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The purpose of this paper is to present the results of a critical analysis of the disability models developed to date and of how they function in practice. Furthermore, it aims to answer the following question: which model of disability (MD) will provide the most suitable foundation for any course of action undertaken in the process of planning accessible tourism development in the future?

In the first stage of the study a critical analysis of the MDs described in the literature as well as in selected reports and expert opinions relating to people with disability (PwD) was performer. These findings then became the basis for the second stage of the study which focuses on identifying attitudes within society towards the types of tourism on offer connected to the analysed MDs. The applied research methods include an analysis of a survey (2013, 2014) carried out face-to-face and on the SurveyMonkey web site. The study group consisted of 619 people (from Poland, Russia, Germany, Portugal, Slovakia, Canada, Tunisia and Great Britain).

The great diversity of disabilities makes finding a universal solution in the creation of accessible tourism supply a complex task. This supports the need for a flexible “mix of various models” aimed at finding optimal solutions and the personalisation of tourism. In this context the greatest potential in the development of accessible tourism are models which are a synthesis of many determiners of disability such as the biopsychosocial or the geographical model of disability. The dynamics of accessible tourism development is likely to be increasingly influenced by the economic model, reflecting current trends for the personalisation of tourism supply.

The survey was carried out mainly within the European Community, the exception being respondents from Irkutsk in eastern (Asian) Russia. In order to gain a global view of the development of accessible tourism, research should be performed in countries representing all continents or tourist regions. Additionally, reflecting the definition of accessible tourism its beneficiaries – PwD – should participate in decision-making processes. Tourism service providers who are directly engaged in tourism supply also have a role to play. Their opinions and attitudes towards the development of accessible tourism determine its very nature in reality.

The survey on attitudes in society regarding the organisation of tourist trips for PwD confirmed conclusions from the analysis of the practical implications of various disability models in the creation of tourism supply that a single universal, optimal solution does not exist. All of the described MD can be applied in the development of a diverse tourism supply. The proposed model “diversification of supply […]” is the theoretical basis for the conscious development of accessible tourism in practice which in accordance with changes observed in the tourism market is undergoing increasing diversification and personalisation.

In each of the tourism supply for PwD types the economic model of disability based on the identification of PwD needs and surrounding society is important. The number of PwD and the scope of necessary services, social support (PwD often travel accompanied by one to three people) is determined by income in all the sectors identified in the structure of tourism supply. From the economic point of view, awareness of different types of disability and the diverse models describing it are significant aids in the segmentation of tourism supply and placement of products accessible to PwD on the tourism market.

The paper presents a new, critical perspective on the selected MD, the key to which is the search for optimal solutions in the development of accessible tourism. The analysis performed indicated the need for a synthesis of paradigms at the core of the conceptualisation of particular models, including those often regarded as being contrary (medical and social). The results of studies would give tourism providers important data on an increasingly competitive tourism market, and also affect changes in how PwD, the elderly, are viewed, from the category of “relatively poor” to “attractive, using a wide range of services”.

Cognitive dysfunctions are a common clinical feature of schizophrenia and represent important indicators of outcome among patients who are affected. Therefore, a randomized, controlled, monocentric, single-blind trial was carried out to compare two different rehabilitation strategies adopted for the restoration and recovery of cognitive functioning of residential patients with schizophrenia. A sample of 110 residential patients were selected and, during the experimental period, a group of 55 patients was treated with sets of domain-specific exercises (SRT+CRT), whereas an equal control group was treated with sets of non-domain-specific exercises (SRT+PBO) belonging to the Cogpack® software. The effects on the scores (between T0 and T1) of the variables treatment and time and of the interaction time X treatment were analyzed: for the total BACS, the main effect of the between-factors variable treatment is statistically significant (F=201.562 P=0.000), as well as the effect of the within-factors variable “time” (F=496.68 P=0.000).The interaction of these two factors is also statistically significant (F=299.594 P=0.000). The addition of cognitive remediation therapy (CRT) to a standard treatment of metacognitive training (MCT) resulted in a significant improvement in global neurocognitive functioning and has reported positive effects with regard to the strengthening of verbal and working memory, selective and sustained attention at T1. A relevant result is the statistically significance of “time X treatment” for all the tests administered: we can assume that the domain-specific cognitive training amplifies the effects of SRT, as the primary and secondary goals of the present study were achieved.

