Recovery in context: Sober living houses and the ecology of recovery.

Sober living houses (SLHs) are an increasingly common element of the recovery support services landscape, yet little is known about their neighborhood context. This study describes neighborhoods in which SLHs are located and examines differences by house characteristics. SLHs in Los Angeles County (N = 297) were geocoded and linked with U.S. Census, alcohol outlet, recovery resources, and accessibility data. Regression analyses tested differences by house characteristics. Co-ed houses were in neighborhoods that were less ethnically diverse and farther away from recovery resources. Larger house capacity was associated with increased density of off-premise alcohol outlets but also increased proximity to treatment. Higher fees were associated with lower neighborhood disadvantage and off-premise alcohol outlet density but the greater distance from treatment programs and other recovery resources. House characteristics are associated with neighborhood factors that both support recovery and place residents at risk.

[Inclusive housing: progress for mental health?] / L'habitat inclusif : un progrès pour la santé mentale ?

People with psychiatric disabilities often have difficulty living by themselves in their home. Sometimes, individual housing may be an isolation vector while a collective institutional setting may be too restrictive. So, alternative forms of co-housing have been developed. The term inclusive housing includes "maisons relais", "pensions de famille", "résidences accueil" and "Familles Gouvernantes" (halfway houses, guest houses, and foster homes). These houses' aim, implemented by the hosts, is to fight against social exclusion in order to open up to the city. The goal is to offer the people the opportunity to empower themselves while respecting their abilities, thus promoting their recovery. When building projects, the limits must be designed to adapt to the needs of tenants, without setting rules that would be too strict. The French government is committed to promoting the development of habitat inclusive (inclusive housing) in the future. The increasing number of projects has to take place under conditions that guarantee their sustainability. To make it happen, it is necessary that the projects respect the people's autonomy.

Estudio de aplicabilidad de la entrevista motivacional para potenciar la rehabilitación en pacientes geriátricos ingresados en una unidad de convalecencia / Feasibility study of motivational interviewing to improve rehabilitation in an Intermediate Care Hospital

Objetivo: La rehabilitación de las personas mayores es una intervención compleja, en la cual intervienen múltiples componentes (clínica, cognitiva, anímica etc.). Nuestro estudio pretende comprobar si la entrevista motivacional (EM) (basada en una atención centrada en la persona), con adaptaciones, es aplicable en pacientes con fractura de fémur o ictus que realizan rehabilitación en una unidad de convalecencia. Metodología: Se realizan entrevistas motivacionales a 20 pacientes > 65 años (10 con fractura de fémur y 10 con ictus). Un geriatra formado en EM realiza dos entrevistas a cada paciente, una inicial en < 72 horas del ingreso y otra de seguimiento la semana siguiente. Para que los pacientes recuerden los ejercicios acordados, se entregan trípticos adaptados. Resultados: Todos los pacientes aceptaron y valoraron satisfactoriamente las dos entrevistas. La segunda entrevista mostraba mejor aceptación si realizada antes del 6è día, porqué se recordaba mejor al profesional y los objetivos acordados. La demanda de esta intervención fue alta (4-5 pacientes/semana). El mejor momento per realizar la entrevista es por la tarde, evitando interferir en el funcionamiento de la planta. La EM en pacientes con deterioro cognitivo leu presenta mayor dificultad, y en 3 ocasiones se incorporó a la entrevista al cuidador principal, con muy buena respuesta. La motivación de los pacientes para realizar rehabilitación fue alta (poca ambivalencia), por ello durante las entrevistas no se trabajó tanto la ambivalencia, sino en empoderar a los pacientes y ayudarlos a encontrar herramientas para aumentar las probabilidades de éxito. Conclusiones: La EM es una herramienta fácilmente aplicable dentro del entorno socio sanitario, realizando algunas adaptaciones. La motivación de los pacientes es alta y la EM se centra sobre todo en empoderar al paciente. Este estudio abre la puerta a evaluar, en un futuro, si la intervención es efectiva en este ámbito

