Societal Reintegration Research Articles

An aphasia research agenda – a consensus statement from the collaboration of aphasia trialists

ABSTRACT Coordination of international aphasia research would minimise duplication of effort, support synergistic international activities across languages and multidisciplinary perspectives, and promote high-quality conduct and reporting of aphasia research, thereby increasing the relevance, transparency, and implementation of findings. The Collaboration of Aphasia Trialists (CATs) sought to develop an aphasia research agenda to direct future research activities, based on priorities shared by people with aphasia, family members, and healthcare professionals. Our established international research network spanning 33 countries contributed to this activity. Research literature reporting the priorities of stakeholders was reviewed and synthesized (phase 1). Representatives from Working Groups on Aphasia Assessment & Outcomes, Prognosis & Predictors of Recovery, Effectiveness of Interventions, and Societal Impact & Reintegration participated in a two-day research agenda-setting meeting. The CATs expert panel refined research objectives and identified constituent components of research and methodological developments required to address these research components. The objectives and research components were grouped into overarching themes (phase 2). The resultant list was then circulated to more than 180 CATs members for review, revision, and approval. Consensus on the final aphasia research agenda and roadmap was reached by CATs executive committee (phase 3). The expert panel identified five overarching research themes: (i) evidence-based interventions for people with aphasia, (ii) effective interventions to support those communicating with people with aphasia, (iii) cross-linguistic assessment and core outcomes for aphasia research, (iv) predictors of language recovery, and (v) clinical implementation of research findings. Within these broad themes, 30 research objectives and 91 individual aphasia research components were identified and sequentially ordered. This agenda builds on research priorities identified by people with aphasia and their families, and includes priorities of healthcare professionals and researchers, and will support the rehabilitation and recovery of people with aphasia. Our internationally relevant research agenda promotes rigor in methodology, considers international applicability, synergistic activities, and sharing of resources and expertise.

Psychosocial impairment following mild blast-induced traumatic brain injury in rats

Traumatic brain injury (TBI) is associated with increased risk for mental health disorders, impacting post-injury quality of life and societal reintegration. TBI is also associated with deficits in psychosocial processing, defined as the cognitive integration of social and emotional behaviors, however little is known about how these deficits manifest and their contributions to post-TBI mental health.In this pre-clinical investigation using rats, a single mild blast TBI (mbTBI) induced impairment of psychosocial processing in the absence of confounding physical polytrauma, post-injury motor deficits, affective abnormalities, or deficits in non-social behavior. Impairment severity correlated with acute upregulations of a known oxidative stress metabolite, 3-hydroxypropylmercapturic acid (3-HPMA), in urine. Resting state fMRI alterations in the acute post-injury period implicated key brain regions known to regulate psychosocial behavior, including orbitofrontal cortex (OFC), which is congruent with our previous report of elevated acrolein, a marker of neurotrauma and 3-HPMA precursor, in this region following mbTBI. OFC of mbTBI-exposed rats demonstrated elevated mRNA expression of metabotropic glutamate receptors 1 and 5 (mGluR1/5) and injection of mGluR1/5-selective agonist in OFC of uninjured rats approximated mbTBI-induced psychosocial processing impairment, demonstrating a novel role for OFC in this psychosocial behavior. Furthermore, OFC may serve as a hotspot for TBI-induced disruption of psychosocial processing and subsequent mental health disorders.

A roadmap for cardiovascular care after release from incarceration: uses of a smartphone application.

Cardiovascular disease (CVD) and its risk factors disproportionately affect people returning from incarceration. These individuals face multiple barriers to obtaining care, which can impact CVD and risk factor management and may be mitigated through use of a smartphone application (app). Therefore, we explored the CVD-related needs of people released from incarceration and which app features would support these needs. In 2019, we collected qualitative data through 7 focus groups with 76 returning citizens and 19 key informants through interviews and small group discussions in Baltimore, Maryland. Verbal data were audio-recorded, transcribed, and analyzed using inductive thematic coding with N-Vivo qualitative software. Returning citizens face multiple barriers when trying to engage in care and services related to cardiovascular health, including around medications and health insurance. Some major challenges were identifying trusted social services and making cardiovascular health a priority. Findings suggested that CVD risk factors could be more effectively addressed in combination with attending to other pressing needs related to employment, housing, behavioral health, and building trust. Participants suggested that a smartphone app would be most useful if it broadly addressed these issues by linking returning citizens to social services, including recommendations from peers, and facilitating access to healthcare. Returning citizens need broad support for societal reintegration. Addressing social issues would allow them to focus on cardiovascular health. Given the challenges experienced after release from incarceration, an app focused on social and health-access issues may help returning citizens meet their CVD needs.

