Improving patient-centered care for HIV and mental illness: exploring hospital and community integration through education.

Current models of care delivery are failing patients with complexity, like those living with HIV, mental illness and other psychosocial challenges. These patients often require resource-intensive personalized care across hospital and community settings, but available supports can be fragmented and challenging to access and navigate. To improve this, the authors created a program to enhance integrated, trauma-informed care through an innovative educational role for a HIV community caseworker embedded in an academic HIV Psychiatry clinic, called the Mental Health Clinical Fellowship. Through qualitative interviews with 21 participants (patients, physicians, clinicians and Mental Health Clinical Fellows) from October 2020-March 2023, the authors explore how implementation of this program affects patient experiences and satisfaction with care. Patients described their care experiences as less stigmatizing, more accessible, holistic and coordinated. They often attributed this to the integration between fellow and psychiatrist, and specifically the accessible stance of community organizations embedded within a hospital, which helped build trust. Interchangeable and integrated support by caseworker and psychiatrist improved patient engagement in psychiatric management and patient satisfaction with their care. Cross-context and cross-disciplinary care provision that includes providers from community and hospital working directly together to deliver care can improve care for patients with significant complexity.

Apropriação dos espaços urbanos na infância e na velhice em Brasília (DF) / Occupation of urban spaces in childhood and old age in Brasilia, Brazil / Apropiación de espacios urbanos en la infancia y en la vejez en Brasília, Brasil

Os estudos sobre as relações mútuas entre as pessoas e o ambiente buscam subsidiar melhorias no contexto urbano a partir de métodos e técnicas pautados na compreensão do uso de espaços públicos e privados. A crescente demanda pela promoção de ambientes amigáveis para idosos e crianças nos cenários urbanos direcionou esta pesquisa e elencou dois componentes: o panorama relativo à população local e o arcabouço teórico da psicologia ambiental. Para tanto, buscou-se identificar as principais atividades realizadas por crianças e idosos em seus respectivos locais de moradia. Foram avaliados os principais usos e atividades desses dois grupos, em duas vizinhanças, diferenciando-os de acordo com suas especificidades em termos de demandas individuais e ambientais. As observações sistemáticas a partir da técnica de mapeamento comportamental centrado no lugar (MCCL) ocorreram na cidade de Brasília, Distrito Federal (DF) e permitiram compreender o processo de apropriação dos espaços na infância e na velhice e suas repercussões em termos da congruência pessoa-ambiente. Cada um destes setores organizados a partir de elementos específicos direciona as ações dos participantes para determinados tipos de comportamentos, observados de maneira a compor um roteiro em que a brincadeira (lazer ativo) surge como central na infância e a caminhada (circulação) como mais potente para a população idosa. Os resultados demonstram que o diálogo entre a psicologia ambiental e a ciência do desenvolvimento humano tem sido bastante profícuo e tem contribuído para a compreensão de aspectos da relação pessoa-ambiente em diferentes momentos do ciclo de vida.(AU)

Studies on the mutual relations between people and the environment seek to support improvements in the urban context from methods and techniques based on understanding the use of public and private spaces. The growing demand for the promotion of friendly urban environments for older people and children guided this research, with two notable components: the panorama related to the local population and the theoretical framework of Environmental Psychology. Therefore, we sought to identify the main activities carried out by children and older people in their respective dwellings. The main uses and activities of these two groups were evaluated in two neighborhoods, differentiating them according to their specificities in terms of individual and environmental demands. Systematic observations using the place-centered behavioral mapping technique took place in the city of Brasília, Federal District, and allowed us to understand the process of appropriation of spaces in childhood and old age and its repercussions in terms of person-environment congruence. Each of these sectors, organized from specific elements, directs the participants' actions towards certain types of behavior, observed in order to compose a script in which playing (active leisure) emerges as central in childhood and walking (circulation) as more potent for the older people. The results demonstrated that the dialogue between environmental psychology and the science of human development has been very fruitful and has contributed to the understanding of aspects of the person-environment relationship at different times in the life cycle.(AU)

