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Forchuk C, Gyamfi S, Booth R. Implementation of the Community Homes for Opportunity Program Among Community Mental Health Staff in Southwestern Ontario. Issues Ment Health Nurs 2024; 45:589-596. [PMID: 38683964 DOI: 10.1080/01612840.2024.2338172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline-spring 2018 and post-implementation - winter 2019). Data analysis guided by Leininger's ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration.
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Affiliation(s)
- Cheryl Forchuk
- Lawson Health Research Institute, London, Canada
- Arthur Labatt School of Nursing, Western University, London, Canada
- Schulich School of Medicine and Dentistry, Department of Psychiatry, Western University, London, Canada
| | - Sebastian Gyamfi
- Lawson Health Research Institute, London, Canada
- University of Windsor, Windsor, Canada
| | - Richard Booth
- Lawson Health Research Institute, London, Canada
- Arthur Labatt School of Nursing, Western University, London, Canada
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2
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Ali F, Law J, Russell C, Crépault JF, Goulão JCB, Lock K, Rehm J. Navigating the nexus between British Columbia's public consumption and decriminalization policies of illegal drugs. Health Res Policy Syst 2024; 22:60. [PMID: 38783308 PMCID: PMC11112927 DOI: 10.1186/s12961-024-01150-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
In January 2023, the province of British Columbia (BC) decriminalized the possession of certain illegal drugs for personal use. The province's primary intent was to reduce the stigma associated with drug use, as well as barriers for people who use drugs (PWUD) to access treatment and supports. However, less than ten months into the decriminalization policy, due to growing concerns about public safety voiced by municipal governments and communities, the provincial government made amendments to the policy to ban the public consumption of illicit drugs in additional locations, and subsequently introduced additional legislation, Bill 34, aimed at regulating public consumption of drugs in public spaces. Some communities have also implemented local bylaws similarly regulating public drug use. Bill 34 and local bylaws may serve as tools to promote community health and safety and minimize direct and indirect harms associated with public drug use. However, such legislation may re-criminalize PWUD and reinforce negative perceptions surrounding drug use, especially if these policies are not paired with strategies to expand the availability and accessibility of critical harm reduction and housing services. Without ample access to these services, limitations on public drug use can potentially displace individuals to areas where they are more likely to use alone, further exposing them to substance use-related harms, and undermining the goals of decriminalization. The potential effects of these restrictions may also disproportionately impact marginalized populations. As of April 2024, Bill 34 remains on hold. Moving forward, it will be important to monitor this bill, as well as other public consumption bylaws and legislation, and their impact on BC's overall decriminalization initiative. Decision-makers are urged to increase engagement with PWUD and relevant stakeholders in the design and implementation of policies pertaining to public consumption to ensure that they effectively address the evolving needs and realities of PWUD, and align with decriminalization goals.
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Affiliation(s)
- Farihah Ali
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada.
- Ontario CRISM Node Team (OCRINT), Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Justine Law
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
- Ontario CRISM Node Team (OCRINT), Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Cayley Russell
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
- Ontario CRISM Node Team (OCRINT), Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jean-Francois Crépault
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Communications and Partnerships, CAMH, Toronto, Canada
| | | | - Kurt Lock
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
- Ontario CRISM Node Team (OCRINT), Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- PAHO/WHO Collaborating Centre, CAMH, Toronto, Canada
- WHO European Region Collaborating Centre at Public Health Institute of Catalonia, Barcelona, Spain
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Fleming T, Boyd J, Chayama KL, Knight KR, McNeil R. Using alone at home: What's missing in housing-based responses to the overdose crisis? Harm Reduct J 2024; 21:24. [PMID: 38281992 PMCID: PMC10823649 DOI: 10.1186/s12954-024-00933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Against the backdrop of North America's overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments (e.g., single-room occupancy housing, shelters), which are often the only forms of housing available to urban poor and drug-using communities. This commentary aims to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. In doing so, we call attention to the need to better understand marginal housing as sites of overdose vulnerability and public health intervention to optimize responses to the overdose crisis. HARM REDUCTION AND OVERDOSE PREVENTION IN HOUSING In response to high overdose rates in marginal housing environments several interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) have recently been implemented in select jurisdictions. However, even with the growing recognition of marginal housing as a key intervention site, housing-based interventions have yet to be scaled up in a meaningful way. Further, there have been persistent challenges to tailoring these approaches to address dynamics within housing environments. Thus, while it is critical to expand coverage of housing-based interventions across marginal housing environments, these interventions must also attend to the contextual drivers of risks in these settings to best foster enabling environments for harm reduction and maximize impacts. CONCLUSION Emerging housing-focused interventions are designed to address key drivers of overdose risk (e.g., using alone, toxic drug supply). Yet, broader contextual factors (e.g., drug criminalization, housing quality, gender) are equally critical factors that shape how structurally vulnerable people who use drugs navigate and engage with harm reduction interventions. A more comprehensive understanding of these contextual factors within housing environments is needed to inform policy and programmatic interventions that are responsive to the needs of people who use drugs in these settings.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Jade Boyd
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Koharu Loulou Chayama
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Kelly R Knight
- Department of Humanities and Social Sciences, School of Medicine, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, USA
| | - Ryan McNeil
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, 10001, USA.
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT, 10001, USA.
