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.

Reflexive Reflection Co-created with Kehte-ayak (Old Ones) as an Indigenous Qualitative Methodological Data Contemplation Tool

The aim of this paper is to propose a new way of understanding data contemplation for Indigenous methodologies. There is a need for Indigenous methods that allow us to explore and organize findings that are steeped in the contextualized story and grounded in the research relationship. A study that asked Cree Kehte-ayak (Old Ones) about the relevance in harmonizing Indigenous and Western ways of knowing in healing from addiction shows that Reflexive Reflection (RR) offers a respectful way for discovery. RR offers epistemological underpinnings for data consideration when engaging Indigenous methodologies. Culturally rooted addictions research can contribute to Indigenous wellness and cultural renewal by bringing awareness to the link between colonialism and addiction and by actively re-centring an Indigenous worldview and governance in the research process (Hall et al., 2015). While challenging colonialism is vital, the strength of Indigenous culture must be central to the overall project, with relational accountability that implies all parts of the research process are related, and that the researcher is responsible for nurturing and maintaining this relationship with the research process and with “all relations.” Indigenous research inquiry involves moments of contemplation that explore dreams, intuition, teachings, and connection to land. It also involves spending intimate hours listening to stories of the “old ones” that are rooted in a sense of kinshipresponsibility that relay culture, identity, and a sense of belonging that are essential to the life of the researcher. Reframing the language around aftercare services for Indigenous Peoples can take place through reflexive investigation and knowledge creation.

A multinational comparison of care-leaving policy and legislation

Care-leavers – those transitioning from alternative care towards young adulthood – are widely recognized as a vulnerable population, yet child protection legislation seldom applies to them because they have reached adulthood. Despite this, little internationally comparative research on care-leaving policy and legislation has been conducted. This paper maps multinational policy and legislation and its impact on the services to care-leavers and the challenges they experience. An online survey was conducted with key informants in 36 countries and analysed by a multinational team of care-leaving scholars. Findings reveal that few countries have well-developed care-leaving legislation. Most countries provide little aftercare beyond the age of 18, even when legislation provides for it. Within the context of suboptimal social policy and limited aftercare services, findings also reveal high vulnerability among care-leavers. Recommendations for policy development, global dialogue, further research and advocacy are proposed.

An Analysis of Actors in the Implementation of Public Policy on Accessibility of Persons with Disabilities for Work in Indonesia’s Special Region Yogyakarta

This study aims to analyze the implementation of public policy on the accessibility of persons with disabilities to get a job in Yogyakarta. It focuses on the actors implementing the policy in the Indonesian region, namely the provincial government of Yogyakarta as the implementer and policymaker, private companies, and Non-Government Organization (NGOs), which should be the stakeholders of the policy, program, and activities in distributing labors with disabilities. To approach this problem, the researchers use the theory of Van Meter and Horn as a reference. Data have been collected through interviews and documentation that later on analyzed qualitatively with the software of NVivo 12 plus. This study concludes that providing employment opportunities for persons with disabilities has not been implemented optimally. First, it is due to the absence of aftercare services, namely follow-up assistance for persons with disabilities after participating in training and rehabilitation programs held by the Regional Government. Secondly, law enforcement in the policy implementation that is pro disabilities (inclusion) to private companies is not optimal. Third, the lack of coordination among the actors in the efforts of empowering persons with disabilities.

Service transitions, interventions and care pathways following remittal to prison from medium secure psychiatric services in England and Wales: national cohort study

Background Little is known internationally about return to prison from in-patient psychiatric services, including: circumstances leading to return, aftercare services and subsequent patient outcomes. Aims To examine and describe: (a) circumstances leading to return to prison from medium secure services; (b) available aftercare and early outcomes of returned persons; and (c) implications for policy development. Method Prospective cohort design with all patients (n = 96) returned to prisons from 33 National Health Service (NHS) medium secure services over a 6-month period in England and Wales. Follow-up was conducted for 1 year post-remittal, across 60 prisons. Results Less than 20% of patients with legal entitlement to section 117 aftercare under the Mental Health Act 1983 were receiving care managed/delivered via the care programme approach. Subsequent pathways included: inter-prison transfer (30%), use of the Assessment, Care in Custody and Teamwork process (49%), referral to secure services (21%) and community release (30%). Less than half of community releases were referred to a community mental health team. Conclusions Findings suggest that persons returned to prison are a vulnerable group of patients, many of whom require intervention (e.g. enhanced monitoring, admission to a healthcare wing, readmission to secure mental health services) on return to prison in the absence of targeted aftercare services. More robust guidance for discharge and aftercare planning procedures for persons remitted to prison should be developed to ensure that the benefits of in-patient admission are maintained and that individuals’ legal rights to ongoing aftercare are upheld.