Los estudios sobre las relaciones mutuas entre las personas y el medio ambiente buscan aportar mejoras en el contexto urbano mediante métodos y técnicas basados en la comprensión del uso de los espacios públicos y privados. La creciente demanda de la promoción de ambientes amigables para las personas mayores y los niños en entornos urbanos guio esta investigación y enumeró dos componentes: el panorama relacionado con la población local y el marco teórico de la Psicología Ambiental. En este contexto, buscamos identificar las principales actividades que realizan los niños y las personas mayores en sus respectivas viviendas. Se evaluaron los principales usos y actividades de estos dos grupos en dos barrios, diferenciándolos según sus especificidades en cuanto a las demandas individuales y ambientales. Las observaciones sistemáticas utilizando la técnica de mapeo conductual centrado en el lugar (MCCL) ocurrieron en la ciudad de Brasília, Distrito Federal (Brasil) y nos permitieron comprender el proceso de apropiación de espacios en la infancia y la vejez y sus repercusiones en la congruencia persona-ambiente. Cada uno de estos sectores, organizados a partir de elementos específicos, orienta las acciones de los participantes hacia determinados comportamientos, observados para componer un guion en el que el juego (ocio activo) emerge como central en la infancia y el caminar (circulación) como el más potente para las personas mayores. Los resultados demuestran que el diálogo entre la Psicología Ambiental y la ciencia del desarrollo humano ha sido muy fructífero y ha contribuido a la comprensión de aspectos de la relación persona-entorno en diferentes momentos del ciclo de vida.(AU)

Effectiveness of community-based multidisciplinary integrated care for older people: a protocol for a systematic review.

INTRODUCTION: The increasing number of older adults with multiple complex care needs has placed increased pressure on healthcare systems internationally to reorientate healthcare delivery. For many older adults, their first point of contact with the health service is with their general practitioner (GP) and GP participation with integrated care models is the foundation of a population-based approach. A knowledge gap remains in relation to the effectiveness of GP participation in community-based integrated health and social care approaches for older adults. This systematic review aims to examine the effectiveness of multidisciplinary-integrated care for community-dwelling older adults with GP participation. METHODS AND ANALYSIS: This systematic review will include randomised controlled trials (RCTs), quasi and cluster RCTs focusing on integrated care interventions for community-dwelling older adults by multidisciplinary teams including health and social care professionals and GPs. The databases PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE will be searched. The primary outcome measure will be functional status. Secondary outcomes will include: primary healthcare utilisation, secondary healthcare utilisation, participant satisfaction with care, health-related quality of life, nursing home admission and mortality. The methodological quality of the studies will be assessed using the Cochrane Risk of Bias Tool V.2. The elements of care integration will be mapped in the individual studies using the Rainbow Model of Integrated Care taxonomy. A meta-analysis will be completed, depending on the uniformity of the data. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess the certainty of evidence. ETHICS AND DISSEMINATION: Formal ethical approval is not required as all data included are anonymous secondary data. Scientific outputs will be presented at relevant conferences and in collaboration with our public and patient involvement stakeholder panel of older adults at the Ageing Research Centre at the University of Limerick. PROSPERO REGISTRATION NUMBER: CRD42022309744.

The impact of sport participation for individuals with spinal cord injury: A scoping review.

BACKGROUND: Spinal cord injury (SCI) leads to various physical, psychological, and social challenges. Sport is a holistic physical activity that may target these challenges. No literature systematically summarizes the overall impact of sport participation for those with SCI. OBJECTIVE: To comprehensively report the findings of quantitative studies investigating the impact of sport on the physical, psychological, and social health of individuals with SCI. METHODS: Six databases were searched: APA PsycInfo, CINAHL, Embase, Emcare, Ovid Medline, and PubMed (non-Medline). Studies were included if (a) participants were adults with SCI for ≥12 months, (b) outcomes resulting from ≥3 months of sport participation were investigated, (c) sport occurred in the community setting, and (d) comparisons of sport and non-sport conditions were analyzed. Details regarding study characteristics, participants, sport(s), and outcomes were extracted. Methodological quality was assessed using the Modified Downs and Black checklist. RESULTS: Forty-nine studies were included. Study quality ranged from poor to moderate. Sport participation showed favourable results for outcomes including function, quality of life, and community integration. Mixed results were found for outcomes including cardiac function, depressive symptoms, and employment. No significant associations were found for postural control, resilience, and education. CONCLUSIONS: The review findings suggest sport may be a promising intervention for addressing some challenges associated with SCI.