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Martin-Fernandez J, Stevens N, Moriceau S, Serre F, Blanc H, Latourte E, Auriacombe M, Cambon L. Realist evaluation of the impact, viability and transferability of an alcohol harm reduction support programme based on mental health recovery: the Vitae study protocol. BMJ Open 2022; 12:e065361. [PMID: 35953259 PMCID: PMC9379535 DOI: 10.1136/bmjopen-2022-065361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Addiction is considered a chronic disease associated with a high rate of relapse as a consequence of the addictive condition. Most of the current therapeutic work focuses on the notion of relapse prevention or avoidance and the control of its determinants. Since only a small portion of patients can access alcohol addiction treatment, it is crucial to find a way to offer new support towards safe consumptions, reductions or cessations. The harm reduction (HR) approach and mental health recovery perspective offers another way to support the patient with alcohol addiction. Vitae is a realist evaluation of the impact, viability and transferability of the IACA! programme, an HR programme based on the principle of psychosocial recovery for people with alcohol use disorders. METHODS AND ANALYSIS The Vitae study adheres to the theory-driven evaluation framework where the realist evaluation method and contribution analysis are used to explore the effects, mechanisms and influence of context on the outcomes and to develop and adjust an intervention theory. This study is a 12-month, multi-case, longitudinal descriptive pilot study using mixed methods. It is multi-centred, and carried out in 10 addiction treatment or prevention centres. In this study, outcomes are related to the evolution of alcohol use and the beneficiaries trajectory in terms of psychosocial recovery during these 12 months after the start of IACA!. The target number of participants are 100 beneficiaries and 23 professionals. ETHICS AND DISSEMINATION This research was approved by the Committee for the Protection of Persons Ouest V n°: 21/008-3HPS and was reported to the French National Agency for the Safety of Health Products. All participants will provide consent prior to participation. The results will be reported in international peer-reviewed journals and presented at scientific and public conferences. TRIAL REGISTRATION NUMBERS NCT04927455; ID-RCB2020-A03371-38.
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Affiliation(s)
- Judith Martin-Fernandez
- PHARes-MéRISP Team, Univ. Bordeaux, ISPED, Inserm, UMR 1219 Bordeaux Population Health, Bordeaux, France
- University Bordeaux, Bordeaux, France
| | - Nolwenn Stevens
- PHARes-MéRISP Team, Univ. Bordeaux, ISPED, Inserm, UMR 1219 Bordeaux Population Health, Bordeaux, France
- University Bordeaux, Bordeaux, France
| | - Sarah Moriceau
- University Bordeaux, Bordeaux, France
- Pôle Addictologie et Filière Régionale, CH Charles Perrens and CHU de Bordeau, Bordeaux, France
- Addiction Team Phenomenology and Determinants of Appetitive Behaviors, SANPSY, CNRS USR 3413, Bordeaux, France
| | - Fuschia Serre
- University Bordeaux, Bordeaux, France
- Pôle Addictologie et Filière Régionale, CH Charles Perrens and CHU de Bordeau, Bordeaux, France
- Addiction Team Phenomenology and Determinants of Appetitive Behaviors, SANPSY, CNRS USR 3413, Bordeaux, France
| | - Hélène Blanc
- Founders, Santé! Organization, Marseille, France
| | | | - Marc Auriacombe
- University Bordeaux, Bordeaux, France
- Pôle Addictologie et Filière Régionale, CH Charles Perrens and CHU de Bordeau, Bordeaux, France
- Addiction Team Phenomenology and Determinants of Appetitive Behaviors, SANPSY, CNRS USR 3413, Bordeaux, France
| | - Linda Cambon
- PHARes-MéRISP Team, Univ. Bordeaux, ISPED, Inserm, UMR 1219 Bordeaux Population Health, Bordeaux, France
- University Bordeaux, Bordeaux, France
- Prevention department, CHU, Bordeaux, France
- Chaire de prévention, ISPED SPF, Bordeaux, France
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Pérez-Figueroa RE, Obonyo DJ, Santoscoy S, Surratt HL, Lekas HM, Lewis CF, Lyons JS, Amesty SC. Housing Instability, Structural Vulnerability, and Non-Fatal Opioid Overdoses Among People Who Use Heroin in Washington Heights, New York City. Behav Med 2022; 48:320-330. [PMID: 34086534 DOI: 10.1080/08964289.2021.1922347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nationally, opioid overdose remains strikingly persistent among people experiencing homelessness and housing instability. Limited information is available about the characteristics of this phenomenon in economically disadvantaged communities of color. This study sought to evaluate the association between key contextual factors and experiencing a non-fatal opioid overdose among people who use heroin in Washington Heights, New York City. We conducted a cross-sectional survey (N = 101) among participants seeking harm reduction services who reported heroin use in the last three months. Binary logistic regression models examined the association between key social and structural factors and the likelihood of ever experiencing a non-fatal opioid overdose and recently experiencing a non-fatal opioid overdose. The majority of the sample reported housing instability and lived in poverty; almost 42% were homeless. After adjustment, participants who injected heroin were more likely to have ever experienced a non-fatal opioid overdose. Also, younger participants who reported hunger in the last six months were more likely to have experienced a non-fatal opioid overdose in the last three months. Findings suggest the role of structural vulnerability in shaping overdose risk among the participants. Overdose prevention strategies should consider factors of the social and economic environment to mitigate barriers to accessing health and social services within the context of the current opioid crisis.
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Affiliation(s)
- R E Pérez-Figueroa
- Department of Health, Behavior, and Society, University of Kentucky College of Public Health.,Center for Innovation in Population Health, University of Kentucky College of Public Health
| | - D J Obonyo
- Department of Health Management and Policy, University of Kentucky College of Public Health
| | - S Santoscoy
- Research and Drug Education, Washington Heights Corner Project
| | - H L Surratt
- Department of Behavioral Science, University of Kentucky College of Medicine
| | - H M Lekas
- Department of Psychiatry, New York University School of Medicine.,Department of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research
| | - C F Lewis
- Department of Psychiatry, New York University School of Medicine.,Department of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research
| | - J S Lyons
- Center for Innovation in Population Health, University of Kentucky College of Public Health.,Department of Health Management and Policy, University of Kentucky College of Public Health
| | - S C Amesty
- Center for Family and Community Medicine, Columbia University Irving Medical Center Vagelos College of Physicians and Surgeons.,Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health
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Santos RRD, Hacker MDAVB, Mota JCD, Bastos FI. Housing characteristics of crack cocaine users in Northeast Brazil, 2011-2013. CIENCIA & SAUDE COLETIVA 2022; 27:2407-2416. [PMID: 35649027 DOI: 10.1590/1413-81232022276.16522021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 12/03/2021] [Indexed: 11/22/2022] Open
Abstract
We compared sociodemographic characteristics, substance use patterns, sexual behavior, use of health services, and criminal records of homeless vs. domiciled users. Data are from the Brazilian National Survey on Crack Use. A discriminant model and correspondence analysis cross-compared characteristics of users according to their housing status. The logistic model revealed associations between "living in the streets" and female gender and intermittent work. "Homelessness" was also associated with the use of tobacco and "oxi" in the previous 30 days, reliance on soup kitchens, low access to public mental health services, and arrests in the previous year. Correspondence analysis highlighted the spatial proximity of the variables as follows: "having traded sex for drugs", "informal work", "age 31 years or older", "access to public mental health services", "problems with law enforcement", and female gender with homeless crack users. People who smoke crack cocaine in Northeast Brazil are seldom studied. Their profiles, stratified according to their housing conditions, show subgroups with specific characteristics. While domiciled users have access to specialized clinics, homeless users basically reported access to free food and harm reduction services.