This chapter discusses how ‘hidden’ populations of women who use drugs (WWUD) in coastal Kenya became ‘visible’ through accessing health, harm reduction and rights services. This effort was facilitated by the Muslim Education and Welfare Association (MEWA) and their work with community leaders. Mapping undertaken by MEWA outreach workers identified women who use opioids and other substances in isolated drug use settings. MEWA introduced daily meals in identified sites, needle and syringe services and residential rehabilitation services for opioid withdrawal. The introduction of residential adherence services for HIV and tuberculosis and the provision of methadone enabled compliance with the 90-90-90 UN HIV cascade. These services achieved sustained HIV viral load suppression at 83% and a 100% cure rate for tuberculosis among WWUD. In addition, disclosure and partner risk tracing was established in the ‘drug dens’ for women who test positive for STIs. The introduction of women-only hours once per week at the drop-in centre contributed to a better understanding of drug dependency among outreach workers and clinicians. Policies on gender-based violence were also refined, leading to an increase in reported cases. Programmes targeting families were introduced to promote effective communication and improve parenting skills. Access barriers to social security programmes were tackled by a network of paralegal officers in partnership with Kenyan authorities. Finally, entrepreneurship training and mentorship programmes were implemented to build resilience among WWUD.

Roughly half a million persons in the USA are homeless on any given night and over a third of those individuals have significant alcohol/other drug (AOD) problems. Many are chronically homeless and in need of assistance for a variety of problems. However, the literature on housing services for this population has paid limited attention to comparative analyses contrasting different approaches. The paper aims to discuss these issues.

The authors examined the literature on housing models for homeless persons with AOD problems and critically analyzed how service settings and operations aligned with service goals.

The authors found two predominant housing models that reflect different service goals: sober living houses (SLHs) and housing first (HF). SLHs are communally based living arrangements that draw on the principles of Alcoholics Anonymous. They emphasize a living environment that promotes abstinence and peer support for recovery. HF is based on the premise that many homeless persons with substance abuse problems will reject abstinence as a goal. Therefore, the HF focus is providing subsidized or free housing and optional professional services for substance abuse, psychiatric disorders, and other problems.

If homeless service providers are to develop comprehensive systems for homeless persons with AOD problems, they need to consider important contrasts in housing models, including definitions of “recovery,” roles of peer support, facility management, roles for professional service, and the architectural designs that support the mission of each type of housing.

This paper is the first to consider distinct consumer choices within homeless service systems and provide recommendations to improve each based upon architecture and community planning principles.

The purpose of this paper is to test whether incorporating a 20-week Kundalini yoga programme into a residential home for children improves well-being outcomes.

This is a mixed methods feasibility study. Feasibility was assessed through recruitment and retention rates as well as participants’ self-report perceptions on social inclusion, mental health and well-being and through semi-structured interviews on the benefits of the study. Mutual recovery entailed that children in care (CIC), youth practitioners and management participated together in the Kundalini yoga sessions.

The study initially enrolled 100 per cent of CIC and 97 per cent (29/30) of eligible staff. Attendance was low with an average rate of four sessions per participant (SD=3.7, range 0-13). All the participants reported that the study was personally meaningful and experienced both individual (e.g. feeling more relaxed) and social benefits (e.g. feeling more open and positive). Pre- and post-yoga questionnaires did not show any significant effects. Low attendance was associated with the challenges faced by the children’s workforce (e.g. high levels of stress, low status, profile and pay) and insufficient consultation and early involvement of stakeholders on the study implementation process.

Because of the chosen research approach (i.e. feasibility study) and low attendance rate, the research results may lack generalisability. Therefore, further research with larger samples including a control or comparison group to pilot similar research questions is mandatory.

This study has generated a number of valuable guiding principles and recommendations that might underpin the development of any future intervention for CIC and staff working in children’s homes.

The concept of togetherness and mutuality within residential spaces is discussed in the paper.

The effects of Kundalini yoga have not been reported before in any peer-review publications. This paper fulfils an identified need (i.e. poor outcomes among CIC and residential staff) and shows how movement and creative practices can support the concept of mutual recovery.

Schizophrenia is a serious psychiatric disorder characterized by positive symptoms, negative symptoms and neurocognitive deficits. The aim of this study was to estimate relationships between wellness, yoga and quality of life in patients affected by schizophrenia spectrum disorders. Participants were 30 patients with a diagnosis of schizophrenia in care at the Rehabilitative Psychiatry and Research Villa Chiara Clinic in Mascalucia (Catania, Italy), after that randomly assigned to two groups. The first group followed the experimental treatment with sets of yoga exercises conducted by a yoga trainer and a psychiatrist or a clinical psychologist expert in yoga, while a second control group was treated with usual care. The results revealed a significant difference, before and after treatment, between the experimental group and the control group in quality of life.