The Dynamics of Implicit Intergroup Biases of Victims and Ex-combatants in Post-conflict Scenarios

Strong group identities arise in intergroup conflict scenarios and perpetuate sectarian violence even in post-conflict scenarios. In particular, out-group negative implicit associations are predictors of decreased intergroup forgiveness, as well as increased distrust and aggression against the out-group. Thus, the presence of implicit intergroup (i.e., ex-combatants and victims) biases seems to be a relevant factor in post-conflict scenarios. Here, we aimed to explore whether negative biases toward the out-group are boosted by (a) previous exposure to conflict violence or (b) identification with an armed violent group. One hundred and twenty-eight participants, 65 ex-combatants from Colombian guerrillas and 63 victims of the armed conflict, were assessed with a modified version of the implicit association test (IAT). Our results revealed that the victim group showed a significant negative bias against ex-combatants. However, no bias toward the out-group (i.e., victims) or in-group favoritism was observed in the ex-combatant group. Similarly, we found that IAT scores were not associated with sociodemographical variables (i.e., sex, years of education, or type of dwelling), the levels of combat exposure, victimization armed-conflict-related experiences, or child abuse antecedents. Our results showed an unexpected lack of in-group bias in ex-combatants, potentially triggered by the effect of current demobilization and reintegration processes. Thus, negative associations with the out-group will persist in the framework of societal condemnation of the out-group. In contrast, these negative biases will tend to be abolished when entering in conflict with larger societal reintegration processes. The results reinforce the idea that reintegration may benefit from interventions at the societal level, including all actors of the conflict. In addition, our findings highlight the importance of implementing victim interventions aimed at reducing stigma and revengeful actions in spaces of collective disarmament.

The workplace integration of veterans: Applying diversity and fit perspectives

Military veterans are a valuable part of the human capital resource pool. Nonetheless, veterans often struggle with their transition into civilian life and workplaces. This problem often limits the extent to which work organizations utilize their talents. Here, we briefly review relevant work from outside the management field and nascent work within the field to build a conceptual model for understanding the integration of veterans into the workplace. We do this by applying diversity and person-environment fit perspectives. A diversity standpoint helps us to understand veterans as a social group and their inclusion in the workplace, while the person-environment fit perspective helps us describe veterans’ compatibility with their work environments in terms of organizational demands and veterans’ needs. We intend for this conceptual model to guide future empirical research on veterans as human capital and their transition into civilian organizations as part of their societal reintegration, career development, and personal well-being.

Novel Psychoactive Substances in Custodial Settings: A Mixed Method Investigation on the Experiences of People in Prison and Professionals Working With Them.

IntroductionNovel Psychoactive Substances (NPS), especially Synthetic Cannabinoid Receptor Agonists (SCRAs), pose a substantial challenge to health and the security of the prison environment. This study analyses the phenomenon from the perspective of people in prison and that of professionals working with them.MethodsA phenomenological qualitative approach was used to analyze self-reported experiences with ‘Spice’ (NPS) among users in prison. A semi-structured questionnaire was also disseminated among professionals working in these settings to better understand (a) the impact of NPS on their work; (b) perceived issues on safety in their working environment; (c) approaches used to tackle the phenomenon and best practices.ResultsPsychotic events resulting from the collected Spice accounts (5) were marked by hallucinations, depression, self-harm, and suicidal ideations. Other emerging elements included fear, paranoia, inability to be with others, mistrust, breakdown and other risky behaviors. Overall, 186 responses from prison staff were collected across the country. 67% claimed NPS to have had a deep impact on their work as they commonly witnessed espisodes involving outbursts of anger, slurred speech, hallucinations, psychosis, and significant mental deterioration among those in prison. Some 91% have witnessed aggression at least once, with 53% experiencing direct harm. Suggested interventions included enhanced training and education (84%), improved detection (92%) and treatment and support services (93%).ConclusionsFindings highlight the urgent need for joint multi-disciplinary efforts to tackle the exponential escalation of NPS in prisons as well as to facilitate the recovery and societal reintegration of those affected. Phenomenology can be recommended as a valuable methods to study drug induced experiences.

