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Kerman N, Marshall CA, Polillo A, Voronov J, de Pass T, Easton C, Ward B, Noble A, Hwang SW, Kozloff N, Stergiopoulos V, Kidd SA. Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry. Soc Sci Med 2024; 348:116831. [PMID: 38574591 DOI: 10.1016/j.socscimed.2024.116831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among people experiencing homelessness in two cities in Ontario, Canada. A total of 49 people experiencing homelessness who had been restricted from an emergency shelter program in the past year were recruited and included in the study analysis. A pragmatic and integrative approach was used for data analysis that involved the development of meta-matrices to identify prominent and divergent perspectives and experiences with regard to service restriction antecedents and consequences. Study findings underscored that service restrictions were often the result of violence and aggression, primarily between service users. There were regional differences in other service restriction reasons, including substance use and possession. Service restrictions affected the shelter status of almost all participants, with many subsequently experiencing unsheltered homelessness, and cycling through institutional health, social, and criminal justice services (i.e., institutional circuitry). Other health and social consequences included substance use relapses and hospitalizations; cold-related injuries due to post-restriction unsheltered homelessness; suicidality; food insecurity; diminished contact with support network and connections; and intense feelings of anger, fear, and hopelessness. Overall, the study findings advance our understanding of the role of homeless services in pathways into unsheltered homelessness and institutional circuitry, which raise critical questions about how to mitigate the harms associated with service restrictions, while concurrently facilitating safety and upholding the rights of people experiencing homelessness and emergency shelter staff.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada.
| | - Carrie Anne Marshall
- Western University, School of Occupational Therapy, 1201 Western Road, London, Ontario, Canada
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Timothy de Pass
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Corinna Easton
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada
| | - Brooklyn Ward
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, 1919 Riverside Drive, Ottawa, Ontario, Canada
| | - Amanda Noble
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Division of General Internal Medicine, 1 King's College Circle, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
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Tetzlaff EJ, Mourad F, Goulet N, Gorman M, Siblock R, Kidd SA, Bezgrebelna M, Kenny GP. " Death Is a Possibility for Those without Shelter": A Thematic Analysis of News Coverage on Homelessness and the 2021 Heat Dome in Canada. Int J Environ Res Public Health 2024; 21:405. [PMID: 38673318 PMCID: PMC11050128 DOI: 10.3390/ijerph21040405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Among the most vulnerable to the health-harming effects of heat are people experiencing homelessness. However, during the 2021 Heat Dome, the deadliest extreme heat event (EHE) recorded in Canada to date, people experiencing homelessness represented the smallest proportion of decedents (n = 3, 0.5%)-despite the impacted region (British Columbia) having some of the highest rates of homelessness in the country. Thus, we sought to explore the 2021 Heat Dome as a media-based case study to identify potential actions or targeted strategies that were initiated by community support agencies, individuals and groups, and communicated in the news during this EHE that may have aided in the protection of this group or helped minimize the mortality impacts. Using media articles collated for a more extensive investigation into the effects of the 2021 Heat Dome (n = 2909), we identified a subset which included content on people experiencing homelessness in Canada (n = 274, 9%). These articles were thematically analysed using NVivo. Three main themes were identified: (i) public warnings issued during the 2021 Heat Dome directly addressed people experiencing homelessness, (ii) community support services explicitly targeting this population were activated during the heat event, and (iii) challenges and barriers faced by people experiencing homelessness during extreme heat were communicated. These findings suggest that mass-media messaging and dedicated on-the-ground initiatives led by various organizations explicitly initiated to support individuals experiencing homelessness during the 2021 Heat Dome may have assisted in limiting the harmful impacts of the heat on this community.
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Affiliation(s)
- Emily J. Tetzlaff
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (F.M.)
- Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, 269 Laurier Avenue W., Ottawa, ON K1A 0P8, Canada; (M.G.); (R.S.)
| | - Farah Mourad
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (F.M.)
| | - Nicholas Goulet
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (F.M.)
- Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, 269 Laurier Avenue W., Ottawa, ON K1A 0P8, Canada; (M.G.); (R.S.)
| | - Melissa Gorman
- Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, 269 Laurier Avenue W., Ottawa, ON K1A 0P8, Canada; (M.G.); (R.S.)
| | - Rachel Siblock
- Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, 269 Laurier Avenue W., Ottawa, ON K1A 0P8, Canada; (M.G.); (R.S.)
| | - Sean A. Kidd
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, 1001 Queen Street W., Toronto, ON M6J 1H4, Canada; (S.A.K.); (M.B.)
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
| | - Mariya Bezgrebelna
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, 1001 Queen Street W., Toronto, ON M6J 1H4, Canada; (S.A.K.); (M.B.)
| | - Glen P. Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (F.M.)
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
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Quilty LC, Tempelaar W, Andrade BF, Kidd SA, Lunsky Y, Chen S, Wang W, Wong JKY, Lau C, Sedrak AB, Kelly R, Sivakumar H, Jani M, Ameis SH, Cleverley K, Goldstein BI, Felsky D, Dickie EW, Foussias G, Kozloff N, Nikolova YS, Polillo A, Diaconescu AO, Wheeler AL, Courtney DB, Hawke LD, Rotenberg M, Voineskos AN. Cognition and Educational Achievement in the Toronto Adolescent and Youth Cohort Study: Rationale, Methods, and Early Data. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:265-274. [PMID: 37979945 DOI: 10.1016/j.bpsc.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Both cognition and educational achievement in youths are linked to psychosis risk. One major aim of the Toronto Adolescent and Youth (TAY) Cohort Study is to characterize how cognitive and educational achievement trajectories inform the course of psychosis spectrum symptoms (PSSs), functioning, and suicidality. Here, we describe the protocol for the cognitive and educational data and early baseline data. METHODS The cognitive assessment design is consistent with youth population cohort studies, including the NIH Toolbox, Rey Auditory Verbal Learning Test, Wechsler Matrix Reasoning Task, and Little Man Task. Participants complete an educational achievement questionnaire, and report cards are requested. Completion rates, descriptive data, and differences across PSS status are reported for the first participants (N = 417) ages 11 to 24 years, who were recruited between May 4, 2021, and February 2, 2023. RESULTS Nearly 84% of the sample completed cognitive testing, and 88.2% completed the educational questionnaire, whereas report cards were collected for only 40.3%. Modifications to workflows were implemented to improve data collection. Participants who met criteria for PSSs demonstrated lower performance than those who did not on numerous key cognitive indices (p < .05) and also had more academic/educational problems. CONCLUSIONS Following youths longitudinally enabled trajectory mapping and prediction based on cognitive and educational performance in relation to PSSs in treatment-seeking youths. Youths with PSSs had lower cognitive performance and worse educational outcomes than youths without PSSs. Results show the feasibility of collecting data on cognitive and educational outcomes in a cohort of youths seeking treatment related to mental illness and substance use.
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Affiliation(s)
- Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Wanda Tempelaar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Brendan F Andrade
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sean A Kidd
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yona Lunsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sheng Chen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wei Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jimmy K Y Wong
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Chloe Lau
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada
| | - Andrew B Sedrak
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel Kelly
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Harijah Sivakumar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Melanie Jani
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stephanie H Ameis
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Felsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erin W Dickie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - George Foussias
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya S Nikolova
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Alexia Polillo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andreea O Diaconescu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Neurosciences and Mental Health Program, Toronto, Ontario, Canada
| | - Darren B Courtney
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Martin Rotenberg
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Napoleon JS, Weva VK, Evans DW, Namdari R, Francois T, Sherman J, Morisseau N, Lafontant E, Atkinson K, Miller S, Kidd SA, Burack JA. Rethinking narratives about youth experiencing homelessness: The influence of self-determined motivation and peer relations on coping. J Community Psychol 2024; 52:382-398. [PMID: 38031717 DOI: 10.1002/jcop.23100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Using the cognitive appraisal theory of coping and the self-determination theory of motivation, we examined the shared variance of motivational orientations, attachment relationships, and gender on adaptive and maladaptive coping among youth experiencing homelessness. Several scales including The Global Motivation Scale (assessing motivational orientations; i.e., autonomous and controlled motivation), the Brief Cope (adaptive and maladaptive coping strategies), and the Inventory of Parent and Peer Attachment (self-perceptions of relationships with mothers, fathers, and peers) were administered to 102 youth aged between 16 and 24 (Mage = 20, SD = 2.07) years recruited from an evening program for youth experiencing homelessness in Montreal, Canada. Autonomous motivation was positively associated with engagement in effective coping strategies, while controlled motivation was positively linked to maladaptive coping. Moderation analyses were used to examine whether gender and relationships with attachment figures moderated the relationship between motivation and coping. A significant main effect of peer attachment on adaptive coping emerged, in which greater peer attachment was related to more adaptive coping among the youth. No interaction effects resulted. Although no significant moderating effects were associated with essential relationships and gender, further research implementing a more nuanced approach to assessing the interaction between these constructs may be warranted. Overall, the findings highlight the importance of intervention programs for youth experiencing homelessness, that focus on enhancing autonomous motivation and utilizing peer support to optimize the use of adaptive coping strategies.