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Affiliation(s)
- Raquel Rodrigues Dos Santos
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz (Fiocruz). R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | | | - Jurema Corrêa da Mota
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Rio de Janeiro RJ Brasil
| | - Francisco Inácio Bastos
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Rio de Janeiro RJ Brasil
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Durieux J, Curtis A, Mirka M, Jefferis E, Felix C, Essel B. An Exploration of Narcan as a Harm Reduction Strategy and User's Attitudes toward Law Enforcement Involvement in Overdose Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063149. [PMID: 35328837 PMCID: PMC8954857 DOI: 10.3390/ijerph19063149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/27/2022]
Abstract
The street homeless, those who spend their nights either in shelters or unofficial camps, whether in tents on a street or in society’s hidden spaces such as beneath an overpass, face multiple challenges beyond finding a safe place to sleep. Of further concern is how official actions can worsen these situations, through day-to-day activities or planned intervention strategies. In this paper we explore how a planned intervention may be negatively perceived—even as a form of “structural violence”—and may prevent Narcan (naloxone) use to stop an overdose related death in the Skid Row of Los Angeles. Data for this study consisted of a combination of Spatial Video Geonarratives (SVGs) and 325 incident reports from the Homeless Health Care Los Angeles Center for Harm Reduction (HHCLA-HRC) between November 2014 and December 2015. Chi-square and simple logistic regression models were used to examine the association between fear-of-arrest and other covariates of interest. Mapping results are presented with different sets of shapefiles created for (1) all Narcan uses, (2) all homeless, (3) all homeless with a worry about being arrested, (4) all Narcan uses where an ambulance attended, (5) and the same as 4 but also with police attendance. In the multivariable model, the estimated adjusted odds of fear-of-arrest is over three times higher among Narcan users ages 30–39 when compared to users under the age of 30. Analyzing the association of calling 9-1-1 on Narcan user demographics, socio-contextual characteristics, and overdose victim demographics, the crude estimated probability of calling 9-1-1 for Narcan users aged 50 and older is nearly three times higher when compared to Narcan users aged 19–29. Conclusion: Results suggest that the fear-of-arrest and calling 9-1-1 during an overdose is still a concern among Narcan users despite protective legislation and access to harm reduction resources.
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Affiliation(s)
- Jared Durieux
- College of Public Health, Kent State University, Kent, OH 44242, USA; (M.M.); (B.E.)
- Correspondence: (J.D.); (E.J.)
| | - Andrew Curtis
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Melissa Mirka
- College of Public Health, Kent State University, Kent, OH 44242, USA; (M.M.); (B.E.)
| | - Eric Jefferis
- College of Public Health, Kent State University, Kent, OH 44242, USA; (M.M.); (B.E.)
- Correspondence: (J.D.); (E.J.)
| | - Chaz Felix
- Tulare County Health and Human Services Agency, Visalia, CA 93277, USA;
| | - Baaba Essel
- College of Public Health, Kent State University, Kent, OH 44242, USA; (M.M.); (B.E.)
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Lawson SG, Lowder EM, Ray B. Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems. BMC Psychiatry 2022; 22:163. [PMID: 35246077 PMCID: PMC8895515 DOI: 10.1186/s12888-022-03803-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations. METHODS We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects. RESULTS Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant. CONCLUSIONS Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors.
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Affiliation(s)
- Spencer G. Lawson
- grid.17088.360000 0001 2150 1785School of Criminal Justice, Michigan State University, East Lansing, MI USA
| | - Evan M. Lowder
- grid.22448.380000 0004 1936 8032Department of Criminology, Law and Society, George Mason University, Fairfax, VA USA
| | - Bradley Ray
- grid.62562.350000000100301493Division for Applied Justice Research, RTI International, Research Triangle Park, NC USA
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Gowda GS, Isaac MK. Models of Care of Schizophrenia in the Community-An International Perspective. Curr Psychiatry Rep 2022; 24:195-202. [PMID: 35230610 PMCID: PMC8967793 DOI: 10.1007/s11920-022-01329-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW We reviewed the existing and recent community models of care in schizophrenia. We examine characteristics, recent updates, evidence, cost-effectiveness, and patients' acceptance for existing and new community-based care models in high-income (HI) and low- and middle-income (LAMI) countries. RECENT FINDINGS Assertive Community Treatment (ACT), Intensive Case Management (ICM), and Crisis Intervention are cost-effective interventions for schizophrenia and time tested in the last few decades in HI countries. The growing evidence suggests that tailor-made ACTs and ICM can effectively reduce substance use, homelessness, and criminal activity in persons with schizophrenia who live in the community. Similarly, in LAMI Countries, a few community-based care models for schizophrenia have been developed and tested based on community-based rehabilitation principles. The modality of a community model of care and interventions for a person with schizophrenia should be chosen based on the person's co-existing psychosocial difficulties and challenges such as homelessness, criminal behaviour, and substance use.