Keeping connected while living apart: an exploration of a prison contact maintenance program

With the increase in incarceration rates, researchers have turned their attention to the broader social implications of removing family members from home and putting them behind bars. This causes a major disruption, particularly when considering the impact this has on the family when the mother is the one in prison. In order to alleviate these harms, contact maintenance programs, which are designed to provide enhanced contact between parents and children during periods of incarceration, are instituted to help maintain these relationships. The purpose of this project is to explore incarcerated women’s perspectives of one of these programs, the Connecting with Kids Program (CKP), at a Midwestern correctional facility (MCF). Thirty-four in-depth interviews were conducted with participants in the program, and themes surrounding the unique services provided emerged, such as enhanced visitation programs and technologically enhanced communication and the privacy and family environment fostered by these programs. These findings have important implications for future policies regarding gender specific prison programing, contact maintenance programs, and incarcerated people’s welfare and societal reintegration.

Legislative discrepancies: an analysis of Missouri’s current human trafficking laws and the need to improve its legal protection of victims

Purpose Human trafficking (HT) is a local, national and international problem with a range of human rights, public health and policy implications. Victims of HT face atrocious abuses that negatively impact their health outcomes. When a state lacks protective laws, such as Safe Harbor laws, victims of HT tend to be seen as criminals. This paper aims to highlight the legal present gaps within Missouri’s anti-trafficking legislation and delineates recommendations for the legal protection of victims of HT and betterment of services needed for their reintegration and healing. Design/methodology/approach This case-study is based on a policy analysis of current Missouri’s HT laws. This analysis was conducted through examining current rankings systems created by nationally and internationally recognized non-governmental organizations as well as governmental reports. Additionally, other state’s best practice and law passage of Safe Harbor legislations were examined. The recommendations were based on human rights and public health frameworks. Findings Missouri is a state that has yet to upgrade its laws lately to reflect Safe Harbor laws. Constant upgrades and evaluations of current efforts are necessary to protect and address HT at the state and local levels. Public health and human rights principles can assist in the upgrading of current laws as well as other states’ best-practice and integration of protective legislation and diversion programs to both youth and adult victims of HT. Research limitations/implications Laws are continually being updated at the state level; therefore, there might be some upgrades that have taken place after the analysis of this case study was conducted. Also, the findings and recommendations of this case study are limited to countries that are similar to the USA in terms of the state-level autonomy to pass laws independently from federal law. Practical implications If Safe Harbor laws are well designed, they have greater potential to protect, support and assist victims of HT in their process from victimization into survivorship as well as to paving the way for societal reintegration. The creation and enforcement of Safe Harbor laws is a way to ensure the decriminalization process. Additionally, this legal protection also ensures that the universal human rights of victims are protected. Consequently, these legal processes and updates could assist in creating healthier communities in the long run in the USA and around the world. Social implications From a public health and human rights perspectives, communities in the USA and around the world cannot provide complete protection to victims of HT until their anti-trafficking laws reflect Safe Harbor laws. Originality/value This case study, to the best of the authors’ knowledge, is a unique analysis that dismantles the discrepancies of Missouri’s current HT laws. This work is valuable to those who create policies at the state level and advocate for the protection of victims and anti-trafficking efforts.

Leadership Amidst Transition and Liminality: The Case of Bosnia and Herzegovina and the Former Yugoslavia

A history of empires and communism created a liminality in the former Yugoslavia and Bosnia and Herzegovina (B&H). When leaders throughout the Soviet Bloc began to discredit communism, an opportunity opened for the leadership of B&H to unify the popular will and transition to democracy. Yet, the appropriate leadership, a master of ceremonies from van Gennep and Turner’s perspectives, a philosopher from Plato’s view was absent. Politicians instead repackaged themselves as nationalists and supported extremists and divisive actions, culminating in war. Subsequently, the mechanisms associated with the Dayton Peace Accords conceived to return B&H to normalcy instead made the divisive liminality a new normal as power sharing elites benefitted if they held to nationalist claims and ignored societal reintegration. This, study examines the reasoning and tactics of elites who rejected the mantle of good leadership and now abuse the spirit of the constitutional and institutional power sharing mechanisms to maintain the schizophrenic division and conflict. It also introduces the type of virtuous leader states needed for transition.

