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Stewart HLN, Wilkerson JM, Gallardo KR, Zoschke IN, Gillespie D, Rodriguez SA, McCurdy SA. "And Now that I Feel Safe…I'm Coming Out of Fight or Flight": A Qualitative Exploration of Challenges and Opportunities for Residents' Mental Health in Substance Use Recovery Housing. Community Ment Health J 2024:10.1007/s10597-024-01301-7. [PMID: 38822922 DOI: 10.1007/s10597-024-01301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/18/2024] [Indexed: 06/03/2024]
Abstract
Co-occurring mental health concerns are prevalent among substance use recovery housing residents. We sought to explore how residents with co-occurring mental health and substance use needs experience recovery housing. We conducted semi-structured interviews with residents (N = 92) in recovery homes across Texas and developed themes through thematic analysis. Residents note that living in a group home can exacerbate anxiety and paranoia, especially during periods of high turnover. Overwhelmingly, however, residents believe recovery housing improves their mental health. Residents use their shared lived experiences to support one another. Residents also express appreciation for the transition period offered by recovery housing, allowing them to solidify their recoveries before fully re-entering society. Participants describe recovery homes as a critical support for their co-occurring mental health and substance use concerns. These results provide key insights on how to better support mental health in recovery housing.
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Fleury MJ, Armoon B. Profiles of Permanent Supportive Housing Residents Related to Their Housing Conditions, Service Use, and Associated Sociodemographic and Clinical Characteristics. Psychiatr Q 2024; 95:203-219. [PMID: 38584240 DOI: 10.1007/s11126-024-10071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
As permanent supportive housing (PSH) is the main strategy promoted to reduce homelessness, understanding how PSH resident profiles may be differentiated is crucial to the optimization of PSH implementation - and a subject that hasn't been studied yet. This study identified PSH resident profiles based on their housing conditions and service use, associated with their sociodemographic and clinical characteristics. In 2020-2021, 308 PSH residents from Quebec (Canada) were interviewed, with K-means cluster analysis produced to identify profiles and subsequent analyses to compare profiles and PSH resident characteristics. Of the three profiles identified, Profiles 1 and 2 (70% of sample) showed moderate or poor housing, neighborhood, and health conditions, and moderate or high unmet care needs and service use. Besides their "moderate" conditions, Profile 1 residents (52%) reported being in PSH for more than two years and being less educated. With the "worst" conditions and high service use, Profile 2 (18%) included younger individuals, while Profile 3 (30%) showed the "best" conditions and integrated individuals with more protective determinants (e.g., few in foster care, homelessness at older age, more self-esteem), with a majority living in single-site PSH and reporting higher satisfaction with support and community-based services. Profiles 1 and 2 may be provided with more psychosocial, crisis, harm reduction, and empowerment interventions, and peer helper support. Profile 2 may benefit from more intensive and integrated care, and better housing conditions. Continuous PSH may be sustained for Profile 3, with regular monitoring of service satisfaction and met needs.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
- Douglas Hospital Research Centre, Montréal, Québec, Canada.
| | - Bahram Armoon
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Douglas Hospital Research Centre, Montréal, Québec, Canada
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Armoon B, Grenier G, Fleury MJ. Perceived Higher Unmet Care Needs among Adults in Permanent Supportive Housing. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01390-2. [PMID: 38819494 DOI: 10.1007/s10488-024-01390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
This study is original in that it assesses various types of care needs, barriers to care, and factors associated with higher unmet needs among 308 permanent supportive housing (PSH) residents in Quebec (Canada). Data from structured interviews that featured the Perceived Need for Care Questionnaire were collected from 2020 to 2022, controlling for the COVID-19 pandemic period. Eight types of care (e.g., information, counseling) were accounted for. Based on the Behavioral Model for Vulnerable Populations, predisposing, need, and enabling factors associated with higher unmet care needs were assessed using a negative binomial regression model. The study found that 56% of adult PSH residents, even those who had lived in PSH for 5 + years, had unmet care needs. Twice as many unmet needs were due to structural (e.g., care access) rather than motivational barriers. Living in single-site PSH, in healthier neighborhoods, having better quality of life and self-esteem, and being more satisfied with housing and outpatient care were associated with fewer unmet care needs. PSH residents with co-occurring mental disorders (MD) and substance use disorders (SUD), and with moderate or severe psychological distress were likely to have more unmet needs. Better access to care, counseling and integrated treatment for co-occurring MD-SUD might be improved, as well as access to information on user rights, health and available support. Welfare benefits could be increased, with more peer support and meaningful activities, especially in single-site PSH. The quality of the neighborhoods where PSH are located might also be better monitored.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montréal, Québec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montréal, Québec, Canada.