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Affiliation(s)
| | - Vanessa K Weva
- Department of Educational & Counselling Psychology, McGill University, Montreal, Canada
| | - David W Evans
- Neuroscience Program, Bucknell University, Lewisburg, Pennsylvania and Clare Hall College, University of Cambridge, Cambridge, UK
| | - Reyhane Namdari
- Department of Educational & Counselling Psychology, McGill University, Montreal, Canada
| | | | | | | | | | - Kristi Atkinson
- Department of Educational & Counselling Psychology, McGill University, Montreal, Canada
| | - Sydney Miller
- Department of Psychology, Concordia University, Montreal, Canada
| | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jacob A Burack
- Department of Educational & Counselling Psychology, McGill University, Montreal, Canada
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D'Arcey JN, Zhao H, Wang W, Voineskos AN, Kozloff N, Kidd SA, Foussias G. An SMS text messaging intervention to improve clinical engagement in early psychosis: A pilot randomized-controlled trial. Schizophr Res 2024; 264:416-423. [PMID: 38241785 DOI: 10.1016/j.schres.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 12/19/2023] [Accepted: 01/01/2024] [Indexed: 01/21/2024]
Abstract
Disengagement of youth with psychosis from Early Psychosis Intervention (EPI) services continues to be a significant barrier to recovery, with approximately one-third prematurely discontinuing treatment despite the ongoing need. The current pilot trial sought to evaluate the preliminary efficacy and feasibility of a weekly short message service (SMS) intervention to improve engagement in EPI services. This was a longitudinal single-blinded randomized control trial in which participants were assigned to receive either an active or sham SMS intervention over nine months. Sixty-one participants with early psychosis between the ages of 16 and 29 were enrolled, randomized, and received at least part of the intervention. Primary outcomes consisted of participant clinic attendance rates over the course of the intervention and clinician-rated engagement. Secondary measures included patient-rated therapeutic rapport, attitude toward medication, psychopathology, cognition, functioning, and intervention feedback from participants. Compared to the sham group, participants receiving the active intervention did not show improved appointment attendance rates; however, did exhibit some improvements in aspects of engagement, including improved clinician-rated availability, attitude toward medication, positive symptoms, avolition-apathy and social functioning. Thus, contrary to our hypotheses, digitally augmented care did not result in enhanced engagement in EPI services, as measured by clinic attendance, although with some indication that it may contribute to improved attitude toward medication and, potentially, medication adherence. Weekly SMS text messaging appeared to result in a pattern of engagement whereby individuals who were improving clinically attended appointments less often, possibly due to inadvertent use of the intervention to check in with clinicians. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04379349).
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Affiliation(s)
- Jessica N D'Arcey
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Haoyu Zhao
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada
| | - Wei Wang
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada; College of Public Health, University of South Florida, United States of America
| | - Aristotle N Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Sean A Kidd
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - George Foussias
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada.