Objective: Our main objective was to test the feasibility of adding a patient centered motivational intervention to the usual rehabilitation in an Intermediate Care (IC) Hospital for patients admitted after a hip fracture or stroke. Methods: 20 patients>65 years (10 hip fracture;10 stroke) participated in the study, receiving two motivational interviewing sessions by a trained geriatrician, the first within the 72 hours after admission, the second one week later. All patients were given leaflets informing about different rehabilitation exercises to perform besides formal physical therapy provided in the hospital, among which they could choose those they felt more suitable. Data collected included socio-demographics, comorbidity, and clinical, cognitive and functional status. Results: The motivational intervention was accepted by all patients and all felt it to be appropriate. Opportunities for this intervention were high,4-5 patients per week, best time for the interventions was in the afternoons, which avoided interferences with hospital activities. In patients with mild cognitive impairment the intervention was harder, and in 3 occasions the primary caregiver was invited to participate, with high acceptance and enthusiasm. Patients at baseline were already highly motivated to do rehabilitation, and ambivalence was not big. Therefore most of the interviews focussed on empowering patients and helping them to identify and set their own goals during rehabilitation. Conclusions: Adding specific motivational interventions to usual rehabilitation treatment in older patients admitted after a hip fracture or stroke, is feasible and acceptable in our IC Hospital. Since patients are quite prone to rehabilitation, interviews tend to focus on empowerment. Further, rigorous research is needed

[Sorting things out: emergence of a halfway house in Avignon with a plan to convert the former Avignon mail sorting facility]. / Faire le tri. Émergence d’un lieu intermédiaire en Avignon... Projet de reconversion de l’ancien centre de tri postal d’Avignon.

Emergence of an intermediate place... In a period of questioning public policies and refoundation of established values, these intermediate places are building a vision and practical renewing the place of art, culture, health and social practices and citizen engagement in society. A movement based on attention to the empowerment of people.The creation of this place on Avignon seems to refer to the Ottawa Charter, in its intention to create enabling environments, and its attention to the links between individuals to their environment..

Oxford recovery housing: Length of stay correlated with improved outcomes for women previously involved with the criminal justice system.

BACKGROUND: Housing plays a crucial role in providing resources for and aiding an individual's reentry into the community following incarceration and substance use treatment. As such, this study examined the influence of recovery homes on a sample of former female substance-using women with criminal justice involvement. METHODS: Two hundred women who had been involved with the criminal justice system within the preceding 2 years were recruited from multiple sites in metropolitan Chicago. These women were assigned to either 1 of 2 conditions: Oxford House (OH) recovery homes or usual aftercare (UA). RESULTS: Those with longer stays in OH (6 months or more) had better outcomes in terms of alcohol and drug use, employment, and self-efficacy than those with shorter stays. Outcomes for those who stayed in OH were not appreciably different than the UA condition on substance use and employment, but fewer deaths occurred for those in the OH condition. CONCLUSIONS: Findings suggest that length of stay of 6 or more months is critical for those in recovery homes, but it is important for us to better understand the processes through which longer stays influence better outcomes.

La atención de la fractura de fémur en las unidades de convalecencia / No disponible

El desarrollo de las Unidades de Media Estancia (UME) o Convalecencia (UC), según las diferentes acepciones, ha permitido proseguir el proceso rehabilitador en los pacientes ancianos afectos de fractura del tercio proximal de fémur. Este hecho, contribuye a una reducción de la mortalidad innata del proceso, un mejor resultado de recuperación funcional así cómo a una disminución de las complicaciones propias, que un evento como la fractura de fémur, dada su magnitud, ocasiona al paciente anciano. Otro aspecto fundamental es el de la utilización de los recursos sociales y sanitarios, que se ven favorecidos y optimizados en su gestión gracias a la existencia de dichas unidades. La reducción de la estancia media en los hospitales de agudos y una menor tasa de institucionalización al final del alta médica, son claros ejemplos de la efectividad y la eficiencia de las unidades de convalecencia(AU)

The development of Geriatric Assesment Units or Geriatric Rehabilitation Units, according to different meanings, has allowed the rehabilitation process to be carried on in old patients affected in hip fracture. This fact, leads to a reduction of the death of the process, a better functional recuperation, and at the same time, decreasing of the common complications, which uses to affect the old patient, due to its magnitude. Another fundamental aspect is the use of sanitary and social sources, which are being optimized in their management due to the existence of some sectors. The reduction of average in hospitals and a lower tax in institutionalization at the end of medical discharge, are clear examples of the effectiveness and efficiency of the convalescence sectors(AU)

[Changes in the subjective perception of the quality of life. Retrospective study of patients treated at the Thalassa House]. / A szubjektív életminoség változása. A Thalassa Házban kezelt páciensek retrospektív vizsgálata.