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montréal, QC, H4H 1R3, Canada.
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Armoon B, L'Espérance N, Fleury MJ. Variables Associated with Quality of Life Among Individuals Living in Permanent Supportive Housing. Community Ment Health J 2024; 60:259-271. [PMID: 37462796 DOI: 10.1007/s10597-023-01167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/05/2023] [Indexed: 01/28/2024]
Abstract
This study identified individual sociodemographic and clinical characteristics and service use patterns associated with quality of life (QoL) among 308 individuals living in permanent supportive housing (PSH) in Québec (Canada). Data were collected between 2020 and 2022, and linear multivariate analyses produced. Results demonstrated that better individual psychosocial conditions were positively associated with higher QoL. As well, living in PSH located in good neighborhoods for at least 5 years, higher self-esteem and community integration were positively associated with greater QoL. Met needs, satisfaction with housing support services, and no use of acute care were also linked with positive QoL. Comprehensive efforts to improve treatment for mental health disabilities responsive to the needs of PSH residents, and sustained long-term housing may reinforce QoL. Encouraging active participation in community-based activities, incorporating biophilic design into the neighborhoods around PSH, and promoting satisfaction with care may also enhance QoL.
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Affiliation(s)
- Bahram Armoon
- Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montréal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Nadia L'Espérance
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Québec, Canada
| | - Marie-Josée Fleury
- Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montréal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
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Ames RL, Loebach JE. Applying Trauma-Informed Design Principles to Therapeutic Residential Care Facilities to Reduce Retraumatization and Promote Resiliency Among Youth in Care. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:805-817. [PMID: 38045853 PMCID: PMC10689333 DOI: 10.1007/s40653-023-00528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 12/05/2023]
Abstract
Purpose: This conceptual paper connects the literature on the experiences and needs of youth in therapeutic residential care, trauma-informed frameworks utilized in these settings, and early research on trauma-informed design to facilitate an understanding of these connections and move towards developing a blueprint for trauma-informed design in residential settings for traumatized youth. Methods: A critical literature review drawing on trauma theory, trauma-informed care, evidence-based design, and trauma-informed design was conducted to inform the argument presented in this conceptual paper. Results: While many therapeutic residential care models engage trauma-informed care approaches to support staff in promoting healing environments for youth who have histories of complex trauma, the focus has remained on the psychosocial environment of care, and has yet to be systematically applied to the design of the built environment in which these programs are implemented. By applying the principles of trauma-informed care to the built environment, trauma-informed design has the potential to reduce retraumatization and promote resiliency among youth in care. Conclusions: Ultimately, this conceptual paper illustrates the value of further developing trauma-informed design principles to apply to settings that serve traumatized youth, such as therapeutic residential care facilities.
