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BACKGROUND: Although systematic and scoping reviews have identified a range of interventions for persons experiencing homelessness, no known reviews have captured the range and quality of intervention studies aimed at supporting a transition from homelessness. OBJECTIVES: To capture the range and quality of occupational therapy intervention studies aimed at supporting a transition to housing following homelessness. METHOD: Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal and narrative synthesis of experimental studies. RESULTS: Eleven studies were included. Critical appraisal scores ranged from 33.3 to 88.9 of a possible score of 100 (Mdn = 62.5; IQR = 33.4). The majority of studies evaluated interventions for the development of life skills (n = 9; 81.8%), and all were conducted in the USA. Several of the included studies were exploratory evaluation and feasibility studies, and all were quasi-experimental in design. Only three studies (27.2%) incorporated a control group. Intervention strategies included (1) integrated group and individual life skills interventions (n = 6); (2) group-based life skills interventions (n = 3); and (3) psychosocial and consultative interventions (n = 2). CONCLUSIONS: Research evaluating occupational therapy interventions aimed at supporting homeless individuals as they transition to housing is in an early stage of development. SIGNIFICANCE: Implications for research and practice are discussed.

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OBJECTIVE: The aims of this study are the translation, cultural adaptation, and validation of the Community Integration Questionnaire-Revised (CIQ-R) in Italian in a group of individuals with no clinical evidence of disability. METHODS: The test's internal consistency and validity were assessed by following international guidelines. The test's internal consistency was examined using Cronbach's alpha (α) coefficient. Pearson's correlation coefficient was calculated to assess the test's concurrent validity compared with the Short Form-12 (SF-12) health survey. RESULTS: The CIQ-R was administrated to 400 people with no clinical evidence of disease, impairment, or disability, aged between 18 and 64. Cronbach's α reported a value of 0.82 in the home integration subscale. The test also showed a good test-retest reliability, with an Intraclass Correlation Coefficient of 0.78, and a significant correlation between the total score of the CIQ-R and the Physical Component Summary (PCS) of the SF-12 (r = 0.118), between the "social integration" subscale's score and PCS12 (r = 0.121) and between the "Electronic Social Networking integration" subscale's score and PCS12 (r = 0.184), with p < 0.05. CONCLUSION: This is the first study to report the results of the translation and validation of the CIQ-R in Italian. The CIQ-R is an important tool for Italian professionals and can be useful in both clinical practice and research for measuring the level of community integration among the healthy population.

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Community integration (CI) has been identified as a key outcome of programs designed to improve the lives of homeless and recently housed individuals (Gaetz, The State of Homelessness in Canada 2016, 2016). Although researchers have explored the extent to which Housing First (HF) impacts on social integration (Quilgars & Pleace, Soc. Incl., 4, 2016), little is known about the range and effectiveness of other interventions on CI more broadly. We conducted a systematic review of experimental studies using Joanna Briggs Institute (JBI) guidelines. Our search strategy was deployed in six databases: EMBASE, CINAHL, PsychINFO, Medline, Sociological Abstracts, and Proquest Dissertations and Theses. Our search was initiated in 2017 and updated on May 5, 2019. Using the definition of CI identified by Wong & Solomon (Ment. Health Serv. Res., 4:13-28, 2002), two independent raters screened 14,158 titles and abstracts after the removal of duplicates. A total of 157 articles were subjected to full-text review. Studies published in the English language and involving participants of any age were included. We conducted a critical appraisal of 25 studies using the JBI checklists for quasi-experimental and randomised controlled trials (Tufanaru, Joanna Briggs Institute Reviewers Manual, 2017), and subsequently excluded four studies as they did not meet a pre-established quality threshold score of 50/100. A total of 21 studies were included in a narrative synthesis. Critical appraisal scores ranged from 53.8-100 (Mdn = 69.2). Interventions evaluated in existing literature included housing and housing support interventions (n = 9), HF (n = 5), psychosocial interventions (n = 5), and employment interventions (n = 2). A meta-analysis could not be performed due to the heterogeneity of outcomes in included studies. Aspects of CI measured by researchers included social (n = 17), psychological (n = 6), and physical (n = 4) integration. Studies that evaluated HF and housing and housing support interventions demonstrated surprisingly mixed or a lack of effectiveness for promoting CI. Psychosocial interventions were the most promising, specifically those which incorporated an element of peer support. Findings of literature included in this review suggests that there is inconsistency in the extent to which existing interventions are effectively targeting CI as an outcome. Furthermore, we contend that existing systems-level interventions, including HF and permanent supportive housing alone may not be enough to promote CI among homeless and formerly homeless individuals. Future research should focus on the development and evaluation of interventions that more effectively target this critical construct.

