (95%CI: 2.2–4.0) to 3.5 (95%CI: 2.5–4.5); (P < 0.001), and the loneliness scale which decreased from 4.1 (95%CI: 2.7–5.5) to 3.5 (95%CI: 2.5–4.5); (P < 0.005). Students level of PA during a typical week also increased from 3.7 (95%CI: 2.1–5.4) to 4.0 (95%CI, 3.5–4.5); (P < 0.05).ConclusionThis study has shown it is feasible to deliver this programme in a medical school’s curriculum. The programme seems to be of benefit and is acceptable to students. Well-designed randomised controlled trials are needed to measure outcomes, durability of effect, and cost effectiveness.

The Influence of Physiotherapy on Neck Disability and Headache among Dental Professionals

This study aim was to identify the impacts of physiotherapy program on reducing neck disability and headache among dental professionals. According to the Neck Disability Index and criteria, set by the International Headache Society, 24 dentists, with neck pain, were selected. To evaluate pain intensity we used visual analog pain scale (VAS). 24 individuals (age 23–39 yr.) were split into 2 groups of 12 people. The first group (age – 27.83 ± 5.0 yr.) had a six – week combined physiotherapy program. The second group was the control group (age 26.17 ± 2.4 yr.) for who physiotherapy was not applied. Physiotherapy program took 45–60 min, twice a week, and consisted of: • soft tissues mobilization techniques; • cervical and thoracic spine mobilization; • active / passive stretching of neck muscles; • exercises which increase neck range of motion; • exercises which increase endurance and strength of upper back muscles. The subjects were assessed before yhe research, 6 and 12 weeks later. The study results showed, that after a six-week physiotherapy program the neck disability index significantly (p &lt; 0.05) decreased. No neck disability index changes were reported in the control group. Daily activity performance significantly improved (p &lt; 0.05), reading and sleeping quality increased and the subjects could lift weights significantly easier. We found a tendency (p &lt; 0.1) that after six weeks of physiotherapy headaches decreased. The neck disability index of the controls did not significantly improve. Six weeks of physiotherapy program significantly reduces neck pain, headache and improves neck disability index in all domains.Keywords: physiotherapy, neck pain, headache, the neck disability index.

A Prospective Outcomes Pilot Evaluation of Inspire Now: A Program for People with Lung Cancer.

Background:Lung cancer is the leading cause of cancer mortality in Canada, yet patients are often under-supported. A six-week program called Inspire Now, created to address unmet supportive care needs, was evaluated in this study. Feasibility and preliminary outcomes were assessed in order to inform future changes to the program.Objectives:(1) Assess the feasibility of the program and its evaluation; (2) pilot the collection of patient-reported outcomes; (3) identify outcomes that may be positively influenced; and (4) inform program modifications.Methods:Participants were recruited from the first session of Inspire Now for an observational pilot study. The primary outcome was feasibility. Secondary outcomes included within-person changes in Functional Assessment of Cancer Therapy – Lung (FACT-L) and Measure Yourself Concerns and Wellbeing (MYCaW), and program satisfaction and qualitative experiences of participants and facilitators through internally-developed questionnaires and semi-structured interviews. Analysis was primarily descriptive, within person changes in FACT-L and MYCaW were analyzed using the Wilcoxon signed-rank test and qualitative data was assessed for common themes.Results:The program and its evaluation were feasible; 8 of 9 (89%) participants consented to the study, median attendance was 6 of 6 sessions (IQR 4.5-6), and questionnaire completion was 100% at baseline and 75% at follow-up. There were clinically meaningful improvements in MYCaW concern 1 (−1.2, 95% CI −2.0 to −0.4) and overall wellbeing (−0.9, 95% CI −2.1 to 0.4). Seven of eight FACT-L sub-sections trended toward improvement, with absolute changes ranging from −1.7 to 10.8%. Participant feedback was overwhelmingly positive; group support and social interactions were highly valued.Conclusions:The group intervention for people with lung cancer was feasible to both run and evaluate. Participants responded positively to the program. Findings will inform changes to future sessions and an analysis of multiple sessions is planned.