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Affiliation(s)
- Rebecca L. Ames
- Department of Human Centered Design, Cornell University, Ithaca, NY 14853 United States
| | - Janet E. Loebach
- Department of Human Centered Design, Cornell University, Ithaca, NY 14853 United States
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Becerik-Gerber B, Lucas G, Aryal A, Awada M, Bergés M, Billington S, Boric-Lubecke O, Ghahramani A, Heydarian A, Höelscher C, Jazizadeh F, Khan A, Langevin J, Liu R, Marks F, Mauriello ML, Murnane E, Noh H, Pritoni M, Roll S, Schaumann D, Seyedrezaei M, Taylor JE, Zhao J, Zhu R. The field of human building interaction for convergent research and innovation for intelligent built environments. Sci Rep 2022; 12:22092. [PMID: 36543830 PMCID: PMC9769481 DOI: 10.1038/s41598-022-25047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Human-Building Interaction (HBI) is a convergent field that represents the growing complexities of the dynamic interplay between human experience and intelligence within built environments. This paper provides core definitions, research dimensions, and an overall vision for the future of HBI as developed through consensus among 25 interdisciplinary experts in a series of facilitated workshops. Three primary areas contribute to and require attention in HBI research: humans (human experiences, performance, and well-being), buildings (building design and operations), and technologies (sensing, inference, and awareness). Three critical interdisciplinary research domains intersect these areas: control systems and decision making, trust and collaboration, and modeling and simulation. Finally, at the core, it is vital for HBI research to center on and support equity, privacy, and sustainability. Compelling research questions are posed for each primary area, research domain, and core principle. State-of-the-art methods used in HBI studies are discussed, and examples of original research are offered to illustrate opportunities for the advancement of HBI research.
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Affiliation(s)
- Burcin Becerik-Gerber
- grid.42505.360000 0001 2156 6853Sonny Astani Department of Civil and Environmental Engineering, University of Southern California, Los Angeles, USA
| | - Gale Lucas
- grid.42505.360000 0001 2156 6853Institute for Creative Technologies, University of Southern California, Los Angeles, USA
| | - Ashrant Aryal
- grid.264756.40000 0004 4687 2082Department of Construction Science, Texas A&M University, College Station, USA
| | - Mohamad Awada
- grid.42505.360000 0001 2156 6853Sonny Astani Department of Civil and Environmental Engineering, University of Southern California, Los Angeles, USA
| | - Mario Bergés
- grid.147455.60000 0001 2097 0344Department of Civil and Environmental Engineering, Carnegie Mellon University, Pittsburgh, USA
| | - Sarah Billington
- grid.168010.e0000000419368956Department of Civil and Environmental Engineering, Stanford University, Stanford, USA
| | - Olga Boric-Lubecke
- grid.410445.00000 0001 2188 0957Department of Electrical and Computer Engineering, University of Hawaii at Manoa, Honolulu, USA
| | - Ali Ghahramani
- grid.4280.e0000 0001 2180 6431Department of the Built Environment, National University of Singapore, Singapore, Singapore
| | - Arsalan Heydarian
- grid.27755.320000 0000 9136 933XDepartment of Engineering Systems and Environment, Link Lab, University of Virginia, Charlottesville, USA
| | - Christoph Höelscher
- grid.5801.c0000 0001 2156 2780Department of Humanities, Social and Political Sciences, ETH Zurich, Zurich, Switzerland ,grid.514054.10000 0004 9450 5164Future Cities Laboratory Global, Singapore ETH Centre, Singapore, Singapore
| | - Farrokh Jazizadeh
- grid.438526.e0000 0001 0694 4940Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, USA
| | - Azam Khan
- Trax.Co, Toronto, Canada ,grid.17063.330000 0001 2157 2938University of Toronto, Toronto, Canada
| | - Jared Langevin
- grid.184769.50000 0001 2231 4551Lawrence Berkeley National Laboratory, Berkeley, USA
| | - Ruying Liu
- grid.42505.360000 0001 2156 6853Sonny Astani Department of Civil and Environmental Engineering, University of Southern California, Los Angeles, USA
| | - Frederick Marks
- grid.250671.70000 0001 0662 7144Salk Institute for Biological Studies, La Jolla, USA
| | - Matthew Louis Mauriello
- grid.33489.350000 0001 0454 4791Department of Computer and Information Sciences, University of Delaware, Newark, USA
| | - Elizabeth Murnane
- grid.254880.30000 0001 2179 2404Thayer School of Engineering, Dartmouth College, Hanover, USA
| | - Haeyoung Noh
- grid.168010.e0000000419368956Department of Civil and Environmental Engineering, Stanford University, Stanford, USA
| | - Marco Pritoni
- grid.184769.50000 0001 2231 4551Building Technology and Urban Systems Division, Lawrence Berkeley National Laboratory, Berkeley, USA
