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Greenwood RM, O'Shaughnessy BR, Manning RM, Hogan N, Vargas-Moniz MJ, Ornelas J. Distal supports, capabilities, and growth-focused recovery: A comparison of Housing First and the staircase continuum of care. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:504-514. [PMID: 38193337 DOI: 10.1002/ajcp.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth-related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth-focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth-related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.
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Affiliation(s)
| | | | - Rachel M Manning
- Research and Innovation, Birmingham Community Healthcare NHS Foundation Trust, Trust Headquarters, Birmingham, England
| | - Niamh Hogan
- Psychology Department, University of Limerick, Castletroy, Co. Limerick, Ireland
| | - Maria J Vargas-Moniz
- Applied Psychology Research Centre Capabilities & Inclusion, ISPA, Lisbon, Portugal
| | - Jose Ornelas
- Applied Psychology Research Centre Capabilities & Inclusion, ISPA, Lisbon, Portugal
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Marshall CA, Easton C, Javadizadeh E, Holmes J, Phillips B, Isard R. Effectiveness of Interventions for Meaningful Activity Participation in Homelessness: A Systematic Review. Can J Occup Ther 2024:84174241233519. [PMID: 38436121 DOI: 10.1177/00084174241233519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background. Meaningful activity participation has been identified as a key outcome of services designed to support individuals during and following homelessness. Little is known about the effectiveness of interventions for promoting this outcome. Purpose. To identify the range and effectiveness of interventions on promoting meaningful activity participation among persons with experiences of homelessness. Method. We conducted a systematic review using the Joanna Briggs Institute methodology following PRISMA guidelines including a critical appraisal and narrative synthesis. Findings. Of 12,343 titles and abstracts screened, we included 12 studies. The authors of the included studies primarily used standardized measures of meaningful activity engagement. Critical appraisal scores ranged from 50.0 to 77.8. The most common interventions evaluated in the included studies were psychosocial interventions (n = 6; 50.0%), followed by case management and housing support interventions (n = 4; 33.3%) and Housing First (n = 2; 16.7%). While several interventions demonstrated effectiveness in promoting meaningful activity participation including psychosocial and case management interventions, Housing First, Critical Time Intervention, and a peer support intervention were found to be ineffective for promoting engagement in meaningful activity. Conclusion. Few intervention studies have been conducted that demonstrate effectiveness for promoting participation in meaningful activity for individuals during and following homelessness. Occupational therapy researchers and practitioners can build on existing evidence by developing and evaluating novel approaches by co-designing interventions in collaboration with persons with experiences of homelessness and service providers.
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Weightman AL, Kelson MJ, Thomas I, Mann MK, Searchfield L, Willis S, Hannigan B, Smith RJ, Cordiner R. Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta-analysis and thematic synthesis. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1329. [PMID: 37206622 PMCID: PMC10189499 DOI: 10.1002/cl2.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Adequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority. Objectives To summarise the best available evidence relating to the components of case-management interventions for PEH via a mixed methods review that explored both the effectiveness of interventions and factors that may influence its impact. Search Methods We searched 10 bibliographic databases from 1990 to March 2021. We also included studies from Campbell Collaboration Evidence and Gap Maps and searched 28 web sites. Reference lists of included papers and systematic reviews were examined and experts contacted for additional studies. Selection Criteria We included all randomised and non-randomised study designs exploring case management interventions where a comparison group was used. The primary outcome of interest was homelessness. Secondary outcomes included health, wellbeing, employment and costs. We also included all studies where data were collected on views and experiences that may impact on implementation. Data Collection and Analysis We assessed risk of bias using tools developed by the Campbell Collaboration. We conducted meta-analyses of the intervention studies where possible and carried out a framework synthesis of a set of implementation studies identified by purposive sampling to represent the most 'rich' and 'thick' data. Main Results We included 64 intervention studies and 41 implementation studies. The evidence base was dominated by studies from the USA and Canada. Participants were largely (though not exclusively) people who were literally homeless, that is, living on the streets or in shelters, and who had additional support needs. Many studies were assessed as having a medium or high risk of bias. However, there was some consistency in outcomes across studies that improved confidence in the main findings. Case Management and Housing Outcomes Case management of any description was superior to usual care for homelessness outcomes (standardised mean difference [SMD] = -0.51 [95% confidence interval [CI]: -0.71, -0.30]; p < 0.01). For studies included in the meta-analyses, Housing First had the largest observed impact, followed by Assertive Community Treatment, Critical Time Intervention and Intensive Case Management. The only statistically significant difference was between Housing First and Intensive Case Management (SMD = -0.6 [-1.1, -0.1]; p = 0.03) at ≥12 months. There was not enough evidence to compare the above approaches with standard case management within the meta-analyses. A narrative comparison across all studies was inconclusive, though suggestive of a trend in favour of more intensive approaches. Case Management and Mental Health Outcomes The overall evidence suggested that case management of any description was not more or less effective compared to usual care for an individual's mental health (SMD = 0.02 [-0.15, 0.18]; p = 0.817). Case Management and Other Outcomes Based on meta-analyses, case management was superior to usual care for capability and wellbeing outcomes up to 1 year (an improvement of around one-third of an SMD; p < 0.01) but was not statistically significantly different for substance use outcomes, physical health, and employment. Case Management Components For homelessness outcomes, there was a non-significant trend for benefits to be greater in the medium term (≤3 years) compared to long term (>3 years) (SMD = -0.64 [-1.04, -0.24] vs. -0.27 [-0.53, 0]; p = 0.16) and for in-person meetings in comparison to mixed (in-person and remote) approaches (SMD = -0.73 [-1.25,-0.21]) versus -0.26 [-0.5,-0.02]; p = 0.13). There was no evidence from meta-analyses to suggest that an individual case manager led to better outcomes then a team, and interventions with no dedicated case manager may have better outcomes than those with a named case manager (SMD = -0.36 [-0.55, -0.18] vs. -1.00 [-2.00, 0.00]; p = 0.02). There was not enough evidence from meta-analysis to assess whether the case manager should have a professional qualification, or if frequency of contact, case manager availability or conditionality (barriers due to conditions attached to service provision) influenced outcomes. However, the main theme from implementation studies concerned barriers where conditions were attached to services. Characteristics of Persons Experiencing Homelessness No conclusions could be drawn from meta-analysis other than a trend for greater reductions in homelessness for persons with high complexity of need (two or more support needs in addition to homelessness) as compared to those with medium complexity of need (one additional support need); effect sizes were SMD = -0.61 [-0.91, -0.31] versus -0.36 [-0.68, -0.05]; p = 0.3. The Broader Context of Delivery of Case Management Programmes Other major themes from the implementation studies included the importance of interagency partnership; provision for non-housing support and training needs of PEH (such as independent living skills), intensive community support following the move to new housing; emotional support and training needs of case managers; and an emphasis on housing safety, security and choice. Cost Effectiveness The 12 studies with cost data provided contrasting results and no clear conclusions. Some case management costs may be largely off-set by reductions in the use of other services. Cost estimates from three North American studies were $45-52 for each additional day housed. Authors' Conclusions Case management interventions improve housing outcomes for PEH with one or more additional support needs, with more intense interventions leading to greater benefits. Those with greater support needs may gain greater benefit. There is also evidence for improvements to capabilities and wellbeing. Current approaches do not appear to lead to mental health benefits. In terms of case management components, there is evidence in support of a team approach and in-person meetings and, from the implementation evidence, that conditions associated with service provision should be minimised. The approach within Housing First could explain the finding that overall benefits may be greater than for other types of case management. Four of its principles were identified as key themes within the implementation studies: No conditionality, offer choice, provide an individualised approach and support community building. Recommendations for further research include an expansion of the research base outside North America and further exploration of case management components and intervention cost-effectiveness.