Effects of Pyrroloquinoline Quinone (PQQ) Supplementation on Aerobic Exercise Performance and Indices of Mitochondrial Biogenesis in Untrained Men

Objective: Pyrroloquinoline quinone (PQQ) is a novel supplement involved in processes such as mitochondrial biogenesis and cellular energy metabolism. Since endurance exercise and PQQ exhibit similar mechanisms for mitochondrial biogenesis, it is plausible that PQQ may have ergogenic value. Therefore, the purpose of this study was to examine the effects of a six-week endurance exercise training program on mitochondrial biogenesis and aerobic performance in non-endurance-trained males.Methods: Twenty-three males were randomized to consume 20 mg/day of PQQ or placebo (PLC). Both groups followed a supervised six-week endurance exercise training program. Body composition was assessed by dual-energy-x-ray-absorptiometry (DEXA). Aerobic exercise performance and peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), a biochemical marker for mitochondrial biogenesis, were assessed before and after the six-week endurance training/supplementation program.Results: There were no significant differences between groups in aerobic performance after endurance-training (p > 0.05). However, there were significant improvements in peak oxygen consumption (VO2peak) and total exercise test duration after endurance-training, irrespective of group (p < 0.05). The PQQ group had a significant increase in PGC-1α protein levels from baseline to post endurance training compared to PLC (p < 0.05). Furthermore, the PQQ group had higher PGC-1α protein levels after 6 weeks of endurance training compared to PLC (p < 0.05).Conclusions: Supplementation of PQQ does not appear to elicit any ergogenic effects regarding aerobic performance or body composition but appears to impact mitochondrial biogenesis by way of significant elevations in PGC-1α protein content.

Psychophysiological Responses in People Living with Dementia after an Art Gallery Intervention: An Exploratory Study.

The use of existing public spaces by people living with dementia, such as museums and art galleries, are becoming popular due to their ability to facilitate programs which promote social engagement and inclusion. However, few studies have investigated physiological outcomes of art gallery-based programs. Using a quasi-experimental design, the present study aimed to investigate the levels of salivary biomarkers of cortisol and interleukin-6, quality of life (QoL), depressive symptoms, cognition, and wellbeing, after attending the National Gallery of Australia (NGA) Art and Dementia program. Twenty-eight people living with dementia, each supported by a carer or family member, were recruited for a six-week program and were followed up at twelve weeks. In total, 25 participants (17 female; mean age 84.6±7.27 years) completed the study, and 22 provided viable saliva samples. The waking to evening salivary cortisol ratio was higher post-intervention (p = 0.033), and returned to baseline levels at follow-up (p = 1.00), indicating a more dynamic salivary cortisol rhythm in response to the six-week program. Interleukin-6 levels remained unchanged (p = 0.664). No improvements in QoL (DEMQOL-Carer) were observed between baseline and post-intervention (p = 0.076). However, self-reported depressive symptoms decreased post-intervention compared with baseline (p = 0.015), and memory (immediate recall) (p = 0.009) and verbal fluency (p = 0.027) improved between the same timepoints. The NGA Art and Dementia program appears to have quantifiable benefits, including improved hypothalamic-pituitary-adrenal axis function, justifying a need for longer controlled trial inclusive of physiological outcomes.

A COMMUNITY-BASED INTERVENTION TO IMPROVE COGNITIVE FUNCTION IN RURAL APPALACHIAN OLDER ADULTS

Research suggests that social isolation in Appalachian older adults may be associated with reduced cognitive function. Despite this, few interventions for these individuals incorporate both social and cognitive components in a community-based setting. The “Memory Masterclass” program was developed to address this care challenge, and implemented through an Adult Day Services Center. With 29 community-dwelling older adult participants from western Virginia, the six-week pilot program focused on strategies and practices associated with improving long-term memory or executive function. In addition to the lifestyle-focused curricula, the course included group activities focused on connecting participants to community networks of resources that might enable them to successfully implement lifestyle changes. Findings support the feasibility of implementation with a wider group of rural Appalachian older adults and suggest that individual differences in self-reported memory may be closely tied to improvements following the program.

