Perspectives of Service Providers on Aftercare Service Provision for Persons with Substance Use Disorders at a Rural District in South Africa.

Background: Provision of aftercare services for persons with substance use disorders (PWSUD) within a rural context is typically met with various intersecting challenges, including unclear policy implications and lack of resources. In the South African context, service providers are expected to provide aftercare services that should achieve successful reintegration of persons with PWSUD into society, the workforce, family and community life as mandated by Act No. 70 of 2008, despite population diversity. Little has been established on the provision of aftercare services in South Africa and specifically within a rural context. This article explores the perspectives of service providers in aftercare service provision for PWSUD in a rural district.Methods: A qualitative exploratory study design was conducted in a rural district in South Africa using semi-structured interviews and focus group discussions with forty-six service providers from governmental and non-governmental institutions, ranging from implementation to policy level of service provision. Data were analyzed thematically using a deductive approach. Codes were predetermined from the questions and the aims and objectives of the study used Beer’s Viable Systems Model as a theoretical framework. NVivo Pro 12 qualitative data analysis software guided the organization and further analysis of the data.Results: Four themes emanated from the data sets. Theme 1 on reflections of the interactional state of aftercare services and program content identified the successes and inadequacies of aftercare interventions including relevant recommendations for aftercare services. Themes 2, 3, and 4 demonstrate reflections of service provision from implementation to policy level, namely, identifying existing barriers to aftercare service provision, situating systemic enablers to aftercare service provision, and associated aftercare system recommendations. Conclusions: The intersecting systemic complexities of providing aftercare services in a rural context in South Africa was evident. There existed minimal enablers for service provision in this rural district. Service providers are confronted with numerous systemic barriers at all levels of service provision. To strengthen the aftercare system, policies with enforcement of aftercare services are required. Moreover, a model of aftercare that is integrated into the existing services, family centered, sensitive to the rural context and one that encourages the collaboration of stakeholders could also strengthen and sustain the aftercare system and service provision.

"When They See Someone Who Is Poor, They Step on Them": The Social Determinants of Health Among Survivors of Sex Trafficking in Cambodia

Social determinants of health (SDH) are defined as the non-medical yet health-affecting conditions of a person’s life. They include such considerations as working conditions, discrimination, and access to health services. The aim of this study was to explore the SDH impacting those who have survived sex trafficking in Cambodia. This study employed a mixed methods, secondary analysis, focusing on 52 survivors of sex trafficking in the Butterfly Longitudinal Research Project from 2010 through 2019. Participants described myriad social determinants of health, including: gender, age, relationship status (marriage), ethnicity, national identification documentation (statelessness), social class, formal education, vocational training, occupation, and monthly income. The negative impacts of these social determinants of health included: poor access to basic needs of food and clean water, unstable housing, low education rates, worsening physical health, depression, and suicidal ideation, along with long unresolved STI-like symptoms. As these are multidisciplinary issues, the study concludes with recommendations for remedial actions to be taken by multidisciplinary stakeholders, namely government agencies, healthcare professionals, and survivor aftercare service providers.

The Impact of a Reentry and Aftercare Program on Recidivism

In this article, we explore the impact of a reentry and aftercare service program on the likelihood of returning to prison by ex-offenders. Using administrative data within a difference-in-differences design, we find that this social program is associated with a reduction in recidivism rates. Benchmark estimates show that the program was associated with estimated reductions in the probability of recidivating of 6.0 to 8.7 percentage points. The estimate appears to be economically significant as it implies an estimated treated effect in the 15.8% to 19.2% range. We consider the heterogeneous effects of the program on reducing recidivism according to race, age group, and program type. The program helped to reduce recidivism among Whites but not Blacks; older participants were the main beneficiaries while the effectiveness of the program was observed among older participants. Back-of-the-envelope cost-savings analysis is incorporated to estimate the potential savings to the state arising from the reduction in recidivism rates likely attributable to the program. The findings are robust to sample selection bias, alternative specifications, and estimation techniques. Our results offer some implications for the role of faith-based social programs within the context of criminal justice reform to combat reentry of former inmates. They also provide a cautionary tale about the need to evaluate programs not just based on their overall effect.