INTRODUCTION: Quality of life and psychosocial functioning are considered important factors both in psychiatric and psychotherapeutic rehabilitation; similarly they are useful outcome measures in prospective studies. In this paper we present a retrospective study conducted with patients treated in Thalassa Haz Psychiatric and Psychotherapeutic Rehabilitation Center (TH). METHOD: 1. Non-systematic review of the literature concerning quality of life and social functioning measures 2. Patients discharged form TH between 01. 01. 2008 and 31. 12. 2008 were included in the study. A semi-structured, patient reported instrument was used to assess psychosocial functioning, including single questions and an open-ended questions. Statistical analysis and manual content analysis were performed. RESULTS: 208 patients were contacted, 84 completed questionnaires were sent back and analysed. Less than 31% of the patients were rehospitalized within six months with the same problem. Subjective evaluation showed that 72% of the patients suffer less from the problem, with which they were treated in TH. The majority reported positive effect on interpersonal relations (67%) and autonomy (70%) due to the treatment. There is a significant correlation between treatment satisfaction and duration of treatment. The content analysis revealed significant negative correlation between generalisational content frequencies and treatment satisfaction. CONCLUSIONS: Psychosocial functioning improved after treatment in the TH. Correlation was identified between treatment satisfaction and satisfaction with life, thus quality of life and duration of treatment. Combination of objective and subjective methods, as well as content analysis are useful measures in the effectiveness studies of therapeutic communities.

A model for sober housing during outpatient treatment.

Finding a living environment that supports recovery is a major challenge for many clients attending outpatient treatment. Yet it is important because family, friends, and roommates who encourage substance use or discourage recovery can undermine the progress made in treatment. Destructive living environments are most problematic for clients who have limited incomes and reside in urban areas where housing markets are tight. Individuals who are homeless face constant threats to their sobriety and often lack the stability necessary to attend treatment consistently. Options Recovery Services is an outpatient program in Berkeley, California that uses sober living houses (SLHs) to provide an alcohol- and drug-free living environment to clients while they attend the outpatient program. This article describes the structure and processes of the houses along with six month outcome data on 46 residents. Improvements were seen in the number of months using substances, maximum number of days of substance use per month, arrests, and employment. Seventy six percent of the residents remained in the house at least five months and 39% reported being employed at some point during the past 30 days. Outpatient programs should consider establishing SLHs for clients who lack a living environment supportive of sobriety.

Halfway houses for alcohol dependents: from theoretical bases to implications for the organization of facilities.

The purpose of this paper is to supply a narrative review of the concepts, history, functions, methods, development and theoretical bases for the use of halfway houses for patients with mental disorders, and their correlations, for the net construction of chemical dependence model. This theme, in spite of its relevance, is still infrequently explored in the national literature. The authors report international and national uses of this model and discuss its applicability for the continuity of services for alcohol dependents. The results suggest that this area is in need of more attention and interest for future research.

Caracterização das Casas de Apoio a portadores de HIV/Aids em Ribeirão Preto (São Paulo, Brasil) e suas práticas de administração / Characterization of support houses for people with HIV/Aids in Ribeirão Preto (São Paulo, Brazil) and their administrative practices

Objetivou-se conhecer a organização, o funcionamento e a prestação da assistência de três Casas de Apoio a portadores de HIV/Aids em Ribeirão Preto-SP. Foram feitas entrevistas semi-estruturadas com as coordenadoras a respeito de suas funções, aplicou-se um questionário sobre os aspectos estruturais do local e registraram-se observações do cotidiano das instituições. Legalmente, eram organizações regidas por entidades de cunho assistencialista-humanitário e procuravam adequar-se às normas técnicas e exigências para seu funcionamento. Recebiam subvenção da prefeitura local, mas eram sustentadas, sobretudo, por doações da sociedade civil. As coordenações eram desempenhadas por mulheres, predominantes nos quadros de funcionários e voluntários. Em suas falas, observou-se uma postura administrativa multifuncional e dificuldade para realizar a inclusão social dos moradores, devido a preconceito ou regras de funcionamento das casas. Conclui-se que, administrativamente as Casas correspondiam ao que se propunham, mas deveriam atentar para a necessidade, como agentes sociais, de fomentar a inclusão social.