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Affiliation(s)
| | - Mark J. Kelson
- Department of Mathematics and Statistics, Faculty of Environment, Science and EconomyUniversity of ExeterExeterUK
| | - Ian Thomas
- Wales Institute of Social and Economic Research and Data (WISERD)Cardiff UniversityCardiffUK
| | - Mala K. Mann
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Lydia Searchfield
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Simone Willis
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Ben Hannigan
- Mental Health Nursing, School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | - Rhiannon Cordiner
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
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Indicadores de boas práticas em saúde para a população de rua: revisão de escopo. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ar004766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Association between Psychological Integration and Permanent Supportive Housing: An Exploratory Study with a Focus on Ethnicity. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10120468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is limited research on the association between Permanent Supportive Housing (PSH) and psychological integration. The purpose of this study was to explore this association among individuals with mental illness and/or substance use disorder (SUD) enrolled in PSH and to identify variables associated with sense of belonging. Given differences in outcomes of PSH by ethnicity, we were interested to determine if an association existed between PSH and psychological integration and whether it was equally observed among Hispanics and non-Hispanics. The target population included individuals who were chronically homeless and diagnosed with a mental illness and/or SUD. Baseline data were collected upon intake (N = 370). Follow-up data were collected at six-months post baseline (N = 286) and discharge (N = 143). Predictor and control variables included demographics, overall health, PTSD symptom severity, interactions with family and friends, and participation in recovery-related groups in the community. Psychological integration scores increased significantly from the baseline to the 6-month follow-up (t = −3.41, p = 0.003) and between the 6-month follow-up and discharge (t = −2.97, p = 0.007). Significant predictors of psychological integration included overall health, interactions with family and/or friends, PTSD symptoms, income, education, and diagnosis. No differences were observed between Hispanics and non-Hispanics. The findings from this exploratory study suggest that future research in this area is warranted.
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Gaboardi M, Santinello M, Shinn M. Beyond behaviour: rethinking integration for people experiencing homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:846-855. [PMID: 33560560 DOI: 10.1111/hsc.13314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
Integration is one of the main goals of homeless services. Despite the growing research on integration and homelessness, few studies start with the perspective of people experiencing homelessness. Integration is often measured as participation in a list of standard behaviours. This process assesses behaviour in accordance with social norms but ignores people's own feelings and understanding of integration. The main aim of this study is to explore the meaning of integration from the perspective of people experiencing homelessness. Data were collected through semi-structured interviews involving 26 people in homeless service programmes. Five main themes regarding the meanings of integration were generated: work, housing, respectful relationships, family and personal dignity. Moreover, two themes of obstacles and facilitators affecting integration were identified. A new conceptualisation of integration is generated that captures the participants' sense of personal dignity, respect and recognition from others and a sense of utility within their living environments (work, house and family). Implications of the results are discussed with respect to homeless services and research on homelessness.
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Affiliation(s)
- Marta Gaboardi
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Massimo Santinello
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
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Smith E, Milaney K, Henderson RI, Crowshoe L. Adverse childhood experiences and health among indigenous persons experiencing homelessness. BMC Public Health 2021; 21:85. [PMID: 33413243 PMCID: PMC7791826 DOI: 10.1186/s12889-020-10091-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Current literature has established that adverse childhood experiences (ACEs) are associated with the onset of a variety of physical, mental, and behavioural illnesses. However, there are few studies that have thoroughly examined this association in low-income or marginalized groups. Methods To address this knowledge gap, this study used self-reported data on childhood experiences and adult health outcomes in a sample of 91 Indigenous persons experiencing homelessness. While the primary focus of the study was to assess the relationship between ACEs and health status, we also assessed reports on use and perceptions of health care services to test for potential illness-mitigating factors. Results Results indicated that reported number of ACEs was significantly associated with reported levels of mental illness (p < .001, d = 1.12). Significant associations were not observed for physical illness or patterns of substance use. We also found that the number of reported ACEs was significantly correlated with the number of formal health care services that an individual used (r = 0.32). Conclusions Our results reveal that the relationship between ACEs and adult illness is not as deterministic as the current literature suggests. Access to formal health care services may allow individuals to mitigate their adverse health, thereby eliminating some of the effects of ACEs. Conversely, current tools used to measure ACEs may not translate to an Indigenous population, which speaks to a need to revise ACE related surveys to include additional adversity categories. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10091-y.