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The United States has the highest incarceration rate in the world. With a substantial number of inmates diagnosed with mental illness, substance use, or both, various diversion strategies have been developed to help decrease and avoid criminalization of individuals with mental illness. This article focuses primarily on the first three Sequential Intercept Model intercept points as related to jail diversion and reviews types of diversion programs, research outcomes for diversion programs, and important components that contribute to successful diversion.

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OBJETIVOS: Examinar la validez predictiva de la guía HCR-20 (The Historical Clinical Risk Management-20) para predecir futuros incidentes violentos en una muestra representativa de pacientes con trastorno mental grave y con antecedentes de ingreso previo en prisión, que tras la excarcelación presentan una situación de exclusión social extrema. MATERIAL Y MÉTODO: La muestra del estudio se seleccionó de los 235 pacientes atendidos por el Equipo de Calle de Salud Mental (ECASAM) de Madrid, desde junio de 2014 hasta junio de 2017, incluyendo finalmente a aquellos con antecedentes de un internamiento previo en un establecimiento penitenciario, sobre los que posteriormente se cumplimentó la HCR-20. RESULTADOS: De los 44 pacientes incluidos, un 29,6% (n=13) terminaron protagonizando un incidente violento tras la excarcelación. El análisis de curvas ROC (Receiver Operating Characteristic) indicó que la puntuación total de la HCR-20 (área bajo la curva o AUC: 0,98, p = 0,01) tiene una alta validez predictiva. CONCLUSIONES: Los cambios sociosanitarios que se van a producir tras la excarcelación de los pacientes con trastorno mental grave justifican la necesidad de revaluar el riesgo de violencia. En esta evaluación, la aplicación de la guía HCR-20 resulta una útil herramienta para predecir el riesgo de protagonizar futuros incidentes violentos, siendo especialmente relevante la consideración de factores como la exclusión social y sus consecuencias, así como los problemas con el consumo de sustancias

OBJECTIVES: To examine the predictive validity of the HCR-20 (The Historical Clinical Risk Management-20) to predict future violent incidents in a representative sample of patients with severe mental disorders and with a history of previous admission to prison, who after release are in a situation of extreme social exclusion. MATERIAL AND METHOD: The study sample was selected from the 235 patients treated by the Mental Health Street Team of Madrid (ECASAM) from June 2014 to June 2017, including those with a previous history of a previous internment in a penitentiary (about which, the HCR-20 was completed). RESULTS: Of the 44 patients included, 29.6% (n=13) ended up participating in a violent incident after the release. The ROC curves (Receiver Operating Characteristic) analysis indicated that the total score of HCR-20 (AUC 0.98, p = 0.01) has a high predictive validity. CONCLUSIONS: The social and medical changes that take place after the release of patients with severe mental illness justify the need to reassess the risk of violence. In this evaluation, the HCR-20 guide is a useful tool for predicting the risk of involvement in future violent incidents, and the inclusion of factors such as social exclusion and its consequences, as well as problems with substance use is especially important