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Affiliation(s)
- Guru S. Gowda
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029 India
| | - Mohan K. Isaac
- grid.415051.40000 0004 0402 6638Clinical Professor of Psychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Fremantle Hospital, Fremantle Hospital, Level 7, T Block, Fremantle, WA 6160 Australia
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10
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Nicholls M, Urada LA. Homelessness and polysubstance use: A qualitative study on recovery and treatment access solutions around an urban library in Southern California, USA. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e175-e183. [PMID: 33988284 PMCID: PMC8590699 DOI: 10.1111/hsc.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 03/19/2021] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
People experiencing homelessness face many obstacles and barriers when it comes to getting help for their substance use. Recently, there has been an increase in substance use and opioid overdoses at public libraries, which are easily accessible public places for those struggling with homelessness. We aimed to understand this population's experience with recovery. This has led to an exploration of the intersection of experiencing homelessness and substance use-related problems and its impact on barriers for recovery, along with facilitators to treatment and recovery. From January to June 2019, researchers interviewed 22 library patrons experiencing homelessness and actively using substances at a Southern Californian library in a major metropolitan area. Data were coded and analysed using a thematic analysis. Researchers independently coded text files for data analysis and discussed codes until consensus was reached. Library patrons who reported substance use were a mean age of 39 (range: 22-63); over half were white people (59%) and male (59%); 77% reported currently sleeping on the street; 18% lived in shelters. Themes for barriers to recovery were experiencing withdrawal, access to resources and coping with being homeless. Themes related to facilitators to treatment and recovery were Narcan access and overdose education, connectedness and trauma recovery. People experiencing homelessness are hard to reach and those using substances pose even more vulnerabilities. Many patrons attribute their circumstances to their substance use and disconnectedness to resources and supports to quit. Further research is needed on best practices for multidisciplinary care coordination for this population.
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Affiliation(s)
- Melanie Nicholls
- San Diego State University School of Social Work
- University of California San Diego, Division of Infectious Diseases and Global Public Health in the Department of Medicine
| | - Lianne A. Urada
- San Diego State University School of Social Work
- University of California San Diego, Division of Infectious Diseases and Global Public Health in the Department of Medicine
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11
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Kerman N, Polillo A, Bardwell G, Gran-Ruaz S, Savage C, Felteau C, Tsemberis S. Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review. Drug Alcohol Depend 2021; 228:109052. [PMID: 34601279 DOI: 10.1016/j.drugalcdep.2021.109052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Harm reduction is a central tenet of Housing First. As the intervention has been shown to stably house people experiencing chronic homelessness across the lifespan with complex behavioural health needs, it is critical to understand the harm reduction outcomes and practices in Housing First. METHODS A systematic review following PRISMA guidelines was conducted of five databases: PsycINFO, MEDLINE, Embase, CINAHL, and Google Scholar. Harm reduction outcomes and practices in Housing First were examined in four domains: substance-related harms, viral health, sexual health, and harm reduction service use. RESULTS A total of 35 articles were included in the review, 23 of which examined harm reduction outcomes and 12 of which investigated harm reduction practices in Housing First. Harm reduction outcome studies focused mostly on nonspecific substance use problems, with Housing First being found to have minimal effects in this domain. More severe harms, such as delirium tremens and substance use-related deaths, have been minimally explored, though preliminary evidence is promising. Viral health, sexual health, and harm reduction service use outcomes were the focus of few studies. Research on harm reduction practices highlighted that Housing First providers experience both flexibility and ambiguity in their work using a harm reduction approach, and the importance of empathetic working relationships for engagement in harm reduction work. CONCLUSIONS Harm reduction outcomes in Housing First remain underexamined and any conclusions of the intervention's impacts in this domain would be premature. Effective harm reduction practices in Housing First require strong working relationships between staff and tenants.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada; University of British Columbia, Department of Medicine, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Sophia Gran-Ruaz
- University of Ottawa, School of Psychology, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada
| | - Cathi Savage
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Charlie Felteau
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Sam Tsemberis
- Pathways Housing First Institute, 1328 2nd Street, Santa Monica, CA, 90403, United States
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MacKinnon L, Socias ME. Housing First: A housing model rooted in harm reduction with potential to transform health care access for highly marginalized Canadians. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:481-483. [PMID: 34261706 PMCID: PMC8279675 DOI: 10.46747/cfp.6707481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Laura MacKinnon
- Family physician practising in the Downtown Eastside in Vancouver, BC, and in northern British Columbia, and is also an addiction medicine research fellow with the BC Centre on Substance Use
| | - M Eugenia Socias
- Research Scientist with the BC Centre on Substance Use and Assistant Professor in the Department of Medicine at the University of British Columbia in Vancouver
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Tinland A, Loubiere S, Cantiello M, Boucekine M, Girard V, Taylor O, Auquier P. Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death. BMC Public Health 2021; 21:1294. [PMID: 34215235 PMCID: PMC8254224 DOI: 10.1186/s12889-021-11310-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Homeless people face large excess mortality in comparison with the general population, but little is known about the effect of housing interventions like Housing First (HF) on their mortality. Aims of the study 1) to explore 2-years mortality among homeless people with severe mental illness (SMI) included in French HF randomized controlled trial (RCT). 2) To examine causes of death among homeless participants. Methods For 703 participants of HF RCT: 353 in experimental group (HF) and 350 in control group (Treatment As Usual - TAU), any proof of life or death and causes of death were collected with a thorough retrospective investigation among relatives, institutions and administrative databases. Data collection took place from March to June 2017. Results 4.8% (n = 34) of the study participants died over the study period. Mean age of death was 40.9 (+/− 11.4) years. The overall 2-years mortality rate was 0.065 in the HF group (n = 23) versus 0.034 in the TAU group (n = 11). Mortality was associated with medications for opioid use disorder in multivariate Cox analysis (HR: 2.37, 95%CI 1.15–5.04, p = 0.025). Those in HF group seem to be more at risk of death compared to TAU group, mainly during the first 6 months of being housed, although the difference did not reach significance (HR: 0.49, 95%CI 0.24–1.01, p = 0.054). Violent deaths occurred in 52.2% of HF group’s deaths versus 18.2% of TAU group’s deaths, this excess being explained by 34.8% (n = 8) deaths by overdoses in HF group versus none in TAU group. Limitations 1) 8.7% (n = 2) people in HF group died before HF intervention but were analyzed in intention-to-treat. 2) No proof of life or death has been found for only 0.6% in HF group (n = 2) but for 9.5% people in TAU group (n = 33) that could be anonymous deaths. 3) Undetermined causes represented 8.7% of deaths in HF group versus 36.4% in TAU group. 4) The small number of events (deaths) in the study population is a limitation for statistical analysis. Conclusions Due to important limitations, we cannot conclude on HF effect on mortality, but our results nevertheless confirm that the vulnerability of long-term homeless people with SMI persists after accessing independent housing. Earlier intervention in the pathways of homelessness should be considered, alongside active specific support for addictions. Trial registration Ethics Committee Sud Mediterrannée V n° 11.050: trial number 2011-A00668–33: 28/07/2011. Clinicaltrials ID NCT01570712: 4/4/2012.