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Naeem F, Khan N, Sohani N, Safa F, Masud M, Ahmed S, Thandi G, Mutta B, Kasaam A, Tello K, Husain MI, Husain MO, Kidd SA, McKenzie K. Culturally Adapted Cognitive Behaviour Therapy (CaCBT) to Improve Community Mental Health Services for Canadians of South Asian Origin: A Qualitative Study. Can J Psychiatry 2024; 69:54-68. [PMID: 37376808 PMCID: PMC10867407 DOI: 10.1177/07067437231178958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND South Asian (SA) Canadians are disproportionately affected by higher rates of mood and anxiety disorders. SA Canadians with depression report significant barriers to accessing mental health care and the highest proportion of unmet mental health needs. The Mental Health Commission of Canada (MHCC) advocates for culturally and linguistically relevant services for SA Canadians. Culturally adapted cognitive behavior therapy (CaCBT) has shown to be more effective than standard cognitive behavior therapy (CBT). Adapting CBT for the growing SA population in Canada will ensure equitable access to effective, culturally-appropriate mental health interventions. METHOD The study used a qualitative design to elicit stakeholder consultation via in-depth interviews. This study is reported using the criteria included in Consolidated Criteria for Reporting Qualitative Studies (COREQ). The analysis follows an ethnographic approach and was informed by the principles of emergent design. RESULTS Five themes were identified from the analysis, (i) Awareness and preparation: factors that impact the individual's understanding of therapy and mental illness. (ii) Access and provision: SA Canadians' perception of barriers, facilitators, and access to treatment. (iii) Assessment and engagement: experiences of receiving helpful treatment. (iv) Adjustments to therapy: modifications and suggestions to standard CBT. (v) Ideology and ambiguity: racism, immigration, discrimination, and other socio-political factors. CONCLUSIONS Mainstream mental health services need to be culturally appropriate to better serve SA Canadians experiencing depression and anxiety. Services must understand the family dynamics, cultural values and socio-political factors that impact SA Canadians to reduce attrition rates in therapy.
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nagina Khan
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nazia Sohani
- Immigrant Services, Ottawa Newcomer Health Centre, Ottawa, ON, Canada
| | - Farhana Safa
- Punjabi Community Health Services, Brampton, ON, Canada
| | | | - Sarah Ahmed
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Gary Thandi
- Moving Forward Family Services, Vancouver, Canada
| | - Baldev Mutta
- Punjabi Community Health Services, Toronto, Canada
| | - Azaad Kasaam
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Kamlesh Tello
- Access to Quality Mental Health Services, Mental Health Commission of Canada, Ottawa, ON, Canada
| | | | | | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Virelli CR, Ebrahimi M, Mohiuddin AG, Tomasi J, Lisoway AJ, Herbert D, Marshe VS, Kidd SA, Ferenbok J, Kennedy JL. User Experiences of Pharmacogenomic Testing and Opinions among Psychiatry Patients. J Pers Med 2023; 14:22. [PMID: 38248723 PMCID: PMC10817619 DOI: 10.3390/jpm14010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Pharmacogenomic testing (PGx) is a tool used to guide physicians in selecting an optimal medication for clients based on their genetic profile. The objective of this qualitative study is to understand patients' experiences with PGx testing as well as their opinions regarding the clinical adoption of such tests in psychiatry. A focus group was conducted to assess the needs of clients who had experience using a PGx test. Participants were recruited from a large study on PGx testing that offered physicians an opportunity to use PGx reports to guide psychotropic prescriptions. The focus group discussions were recorded, transcribed, and coded using NVivo to identify core themes. A total of 11 people participated in the focus group. Our analysis revealed that many participants were in favour of implementing PGx testing in psychiatric practice, and all expressed important considerations for patient-centred optimization of PGx testing. The main themes captured were: education and awareness among clinicians, cost considerations, PGx results-sharing and accessibility, and prospective benefits. The results of this study suggest that patients are keen to see PGx testing in widespread clinical care, but they report important opportunities to improve knowledge mobilization of PGx testing.