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INTRODUCTION: Systematic reviews reporting self-management interventions are associated with significant improvements in stroke survivors' self-efficacy, health-related quality of life (HRQoL) and independence. However, common barriers such as transportation and availability of carers were identified. Health coaching is suggested as an innovative and cost-effective care model with potential benefits in managing chronic diseases. A randomised controlled trial is proposed to evaluate the effectiveness of an enhanced self-management programme by health coaches on stroke survivors' recovery outcomes. METHODS AND ANALYSIS: All adult community-dwelling stroke survivors with a modified Rankin Scale Score ≥3 will be recruited from a community rehabilitation network. Eligible participants will be randomly allocated to receive either the enhanced stroke self-management programme (Coaching Ongoing Momentum Building On stroKe rEcovery journeY [COMBO-KEY]) plus usual care or usual care only. COMBO-KEY is an 8-week programme underpinned by Bandura's principles of self-efficacy and outcome expectation. It consists of four home visits and five phone-coaching sessions delivered by trained health coaches. Each participant will receive a resource package containing a workbook, a quick reference guide, a planning toolkit and 15 videos of peer survivors' stroke survival experience. Survivors' outcomes include self-efficacy, outcome expectation and satisfaction with performance of self-management behaviours, HRQoL, depressive symptoms and community reintegration. Assessment will be conducted at baseline and immediately after completing the programme. Generalised estimating equations' model will be used to analyse the data. DISCUSSION: It is anticipated that the programme will build community capacity in supporting stroke survivors. The results will shed light on integrating the programme into the current stroke rehabilitation services. ETHICS AND DISSEMINATION: The Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee has approved this protocol (CREC Ref. No.: 2018.009). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals and presentations at local and international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT03741842; Pre-results.

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PURPOSE: Early surgery for older adults with hip fracture has been shown to improve outcomes. We aim to study the factors contributing to delay in surgery (defined as surgery performed more than 48 h after admission) and its associated outcomes in a tertiary hospital in Singapore with an integrated hip fracture program. METHODS: This is a prospective cohort study of hip fracture patients aged more than 60 years over 1 year. We collected data on demographics, premorbid mobility and functional status, time to surgery, postoperative complications, and inhospital mortality. Mortality data and functional performance were reviewed at 1 year. RESULTS: High American Society of Anaesthesiologists score independently predicted delay in surgery (odd ratio (OR) = 9.52, 95% confidence interval (CI): 1.69-53.68). Delayed surgery was significantly associated with longer length of stay (median 12.8 days with interquartile range (IQR) 9.7-17.6 days vs. 8.35 days with IQR 5.9-10.9 days, p < 0.01). Surgery within 48 h significantly reduced functional decline (Modified Barthel Index change -3.89 ± 17.23 vs. -9.29 ± 20.30, p = 0.01) and 1-year mortality (3.5% vs. 9.3%, p = 0.03). Surgical delay was an independent risk factor for early postoperative complications (OR = 3.21, 95% CI: 1.21-8.49), and patients were significantly less likely to return to premorbid mobility at 1 year (OR = 0.62, 95% CI: 0.39-0.97). CONCLUSIONS: Delayed hip fracture surgery in older adults is associated with worse short- and long-term outcomes, including early postoperative complications and poorer functional recovery.

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PURPOSE: This study reports level of community integration and life satisfaction among individuals who sustained traumatic spinal cord injuries, received institutional rehabilitation care services, and went back to live in the community in Bangladesh. It examines the impact of type of injury, demographic characteristics, socio-economic profile, and secondary health conditions on community integration and life satisfaction and explores the association between these two measures. METHOD: Individuals with spinal cord injury were telephone interviewed by the Centre for the Rehabilitation of the Paralysed, Bangladesh from February to June of 2014. Data were collected from the subjects on type of injury, demographic and socio-economic profile, and secondary health conditions. The outcome measures were determined by using two validated tools - Community Integration Questionnaire and Life Satisfaction 9 Questionnaire. RESULTS: Total community integration and life satisfaction scores were 15.09 and 3.69, respectively. A significant positive relationship between community integration and life satisfaction was revealed. Type of injury, gender, and age were found to be significant predictors of both community integration and life satisfaction scores. Higher education was significantly related to community integration and life satisfaction scores. CONCLUSION: Participants scored low in total community integration and life satisfaction, suggesting there is a great need to develop interventions by governmental and non-governmental organizations to better integrate individuals with spinal cord injury in the community. Implications for Rehabilitation Government and non-government organizations should offer disability friendly public transportation facilities for individuals with spinal cord injury so that they can return to education, resume employment, and involve in social activities. Entrepreneurs and businesses should develop assistive devices featuring low technology, considering the rural structure and housing conditions in Bangladesh. Innovations being made in assistive technology should be supported by subsidies and grants. They should also plan to offer injury appropriate employment opportunities for individuals who suffer major injuries like spinal cord injury in Bangladesh. Housing facilities with accessible bathrooms, kitchens and stairs should be designed and offered for this population to improve their ability to self-care and decrease the dependence on caregivers for household tasks such as - cooking meals and taking care of children.