While recent years have seen a number of studies of social networks in therapeutic communities (TCs) and other residential settings, these have primarily focused on male residents. This paper aims to conduct a longitudinal social network analysis of interpersonal interactions in a TC for women.

The data consists of a longitudinal directed social network of instances of feedback between 56 residents of a 16 bed TC for women over a period of 611 days. Mean age of the participants was 33.1 years, mean length of stay was 133.9 days and 91% of the participants were female. Feedback consisted of written affirmations for prosocial behavior and written corrections for contravening TC norms. Data was analyzed using a latent factor longitudinal social network model.

Residents react to peer intervention in complex ways. Residents reciprocated affirmations (B = 0.14, 95% confidence interval = 0.10, 0.18) and corrections (B = 0.20, 95% CI = 0.13, 0.25). Controlling for reciprocity, participants who received affirmations were more likely to affirm and correct peers (B = 0.10, 95% CI = 0.06, 0.15; B = 0.17, 95% CI = 0.10, 0.23), suggesting that the encouragement offered by affirmations leads to increased activity. Homophily by admission time occurred in both affirmations and corrections (B = 0.23, 95% CI = 0.10, 0.37; B = 0.51, 95% CI = 0.29, 0.74).

While affirmations and corrections serve as vehicles for behavioral reinforcement and social learning, they also allow residents to interact in ways that strengthen social bonds.

The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a broad range of languages may be such an augmentation of our diagnostic armamentarium. Whether such tests are in use, and how they are distributed among different patient categories was the aim of the study. All referrals in one calendar year (N=1168), as they are depicted in the hospital computerized medical records, were investigated. Fifty-six (6.1%) out of 926 ethnic Norwegians and six (3.0%) out of 198 non-Western immigrants were tested, whereas none of the 44 Western immigrants. The difference between ethnic Norwegians and the immigrants was significant (Z=-3.05 and P=0.002). Psychometric tests were thus almost not in use, and even lesser so in immigrants. Mean number of resident days was higher among those tested, 11.7 (SD=11.2) versus those not tested, 7.4 (SD=10.4) days, t=2.97 and P=0.004. Length of stay for ethnic Norwegians did not differ from that for non-Western immigrants 11.4 versus 11.7, respectively. The patients tested were older than those not tested. Mean age was 43.0 (SD=14.4) versus 38.8 (SD=12.1), with a t=2.65 and P=0.03. The difference in resident days between all immigrants and ethnic Norwegians was significant with a Z=−2.232 and P=0.026. Level of testing was higher in ethnic Norwegians, and the tested patients stayed longer, maybe indicating more room for testing. Whether this low test-activity influences treatment quality is an unsettled question.

Prediction of increased risk of suicide is difficult. We had the opportunity to follow up 20 patients receiving electroconvulsive therapy (ECT) because of severe depression. They filled in the Antonovsky sense of coherence test (SOC) and Beck depression inventory (BDI) before and after a series of ECT treatments. Seventeen surviving patients had a mean observation time of 20.6 months, whereas the three deceased patients had 11.3 months. There was a lower mean age at onset of illness and a longer mean duration of disease in the deceased. Other clinical parameters did not differ. The surviving patients had a significant decrease on the BDI from 35 to 18 (P<0.001) and an increase on the SOC test after ECT from 2.45 to 3.19 (P<0.001), indicating both less depression and better functioning in life. The deceased had a larger change on the BDI from 32 to 13, not attaining significance because of the low number of deceased. The SOC test, however, did not increase to a purported normal level; that is, from 2.43 to 2.87. Although the SOC scale has been shown to predict mortality in substance abusers, the SOC test has not been part of earlier reviews of predictive power. Tentatively, a low pathological score on the SOC test may indicate low sense of coherence in life that might increase the propensity for suicide. These preliminary results need replication in larger studies.

Olanzapine-induced neutropenia is a rare adverse effect that is currently poorly described in literature. Although neutropenia is a known adverse effect of clozapine, it has been associated with the use of other antipsychotic medications like olanzapine. This case report describes and reviews a case of olanza-pine-induced neutropenia in a schizophrenic patient. Although the mechanism of antipsychotic-induced neutropenia is still debated, this report attempts to discuss current theories as well as supply evidence in literature of this rare but potentially dangerous adverse effect.