Formação em Odontologia sob o olhar da integração ensino, serviço e comunidade: um relato de experiência / Training in Dentistry under the view of integration teaching, service and community: an experience report

Este estudo se refere a um relato sobre a experiência vivenciada nos Estágios que ocorrem de forma articulada entre universidade, serviço de saúde e comunidade do curso de Odontologia da Universidade Estadual de Feira de Santana (Bahia, Brasil), após dez anos de implantação do novo currículo obedecendo às Diretrizes Curriculares Nacionais. Quanto aos resultados, observou-se um maior comprometimento social e criticidade dos discentes em relação à aplicação do conteúdo teórico-prático, adquirido ao longo da graduação, bem como a aproximação destes com os outros profissionais da Equipe de Saúde da Família e a busca em atender às necessidades de transformação e melhorias da sociedade. Para que os objetivos pedagógicos sejam plenamente alcançados, destaca- se a relevância, não só da capacitação docente e da existência de uma matriz curricular do curso estruturada a partir do conceito de integralidade, como também da sensibilização dos estudantes, da interlocução com os preceptores e da participação ativa de todos os protagonistas nos estágios, colaborando e retroalimentando a integração ensino-serviço-comunidade (AU).

This study refers to a report on the experience in the Internships that occur in an articulated way between the university, the health service, and the community of the Dentistry course at the State University of Feira de Santana (Bahia, Brazil), after ten years of implementation of the new curriculum obeying the National Curriculum Guidelines. As the result, there was a significant social commitment and criticality of the students about the application of theoretical and practical content, acquired during graduation, as well as the approximation of these with other professionals of the Family Health Team and the search for meet society's needs for transformation and improvement. For the pedagogical objectives to be fully achieved, the relevance is highlighted, not only of teacher training and the existence of a curricular matrix of the course structured on the concept of comprehensiveness but also of student awareness, dialogue with preceptors, and the active participation of all the protagonists in the internships, collaborating and providing feedback to the teaching-service-community integration (AU).

World Café- a community conversation: a Canadian perspective on stroke survivors needs for community integration.

BACKGROUND: Stroke is an acute condition that requires immediate care and long-term community-based chronic care supports. Communities vary in their ability to support the complex needs of this population. OBJECTIVES: To bring stroke recovery stakeholders together to discuss the needs of community-based stroke recovery and develop possible solutions across one province in Canada. METHODS: The participatory research approach of the World Café was used to explore topics related to community-based stroke recovery. Three World Cafés were held in three communities, including rural, urban-multicultural, and indigenous communities. Sixty-one stakeholders participated in this study. The data was analyzed following an inductive approach for all three Word Cafés. RESULTS: Four main themes were revealed from the data. First, Individual Needs, but Holistic Care encompassed the idea that stroke survivors' needs are complex and changing. Second, Whole of the Community indicated that all the people in stroke survivors' communities should be considered when designing solutions. Third, Transition in Care focused on the needs and solutions during the transition from hospital to community. Lastly, participants emphasized that better Connection, Collaboration, and Communication are needed among all stakeholders. CONCLUSIONS: While some similarities in needs and solutions were identified for stroke survivors across three diverse communities, differences between them were also reported. Approaches to enhance better communication among all stakeholders and facilitate a continuous transition from hospital to community are needed. Co-creating solutions with each local community should be considered as individual needs, and challenges are specific to each community.

Impacto social del megaproyectocomunitario Vidas en la comunidad Orestes Gutiérrez. Manzanillo. Curso 2018-2019 / Social impact of the Lives community megaproject in the Orestes Gutiérrez community. Manzanillo. 2018 - 2019 academic year

La actualización del modelo económico y social cubano requiere de una participación activa de las universidades en su integración con las sociedades, sectores productivos, territorios y comunidades. Se realiza este trabajo con el objetivo de evaluar el impacto social del megaproyecto comunitario Vidas en la comunidad Orestes Gutiérrez de Manzanillo. La investigación responde fundamentalmente a la metodología cualitativa, con uso de técnicas como: la observación participante, entrevistas en profundidad y entrevistas grupales; se desarrolla en tres dimensiones: salud, político-ideológico-cultural y medio ambiental, cuyas tareas a ejecutar están encaminadas a mejorar el estado de salud, elevar el nivel político e ideológico y cultural y minimizar el daño por el cambio climático como consecuencia de enfermedades trasmitidas por el Aedes aegypti, en particular el dengue. Se elevó en adolescentes el nivel de conocimientos sobre los factores de riesgo de enfermedades bucales y el uso de métodos eficaces de anticoncepción para prevenir el embarazo; se reforzaron valores en estudiantes de primaria como colectivismo, amor al trabajo, justicia social, honestidad, responsabilidad, se desarrolló el lenguaje artístico y se lograron cambios de conducta de la población en el control más efectivo del Aedes aegypti para la prevención del dengue. El megaproyecto constituye una alternativa de participación comunitaria en el que estudiantes, profesores y miembros de la comunidad desarrollaron de forma activa procesos, programas o actividades que permitieron dinamizar la vida, resolver problemas, elevar el bienestar y la calidad de vida de la comunidad(AU)