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BACKGROUND: Little is known about the effectiveness of Housing First (HF) among ethnic minority groups, despite its growing popularity for homeless adults experiencing mental illness. This randomized controlled trial tests the effectiveness of a HF program using rent supplements and intensive case management, enhanced by anti-racism and anti-oppression practices for homeless adults with mental illness from diverse ethnic minority backgrounds. METHODS: This unblinded pragmatic field trial was carried out in community settings in Toronto, Canada. Participants were 237 adults from ethnic minority groups experiencing mental illness and homelessness, who met study criteria for moderate needs for mental health services. Participants were randomized to either adapted HF (n = 135) or usual care (n = 102) and followed every 3 months for 24 months. The primary study outcome was housing stability; secondary outcomes included physical and mental health, social functioning, quality of life, arrests and health service use. Intention to treat statistical analyses examined the effectiveness of the intervention compared to usual care. RESULTS: During the 24-month study period, HF participants were stably housed a significantly greater proportion of time compared to usual care participants, 75 % (95 % CI 70 to 81) vs. 41 % (95 % CI 35 to 48), respectively, for a difference of 34 %, 95 % CI 25 to 43. HF also led to improvements in community integration over the course of the study: the change in the mean difference between treatment groups from baseline to 24-months was significantly greater among HF participants compared to those in usual care (change in mean difference = 2.2, 95 % CI 0.06 to 4.3). Baseline diagnosis of psychosis was associated with reduced likelihood of being housed ≥ 50 % of the study period (OR = 0.37, 95 % CI 0.18 to 0.72). CONCLUSION: Housing First enhanced with anti-racism and anti-oppression practices can improve housing stability and community functioning among ethnically diverse homeless adults with mental illness. TRIAL REGISTRATION: International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374 , assigned August 18, 2009.

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INTRODUCTION: Overweight and obesity are influenced by a complex interplay of individual and environmental factors that affect physical activity and healthy eating. Nevertheless, little has been reported on people's perceptions of those factors. Addressing this critical gap and community partner needs, this study explored how people perceived the influence of micro- and macroenvironmental factors on physical activity and healthy eating. METHODS: Community partners wanted the study results in a format that would be readily and easily used by local decision makers. We used photovoice to engage 35 community members across four municipalities in Alberta, Canada, and to share their narratives about their physical activity and healthy eating. A combination of inductive and deductive analysis categorized data by environmental level (micro vs. macro) and type (physical, political, economic, and sociocultural), guided by the Analysis Grid for Environments Linked to Obesity Framework. RESULTS: Participants conceptualized health-influencing factors more broadly than physical activity and healthy eating to include "community social health." Participants spoke most often about the influence of the microenvironment (n = 792 ANGELO Framework coding tallies) on their physical activity, healthy eating and community social health in comparison to the macroenvironment (n = 93). Photovoice results provided a visual narrative to community partners and decision makers about how people's ability to make healthy choices can be limited by macroenvironmental forces beyond their control. CONCLUSION: Focussing future research on macro- and microenvironmental influences and localized community social health can inform practice by providing strategies on how to implement healthy changes within communities, while ensuring that research and interventions echo diverse people's perceptions.