THE USE OF SOLUTION-ORIENTED STRATEGIES TO SUPPORT GRANDPARENTS RAISING GRANDCHILDREN

There is consistent evidence that caregiving for grandchildren is psychologically, emotionally and physically challenging for grandparents. However, many of them may not be able to receive the support they need from their own families or public services. Using the Selective Optimization with Compensation framework and principles of solution-oriented cognitive models, we implemented a six-week session pilot program to increase grandparents’ effective coping strategies, reduce stress, and improve parenting and communication with grandchildren. Preliminary data from 22 grandparents suggest that participants improved their use of effective selection strategies to set priorities and pursue goals related to their wellbeing and the quality of their relationship with grandchildren. Their pre-post test scores also indicated a higher level of parental efficacy, social relations and confidence in organizing their time and priorities. Results indicate that focusing on solution-oriented strategies may empower grandparents to improve their psychological adjustment and take care of their needs.

IMPROV FOR CARE: TEACHING CAREGIVERS IMPROVISATION IMPROVES MOOD AND SENSE OF BURDEN

There is a growing need for novel intervention for caregivers of family members with dementia. Improv for Care is a six-week program designed to teach improvisation (“improv”) skills to caregivers to practice flexible communication, build social support, and process the demands of caregiving through humor and play. This study aimed to examine changes in caregiver depression (Beck Depression Inventory-II), perception of burden (Zarit Burden Interview), qualitative experiences related to caregiving, and their cared-for person’s neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire). Fifteen caregivers completed questionnaires before and after the Improv for Care program. Wilcoxon signed rank tests for related samples revealed significant declines in both caregivers’ depressive symptoms, Z = -2.64, p = .008, and sense of burden, Z = -2.16, p = .031, after completing the program. Caregivers reported that their loved ones’ neuropsychiatric symptoms increased during the course of the intervention, Z = -2.10, p = .036, though associated distress did not also increase, Z = -1.12, p = .265. Of the 15 caregivers, 12 completed follow up questionnaires three months after course completion, which showed that their post-intervention reduction in depressive symptoms remained stable, Z = -1.02, p = .306. The Improv for Care program shows promise as an intervention for caregivers to improve stress, mood, and coping skills.

“Our Story”: Exposition of a Group Support Program for Parents of Children with Developmental Disabilities

ABSTRACT Learning about a child’s condition and raising a child with a developmental disability can be challenging and emotionally overwhelming, but systematic support programs for parents are practically nonexistent. We find that providing support for parents should be an important public health priority which should be made available through educational, social and healthcare systems. This paper describes a six-week support program for parents of children with developmental disabilities. The program is based on the importance of resolution for providing quality care for the child and for achieving a state of wellbeing for the entire family. Resolution is defined as a process of acceptance and coming to terms with the child’s health condition. It refers to the integration of parents’ emotions and information regarding their child’s disability within the parents’ representational system of themselves, their child and their relationship with their child. The main characteristics and goals of this psychoeducational program are highlighted, along with the specific goals for each session. A group setting is applied with the idea that parents will benefit from hearing from people with similar experiences. The structure of all sessions is given in detail and all their components are explained: the introductory section, educational section, counseling section and the final section during which parents are given a handout in which the key content of a particular session is restated. Measures of subjective change and satisfaction with the program are promising, but we intend to further evaluate them in subsequent studies.