| | - Shawn Roll
- grid.42505.360000 0001 2156 6853Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, USA
| | - Davide Schaumann
- grid.6451.60000000121102151Faculty of Architecture and Town Planning, Technion – Israel Institute of Technology, Haifa, Israel
| | - Mirmahdi Seyedrezaei
- grid.42505.360000 0001 2156 6853Sonny Astani Department of Civil and Environmental Engineering, University of Southern California, Los Angeles, USA
| | - John E. Taylor
- grid.213917.f0000 0001 2097 4943School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, USA
| | - Jie Zhao
- Delos Labs, Delos, USA ,grid.25879.310000 0004 1936 8972Weitzman School of Design, University of Pennsylvania, Philadelphia, USA
| | - Runhe Zhu
- grid.42505.360000 0001 2156 6853Sonny Astani Department of Civil and Environmental Engineering, University of Southern California, Los Angeles, USA
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Owen C, Crane J. Trauma-Informed Design of Supported Housing: A Scoping Review through the Lens of Neuroscience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14279. [PMID: 36361166 PMCID: PMC9658651 DOI: 10.3390/ijerph192114279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
There is growing recognition of the importance of the design of the built environment in supporting mental health. In this context, trauma-informed design has emerged as a new field of practice targeting the design of the built environment to support wellbeing and ameliorate the physical, psychological and emotional impacts of trauma and related pathologies such as Post Traumatic Stress Disorder (PTSD). With high levels of prevalence of PTSD among people escaping homelessness and domestic violence, a priority area is the identification and application of evidence-based design solutions for trauma-informed supported housing. This study sought to examine the scope of existing evidence on the relationship between trauma, housing and design and the correlation of this evidence with trauma-informed design principles, and to identify gaps and opportunities for future research. In response to the commonly articulated limitations of the evidence-base in built environment design research, we combined a scoping review of literature on trauma, housing and design with insights from neuroscience to focus and extend understanding of the opportunities of trauma-informed design. We found that while limited in scope, there is strong alignment between existing evidence and the principles of trauma-informed design. We also identify three areas of future research related to the key domains of safety and security; control; and enriched environments.
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Affiliation(s)
- Ceridwen Owen
- School of Architecture and Design, College of Sciences and Engineering, University of Tasmania, Launceston, TAS 7250, Australia
| | - James Crane
- Tasmanian School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia
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Engaging U.S. Adults with Serious Mental Illness in Participatory Design Research Exercises. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116743. [PMID: 35682321 PMCID: PMC9180822 DOI: 10.3390/ijerph19116743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
Clubhouses are non-clinical, community-based centers for adult members with serious mental illness. The evidence-based model assists adults with identifying employment, housing, education, and social opportunities; wellness and health-promoting activities; reducing hospitalizations and criminal justice system involvement; and improving social relationships, satisfaction, and quality of life. The model enables member participation in all Clubhouse operations, yet offers little guidance concerning facility design and member engagement in the design process. This case study explored the use of participatory design research exercises to (1) document member needs, preferences, and priorities to inform the design of a new midwestern U.S. Clubhouse facility and (2) meaningfully engage members (n = 16) in the design process. Four participatory design research exercises were developed, administered, and analyzed. Results revealed aesthetics and ambience; safety and security; ease of use and maintenance; adaptability, flexibility, and accessibility; and transportation as future priorities. Space and furnishing needs and priorities were also identified. Informal observations and participant feedback suggested that the participatory exercises meaningfully engaged members in a manner aligned with Clubhouse Model principles by centering member dignity, strengths, and work-oriented expectations. Future directions for research on Clubhouse design and member engagement in the design process are also discussed.
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