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Affiliation(s)
- Eric Smith
- University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Katrina Milaney
- University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
| | - Rita I Henderson
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Lyndon Crowshoe
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Patterns and effects of social integration on housing stability, mental health and substance use outcomes among participants in a randomized controlled Housing First trial. Soc Sci Med 2020; 265:113481. [PMID: 33218893 DOI: 10.1016/j.socscimed.2020.113481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Recent research has shown that social integration, involving community integration and social support, can be protective resources for the health of homeless individuals. However, it is not clear how social integration affects health in the transition from homelessness into housing, and subsequent housing retention. This paper examines, through mixed quantitative and qualitative methods, how social integration changes over time, and how these changes relate to housing stability, substance use and mental health outcomes among a sample of homeless individuals experiencing mental illness participating in the At Home/Chez Soi Housing First randomized controlled trial in Canada. METHODS Longitudinal quantitative data (baseline, 6, 12, 24 month) and qualitative data ( 18 month) from the five trial sites (Moncton, Montreal, Toronto, Winnipeg and Vancouver) were examined using mixed models, mediation analyses, and thematic analysis. RESULTS Social integration (i.e., social network size, social interest, psychological integration) increased over time among study participants, with social network size increasing significantly more among Housing First participants than Treatment as Usual participants. Social network size mediated the effect of the intervention on the percentage of days in stable housing, indicating that the Housing First intervention may have increased participants' social network size, which in turn increased the percentage of days stably housed. No significant mediation of social integration on the effects of the intervention on mental health and substance use outcomes was found. Findings from the qualitative interviews support and expand upon these quantitative findings.
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Marshall CA, Boland L, Westover LA, Marcellus B, Weil S, Wickett S. Effectiveness of interventions targeting community integration among individuals with lived experiences of homelessness: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1843-1862. [PMID: 32458462 DOI: 10.1111/hsc.13030] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
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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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, Occupational Therapy, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada
| | - Leonie Boland
- Occupational Therapy, Faculty of Health and Human Sciences, University of Plymouth, Peninsula Allied Health Centre, Plymouth, UK
| | | | | | - Silka Weil
- St. Anne's Hospital, Montreal, QC, Canada
| | - Sarah Wickett
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
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Brown M, Tran AD, Cummings C, Fay L, Malone D, Fyall R, Tsemberis S. Attempting Randomized Housing First Research in a Community Context: Reflections on Failure. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:201-213. [PMID: 32153031 DOI: 10.1002/ajcp.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Housing First (HF) model of permanent supportive housing for individuals experiencing chronic homelessness has a strong evidence base that has largely been driven by researchers in the field of community psychology in partnership with community-based organizations. However, important gaps in the HF literature remain. Implementing rigorous research designs to further the evidence for HF requires immense resources to fund both the housing intervention and the research activities. In the absence of such resources, university-community partnerships may be established to integrate research within business-as-usual services and utilize existing housing units. This first person account presents a "post-mortem" exploration of an attempt to conduct a randomized trial of scattered-site and single-site approaches to HF within a community context from the perspectives of multiple stakeholders involved in the endeavor. Despite strengths of the research collaborative, the project did not come to completion due to a series of both insurmountable and avoidable barriers. Yet, the experience illuminated several potential challenges researchers and housing providers conducting work in this area may encounter, such as ever-changing homeless service system policies that may impact research and organizational procedures. Lessons learned and recommendations for preventing or overcoming systems-level barriers and potential challenges within the university-community partnership are described.
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Affiliation(s)
| | | | | | - Lauren Fay
- Downtown Emergency Service Center, Seattle, WA, USA
| | | | | | - Sam Tsemberis
- Pathways Housing First Institute, Los Angeles, CA, USA
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Shioda A, Yamauchi K. Community integration and related factors among people with mental illness in Japan: Multiple regression analysis stratified by social isolation level. Int J Soc Psychiatry 2020; 66:614-622. [PMID: 32475198 DOI: 10.1177/0020764020924690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUD AND AIM Community integration is an essential for people with mental illness that affects their health and quality of life. The objective of this study is to find the factors useful in improving community integration of people with mental illness. METHODS The study method was self-reporting questionnaires for people with mental illness living in the community. The decision tree analysis revealed that people with mental illness into high or low social isolation level strata. Multiple regression analyses stratified by using two social isolation levels were conducted. RESULTS Common factors among the strata were living environment of formal care accessibility and daily life activity. Specific factors for social isolation low-level stratum were self-efficacy for coping with symptoms, self-efficacy for social relationships, healthy lifestyle habits, treatment, exchange daily life information with friends and family members. Specific factors for social isolation high-level stratum were self-efficacy for daily living, self-efficacy for treatment-related behavior and satisfaction with formal care. All specific factors were positively associated with community integration. CONCLUSIONS The findings suggest the devising interventions to enhance community integration by social isolation level among people with mental illness.
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Affiliation(s)
- Ai Shioda
- Keio Research Institute at SFC, Fujisawa, Japan
| | - Keita Yamauchi
- Graduate School of Health Management, Keio University, Fujisawa, Japan
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12
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Gurdak K, Tiderington E, Stefancic A. Community integration when moving on from permanent supportive housing. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1913-1928. [PMID: 32516837 DOI: 10.1002/jcop.22389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/28/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
AIMS This study explored community integration within a Moving On initiative that assisted individuals with the transition from permanent supportive housing (PSH) to more independent housing without service requirements. METHODS Participants completed baseline interviews while in PSH (n = 90) and, for those who moved on, a follow-up 1-year post-move (n = 45). Bivariate analyses and OLS regression were used to examine community integration outcomes and potential correlates. RESULTS For participants who moved on, subjective social quality of life and sense of community were higher post-move, while physical integration decreased, and time spent at home increased. Gender, mastery, and housing quality were associated with community integration post-move. CONCLUSION Moving On did not adversely impact most aspects of community integration, though PSH residents may need more support to facilitate participation in routine activities outside their home post-move. Findings also highlight the importance of supporting mastery given its potential role in community integration.