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Affiliation(s)
- Aurélie Tinland
- Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France. .,Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.
| | - Sandrine Loubiere
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
| | - Matthieu Cantiello
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Mohamed Boucekine
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Vincent Girard
- Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
| | - Owen Taylor
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
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MacKinnon L, Socias ME. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e154-e156. [PMID: 34261722 PMCID: PMC8279674 DOI: 10.46747/cfp.6707e154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Laura MacKinnon
- Médecin de famille et exerce dans l'est du centre-ville de Vancouver (C.-B.) et au nord de la Colombie-Britannique; elle est aussi boursière en recherche sur la médecine des dépendances au BC Centre on Substance Use
| | - M Eugenia Socias
- Scientifique en recherche au BC Centre on Substance Use et professeure adjointe au Département de médecine de l'Université de la Colombie-Britannique à Vancouver
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Mercado M, Marroquín JM, Ferguson KM, Bender K, Shelton J, Prock KA, Maria DS, Hsu HT, Narendorf SC, Petering R, Barman-Adhikari A. The intersection of housing and mental well-being: Examining the needs of formerly homeless young adults transitioning to stable housing. SSM Popul Health 2021; 14:100775. [PMID: 33816749 PMCID: PMC8005844 DOI: 10.1016/j.ssmph.2021.100775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/03/2021] [Accepted: 03/05/2021] [Indexed: 11/27/2022] Open
Abstract
We examine the challenges formerly homeless young adults (FHYAs) face after they transition out of homelessness. Considering the adversities FHYAs face, it is unclear how transitioning to stable housing may affect their mental well-being or what types of stressors they may experience once housed. This study investigates the social environment young adults encounter in their transition to stable housing and examines trauma and social coping predictors of mental health symptoms in a sample of FHYAs to generate new knowledge for better intervening to meet their needs. Data were obtained from REALYST, a national research collaborative comprised of interdisciplinary researchers investigating young adults' (ages 18-26) experiences with homelessness. Cross-sectional data for 1426 young adults experiencing homelessness were collected from 2016 to 2017 across seven cities in the United States (i.e., Los Angeles, Phoenix, Denver, Houston, San Jose, St. Louis, and New York City). The analytical sub-sample for this study consisted of 173 FHYAs who were housed in their own apartment (via voucher from Housing and Urban Development or another source) or in transitional living programs during their participation in the study. Ordinary Least Squares regression was used to examine the influence of trauma and social coping strategies on indicators of mental well-being. Findings indicated that higher adversity scores and higher mental health help-seeking intentions were positively associated with higher levels of stress, psychological distress, and depression severity. Higher level of social coping was associated with lower levels of depression severity. Logistic regression results showed that young adults with higher adversity scores had higher odds of reporting clinical levels of post-traumatic symptoms. The study implications suggest that FHYAs who transition to stable housing continue to need support navigating and coping with stressful life events; and interventions that help FHYAs develop strong networks of social supports are needed to promote positive mental well-being.
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Affiliation(s)
- Micaela Mercado
- Arizona State University 201 North Central Avenue, 33rd Floor Phoenix, AZ, 85004, USA
| | - J Marisol Marroquín
- Arizona State University 201 North Central Avenue, 33rd Floor Phoenix, AZ, 85004, USA
| | - Kristin M Ferguson
- Arizona State University 201 North Central Avenue, 33rd Floor Phoenix, AZ, 85004, USA
| | - Kimberly Bender
- University of Denver, Graduate School of Social Work, 2148 S. High Street Denver, CO, 80208, USA
| | - Jama Shelton
- Silberman School of Social Work, Hunter College, 2180 3rd Avenue NYC, NY, 10035, USA
| | - Kristen A Prock
- University of Wisconsin-Whitewater, Department of Social Work, 800 W Main St, Whitewater, WI, 53190, USA
| | - Diane Santa Maria
- University of Texas Health Science Center at Houston, Cizik School of Nursing, 6901 Bertner Ave, Houston, TX, 77030, USA
| | - Hsun-Ta Hsu
- University of Missouri.edu, 709 Clark Hall, Columbia, MO, 65211, USA
| | - Sarah Carter Narendorf
- University of Houston, Graduate College of Social Work 3511 Cullen Blvd., Houston, TX, 77204, USA
| | - Robin Petering
- Lens Co, Research and Advocacy Consulting, Los Angeles, CA, 90026, USA
| | - Anamika Barman-Adhikari
- University of Denver, Graduate School of Social Work, 2148 S. High Street Denver, CO, 80208, USA
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Watson DP, Snow-Hill N, Saldana L, Walden AL, Staton M, Kong A, Donenberg G. A Longitudinal Mixed Method Approach for Assessing Implementation Context and Process Factors: Comparison of Three Sites from a Housing First Implementation Strategy Pilot. IMPLEMENTATION RESEARCH AND PRACTICE 2020; 1. [PMID: 33392509 DOI: 10.1177/2633489520974974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Implementation science's focus on establishing implementation strategy effectiveness has overshadowed the need to understand differential performance of such strategies under various conditions. Methods allowing for assessment between implementation context and process can help address this gap. This paper provides a detailed description of a mixed method procedure for assessing factors related to the implementation context and process intersection, which was developed as part of the pilot study of the Housing First Technical Assistance and Training (HFTAT) Program, a multifaceted strategy designed to support Housing First model implementation. Methods The HFTAT was pilot tested among a sample of three organizations. Our mixed method approach combines two tools often used in implementation research-the Stages of Implementation Completion and the Consolidated Framework for Implementation Research-in a novel way. Several stages to analysis were completed, starting with a separate analysis of data pertaining to each measure and then two levels of mixed method analysis. Results The approach provided a better understanding of the issues that impacted the implementation guided by the HFTAT, suggesting: (1) individual determinants seemed to have a bigger impact based on the number of SIC phases they affected, (2) implementation context and process were connected through climate-related factors in the inner setting that made the sites more or less responsive to addressing identified barriers, and (3) there is a need to better assess context factors to identify areas where implementation drivers should be better targeted to facilitate change, and this is supported by prior research. Conclusions Understanding the underlying factors impacting a setting's performance related to a specific implementation strategy has potential to improve decision-making and optimize future implementation efforts. The approach likely be as successful combining the SIC with other determinant frameworks and should be utilized at the onset of an implementation project to maximize its usefulness.