INTRODUCTION: Le surpoids et l'obésité dépendent de l'interaction complexe entre facteurs liés à l'indivu et facteurs liés à l'environnement ayant une influence sur l'activité physique et une alimentation saine. Il existe pourtant peu d'information sur les perceptions des individus à l'égard de ces facteurs. Afin de combler cette lacune importante et de répondre aux besoins de nos partenaires des collectivités, nous examinons comment les individus perçoivent l'influence des facteurs micro- et macroenvironnementaux sur leur activité physique et leur alimentation. MÉTHODOLOGIE: Nos partenaires des collectivités souhaitaient que les résultats de l'étude soient diffusés dans un format facile à utiliser par les décideurs locaux. Avec la méthode photovoix, nous avons motivé 35 membres issus de quatre collectivités de l'Alberta (Canada) à fournir leurs témoignages à propos de leur activité physique et d'une alimentation saine. Nous avons employé une combinaison d'analyses inductives et déductives pour classer les données par niveau (micro et macro) d'environnement et par type (environnement physique, politique, économique et socioculturel), à l'aide de la Grille d'analyse des environnements liés à l'obésité (ANGELO). RÉSULTATS: Pour les participants, les facteurs liés à la santé étaient plus larges que l'activité physique et une alimentation saine, incluant la « santé sociocommunautaire ¼. Les participants ont parlé plus souvent de l'influence du microenvironnement (score de 792 après codage au moyen du cadre ANGELO) sur l'activité physique, une alimentation saine ou la santé sociocommunautaire que sur l'influence du macroenvironnement (score de 93). Les résultats obtenus avec la méthode photovoix ont fourni aux partenaires des collectivités et aux décideurs un témoignage visuel de la manière dont la capacité des individus à faire des choix sains peut être restreinte par des forces macroenvironnementales qui échappent à leur contrôle. CONCLUSION: Axer les recherches ultérieures sur les influences et macroenvironnementales et microenvironnementales ainsi que sur la santé sociocommunautaire locale sera utile, car cela alimentera les stratégies de changement en vue d'améliorer la santé des collectivités tout en garantissant que la recherche et les interventions font écho aux perceptions diverses de la population.

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RATIONALE: The health effects of social integration have been extensively studied, yet the underlying dynamics of this relationship deserves more exploration. One of the important hypothesized pathways through which social integration affects health is psychological functioning, including a sense of belonging, personal control and generalized trust. OBJECTIVE: Using a Canadian national survey, this study explored the effect of social integration on different health outcomes via psychological pathways, while incorporating network homophily as a predictor in the model. METHODS: Five distinct demographic groups of Canadians (the Native-born Whites, Native-born visible minorities, the Aboriginal people, immigrant Whites and immigrant visible minorities) were compared on their social integration, psychological functioning, and health outcomes. Structural equation models tested the mediation effects of psychological pathways, and group differences were explored by adding interaction terms. RESULTS: The study found that visible minority immigrants were least socially integrated, and the Aboriginal people had the poorest self-reported physical and mental health. Although the Aboriginal people had large networks and active network interactions, they showed stronger ethnic and linguistic homophily in their network formation than the two visible minority groups. Structural equation model results supported the mediated relationship between social integration and health via psychological pathways. A positive effect of friendship ethnic homophily on health was identified and explored. CONCLUSION: Policy makers may seek opportunities to create social environments that facilitate social interactions and formation of social ties and provide support for programs serving ethnic and immigrant groups.

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The aims of this study were to assess the trajectories of community integration in individuals with traumatic brain injury (TBI) through one, two, and five years post-injury and to examine whether those trajectories could be predicted by demographic and injury characteristics. A longitudinal cohort study was conducted with 105 individuals with moderate-to-severe TBI admitted to a trauma referral center in 2005-2007. Demographics and injury-related factors were extracted from medical records. At the one-, two- and five-year follow-ups, community integration was measured by the Community Integration Questionnaire (CIQ). A hierarchical linear model (HLM) examined whether longitudinal trajectories of community integration could be predicted by: time, sex, age, relationship status, education, employment status, occupation, acute Glasgow Coma Scale score, cause of injury, days in post-traumatic amnesia (PTA), computed tomography Marshall Score, and Injury Severity Score. CIQ scores improved across the three time-points (p<0.001). Additionally, higher trajectories of community integration were predicted by being single at the time of injury (p<.001), higher level of education (p=0.006), employment (p<0.001), and a shorter length of PTA (p<0.001). In a follow-up HLM with interaction terms, time*PTA was statistically significant (p<0.001), suggesting that participants with longer PTA increased in community integration more rapidly than those with shorter PTA. The longitudinal course of community integration described in this study may help rehabilitation professionals to plan more extensive follow-ups and targeted rehabilitation programs in the early stage of recovery for patients with specific demographic and injury characteristics.

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