The study aimed to determine how three support houses for people with HIV/Aids in Ribeirão Preto, SP, are organized and operated by their coordinators, and how care is provided. Semi-structured interviews were held regarding coordination functions. Structural characteristics of the locality were probed and daily institutional life was recorded using a field diary. It was found that, legally, these organizations are governed by assistance-providing and humanitarian entities that sought to conform to operational technical standards and requirements. They received subsidies from local municipal authorities but were especially maintained through donations from civil society. Women predominated among the employees and volunteers and were the coordinators. From their words, they had a multifunctional administrative stance and had difficulty in achieving social inclusion for the residents because of prejudice or the rules for how the houses should function. In conclusion, the houses are what they purport to be administratively, but should be attentive towards the need, as social agents, to encourage social inclusion.

La finalidad del estudio fue conocer la organización, funcionamiento y prestación de cuidado por las coordinaciones de las tres Casas de Apoyo a portadores de HIV/Sida en Ribeirão Preto-São Paulo. Se realizaron entrevistas semi-estructuradas con las coordinadoras respecto a sus funciones, se aplicó un cuestionario sobre los aspectos estructurales del local y se registraron observaciones del cotidiano de las instituciones (diario de campo). Se obtuvo que, legalmente, eran organizaciones regidas por entidades del tipo asistencialista-humanitario e intentaban adecuarse a las normas técnicas y exigencias para su funcionamiento. Recibían subvención del ayuntamiento local, pero eran sostenidas principalmente por donativos de la sociedad civil. Las coordinaciones eran desempeñadas por mujeres, predominantes en los equipos de funcionarios y voluntarios. En sus discursos, se observó una postura administrativa multifuncional y dificultad en realizar la inclusión social de los habitantes, debido al preconcepto o reglas de funcionamiento de las casas. Se concluye que, administrativamente, las casas cumplían con aquello que se proponían, pero necesitarían atentar para que, como agentes sociales, fomentaran la inclusión social.

Halfway houses for alcohol dependents: from theoretical bases to implications for the organization of facilities: [review]

The purpose of this paper is to supply a narrative review of the concepts, history, functions, methods, development and theoretical bases for the use of halfway houses for patients with mental disorders, and their correlations, for the net construction of chemical dependence model. This theme, in spite of its relevance, is still infrequently explored in the national literature. The authors report international and national uses of this model and discuss its applicability for the continuity of services for alcohol dependents. The results suggest that this area is in need of more attention and interest for future research.

Housing First for long-term shelter dwellers with psychiatric disabilities in a suburban county: a four-year study of housing access and retention.

Housing First is an effective intervention that ends and prevents homelessness for individuals with severe mental illness and co-occurring addictions. By providing permanent, independent housing without prerequisites for sobriety and treatment, and by offering support services through consumer-driven Assertive Community Treatment teams, Housing First removes some of the major obstacles to obtaining and maintaining housing for consumers who are chronically homeless. In this study, consumers diagnosed with severe mental illness and who had the longest histories of shelter use in a suburban county were randomly assigned to either one of two Housing First programs or to a treatment-as-usual control group. Participants assigned to Housing First were placed in permanent housing at higher rates than the treatment-as-usual group and, over the course of four years, the majority of consumers placed by both Housing First agencies were able to maintain permanent, independent housing. Results also highlight that providers new to Housing First must be aware of ways in which their practices may deviate from the essential features of Housing First, particularly with respect to enrolling eligible consumers on a first-come, first-served basis and separating clinical issues from tenant or housing responsibilities. Finally, other aspects of successfully implementing a Housing First program are discussed.

From principles to practice: a study of implementation of supported housing for psychiatric consumers.

In the post-deinstitutionalization era, supported housing has emerged as a housing and service approach considered most conducive to the goal of consumer empowerment and community integration. Although prior research found beneficial effects of supported housing, little empirical work has been done on identifying the gaps between the principles and practice of supported housing. Using multiple data sources on 27 supported independent living (SIL) programs for psychiatric consumers in a large metropolitan community, this paper examines the extent to which these programs are implemented in accordance with supported housing. Findings suggest consistency with as well as deviation from the supported housing approach in regard to consumer choice, typical and normalized housing, resource accessibility, consumer control and provision of individualized and flexible support. This study suggests methods for assessing housing programs for psychiatric consumers along these domains. Implications for the development of housing programs that promote consumer empowerment and community integration are discussed.