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Affiliation(s)
| | - Nyssa Snow-Hill
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
| | | | | | - Monte Staton
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, & Policy, University of Illinois at Chicago
| | - Geri Donenberg
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
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Opioid Misuse Among HIV-Positive Adults in Medical Care: Results From the Medical Monitoring Project, 2009-2014. J Acquir Immune Defic Syndr 2019; 80:127-134. [PMID: 30383590 DOI: 10.1097/qai.0000000000001889] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND People living with HIV are prescribed opioids more often and at higher doses than people who do not have HIV, and disproportionately experience risk factors for substance use disorder, which suggests they could be at increased risk of the misuse of opioids. Researchers also suggest that opioid misuse negatively affects various HIV clinical outcomes, increasing the risk of transmission to partners with an HIV-negative status. METHODS We calculated weighted percentages and 95% confidence intervals to estimate substance use characteristics among a probability sample of 28,162 HIV-positive adults receiving medical care in the United States who misused opioids (n = 975). Then, we used Rao-Scott χ tests to assess bivariate associations between opioid misuse and selected characteristics. RESULTS In all, 3.3% misused opioids. Misuse was more common among young adults, males, and non-Hispanic whites. Persons who misused opioids were less likely to: have been prescribed antiretroviral therapy (ART) (88.7%), report being adherent to ART medications in the past 3 days (78.1%), and have durable viral suppression (54.3%) than persons who did not misuse opioids (92.5%, 87.7%, and 64.7%, respectively). Persons who misused opioids were more likely to report condomless sex with partners of negative or unknown HIV status while not durably virally suppressed (11.7% vs 3.4%) than persons who did not misuse opioids. CONCLUSIONS Opioid misuse among adults receiving HIV medical care is associated with inadequate ART adherence, insufficient durable viral suppression, and higher risk of HIV transmission to sexual partners.
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Miao Z. Investigation on human rights ethics in artificial intelligence researches with library literature analysis method. ELECTRONIC LIBRARY 2019. [DOI: 10.1108/el-04-2019-0089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper was to identify whether artificial intelligence (AI) products can possess human rights, how to define their rights and obligations and what ethical standards they should follow. In this study, the human rights ethical dilemma encountered in the application and development of AI technology has been focused on and analyzed in detail in the light of the existing research status of AI ethics.
Design/methodology/approach
In this study, first of all, the development and application of AI technology, as well as the concept and characteristics of human rights ethics, are introduced. Second, the human rights ethics of AI technology are introduced in detail, including the human rights endowment of AI machines, the fault liability of AI machines and the moral orientation of AI machines. Finally, the approaches to human rights ethics are proposed to ensure that AI technology serves human beings. Every link of its research, production and application should be strictly managed and supervised.
Findings
The results show that the research in this study can provide help for the related problems encountered in AI practice. Intelligent library integrates human rights protection organically so that readers or users can experience more intimate service in this system. It is a kind of library operation mode with more efficient and convenient characteristics, which is based on digital, networked and intelligent information science. It aims at using the greenest way and digital means to realize the reading and research of human rights protection literature in the literature analysis method.
Originality/value
Intelligent library is the future development mode of new libraries, which can realize broad interconnection and sharing. It is people-oriented and can make intelligent management and service and establish the importance of the principle of human rights protection and the specific idea of the principle. The development of science and technology brings not only convenience to people's social life but also questions to be thought. People should reduce its potential harm, so as to make AI technology continue to benefit humankind.
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Afshar M, Joyce C, Dligach D, Sharma B, Kania R, Xie M, Swope K, Salisbury-Afshar E, Karnik NS. Subtypes in patients with opioid misuse: A prognostic enrichment strategy using electronic health record data in hospitalized patients. PLoS One 2019; 14:e0219717. [PMID: 31310611 PMCID: PMC6634397 DOI: 10.1371/journal.pone.0219717] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Approaches are needed to better delineate the continuum of opioid misuse that occurs in hospitalized patients. A prognostic enrichment strategy with latent class analysis (LCA) may facilitate treatment strategies in subtypes of opioid misuse. We aim to identify subtypes of patients with opioid misuse and examine the distinctions between the subtypes by examining patient characteristics, topic models from clinical notes, and clinical outcomes. METHODS This was an observational study of inpatient hospitalizations at a tertiary care center between 2007 and 2017. Patients with opioid misuse were identified using an operational definition applied to all inpatient encounters. LCA with eight class-defining variables from the electronic health record (EHR) was applied to identify subtypes in the cohort of patients with opioid misuse. Comparisons between subtypes were made using the following approaches: (1) descriptive statistics on patient characteristics and healthcare utilization using EHR data and census-level data; (2) topic models with natural language processing (NLP) from clinical notes; (3) association with hospital outcomes. FINDINGS The analysis cohort was 6,224 (2.7% of all hospitalizations) patient encounters with opioid misuse with a data corpus of 422,147 clinical notes. LCA identified four subtypes with differing patient characteristics, topics from the clinical notes, and hospital outcomes. Class 1 was categorized by high hospital utilization with known opioid-related conditions (36.5%); Class 2 included patients with illicit use, low socioeconomic status, and psychoses (12.8%); Class 3 contained patients with alcohol use disorders with complications (39.2%); and class 4 consisted of those with low hospital utilization and incidental opioid misuse (11.5%). The following hospital outcomes were the highest for each subtype when compared against the other subtypes: readmission for class 1 (13.9% vs. 10.5%, p<0.01); discharge against medical advice for class 2 (12.3% vs. 5.3%, p<0.01); and in-hospital death for classes 3 and 4 (3.2% vs. 1.9%, p<0.01). CONCLUSIONS A 4-class latent model was the most parsimonious model that defined clinically interpretable and relevant subtypes for opioid misuse. Distinct subtypes were delineated after examining multiple domains of EHR data and applying methods in artificial intelligence. The approach with LCA and readily available class-defining substance use variables from the EHR may be applied as a prognostic enrichment strategy for targeted interventions.