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Affiliation(s)
- Kristen Gurdak
- Silver School of Social Work, New York University, New York, New York
| | - Emmy Tiderington
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, New York, New York
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Adame AL, Perry C, Pierce E. Community and Housing First: A qualitative analysis of USA residents' perspectives. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1292-1300. [PMID: 32128910 DOI: 10.1111/hsc.12962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 06/10/2023]
Abstract
Plymouth Housing is a Housing First organisation in Seattle, WA (USA) that provides far more than housing for its residents-staff are equally concerned with building community and creating a sense of belonging. The objective of this study was to interview residents about their experiences of community and collect their suggestions for improving community, building efforts within this organisation. This exploratory qualitative study was conducted across eight buildings and included 38 participants from November 2018 to February 2019. Data were collected by the researchers in the form of focus groups and individual interviews, utilising a semi-structured interview protocol. The interviews were recorded, transcribed and analysed using thematic analysis. Themes were identified by each researcher separately and then cross referenced for validity using direct quotes from participants. Five main themes emerged from the data: 'really good community here'; mutual support and care; interpersonal connections; gatherings and events; lack of community. This study demonstrates that regularly held events and activities help to build community, create a sense of stability and increase familiarity and trust amongst residents. An implication of this study is the importance of actively soliciting residents' input to guide community building efforts. This is a small-scale exploratory study and although the findings are applicable to the participants' experiences, further research is needed to build on these findings in other parts of the USA as well as internationally.
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Affiliation(s)
| | | | - Emma Pierce
- Department of Psychology, Seattle University, Seattle, WA, USA
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14
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Terry R, Townley G. Exploring the Role of Social Support in Promoting Community Integration: An Integrated Literature Review. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:509-527. [PMID: 31116874 DOI: 10.1002/ajcp.12336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Community integration has emerged as a priority area among mental health advocates, policy makers, and researchers (Townley, Miller, & Kloos, 2013; Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007). Past research suggests that social support influences community integration for individuals with serious mental illnesses (Davidson, Haglund, Stayner, Rakfeldt, Chinman, & Tebes, 2001; Davidson, Stayner, Nickou, Styron, Rowe, & Chinman, 2001; Wong & Solomon, 2002), but there has not yet been a systematic review on this topic. Therefore, the purpose of this paper was to explore the influence of social support on community integration through a review of the existing literature. An extensive literature search was conducted, resulting in 32 articles that met the search criteria. These articles were organized into three categories: defining community integration, supportive relationships, and mental health services. The search results are analyzed according to the types of support being provided. Article strengths, limitations, implications, and future directions are also addressed. Overall, the findings of this review suggest that social support, which may be provided by a variety of individuals and services, plays an important role in promoting community integration for individuals with serious mental illnesses. Therefore, as community mental health research and practice continues to promote community integration for individuals with serious mental illnesses, the mental health field should emphasize the importance of social support as a key factor influencing community integration.
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Affiliation(s)
- Rachel Terry
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Greg Townley
- Department of Psychology, Portland State University, Portland, OR, USA
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15
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Hainstock M, Masuda JR. "We have a roof over our head, but we have to eat too:" Exploring shifting foodscapes from homelessness into Housing First in Kingston, Ontario. Health Place 2019; 59:102197. [PMID: 31518891 DOI: 10.1016/j.healthplace.2019.102197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/28/2019] [Accepted: 08/22/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND People facing extended periods of homelessness exhibit a remarkable degree of agency and resilience in procuring food. The literature on foodscapes considers the sociospatial contexts of food procurement, finding that what happens within and along the way to sites of food acquisition and consumption are important considerations in fully understanding and realizing food security. PURPOSE This study explores the shift in foodscapes of people who are transitioning from homelessness into scattered-site independent housing via a municipal Housing First program and considers implications for health and wellbeing. METHODS Our mixed-method approach included observational research at 11 local food providers and drop-in centres that provided context for semi-structured interviews with 10 Housing First clients in Kingston, Ontario between November 2016 and March 2017. RESULTS The findings confirm that the provision of stable housing makes it possible for people to store, prepare, and consume food at home. An increased ability to have control over when, where, and what is eaten had a positive impact on people's sense of health and wellbeing. However, other effective markers of wellbeing were enacted along people's everyday routines and activities that had negative impacts. Interviewees remained heavily dependent on charitable food programs, including increased use of foodbanks. Others reported increasing detachment and social isolation from previously established food routines. Finally, the structured transition perpetuated a circuit of dependence and marginalization that fell short of contributing to improved food security as well as health and wellbeing. IMPLICATIONS Understanding the relational geography of foodscape transitions is critical to the design of effective Housing First programs. Addressing the root causes of homelessness and poverty requires investments in comprehensive housing strategies including adequate social assistance and community supports that take a sociospatially holistic approach to wellbeing.
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Affiliation(s)
- Madison Hainstock
- Queen's University, School of Kinesiology & Health Studies, 28 Division Street, Kingston, Ontario, K7L 3N6, Canada.
| | - Jeffrey R Masuda
- Queen's University, School of Kinesiology & Health Studies, 28 Division Street, Kingston, Ontario, K7L 3N6, Canada.
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16
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Canham SL, Wister A, O'Dea E. Strengths, weaknesses, opportunities, and threats to housing first in Metro Vancouver. EVALUATION AND PROGRAM PLANNING 2019; 75:69-77. [PMID: 31121391 DOI: 10.1016/j.evalprogplan.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To understand the experience of Metro Vancouver's Homelessness Partnering Strategy-funded Housing First program and how it is functioning from the perspective of a representative sample of providers and clients who deliver and receive HF services. METHODS Thirty-four clients and providers who currently or formerly delivered HF in Metro Vancouver participated in one-on-one interviews (n = 26) or focus groups (n = 8) between March and April 2017 and data were thematically analyzed. RESULTS Strengths of the HF program included: the ability to transition persons from the street into housing with individualized service supports and, in certain cases, with 12-month rent subsidies, household goods, and connection to community resources. Identified program weaknesses were: eligibility criteria, limited rent subsidy funds, limited provider capacity, and workload burden. Suggested opportunities to improve HF were: streamlining federal and provincial reporting and rent subsidy systems and building friendly landlord networks. Potential threats to HF described were: limited affordable housing, stigma and discrimination toward clients, inadequate income assistance, and limited opportunity for cross-sector collaboration. CONCLUSIONS The delivery of HF in regions that have limited affordable housing presents unique challenges. Recommendations are provided to improve HF practice and policy in these contexts.