Perceptions of sex educators: A qualitative analysis

The fear of children getting victimized by strangers is the basis for several current pieces of legislation, specifically Megan ’ s law, despite the lack of corresponding empirical data. This legislation causes significant negative consequences for those who are on the registry, especially for juvenile offenders as they have unique challenges they face regarding labeling and societal reintegration. As most juveniles receive most of their sex education in school, and a lack sex education is a contributing factor to the commission of sex offenses, this study aims to explore a proactive method of preventing sex offenses. This study includes exploratory interviews with sex education teachers to highlight the critical gap between training for sex education and teaching sex education, and the difference between teaching sex education and knowledge about sex offenses. This study opens the dialogue regarding these connections and calls for proactive thinking in preventing juvenile sex offenses.

Self-efficacy for Re-acceptance in Communities Among Obstetric Fistula Patients in Africa: A Systematic Review of Qualitative Data

The physical and psychosocial problems associated with obstetric fistula affect the patients’ efficacy to function within specific realms of life and affect their quality of life. This study documented the obstetric fistula patients’ self-efficacy for reacceptance in the communities in Africa. The study used keywords and the year of publication (2000 to 2019) as a search strategy to obtain data for review. A Critical Appraisal Skills Programme checklist specifically for qualitative studies was used. The search resulted in 284 studies: Google Scholar; 37, PubMed; 12, Hinari; 3, African Journals Online; 36, Psych-INFO; 1 and other websites; 195. Subsequently, 258 studies were excluded due to duplication and failure to meet the study objective leaving 26 studies, which were thematically analyzed. Studies report loss of hope, dignity, confidence, and self-esteem among obstetric fistula patients. They feel unfit, and are often anxious, attributes that impede their employability, mobility, connections, conjugal affairs, childbearing, and enthusiasm to accomplish various tasks; an index of low self-efficacy. However, when repaired and empowered through skills training and counseling, their self-efficacy improves. Self-efficacy is generally low among obstetric fistula patients especially those that have not yet had fistula repair. Alongside repair of the fistula, activities intended for societal reintegration reduce levels of anxiety, increase confidence and overall self-efficacy, which enables reacceptance.

Discrepancies between Self- and Clinical Staff Members' Perception of Cognitive Functioning among Patients with Schizophrenia Undergoing Long-Term Hospitalization.

In Japan, long-term hospitalization of patients with schizophrenia is still prevalent, even though the focus of psychiatric care is shifting from hospitals to the community. Difficulties in discharge planning often arise because clinical staff members' functional assessment differs from that of patients' self-assessment. Therefore, we attempted to identify characteristics related to these perceptual differences to promote the development of more effective approaches toward the discharge and societal reintegration of patients with schizophrenia undergoing prolonged hospitalization. Forty-eight long-term inpatients (23 men and 25 women with a mean age of 60.72 years) with schizophrenia were examined using the Schizophrenia Cognition Rating Scale Japanese version (SCoRS-J), Life Skills Profile (LSP), and Profile of Mood States- (POMS-) Brief Form. Differences between patients' self-ratings and clinical staff members' ratings on the SCoRS-J were used to divide patients into overestimators, underestimators, and accurate raters. These groups were then comparatively analyzed. Accordingly, overestimators displayed significantly severe cognitive dysfunction on the SCoRS-J objective ratings (p = .001) and significantly less difficulty on the SCoRS-J subjective ratings (p = .002) as compared to underestimators. Overestimators also scored significantly lower on the communication (p = .012) and responsibility (p = .021) LSP subscales compared to underestimators, and the total LSP score for overestimators was significantly lower compared to accurate raters (p = .036) and underestimators (p = .009). However, underestimators displayed significantly higher confusion on the titular POMS subscale than did overestimators (p = .021). These findings indicate that, among the three groups, overestimators scored lowest for objectively rated functioning. In contrast, underestimators attained the highest functioning; however, they were also confused. Clinical staff should examine how patients' self-perceptions deviate from the perceptions of staff and implement an appropriate approach considering the patient characteristics revealed from the results of this study.