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Affiliation(s)
- Majid Afshar
- Department of Public Health Sciences, Loyola University, Maywood, Illinois, United States of America
- Center for Health Outcomes and Informatics Research, Loyola University, Maywood, Illinois, United States of America
- Stritch School of Medicine, Loyola University, Maywood, Illinois, United States of America
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University, Maywood, Illinois, United States of America
- Center for Health Outcomes and Informatics Research, Loyola University, Maywood, Illinois, United States of America
- Stritch School of Medicine, Loyola University, Maywood, Illinois, United States of America
| | - Dmitriy Dligach
- Department of Public Health Sciences, Loyola University, Maywood, Illinois, United States of America
- Center for Health Outcomes and Informatics Research, Loyola University, Maywood, Illinois, United States of America
- Department of Computer Science, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Brihat Sharma
- Department of Computer Science, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Robert Kania
- Department of Computer Science, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Meng Xie
- Department of Mathematics and Statistics, Loyola University, Chicago, Illinois, United States of America
| | - Kristin Swope
- Department of Public Health Sciences, Loyola University, Maywood, Illinois, United States of America
- Stritch School of Medicine, Loyola University, Maywood, Illinois, United States of America
| | - Elizabeth Salisbury-Afshar
- Center for Multi-System Solutions to the Opioid Epidemic, American Institute for Research, Chicago, Illinois, United States of America
| | - Niranjan S. Karnik
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
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Watson DP, Ahonen EQ, Shuman V, Brown M, Tsemberis S, Huynh P, Ouyang F, Xu H. The housing first technical assistance and training (HFTAT) implementation strategy: outcomes from a mixed methods study of three programs. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:32. [PMID: 30241546 PMCID: PMC6151066 DOI: 10.1186/s13011-018-0172-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/17/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This paper discusses the initial testing of the Housing First Training and Technical Assistance (HFTAT) Program, a multifaceted, distance-based strategy for the implementation of the Housing First (HF) supportive housing model. HF is a complex housing intervention for serving people living with serious mental illness and a substance use disorder that requires significant individual- and structural-level changes to implement. As such, the HFTAT employs a combined training and consultation approach to target different levels of the organization. Training delivered to all organizational staff focuses on building individual knowledge and uses narrative storytelling to overcome attitudinal implementation barriers. Consultation seeks to build skills through technical assistance and fidelity audit and feedback. METHOD We employed a mixed method design to understand both individual-level (e.g., satisfaction with the HFTAT, HF knowledge acquisition and retention, and HF acceptability and appropriateness) and structural-level (e.g., fidelity) outcomes. Quantitative data were collected at various time points, and qualitative data were collected at the end of HFTAT activities. Staff and administrators (n = 113) from three programs across three states participated in the study. RESULTS Satisfaction with both training and consultation was high, and discussions demonstrated both activities were necessary. Flexibility of training modality and narrative storytelling were particular strengths, while digital badging and the community of practice were perceived as less valuable because of incompatibilities with the work context. HF knowledge was high post training and retained after 3-month follow-up. Participants reported training helped them better understand the model. Attitudes toward evidence-based interventions improved over 6 months, with qualitative data supporting this but demonstrating some minor concerns related to acceptability and appropriateness. Fidelity scores for all programs improved over 9 months. CONCLUSION The HFTAT was a well-liked and generally useful implementation strategy. Results support prior research pointing to the value of both (a) multifaceted strategies and (b) combined training and consultation approaches. The study also provides evidence for narrative storytelling as an approach for changing attitudinal implementation barriers. The need for compatibility between specific elements of an implementation strategy and the work environment was also observed.
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Affiliation(s)
- Dennis P Watson
- Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA.
| | - Emily Q Ahonen
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Valery Shuman
- Heartland Alliance Health, Midwest Harm Reduction Institute, 1207 W. Leland Ave, Chicago, IL, 60640, USA
| | - Molly Brown
- Department of Psychology, DePaul University, 1 E. Jackson, Chicago, IL, 60604, USA
| | - Sam Tsemberis
- Department of Psychiatry, NYPH, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Philip Huynh
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Fangqian Ouyang
- Indiana University School of Medicine, 340 W. 10th St, Indianapolis, IN, 46202, USA
| | - Huiping Xu
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
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Bonny-Noach H, Ronel N. Everyday Substance Insecurity Among Homeless Injection Drug Users in Israel’s Largest Open Drug Scene. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618791261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Limited attention has been given to Homeless Injection Drug Users (HIDUs) perceived need for illegal substances. This study assessed self-perceived illegal drug need in HIDUs based on their experiences. Observations and in-depth qualitative interviews were conducted with 11 HIDUs and with four treatment professionals. The findings revealed three findings concerning the unique experiences and perceptions of HIDUs: (a) Everyday Substance Need caused fear and anxiety, (b) Substance Need was experienced as more urgent than basic survival needs, and (c) HIDU participants attributed misunderstanding and denial of Substance Need to the authorities. It was found that HIDUs suffer from “Substance Insecurity,” which may be defined as the uncertain availability of quality substances (or their substitutes) and uncertain ability to acquire substances/substitutes and safe injection equipment in socially acceptable (or not) ways. Increased awareness of Substance Insecurity for HIDUs as a Substance Security First (SSF) model should be adopted.
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Andraka-Christou B, Rager JB, Brown-Podgorski B, Silverman RD, Watson DP. Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:17. [PMID: 29789018 PMCID: PMC5964673 DOI: 10.1186/s13011-018-0153-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/19/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature. METHODS We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy. RESULTS In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions. CONCLUSIONS This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision-making and state-level health outcomes.