Implementing a peer-support programme by group videoconferencing for isolated carers of people with dementia

Introduction Carers support programmes are commonly delivered in person, limiting attendance opportunities for rural carers and others who have access barriers. Studies using technology typically use text-based forums rather than real-time technology such as videoconferencing (VC). Delivering home-based carers support programmes by VC may mitigate barriers for accessing support. We report implementation findings for delivering a telehealth peer-support programme for isolated carers of people with dementia. Methods Participants were recruited through aged care providers, peak bodies and media activities. Inclusion criteria were primary dementia caregiver with Internet access and being socially or geographically isolated. The study design was a staggered randomised waitlist design. Measures included the UCLA Loneliness Scale (ULS-6) and selected scales from the e-Health Literacy Questionnaire. Recruitment activities utilised digital processes. Participants completed a six-week programme delivered by VC. Qualitative data comprised logs detailing administration and IT procedures and difficulties. Post programme, 28 participants undertook semi-structured interviews. Data were analysed using descriptive statistics and thematic analysis. Results There were 16 groups comprising 69 participants located throughout Australia, with 87% using their own devices. Technical issues were few but included connection problems, which were compounded by low digital literacy skills. Qualitative data themes included changing perceptions in using technology, differences in communicating by VC and technical support required. Recruitment activities were time-consuming and would benefit from IT tailored for group-based work. Eight groups continued to meet on a self-organised basis. Discussion Providing peer-support groups using telehealth may have the potential to develop self-sustaining peer networks for isolated caregivers of people with dementia.

My invisible PTSD: Exploring the experiences of recovery in treatment seeking veterans

Background Research suggests that ex-military personnel are at high risk of developing mental health disorders such as Post-traumatic Stress Disorder (PTSD) and have been found to underuse mental health services. Research has used quantitative methods focused on barriers to accessing services, with less emphasis on factors that enable veterans to seek support. Objective The aim of this qualitative research study was to explore the experiences of veterans who seek treatment and how they define their experience of ‘recovery’. Methods Nine male veterans who had completed a six-week Intensive Treatment Programme at Combat Stress participated in the study. Qualitative data was collected using semi-structured interviews and was analysed using Interpretative Phenomenological Analysis. Results Four key themes emerged: (1) discovering PTSD: ‘breaking the silence’, ‘experiences of diagnosis’ and ‘normalisation and containment’, (2) engaging with PTSD: ‘preconceptions and the challenges of military identity’ and ‘accepting PTSD’, (3) a road to recovery: ‘a shared experience of PTSD’, ‘finding me again’ and ‘adjusting to civvy street’ and (4) maintaining and rebuilding: ‘owning your PTSD’, ‘tackling PTSD in everyday life’ and ‘managing social relationships’. Conclusions This study highlights the importance of treatment, an Multi-Disciplinary Team approach and of psychological input for veterans with PTSD. In addition, the experience of being treated within a cohort, provides a familiar framework of treatment to veterans and which had a therapeutic effect in their recovery journey.

“It’s What’s on the Inside That Counts”: A Pilot Study of the Subjective Changes among Returned Citizens Participating in a Peer-Mentor Support Initiative

Peer mentorship programs with returned citizens (i.e., formally incarcerated) have recently emerged as a model that provides mentees and mentors with opportunities to practice new roles that broaden their self-identity and consequently can also assist with maintaining ongoing, non-recidivating behavior. Yet, few evidence-based models focus directly on supporting the peer mentor’s identity change process. This study employed a pretest–posttest evaluation of a pilot six-week training program, the Credible Messengers Institute, designed to support subjective factors that strengthen the self-identity change process among returning citizens (N = 35) who are mentoring adjudicated youth. Findings revealed a statistically significant improvement in subjective factors, including, self-esteem, level of hope, and elements of self-identity change behaviors (self-knowledge; self-awareness and self-reflection; self-care) from pretest to posttest. The issue of developing the self-identity of returned citizens contributes to a wider discussion on the challenges and recent trends in the development of post-incarceration services and supports. Future research should replicate this pilot study with additional participants and rigorous research methodologies to further substantiate the subjective changes among peer mentors.