The updating of the Cuban economic and social model requires an active participation of universities in their integration with societies, productive sectors, territories and communities. This work is carried out with the aim of assessing the social impact of the community megaproject Vidas in the Orestes Gutiérrez community of Manzanillo. The research responds fundamentally to qualitative methodology, using techniques such as: participating observation, in-depth interviews and group interviews; it is developed in three dimensions: health, political–ideological–cultural and environmental, whose tasks to be carried out are aimed at improving the state of health, raising the political and ideological and cultural level and minimizing the damage from climate change as a result of diseases transmitted by the Aedes aegypti, in particular dengue. Adolescents raised knowledge about oral disease risk factors and the use of effective methods of contraception to prevent pregnancy; values were reinforced in primary school students such as collectivism, love of work, social justice, honesty, responsibility, artistic language was developed and changes in population behavior were achieved in the most effective control of the Aedes aegypti for the prevention of dengue. The megaproject is an alternative of community participation in which students, teachers and community members actively developed processes, programs or activities that enabled the energize of life, solving problems, raising the well-being and quality of life of the community(EU)

Community reintegration following holistic milieu-oriented neurorehabilitation up to 30 years post-discharge.

BACKGROUND: The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills. OBJECTIVES: The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors. METHOD: Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study. RESULTS: The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients' marital status, living situation, income, and quality of social life. CONCLUSION: The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.

A qualitative study of LoveYourBrain Yoga: a group-based yoga with psychoeducation intervention to facilitate community integration for people with traumatic brain injury and their caregivers.

Purpose: To explore participants' experiences in a group-based yoga with psychoeducation intervention designed to facilitate community integration for people with traumatic brain injury and their caregivers.Materials and methods: We conducted semi-structured interviews with 13 people with traumatic brain injury and three caregivers who had completed LoveYourBrain Yoga, a 6-session, manualized, group-based yoga intervention that incorporates breathing exercises, yoga, meditation, and psychoeducation. Interviews were analyzed using content analysis.Results: We identified seven themes: ease of participation, belonging, sustaining community connection, physical health, self-regulation, self-efficacy, and resilience. All participants valued the community-based yoga studio environment and multifaceted structure of the program. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community.Conclusions: LoveYourBrain Yoga successfully promoted community integration for people with traumatic brain injury. It also facilitated diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation.Implications for rehabilitationTraumatic brain injury survivors often struggle to participate in their community, the ultimate goal of rehabilitationYoga is a holistic therapy with many benefits, yet is not accessible to the traumatic brain injury population at the community levelParticipants in a community-based yoga with psychoeducation intervention in six states experienced diverse and meaningful physical, psychological, and social health benefitsGroup-based yoga with psychoeducation may be an effective mode of community integration and community-based rehabilitation for traumatic brain injury survivors.

Providing Dignified Palliative Care Services in Liberia.

Background: Liberia faces a critical shortage of palliative care services, particularly for persons with advanced-stage HIV/AIDS, tuberculosis, diabetes, and cancers. Access to healthcare services is especially limited in rural areas, along with a lack of supportive social and economic resources. Home of Dignity (HoD) Health Center was established in 2013 in Yarbah's Town to fill a last-option palliative care gap. The mission emphasizes patient wellbeing and worth. HoD integrates health, agriculture, and education on-site for immediate medical needs, broader sustainable development, and reducing disease-associated stigma in local communities. Objective: We aimed to describe the Center's integrated approach and conduct a descriptive analysis of the HoD patient population. Methods: We reviewed patient characteristics (sex, age distribution, mobility status, and CD4 count on arrival) and outcomes (survival rate and community reintegration) for patients with HIV seeking care at the Center between 2013-2017. Findings: Of 182 patients (ages 3 months-50 years), over half arrived to the facility bedridden and over 82% had CD4 counts between <100-350. Of the 182 patients, 66% survived, 27% died, and 7% were lost to follow-up. Of surviving patients, 90% were successfully reintegrated into their communities. The clinic also served over 365 chronically ill patients that had been rejected by other health providers during the 2014-2015 Ebola outbreak. Conclusions: The Center is providing last-option palliative care services in the country. As a trusted healthcare center, patients also seek care for acute conditions, resulting in unanticipated resource demands. HoD's experience underscores the need for development of training programs for medical professionals, supply chains, community outreach, and resourcing channels to ensure adequate and sustainable service provision for hospice and palliative care services and reduce stigma in the country. There is an urgent need to invest in holistic palliative and overall healthcare services in Liberia.