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Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management and Informatics, College of Health and Public Affairs, University of Central Florida, 4364 Scorpius Street, Orlando, FL, 32816, USA.
| | - Joshua B Rager
- School of Medicine, Indiana University, 340 W 10th St #6200, Indianapolis, IN, 46202, USA
| | - Brittany Brown-Podgorski
- Department of Social and Behavioral Sciences, Indiana University Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Ross D Silverman
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Dennis P Watson
- Department of Social and Behavioral Science, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
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Watson DP, Adams EL, Shue S, Coates H, McGuire A, Chesher J, Jackson J, Omenka OI. Defining the external implementation context: an integrative systematic literature review. BMC Health Serv Res 2018; 18:209. [PMID: 29580251 PMCID: PMC5870506 DOI: 10.1186/s12913-018-3046-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/20/2018] [Indexed: 11/27/2022] Open
Abstract
Background Proper implementation of evidence-based interventions is necessary for their full impact to be realized. However, the majority of research to date has overlooked facilitators and barriers existing outside the boundaries of the implementing organization(s). Better understanding and measurement of the external implementation context would be particularly beneficial in light of complex health interventions that extend into and interact with the larger environment they are embedded within. We conducted a integrative systematic literature review to identify external context constructs likely to impact implementation of complex evidence-based interventions. Methods The review process was iterative due to our goal to inductively develop the identified constructs. Data collection occurred in four primary stages: (1) an initial set of key literature across disciplines was identified and used to inform (2) journal and (3) author searches that, in turn, informed the design of the final (4) database search. Additionally, (5) we conducted citation searches of relevant literature reviews identified in each stage. We carried out an inductive thematic content analysis with the goal of developing homogenous, well-defined, and mutually exclusive categories. Results We identified eight external context constructs: (1) professional influences, (2) political support, (3) social climate, (4) local infrastructure, (5) policy and legal climate, (6) relational climate, (7) target population, and (8) funding and economic climate. Conclusions This is the first study to our knowledge to use a systematic review process to identify empirically observed external context factors documented to impact implementation. Comparison with four widely-utilized implementation frameworks supports the exhaustiveness of our review process. Future work should focus on the development of more stringent operationalization and measurement of these external constructs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3046-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dennis P Watson
- Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
| | - Erin L Adams
- Department of Psychology, Indiana University Purdue University-Indianapolis, 420 N Blackford St, Indianapolis, IN, 46202, USA
| | - Sarah Shue
- Indiana University-Purdue University Indianapolis, School of Health and Rehabilitation Sciences, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Heather Coates
- Indiana University-Purdue University Indianapolis, University Library, Center for Digital Scholarship, 755 W. Michigan St, Indianapolis, IN, 46202, USA
| | - Alan McGuire
- Richard L. Roudebush VA, 1481 W. 10th St, Indianapolis, IN, 46202, USA
| | - Jeremy Chesher
- Department of Environmental Health Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Joanna Jackson
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Ogbonnaya I Omenka
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
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Harm reduction in a Norwegian housing first project: a qualitative study of the treatment providers’ practice. ADVANCES IN DUAL DIAGNOSIS 2018. [DOI: 10.1108/add-08-2017-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Little is known about how harm reduction is practiced in Norwegian housing first (HF) projects. The purpose of this paper is to explore, describe, and interpret how providers apply a harm reduction approach within a housing project focused on individuals who are homeless with co-morbid substance use and mental health problems.
Design/methodology/approach
This qualitative study was part of a larger evaluation study of a three-year HF project in a Norwegian municipality. Data were collected using four multi-stage focus groups with five providers working in the HF project. Focus group interviews were transcribed verbatim and analyzed using thematic analysis.
Findings
Analysis resulted in three main themes: “Letting the service user sit in the driver’s seat,” “We don’t follow service provision contracts, we do everything,” and “Collaborating with the local community.”
Research limitations/implications
There is a need to develop increased knowledge about service users’ experiences within the harm reduction approach.
Practical implications
To practice effective harm reduction, treatment providers must have open authorizations and the opportunity to exercise professional judgment. Harm reduction practice must also focus on social, political, and economic factors influencing users’ everyday lives.
Originality/value
The paper contributes to the knowledge base on harm reduction within HF practice that differs from a traditional model wherein clients are expected to abstain from substance use. It highlights important preconditions for challenges practitioners might encounter at both individual and service system levels.
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Bardwell G, Collins AB, McNeil R, Boyd J. Housing and overdose: an opportunity for the scale-up of overdose prevention interventions? Harm Reduct J 2017; 14:77. [PMID: 29212507 PMCID: PMC5719740 DOI: 10.1186/s12954-017-0203-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background North America is currently experiencing an overdose epidemic due to a significant increase of fentanyl-adulterated opioids and related analogs. Multiple jurisdictions have declared a public health emergency given the increasing number of overdose deaths. In the province of British Columbia (BC) in Canada, people who use drugs and who are unstably housed are disproportionately affected by a rising overdose crisis, with close to 90% of overdose deaths occurring indoors. Despite this alarming number, overdose prevention and response interventions have yet to be widely implemented in a range of housing settings. Overdose prevention interventions There are few examples of overdose prevention interventions in housing environments. In BC, for example, there are peer-led naloxone training and distribution programs targeted at some housing environments. There are also “supervised” spaces such as overdose prevention sites (similar to supervised consumption sites (SCS)) located in some housing environments; however, their coverage remains limited and the impacts of these programs are unclear due to the lack of evaluation work undertaken to date. A small number of SCS exist globally in housing environments (e.g., Germany), but like overdose prevention sites in BC, little is known about the design or effectiveness, as they remain under-evaluated. Conclusions Implementing SCS and other overdose prevention interventions across a range of housing sites provides multiple opportunities to address overdose risk and drug-related harms for marginalized people who use drugs. Given the current overdose crisis rising across North America, and the growing evidence of the relationship between housing and overdose, the continued implementation and evaluation of novel overdose prevention interventions in housing environments should be a public health priority. A failure to do so will simply perpetuate what has proven to be a devastating epidemic of preventable death.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Alexandra B Collins
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, 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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