The Influence of Vocational Rehabilitation for Societal Re- Integration of Inmates in Nigerian Prisons in Rivers State

The study examines how vocational trades’ acquisition rehabilitates inmates for reintegration in to the society. Inmates that are expose to vocational training during the period of incarceration easily gets rehabilitated and can reintegrate in to the society upon discharge as a result of possession of skills that can make him/her useful. The study adopted the descriptive research survey design. The population of the study consists of 4723 inmates and 509 prison officers. A sample of 593 respondents (369 convicted inmates and 224 officers) were selected which is a representative of the population. Inmates were purposively selected while simple random sampling technique was adopted for the selection of the officers from four Nigerian prisons in Rivers State. Three research questions were answered with two null hypotheses that were tested at 0.05 significant levels. Instrument for data collection was a self-constructed questionnaire titled “Vocational Rehabilitation of Inmates for Societal Reintegration Questionnaire” (VRISRQ) which was validated by two experts. The instrument was designed using a checklist and Likert-5 point rating scale of agreement. The instrument was subjected to reliability test through Kuder-Richardson formula 20 (KR20) and Pearson Product Moment Correlation (PPMC). Reliability coefficients of 0.87, 0.82 and 0.86 were obtained for different sections of the instrument respectively. Frequency and percentage was used to answered research question 1 while research questions 2 and 3 were answered using mean with standard deviation. Hypotheses were tested at 0.05 level of significant using independent sample t-test. The findings of the study revealed that vocational trades that are available in Nigerian prisons in Rivers State can rehabilitate inmates if they are acquired. The study also found that acquisitions of vocational trades by inmates are marred with challenges such as poor training facilities, poor funding. Based on the findings of the study, it was recommended among others that prison authorities should expose the inmates to vocational trades that are available in the prison for acquisition to enhance their rehabilitation and reintegration and that Government, Non-Governmental Organizations (NGOs) should assist in provision of training facilities in the prison as this will make acquisition of vocational trades realizable.

Medical nutrition therapy in Canadian federal correctional facilities

BackgroundUnder- and over nutrition as well as nutrition risk factors such as communicable and non-communicable diseases are a common and major cause of morbidity and mortality in correctional facilities. Consequently, medical nutrition therapy (MNT), a spectrum of nutrition services aimed at optimizing individual well-being, is being recognized as integral to the health of people who experience incarceration. However, there is a paucity of research that explores the delivery of MNT in correctional facilities.MethodsA scoping review combined with secondary analysis of qualitative data (field notes, in-depth stakeholder interviews) from a 2-year ethnographic study about food insecurity and incarceration was undertaken to gain insights about the delivery of corrections-based MNT in Canada. Thematic analysis of all documents was done using an interpretive framework.ResultsAn understanding about MNT was developed within three themes: 1) specialized service provision in a unique environment; 2) challenges with the provision of MNT; and 3) consideration of corrections-based MNT alternatives. An incarcerated individual’s nutritional health was conceptualized as culminating from various factors that included dietary intake and health status, enabling environments, access to quality health services, and clinical nutrition services. Nutrition care practices, which range from health promotion to rehabilitation, are challenged by issues of access, visibility, adequacy, and environmental barriers. Their success is dependent on demand (e.g., ability of recipient to act) and factors that enable quality health and food services. Advancing corrections-based MNT will require policies that provide supportive food and health environments and creating sustainable services by integrating alternatives such as peer approaches and telehealth.ConclusionsProfessional associations, government, researchers and other stakeholders can help to strengthen corrections-based MNT by fostering shifts in thinking about the role of health practitioners in these contexts, preparing future health professionals with the specialized skills needed to work in these environments, generating evidence that can best inform practice, and cultivating collaborations aimed at crime prevention, successful societal reintegration, and the reduction of recidivism.