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Affiliation(s)
- Sarah L Canham
- Gerontology Research Centre, Simon Fraser University, 2800 - 515 W. Hastings, Vancouver, BC, V6B 5K3 Canada.
| | - Andrew Wister
- Gerontology Research Centre, Simon Fraser University, 2800 - 515 W. Hastings, Vancouver, BC, V6B 5K3 Canada; Department of Gerontology, Simon Fraser University, 2800 - 515 W. Hastings, Vancouver, BC, V6B 5K3 Canada.
| | - Eireann O'Dea
- Department of Gerontology, Simon Fraser University, 2800 - 515 W. Hastings, Vancouver, BC, V6B 5K3 Canada.
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17
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Marshall CA, Davidson L, Li A, Gewurtz R, Roy L, Barbic S, Kirsh B, Lysaght R. Boredom and meaningful activity in adults experiencing homelessness: A mixed-methods study. The Canadian Journal of Occupational Therapy 2019; 86:357-370. [PMID: 30987447 DOI: 10.1177/0008417419833402] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. Boredom has been reported as a frequent problem experienced by homeless persons, with implications for mental and social well-being. PURPOSE. This study aimed to explore the nature and impact of boredom in the lives of homeless and formerly homeless persons. METHOD. A mixed-methods design was used to engage 13 participants in a structured 92-item quantitative interview using six standardized measures, followed by a semistructured qualitative interview. Correlational analyses were performed with the data compiled from the quantitative interviews, and grounded theory strategies were used to analyze our qualitative data. The two analyses were integrated at the stage of interpretation. FINDINGS. Boredom was described as a profound and pervasive experience for homeless persons, imposing deleterious impacts on mental well-being and driving substance use. A strong positive correlation between meaningful activity and mental well-being (r s = .767, p <. 01) and a strong negative correlation between boredom and belonging in one's community (r s = -.771, p < .01) were identified. IMPLICATIONS. Boredom is a critical topic of study for occupational therapy in the area of homelessness. Future research is needed to design and test interventions to optimize the mental well-being, participation, and social connectedness of this population.
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18
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Rezansoff SN, Moniruzzaman A, Fazel S, McCandless L, Procyshyn R, Somers JM. Housing First Improves Adherence to Antipsychotic Medication Among Formerly Homeless Adults With Schizophrenia: Results of a Randomized Controlled Trial. Schizophr Bull 2018; 43:852-861. [PMID: 27665002 PMCID: PMC5274537 DOI: 10.1093/schbul/sbw136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Adherence to antipsychotic medication is a significant challenge among homeless patients. No experimental trials have investigated the impact of Housing First on adherence among patients with schizophrenia. We investigated whether Housing First in congregate and scattered-site configurations resulted in superior adherence compared to usual care. Adult participants (n = 165) met criteria for homelessness, schizophrenia, and initiation of antipsychotic pharmacotherapy prior to recruitment to an unblinded, 3-arm randomized controlled trial in Vancouver, Canada. Randomization arms were: congregate Housing First (CHF) with on-site supports (including physician and pharmacy services); scattered-site Housing First (SHF) with Assertive Community Treatment; or treatment as usual (TAU) consisting of existing services. Participants were followed for an average of 2.6 years. Adherence to antipsychotic medication was measured using the medication possession ratio (MPR), and 1-way ANOVA was used to compare outcomes between the 3 conditions. Data were drawn from comprehensive pharmacy records. Prior to randomization, mean MPR among participants was very low (0.44–0.48). Mean MPR in the follow-up period was significantly different between study arms (P < .001) and approached the guideline threshold of 0.80 in SHF. Compared to TAU, antipsychotic adherence was significantly higher in SHF but not in CHF. The results demonstrate that further implementation of SHF is indicated among homeless people with schizophrenia, and that urgent action is needed to address very low levels of antipsychotic adherence in this population (trial registration: ISRCTN57595077).
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Affiliation(s)
- Stefanie N Rezansoff
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | | | - Ric Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Julian M Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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McPherson P, Krotofil J, Killaspy H. Mental health supported accommodation services: a systematic review of mental health and psychosocial outcomes. BMC Psychiatry 2018; 18:128. [PMID: 29764420 PMCID: PMC5952646 DOI: 10.1186/s12888-018-1725-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 05/04/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Post-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and resistant to synthesis attempts, leaving researchers and policy makers with no clear summary what works and for whom. In this context, we undertook a comprehensive systematic review of quantitative studies in order to synthesise the current evidence on mental health and psychosocial outcomes for individuals residing in mental health supported accommodation services. METHODS Using a combination of electronic database searches, hand searches, forward-backward snowballing and article recommendations from an expert panel, 115 papers were identified for review. Data extraction and quality assessments were conducted, and 33 articles were excluded due to low quality, leaving 82 papers in the final review. Variation in terminology and service characteristics made the comparison of service models unfeasible. As such, findings were presented according to the following sub-groups: 'Homeless', 'Deinstitutionalisation' and 'General Severe Mental Illness (SMI)'. RESULTS Results were mixed, reflecting the heterogeneity of the supported accommodation literature, in terms of research quality, experimental design, population, service types and outcomes assessed. There is some evidence that supported accommodation is effective across a range of psychosocial outcomes. The most robust evidence supports the effectiveness of the permanent supported accommodation model for homeless SMI in generating improvements in housing retention and stability, and appropriate use of clinical services over time, and for other forms of supported accommodation for deinstitutionalised populations in reducing hospitalisation rates and improving appropriate service use. The evidence base for general SMI populations is less developed, and requires further research. CONCLUSIONS A lack of high-quality experimental studies, definitional inconsistency and poor reporting continue to stymie our ability to identify effective supported accommodation models and practices. The authors recommend improved reporting standards and the prioritisation of experimental studies that compare outcomes across different service models.