Shifting Academic Health Centers From a Culture of Community Service to Community Engagement and Integration.

There is an increasing need for academic health centers (AHCs) to engage communities across their clinical, research, and educational missions. Although AHCs have a long-standing history of community service, a more comprehensive approach to working with communities is required to respond to shifts toward a population health paradigm, funder requirements for community engagement in research, and demands that medical education focus more on social and environmental determinants of health. Community engagement has been employed at many AHCs, though often in limited ways or relying heavily on students and faculty interested in serving communities. This limited involvement has been due, in part, to lack of infrastructure to support engagement, resource constraints, and the lack of a clear value proposition for long-term investments in community partnerships. However, there are compelling reasons for AHCs to take an enterprise-wide approach to working with communities. An enterprise-wide approach to community engagement will require reconsideration of communities, moving from viewing them as people or groups in need of service to seeing them as assets who can help AHCs better understand and address social determinants of health, enhance students' and trainees' ability to provide care, and increase the relevance and potential impact of research discoveries. To accomplish this, AHCs will need to establish the necessary infrastructure to support long-term community partnerships, adapt policies to support and reward engaged scholarship and teaching, and consider new ways of integrating community members in roles as advisors and collaborators across the AHC.

Music therapy applied to complex blast injury in interdisciplinary care: a case report.

Purpose: Music therapy has a long history of treating the physiological, psychological, and neurological injuries of war. Recently, there has been an increase in the use of music therapy and other creative arts therapies in the care of combat injured service members returning to the United States from Iraq and Afghanistan, especially those with complex blast-related injuries. This case report describes the role of music therapy in the interdisciplinary rehabilitation of a severely injured service member. Methods: Music therapy was provided as stand-alone treatment and in co-treatment with speech language pathology, physical therapy, and occupational therapy. The report is based on clinical notes, self-reports by the patient and his wife, and interviews with rehabilitation team members. Results: In collaboration with other treatment disciplines, music therapy contributed to improvements in range of motion, functional use of bilateral upper extremities, strength endurance, breath support, articulation, task-attention, compensatory strategies, social integration, quality of life, and overall motivation in the recovery process. The inclusion of music therapy in rehabilitation was highly valued by the patient, his family, and the treatment team. Conclusions: Music therapy has optimized the rehabilitation of a service member through assisting the recovery process on a continuum from clinic to community. Implications for Rehabilitation Music therapy in stand-alone sessions and in co-treatment with traditional disciplines can enhance treatment outcomes in functional domains of motor, speech, cognition, social integration, and quality of life for military populations. Music therapists can help ease discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care. Music therapy assists treatment processes from clinic to community, making it highly valued by the patient, family, and interdisciplinary team members in military healthcare. Music therapy provides a platform to prevent social isolation by promoting community integration through music performance.

Evaluating a novel Integrated Community of Care (ICoC) for patients from an urbanised low-income community in Singapore using the participatory action research (PAR) methodology: a study protocol.