Special Issue: Community, Psychology and Family Therapy

Special Issue: Community, Psychology and Family Therapy

Determinants of health-related quality of life in stroke survivors in Kano, Northwest Nigeria

Background: The long-term consequences of stroke, particularly among the young and middle-aged population in sub-Saharan Africa, constitute a major challenge to the labor work force in resource-limited settings. Previous studies have focused mainly on mortality, recurrence, and functional recovery but less on the quality of life of these patients. We sought to assess the determinants of the health-related quality of life (HRQoL) of stroke survivors in Kano, Northwestern Nigeria. Material and Methods: A prospective case–control study conducted at Aminu Kano Teaching Hospital, Nigeria over a period of 18 months where 310 (155 patients with stroke and 155 sex- and age-matched healthy controls) participants were assessed using the health-related quality of life in stroke patient-40 (HRQoLISP-40) questionnaire. Multiple logistic regression was used to identify the independent predictors of global HRQoL after controlling for other covariates. Results: The overall mean global HRQoL scores among the patients with stroke and the controls were 66.1 vs. 86.1, respectively, with a mean difference of −20.0. There mean difference in the physical and spiritual spheres were −28.1 vs. −9.1, respectively. Determinants of the poor quality of life in the stroke survivors were aphasia, lesion location, and poststroke depression. Conclusion: The HRQoL among the stroke survivors was poor, which demonstrates that the determinants if effectively subjected to evidenced-based therapeutic interventions may lead to improvement in their overall functional recovery and societal reintegration.

Functional Gain and Societal Reintegration After a Stroke: Evidence From Home-Based Outpatient Rehabilitation

Functional Gain and Societal Reintegration After a Stroke: Evidence From Home-Based Outpatient Rehabilitation

Optimizing post-acute care in breast cancer survivors: a rehabilitation perspective.

Breast cancer (BC) is the most common malignancy and a leading cause of morbidity and mortality in women worldwide. Therapeutic advances and improved survival rates of women with BC have implications for long-term impact on disability, psychological function and quality of life (QoL), which may be amenable to rehabilitation. The focus of rehabilitation is on managing disability, reducing sequelae and symptoms, and enhancing participation and societal reintegration, to achieve the highest possible independence and the best QoL. Rehabilitation interventions should be considered early for maintaining functional capacity and reducing the risk of losing important abilities or independence and should be individualized depending on disease phase, functional deficits, personal requirements and specific goals. A number of interventions have been trialled to support rehabilitation input for women with BC, which include physical therapy, psychological interventions (psychotherapy, cognitive behavioral training) and others. Multidisciplinary rehabilitation and uni-disciplinary interventions such as physical therapy have been shown to be beneficial in reducing disability, and improving participation and QoL. There is a need for comprehensive assessment of health domains in BC patients using a standardized framework and a common language for describing the impact of disease at different levels, using the International Classification of Functioning, Disability and Health core sets. This will provide more detailed information on the needs of these patients, so more efficient and targeted rehabilitation interventions can be provided.

Societal reintegration following cadaveric orthotopic liver transplantation.

Studies on patients' societal reintegration following orthotopic liver transplantation (OLT) are scarce. Between September 2006 and January 2008, all adults who were alive after 3 years post OLT were included in this prospective cohort study. Validated questionnaires were administered to all candidates with the primary aim of investigating the rate of their social re-integration following OLT and potential barriers they might have encountered. Among 157 eligible patients 110 (70%) participated. Mean participants' age was 57 years (SD 11.4) and 43% were females. Prior to OLT, 75% of patients were married and 6% were divorced. Following OLT there was no significant difference in marital status. Employment rate fell from 72% to 30% post-OLT. Patients who had been employed in either low-skill or advanced-skill jobs were less likely to return to work. After OLT, personal income fell an average of 4,363 Canadian dollars (CAN$) (SD 20,733) (P=0.03) but the majority of recipients (80%) reported high levels of satisfaction for their role in society. Although patients' satisfaction post-OLT is high, employment status is likely to be negatively affected for individuals who are not self-employed. Strategies to assist recipients in returning to their pre-OLT jobs should be developed to improve patients' economical status and societal ability to recoup resources committed for OLT.

Practice relevant research in biological psychiatry

The practice of psychiatry would be unthinkable without modern psychopharmacology. Drug treatment, especially of severe psychiatric disorders, is often a precondition of community participation, societal reintegration and recovery. Seen in this context it is understandable that biological psychiatry has long been primarily defined by its close interconnection with psychopharmacology and has been perceived this way by practicing physicians. In recent years, however, the concept of what is "biological" has markedly expanded and so has the outreach of this approach into the practice of psychiatry. This article discusses examples showing that biological research methods provide new impulses for individualized medicine, psychotherapy and understanding environmental risks and therefore provide the basis for a preemptive and preventive approach that will be the key to master the challenges posed by the severe burden of mental illness.