‘Developing an App Could Be the Wrong Place to Start’: User Reflections and Ideas about Innovation in Municipal Substance Abuse Services

Introduction: There has been an increased focus on the search for innovative ways to use technology to improve services among many public welfare services. However, this focus has been less apparent among municipal substance abuse follow-up and aftercare services. Historically, this is a field that has had weak user involvement. Therefore, we have explored user ideas and reflections on whether and how technological innovation can improve these services. Method: We conducted four group sessions with a total of 14 users of substance abuse follow-up services (five women and nine men) in the southern part of Norway in June of 2014 and February of 2016. Results: The users who participated in the study pointed out that face-to-face interaction with service practitioners is an important dimension of these services. Some expressed fear that more technology might lead to services that are less relational or more standardized and that such developments might lead to reduced availability. They pointed out that enhancing individualization, continuity and service collaboration might be more important than prioritizing technology-oriented innovation. Nevertheless, the users viewed technology as positive and useful when it improves service accessibility and communication between service providers and users. More generally, the data also shed light on users’ service experiences. The analysis of these data shows that access to support from peers who have had user experiences was found to be particularly valuable. Discussion: We contribute to the literature on co-production and user involvement by highlighting user perspectives on the risks, uncertainties and possibilities for the use of new technologies in service delivery. Based on these findings, we develop the ‘co-production triangle’. In this model, the relationship between the service provider and the user is expanded to include skilled peers as a third actor. Keywords: User involvement, co-production, technology, follow-up care, addiction, peer support

Mobile Phone Access and Preference for Technology-Assisted Aftercare Among Low-Income Caregivers of Teens Enrolled in Outpatient Substance Use Treatment: Questionnaire Study

Background Improvements in parenting practices can positively mediate the outcomes of treatment for adolescent substance use disorder. Given the high rates of release among adolescents (ie, 60% within three months and 85% within one year), there is a critical need for interventions focused on helping parents achieve and maintain effective parenting practices posttreatment. Yet, research suggests that engaging parents in aftercare services is difficult, partly due to systemic-structural and personal barriers. One way to increase parent use of aftercare services may be to offer mobile health interventions, given the potential for wide availability and on-demand access. However, it remains unclear whether mobile phone–based aftercare support for caregivers of substance-using teens is feasible or desired. Therefore, formative work in this area is needed. Objective This study aims to determine the feasibility and acceptability of mobile phone–based aftercare support in a population of caregivers with teens in treatment for substance use. Methods Upon enrollment in a treatment program, 103 caregivers completed a mobile phone use survey, providing information about mobile phone ownership, access, and use. Caregivers also provided a response to items assessing desire for aftercare services, in general; desire for mobile phone–based aftercare services specifically; and desire for parenting specific content as part of aftercare services. Research assistants also monitored clinic calls made to caregivers’ mobile phones to provide an objective measure of the reliability of phone service. Results Most participants were mothers (76.7%) and self-identified as Hispanic (73.8%). The average age was 42.60 (SD 9.28) years. A total of 94% of caregivers owned a mobile phone. Most had pay-as-you-go phone service (67%), and objective data suggest this did not impede accessibility. Older caregivers more frequently had a yearly mobile contract. Further, older caregivers and caregivers of adolescent girls had fewer disconnections. Bilingual caregivers used text messaging less often; however, caregivers of adolescent girls used text messaging more often. Although 72% of caregivers reported that aftercare was needed, 91% of caregivers endorsed a desire for mobile phone–based aftercare support in parenting areas that are targets of evidence-based treatments. Conclusions The results suggest that mobile phones are feasible and desired to deliver treatments that provide support to caregivers of teens discharged from substance use treatment. Consideration should be given to the age of caregivers when designing these programs. Additional research is needed to better understand mobile phone use patterns based on a child’s gender and among bilingual caregivers.