INTRODUCTION: Poorer health outcomes and disproportionate healthcare use in socioeconomically disadvantaged patients is well established. However, there is sparse literature on effective integrated care interventions that specifically target these high-risk individuals. The Integrated Community of Care (ICoC) is a novel care model that integrates hospital-based transitional care with health and social care in the community for high-risk individuals living in socially deprived communities. This study aims to evaluate the effectiveness of the ICoC in reducing acute hospital use and investigate the implementation process and its effects on clinical outcomes using a mixed-methods participatory action research (PAR) approach. METHODS AND ANALYSIS: This is a single-centre prospective, controlled, observational study performed in the SingHealth Regional Health System. A total of 250 eligible patients from an urbanised low-income community in Singapore will be enrolled during their index hospitalisation. Our PAR model combines two research components: quantitative and qualitative, at different phases of the intervention. Outcomes of acute hospital use and health-related quality of life are compared with controls, at 30 days and 1 year. The qualitative study aims at developing a more context-specific social ecological model of health behaviour. This model will identify how influences within one's social environment: individual, interpersonal, organisational, community and policy factors affect people's experiences and behaviours during care transitions from hospital to home. Knowledge on the operational aspects of ICoC will enrich our evidence-based strategies to understand the impact of the ICoC. The blending of qualitative and quantitative mixed methods recognises the dynamic implementation processes as well as the complex and evolving needs of community stakeholders in shaping outcomes. ETHICS AND DISSEMINATION: Ethics approval was granted by the SingHealth Centralised Institutional Review Board (CIRB 2015/2277). The findings from this study will be disseminated by publications in peer-reviewed journals, scientific meetings and presentations to government policy-makers. TRIAL REGISTRATION NUMBER: NCT02678273.

Access to Recovery and Recidivism Among Former Prison Inmates.

Access to Recovery (ATR) is a Substance Abuse and Mental Health Services Administration (SAMHSA)-funded initiative that offers a mix of clinical and supportive services for substance abuse. ATR clients choose which services will help to overcome barriers in their road to recovery, and a recovery consultant provides vouchers and helps link the client to these community resources. One of ATR's goals was to provide services to those involved in the criminal justice system in the hopes that addressing substance abuse issues could reduce subsequent criminal behaviors. This study examines this goal by looking at recidivism among a sample of clients in one state's ATR program who returned to the community after incarceration. Results suggest that there were few differential effects of service selections on subsequent recidivism. However, there are significant differences in recidivism rates among the agencies that provided ATR services. Agencies with more resources and a focus on prisoner reentry had better recidivism outcomes than those that focus only on substance abuse services.

[Ophthalmological rehabilitation of visually impaired children]. / Ophthalmologische Rehabilitation sehbehinderter Kinder.

BACKGROUND: There are very few studies on visually impaired children in Germany; therefore, the aim of this study was to investigate the current spectrum of diseases of visually impaired children and the care of these children in schools and kindergartens with aids and integrative support. PATIENTS AND METHODS: In a retrospective study all children (n =303) who attended the outpatient department for the visually impaired of the University Eye Hospital Tübingen in 2013 and 2014 were evaluated. The target values were ophthalmological diagnosis, best corrected visual acuity, needs for magnification, prescribed aids, measures for early support and integrative care and inclusion during schooltime. RESULTS: The most frequent diagnosis in this collective which led to visual impairment in children was optic atrophy (22.4%) followed by hereditary retinal dystrophy (18.5%), congenital nystagmus (9.9%), albinism (8.6%), retinopathy of prematurity (ROP, 7.9%), aniridia (4.6%), cerebral visual impairment (CVI, 4.3%) and severe myopia (3%). Of the children 21% suffered from multiple disabilities, 66% were visually impaired (visual acuity ≤0.3 and >0.05), 9% were severely visually impaired (visual acuity ≤0.05) and 6% were legally defined as blind (visual acuity ≤0.02). Of the schoolchildren 52% (n = 241) were able to visit a mainstream school within the framework of integrative care. For 77% of these schoolchildren integrative care was already provided by a special pedagogic institution at the time of presentation for school entry and 73% of all the schoolchildren needed magnifying aids at school: 20% used optical magnifying aids (e.g. reading stones) and 53% needed electronic magnifying aids, such as screen magnifiers or camera reading systems. CONCLUSION: Particularly for children, the use of magnifying aids for reading is essential for education in schools and 73% of the children used optical or electronic devices for reading. Of the children 52% attended a mainstream school and were additionally supported by special pedagogic counseling services.

Recovery-Oriented Mental Health Practice in a Community Care Unit: An Exploratory Study.

A recovery-oriented model of care has become the major focus of mental health service delivery in the state of Victoria, Australia. However, there is a total absence of knowledge of recovery-oriented mental health practice in community care units (CCUs). Therefore, the aims of this exploratory study were to: (a) describe what aspects of the current model of care fit within the domains of recovery; and (b) describe the pragmatic processes that staff use to mold their care within the domains of recovery. Twenty-one key stakeholders provided informed voluntary consent to participate in one-to-one interviews. Six content domains evolved to include: (a) a common vision: "a continuous journey"; (b) promoting hope; (c) promoting autonomy and self-determination; (d) meaningful engagement; (e) holistic and personalized care; and (f) community participation and citizenship. The CCU appeared to be on a journey of transformation toward personal recovery. However, clinicians were grappling with an identified tension among personal recovery and clinical recovery. The tension among personal recovery and clinical recovery may be attributed to the psychosocial rehabilitation model of care, which was previously systemic in Victorian CCUs.