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Affiliation(s)
- Peter McPherson
- Division of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Joanna Krotofil
- 0000000121901201grid.83440.3bDivision of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Helen Killaspy
- 0000000121901201grid.83440.3bDivision of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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20
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Yanos PT, Stefancic A, Alexander MJ, Gonzales L, Harney-Delehanty B. Association between housing, personal capacity factors and community participation among persons with psychiatric disabilities. Psychiatry Res 2018; 260:300-306. [PMID: 29223799 DOI: 10.1016/j.psychres.2017.11.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
There is a need to understand which housing and personal capacity factors facilitate and hinder maximum community participation among people with psychiatric disabilities. The present study examined housing and personal capacity factors associated with community participation in a large sample of persons with psychiatric disabilities living in the same neighborhoods (defined by specified zip codes). Three hundred and forty-three persons with psychiatric disabilities were recruited from congregate and independent scatter-site housing programs in 3 New York City-area neighborhoods with high concentrations of housing for persons with psychiatric disabilities. Participants completed measures of community participation, psychiatric symptoms, substance use, independent living-skill, self-efficacy, and coping style. Community participation measures grouped into 3 factors: social community participation, physical community participation, and vocational involvement. Social community participation was associated with negative symptoms and active coping, but not by housing. Independent living-skill moderated the relationship between independent scatter-site housing and social community participation. Physical community participation was associated with negative symptoms, active coping, independent living-skill, and residence in independent scatter-site housing. Vocational involvement was only associated with negative symptoms. Findings suggest that a complex array of personal capacity and housing factors are associated with community participation among persons with psychiatric disabilities.
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Affiliation(s)
- Philip T Yanos
- Psychology Department, John Jay College of Criminal Justice and the Graduate Center, City University of New York, 524 W. 59th St., New York, NY 10019, USA.
| | - Ana Stefancic
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mary Jane Alexander
- Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Lauren Gonzales
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA
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21
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McPherson P, Krotofil J, Killaspy H. What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E190. [PMID: 29364171 PMCID: PMC5858263 DOI: 10.3390/ijerph15020190] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/15/2018] [Accepted: 01/19/2018] [Indexed: 11/16/2022]
Abstract
Inconsistent terminology and variation in service models have made synthesis of the supported accommodation literature challenging. To overcome this, we developed a brief, categorical taxonomy that aimed to capture the defining features of different supported accommodation models: the simple taxonomy for supported accommodation (STAX-SA). Data from a previous review of existing classification systems were used to develop the taxonomy structure. After initial testing and amendments, the STAX-SA and an existing taxonomy were applied to 132 supported accommodation service descriptions drawn from two systematic reviews and their performance compared. To assess external validity, the STAX-SA was distributed to a sample of supported accommodation managers in England and they were asked to use it to classify their services. The final version of the STAX-SA comprised of five supported accommodation 'types', based on four domains; Staffing location; Level of support; Emphasis on move-on; and Physical setting. The STAX-SA accurately categorized 71.1% (n = 94) of service descriptions, outperforming the comparison tool, and was not affected by publication date or research design. The STAX-SA effectively discriminated between 'real world' service models in England and 53.2% (n = 17) of service managers indicated that the taxonomy was 'Very effective' or 'Extremely effective' in capturing key characteristics of their service. The STAX-SA is an effective tool for classifying supported accommodation models and represents a promising approach to synthesizing the extant effectiveness literature. The authors recommend the development of reporting guidelines for future supported accommodation publications to facilitate comparison between models.
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Affiliation(s)
- Peter McPherson
- Division of Psychiatry, University College London (UCL), London W1T 7NF, UK.
| | - Joanna Krotofil
- Division of Psychiatry, University College London (UCL), London W1T 7NF, UK.
| | - Helen Killaspy
- Division of Psychiatry, University College London (UCL), London W1T 7NF, UK.
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22
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Richter D, Hoffmann H. Independent housing and support for people with severe mental illness: systematic review. Acta Psychiatr Scand 2017. [PMID: 28620944 DOI: 10.1111/acps.12765] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To systematically explore the outcomes of Independent Housing and Support (IHS) for people with severe mental disorders when compared to other residential settings. METHOD Systematic review of Randomised and Non-Randomised Controlled Trials of publications that analyse the outcomes of living in independent settings versus institutionalised accommodation. Risk of bias assessment was adapted from the Cochrane Collaboration's ACROBAT-Tool. The analysis was conducted separately for publications with homeless and non-homeless people. RESULTS Twenty-four publications from studies with homeless people and eight publications from studies with non-homeless people were included. Risk of bias was much lower in studies with the homeless. No RCT was found in the sample of publications with the non-homeless. Overall, results from Independent Housing and Support-settings are not inferior to results from institutionalised settings. CONCLUSION The results indicate that Independent Housing and Support-settings provide at least similar outcomes than residential care. We propose that clients' preferences should determine the choice of housing setting.