Client satisfaction and experience of home use of mifepristone and misoprostol for medical abortion up to 10 weeks’ gestation at British Pregnancy Advisory Service: a cross-sectional evaluation

Objective: Evaluate satisfaction and experience with telemedicine and home use of mifepristone and misoprostol for abortion to 10 weeks’ gestation. Design: Cross-sectional evaluation. Setting: British Pregnancy Advisory Service (BPAS) clinics in England and Wales. Population: 1,144 clients who used mifepristone and misoprostol at home from 11 May to 10 July 2020. Methods: We sent a text message with a link to a web-survey 2-3 weeks after treatment. Questions evaluated satisfaction and experiences, including telephone consultations and provision of medicines by post or collection from clinic. We used bivariate and multivariate regression to explore associations between client characteristics and outcomes. Main Outcome Measures: Overall satisfaction (5-point Likert scale) and reported contact with a healthcare provider (HCP). Results: Respondents primarily described home use of medications as ‘straightforward’ (75.8%) and most were ‘very satisfied’ (78.3%) or ‘satisfied’ (18.6%) with their overall experience. Being ‘very satisfied’ was associated with parity (aOR 1.53, 95% CI 1.09-2.14) and pain control satisfaction (aOR 2.22, 95% CI 1.44-3.44). HCP contact was reported by 14.7%; mainly to BPAS’ telephone aftercare service (76.8%). Dissatisfaction with pain control (aOR 3.62 95% CI 1.79-7.29) and waiting >1 week to use mifepristone (aOR3.71, 95% CI 1.48-9.28) were associated with HCP contact. If needed in future, most (77.8%) would prefer home use of mifepristone and misoprostol and pills by post (68.9%). Conclusions: Satisfaction with home use of mifepristone and misoprostol is high. Most clients do not need HCP support during or after home use, but aftercare should be available.

KEBERFUNGSIAN SOSIAL MANTAN WBS/ KLIEN PANTI REHABILITASI SOSIAL NAPZA SETELAH MENDAPATKAN PEKERJAAN

<span>This research describes the condition of social functioning of drug abuser victim client after undergoing social rehabilitation period in PSPP Husnul Khatimah and get job. This research uses qualitative method with data collection technique in the form of unstructured interview, observation and literature study. The result is that the social functioning of drug abuse victims after obtaining social rehabilitation can be observed from the changes that occur to the victim through his ability to carry out his role, meet his needs, and solve his own problems. Good social functioning was successfully shown from all respondents in five aspects of life such as personal aspect, social aspect, vocational aspect, physical aspect and spiritual aspect. Where one aspect has relevance to other aspects. Recommendations from this study consist of recommendations for respondents who have worked this should always improve the efforts that are beneficial in improving social functioning. Supervision and attention is an important component that helps respondents in aftercare life in shelter dormitories. For the institution of PSPP Husnul Khatimah, it is better to improve the quality of aftercare service for the respondents who have finished the rehabilitation and have got the job so as to strengthen the social functioning of the respondents. For further research can be done by focusing on aspects of the right type of work for respondents after undergoing rehabilitation so that the suitability of interests, talents and needs of respondents with the availability of labor market.</span>

Are we doing enough to enhance attendance to aftercare? Service users’ evaluation of a group relapse prevention programme for alcohol dependence

Purpose – The purpose of this paper was to evaluate and improve the quality of the aftercare services we provide for alcohol dependence. This presentation discusses the patient satisfaction of the Relapse Prevention Group. Design/methodology/approach – This was a prospective service users' satisfaction survey of those who attended the relapse prevention group programme at the Community Drug and Alcohol Team for the first 11 months of programme implementation. Findings – In all, 33 out of 36 people participated in the evaluation. The overall results were positive for the whole programme and people felt that the programme helped them in their recovery. Originality/value – Monitoring of service users’ satisfaction with aftercare services could provide insight into the barriers compromising engagement.

FC22-05 - Effectiveness of a home aftercare service for patients with schizophrenia and bipolar disorder: A 12-month randomized controlled study

IntroductionThe revolving door phenomenon of hospitalization and relapse is very common among psychiatric patients in Iran.ObjectiveTo examine the effectiveness of a home aftercare service for patients with schizophrenia and bipolar disorders.MethodsPatients admitted to Roozbeh hospital (Tehran, Iran) were consecutively enrolled and were randomized into the home aftercare service and the treatment-as-usual groups. In the home aftercare group, multidisciplinary teams made home visits on a monthly basis that provided education and treatment. The treatment-as-usual group received the existing services. All patients were followed one year after discharge in 4-month intervals in which data about rehospitalisations, symptoms, functioning, quality of life, and service satisfaction were obtained.ResultsA total of 130 patients were enrolled (70 with bipolar disorder and 60 with schizophrenia) and were randomized to receive either home aftercare (66) or treatment-as usual (64). Home aftercare led to greater reduction in mean rehospitalization rate in the follow-up (0.4 in home care vs 0.07 in TAU, p = 0.011). Moreover, patients in the home care group had more improvement in psychotic symptoms (p = 0.003), depressive symptoms (p = 0.003), and clinical global impression of illness severity (p = 0.008), as well as greater patient satisfaction with the service (p < 0.001). In multiple regression analysis, home aftercare and bipolar diagnosis were associated with less rehopsitalization.ConclusionsHome aftercare is an effective service for patients with severe mental disorders after being discharged from the hospital. Its implementation in aftercare services is suggested.