"It Gave Me My Life Back": An Evaluation of a Specialist Legal Domestic Abuse Service.

Community-based advocacy services are important in enabling victims to escape domestic abuse and rebuild their lives. This study evaluated a domestic abuse service. Two phases of research were conducted following case-file analysis (n = 86): surveys (n = 22) and interviews (n = 12) with victims, and interviews with key individuals (n = 12) based in related statutory and community organizations. The findings revealed the holistic model of legal, practical, mental health-related, and advocacy components resulted in a range of benefits to victims and enhanced interagency partnership working. Core elements of a successful needs-led, victim-centered service could be distilled.

Predisaster integration of community emergency response teams.

OBJECTIVE: The Community Emergency Response Team (CERT) program has been increasingly used within local emergency management systems since the United States' Federal Emergency Management Agency (FEMA) adopted and began promoting the program in 1993. The objective of this study was to explore the integration of CERT programs within local emergency management systems predisaster. DESIGN: Qualitative, semistructured telephone interviews were used to collect data from a purposive sample of CERT program coordinators. SETTING: Telephone interviews were conducted with CERT program coordinators in FEMA Region VII (Iowa, Kansas, Missouri, and Nebraska). SUBJECTS, PARTICIPANTS: Twenty-five local county emergency managers participated in this study. RESULTS: This study found that the integration of CERTs varied significantly. The extent to which most teams were integrated allowed them to be placed along an integration continuum and classified as one of three types including Least Integrated, Somewhat Integrated, and Highly Integrated. Other team characteristics seemed to covary with the team integration. A phenomenon of team Piggy Backing-where the integration of the team was no longer relevant-was also found. CONCLUSIONS: This study concludes by making a key recommendation that could benefit any CERT-add a module to the CERT training curriculum designed to integrate the individuals associated with the CERT program within their local emergency management system.

Long term rehabilitation management and outcome of anti-NMDA receptor encephalitis: case reports.

BACKGROUND: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an auto immune-disorder. It is a life threatening condition that typically presents with viral illness, headaches, severe psychiatric symptoms, seizures, behavioural changes, decreasing levels of unconsciousness and progressive unresponsiveness, cognitive impairment, abnormal movements (e.g., dyskinesia), ataxia and hypoventilation. OBJECTIVE: This paper describes the long term outcome and rehabilitation management of patients with NMDAR encephalitis and highlights the diverse outcome of this condition and the unique and individual long term management needs associated with this disorder. METHODS: This is a case report study of three different patients with NMDAR encephalitis. All three cases are young women, two of whom presented with ovarian teratoma. Patient KH is the most impaired and was resident in a slow stream rehabilitation care home and presented with challenging behaviour. Patients RM and OA both lived in the community and presented with similar anxieties but diverse levels of cognition and motivation. A review of the literature is provided summarizing the disorder, interventions, management and challenges of this varied and complex condition. Standard neuropsychological tests and questionnaires to assess community integration (BICRO-39), quality of life (QOLIBRI-OS) and mood (HADS) were administered. RESULTS: Positive outcomes were achieved for all three patients using a variety of interventions which included behavioural management, family psycho-education and an integrated holistic multi-disciplinary team community approach. Memory and executive deficits were persistent in the long term and severity of impairments showed wide variability between patients. Emotional distress and behavioural difficulties were prominent and persistent and had a pronounced impact on rehabilitation. Continence issues were also a major factor impacting on the rehabilitation. CONCLUSIONS: Long term integrated and multi-disciplinary input by a variety of therapies and health disciplines is required in order to improve the long term outcome and quality of life for NMDAR patients and their families, and ultimately leads to improved positive outcomes. Each of these cases had markedly differing cognitive profiles suggesting that in the context of long term rehabilitation outcome, cognition may have less valence than emotional and behavioural factors. Guidelines and standardised procedures for ethical issues and counselling for iatrogenic infertility should be developed and integrated into long term programmes of rehabilitation care.