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Affiliation(s)
- D Richter
- Centre for Psychiatric Rehabilitation, University Bern Psychiatric Services, Bern, Switzerland.,Health Division, Bern University of Applied Sciences, Bern, Switzerland
| | - H Hoffmann
- Centre for Psychiatric Rehabilitation, University Bern Psychiatric Services, Bern, Switzerland.,Soteria Clinic, Bern, Switzerland
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23
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Welch V, Doull M, Yoganathan M, Jull J, Boscoe M, Coen SE, Marshall Z, Pardo JP, Pederson A, Petkovic J, Puil L, Quinlan L, Shea B, Rader T, Runnels V, Tudiver S. Reporting of sex and gender in randomized controlled trials in Canada: a cross-sectional methods study. Res Integr Peer Rev 2017; 2:15. [PMID: 29451565 PMCID: PMC5803639 DOI: 10.1186/s41073-017-0039-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Accurate reporting on sex and gender in health research is integral to ensuring that health interventions are safe and effective. In Canada and internationally, governments, research organizations, journal editors, and health agencies have called for more inclusive research, provision of sex-disaggregated data, and the integration of sex and gender analysis throughout the research process. Sex and gender analysis is generally defined as an approach for considering how and why different subpopulations (e.g., of diverse genders, ages, and social locations) may experience health conditions and interventions in different or similar ways.The objective of this study was to assess the extent and nature of reporting about sex and/or gender, including whether sex and gender analysis (SGA) was carried out in a sample of Canadian randomized controlled trials (RCTs) with human participants. METHODS We searched MEDLINE from 01 January 2013 to 23 July 2014 using a validated filter for identification of RCTs, combined with terms related to Canada. Two reviewers screened the search results to identify the first 100 RCTs that were either identified in the trial publication as funded by a Canadian organization or which had a first or last author based in Canada. Data were independently extracted by two people from 10% of the RCTs during an initial training period; once agreement was reached on this sample, the remainder of the data extraction was completed by one person and verified by a second. RESULTS The search yielded 1433 records. We screened 256 records to identify 100 RCTs which met our eligibility criteria. The median sample size of the RCTs was 107 participants (range 12-6085). While 98% of studies described the demographic composition of their participants by sex, only 6% conducted a subgroup analysis across sex and 4% reported sex-disaggregated data. No article defined "sex" and/or "gender." No publication carried out a comprehensive sex and gender analysis. CONCLUSIONS Findings highlight poor uptake of sex and gender considerations in the Canadian RCT context and underscore the need for better articulated guidance on sex and gender analysis to improve reporting of evidence, inform policy development, and guide future research.
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Affiliation(s)
- V. Welch
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - M. Doull
- School of Nursing, University of British Columbia, T223-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5 Canada
| | - M. Yoganathan
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
| | - J. Jull
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario Canada
| | - M. Boscoe
- Research Sex/gender, Health Equity, Primary Care Consultant, 906 Bowron Court, North Vancouver, BC V7H 2S7 Canada
| | - S. E. Coen
- Department of Geography and Planning, Queen’s University, Mackintosh-Corry Hall, Kingston, Ontario K7L 3 N6 Canada
| | - Z. Marshall
- Renison University College, University of Waterloo, 240 Westmount Road North, Waterloo, Ontario N2L 3G4 Canada
| | - J. Pardo Pardo
- Cochrane Musculoskeletal, University of Ottawa, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - A. Pederson
- B.C. Women’s Hospital + Health Centre, E305, 4500 Oak Street, Vancouver, BC V6H 3E1 Canada
| | - J. Petkovic
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - L. Puil
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - L. Quinlan
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
| | - B. Shea
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - T. Rader
- Canadian Agency for Drugs and Technology in Health, 865 Carling Ave, Ottawa, Ontario Canada
| | - V. Runnels
- Globalization and Health Equity Research Unit, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
| | - S. Tudiver
- Gender and Health Consultant, 161 Northwestern Avenue, Ottawa, Ontario K1Y 0 M1 Canada
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Golembiewski E, Watson DP, Robison L, Coberg JW. Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming. SOCIAL SCIENCES 2017; 6. [PMID: 28890807 PMCID: PMC5585738 DOI: 10.3390/socsci6030096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The positive relationship between social support and mental health has been well documented, but individuals experiencing chronic homelessness face serious disruptions to their social networks. Housing First (HF) programming has been shown to improve health and stability of formerly chronically homeless individuals. However, researchers are only just starting to understand the impact HF has on residents’ individual social integration. The purpose of the current study was to describe and understand changes in social networks of residents living in a HF program. Researchers employed a longitudinal, convergent parallel mixed method design, collecting quantitative social network data through structured interviews (n = 13) and qualitative data through semi-structured interviews (n = 20). Quantitative results demonstrated a reduction in network size over the course of one year. However, increases in both network density and frequency of contact with network members increased. Qualitative interviews demonstrated a strengthening in the quality of relationships with family and housing providers and a shedding of burdensome and abusive relationships. These results suggest network decay is a possible indicator of participants’ recovery process as they discontinued negative relationships and strengthened positive ones.
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Affiliation(s)
- Elizabeth Golembiewski
- Department of Health Policy & Management, Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., Indianapolis, IN 46202, USA
| | - Dennis P. Watson
- Department of Social & Behavioral Sciences, Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., Indianapolis, IN 46202, USA
- Correspondence: ; Tel.: +1-317-274-3245
| | - Lisa Robison
- Department of Social & Behavioral Sciences, Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., Indianapolis, IN 46202, USA
| | - John W. Coberg
- Department of Social & Behavioral Sciences, Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., Indianapolis, IN 46202, USA
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25
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Ecker J, Aubry T. Individual, Housing, and Neighborhood Predictors of Psychological Integration Among Vulnerably Housed and Homeless Individuals. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 58:111-122. [PMID: 27422121 DOI: 10.1002/ajcp.12066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The current longitudinal study evaluated the individual, housing, and neighborhood characteristics predictive of feeling psychologically integrated within one's neighborhood among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada and participated in three in-person interviews, each approximately 1 year apart. Prospective and cross-sectional predictors of psychological integration at Follow-up 1 and Follow-up 2 were examined. There were 397 participants at baseline, 341 at Follow-up 1 and 320 at Follow-up 2. A hierarchical multiple regression uncovered several significant predictors of psychological integration. The most salient and common predictors were being older, having greater social support, living in high quality housing, and residing in a neighborhood with a positive impact. Implications for service provision and policy advancements are discussed.
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Affiliation(s)
- John Ecker
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada.
| | - Tim Aubry
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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26
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Macnaughton E, Townley G, Nelson G, Caplan R, Macleod T, Polvere L, Isaak C, Kirst M, McAll C, Nolin D, Patterson M, Piat M, Goering P. How does Housing First catalyze recovery?: Qualitative findings from a Canadian multi-site randomized controlled trial. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1162759] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Iaquinta MS. A Systematic Review of the Transition from Homelessness to Finding a Home. J Community Health Nurs 2016; 33:20-41. [PMID: 26813052 DOI: 10.1080/07370016.2016.1120593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Homelessness is associated with premature mortality, increased morbidity, and poor quality of life. Transitioning from homelessness to housing is a complex process, particularly for individuals with mental illness. This article presents a systematic review of 26 empirical studies exploring the transition of adults from homelessness to finding a home. Seven qualitative, 14 quantitative, and 5 mixed-method studies were critically appraised and synthesized yielding persistent qualitative themes such as maintaining stability, making adjustments, and a place called home, and quantitative key categories including quality of life, sociodemographics, and housing conditions. More research is needed exploring factors related successful housing placement.
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28
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Somers JM, Moniruzzaman A, Palepu A. Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care. Addiction 2015; 110:1605-14. [PMID: 26052657 DOI: 10.1111/add.13011] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/05/2014] [Accepted: 06/01/2015] [Indexed: 11/27/2022]
Abstract
AIMS Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU). DESIGN Two concurrent randomized controlled trials with 24-month follow-up. SETTING Market rental apartments with support provided by Assertive Community Treatment (ACT) or Intensive Case Management (ICM); a single building with on-site supports (CONG); TAU in Vancouver, Canada. PARTICIPANTS Inclusion criteria were current homelessness and mental illness. Participants were assessed as having either 'high needs' (HN; n = 297) or 'moderate needs' (MN; n = 200). MN participants were randomized to ICM (n = 100) or MN-TAU (n = 100). HN participants were randomized to ACT (n = 90), CONG (n = 107) or HN-TAU (n = 100). INTERVENTIONS AND COMPARATORS All HF interventions included independent housing with support services, with an emphasis on promoting client choice and harm reduction in relation to substance use. TAU included existing services and support available to homeless adults with mental illness. MEASUREMENTS DSU over 24 and 12 months was derived from the Maudsley Addiction Profile. Also measured were demographics, homelessness history, psychiatric diagnoses, symptom severity, comorbid illnesses and duration of stable housing. FINDINGS Compared with HN-TAU, neither CONG [adjusted odds (AOR) ratio = 0.73, 95% confidence interval (CI) = 0.39-1.37] nor ACT (AOR = 1.22, 95% CI = 0.61-2.45) differed on DSU at 24 months, and MN-TAU did not differ from ICM (AOR = 0.78, 95% CI = 0.37-1.63). There were no differences at 12 months, when analyses were restricted to participants who indicated substance use at baseline, or when considering the duration of stable housing. CONCLUSIONS Housing First, an intervention to support recovery for homeless people who have co-occurring mental illness and substance use disorders, did not reduce daily substance use compared with treatment as usual after 12 or 24 months.
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Affiliation(s)
- Julian M Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Anita Palepu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Henwood BF, Stefancic A, Petering R, Schreiber S, Abrams C, Padgett DK. Social Relationships of Dually Diagnosed Homeless Adults Following Enrollment in Housing First or Traditional Treatment Services. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2015; 6:385-406. [PMID: 26635919 PMCID: PMC4664074 DOI: 10.1086/682583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Strong and effective social support is a critical element of mental health recovery, yet social support is often lacking for adults experiencing homelessness. This study examines differences in the social networks of participants newly enrolled in programs that use either a Housing First (HF) approach (i.e., provides immediate access to permanent housing with ongoing consumer-driven support services) or a treatment first (TF) approach (i.e., traditional clinician-driven staircse model that requires temporary or transitional housing and treatment placements before accessing permanent housing). METHOD We use a mixed-methods social network analysis approach to assess group differences of 75 individuals based on program type (HF or TF) and program retention. RESULTS Quantitative results show that compared with TF, HF participants have a greater proportion of staff members in their network. TF participants are more likely than HF participants to maintain mixed-quality relationships (i.e., relationships with elements of support and conflict). As compared with participants who remain in a program, those who disengage from programs have a greater proportion of mixed relationships and relationships that grow distant. Qualitative analyses suggest that HF participants regard housing as providing a stable foundation from which to reconnect or restore broken relationships. However, HF participants are guarded about close relationships for fear of being exploited due to their newly acquired apartments. TF participants report that they are less inclined to develop new relationships with peers or staff members due to the time-limited nature of the TF programs. CONCLUSIONS These findings suggest that HF participants are not more socially isolated than those in traditional care. Implications for practice, policy and future research are discussed.
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Chan DV, Gopal S, Helfrich CA. Accessibility patterns and community integration among previously homeless adults: a Geographic Information Systems (GIS) approach. Soc Sci Med 2014; 120:142-52. [PMID: 25243640 DOI: 10.1016/j.socscimed.2014.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 06/30/2014] [Accepted: 09/02/2014] [Indexed: 01/08/2023]
Abstract
Although a desired rehabilitation goal, research continues to document that community integration significantly lags behind housing stability success rates for people of a variety of ages who used to be homeless. While accessibility to resources is an environmental factor that may promote or impede integration activity, there has been little empirical investigation into the impact of proximity of community features on resource use and integration. Using a Geographic Information Systems (GIS) approach, the current study examines how accessibility or proximity to community features in Boston, United States related to the types of locations used and the size of an individual's "activity space," or spatial presence in the community. Significant findings include an inverse relationship between activity space size and proximity to the number and type of community features in one's immediate area. Specifically, larger activity spaces were associated with neighborhoods with less community features, and smaller activity spaces corresponded with greater availability of resources within one's immediate area. Activity space size also varied, however, based on proximity to different types of resources, namely transportation and health care. Greater community function, or the ability to navigate and use community resources, was associated with better accessibility and feeling part of the community. Finally, proximity to a greater number of individual identified preferred community features was associated with better social integration. The current study suggests the ongoing challenges of successful integration may vary not just based on accessibility to, but relative importance of, specific community features and affinity with one's surroundings. Community integration researchers and housing providers may need to attend to the meaning attached to resources, not just presence or use in the community.
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Affiliation(s)
- Dara V Chan
- The University of North Carolina at Chapel Hill, USA.
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