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Affiliation(s)
- Catherine R. Virelli
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Translational Research Program, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Mahbod Ebrahimi
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ayeshah G. Mohiuddin
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Translational Research Program, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Julia Tomasi
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Amanda J. Lisoway
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Deanna Herbert
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
| | | | - Sean A. Kidd
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Joseph Ferenbok
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - James L. Kennedy
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada (M.E.); (J.T.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
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Kerman N, Kidd SA, Mutschler C, Sylvestre J, Henwood BF, Oudshoorn A, Marshall CA, Aubry T, Stergiopoulos V. Managing high-risk behaviours and challenges to prevent housing loss in permanent supportive housing: a rapid review. Harm Reduct J 2023; 20:140. [PMID: 37775776 PMCID: PMC10542260 DOI: 10.1186/s12954-023-00873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023] Open
Abstract
Permanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the relationship between high-risk issues and housing stability in permanent supportive housing has not been previously synthesized. This rapid review aimed to identify the housing-related outcomes of high-risk behaviours and challenges in permanent supportive housing settings, as well as the approaches used by agencies and residents to address them. A range of high-risk behaviours and challenges were examined, including risks to self (overdose, suicide/suicide attempts, non-suicidal self-injury, falls/fall-related injuries), and risks to multiple parties and/or building (fire-setting/arson, hoarding, apartment takeovers, physical/sexual violence, property damage, drug selling, sex trafficking). The search strategy included four components to identify relevant academic and grey literature: (1) searches of MEDLINE, APA PsycINFO, and CINAHL Plus; (2) hand searches of three journals with aims specific to housing and homelessness; (3) website browsing/searching of seven homelessness, supportive housing, and mental health agencies and networks; and (4) Advanced Google searches. A total of 32 articles were eligible and included in the review. Six studies examined the impacts of high-risk behaviours and challenges on housing tenancies, with overdose being identified as a notable cause of death. Twenty-six studies examined approaches and barriers to managing high-risk behaviours and challenges in PSH programs. These were categorized into eight types of approaches: (1) clinical, (2) relational/educational, (3) surveillant, (4) restrictive, (5) strategic, (6) design-based, (7) legal, and (8) self-defence. Consistent across all approaches was a lack of rigorous examination of their effectiveness. Further, some approaches that are legal, restrictive, surveillant, or strategic in nature may be used to promote safety, but may conflict with other program objectives, including housing stability, or resident empowerment and choice. Research priorities were identified to address the key evidence gaps and move toward best practices for preventing and managing high-risk behaviours and challenges in permanent supportive housing.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - John Sylvestre
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | | | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Kerman N, Kidd SA, Voronov J, Marshall CA, O'Shaughnessy B, Abramovich A, Stergiopoulos V. Victimization, safety, and overdose in homeless shelters: A systematic review and narrative synthesis. Health Place 2023; 83:103092. [PMID: 37515964 DOI: 10.1016/j.healthplace.2023.103092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
The objective of this prospectively registered systematic review was to identify the factors that contribute to sense of safety, victimization, and overdose risk in homeless shelters, as well as groups that are at greater risk of shelter-based victimization. Fifty-five articles were included in the review. Findings demonstrated that fears of violence and other forms of harm were prominent concerns for people experiencing homelessness when accessing shelters. Service users' perceptions of shelter dangerousness were shaped by the service model and environment, interpersonal relationships and interactions in shelter, availability of drugs, and previous living arrangements. 2SLGBTQ+ individuals were identified as being at heightened risk of victimization in shelters. No studies examined rates of shelter-based victimization or tested interventions to improve safety, with the exception of overdose risk. These knowledge gaps hinder the establishment of evidence-based practices for promoting safety and preventing violence in shelter settings.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Alex Abramovich
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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10
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Hajat S, Sarran CE, Bezgrebelna M, Kidd SA. Ambient Temperature and Emergency Hospital Admissions in People Experiencing Homelessness: London, United Kingdom, 2011-2019. Am J Public Health 2023; 113:981-984. [PMID: 37384875 PMCID: PMC10413738 DOI: 10.2105/ajph.2023.307351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 07/01/2023]
Abstract
Objectives. To assess the impacts of ambient temperature on hospitalizations of people experiencing homelessness. Methods. We used daily time-series regression analysis employing distributed lag nonlinear models of 148 177 emergency inpatient admissions with "no fixed abode" and 20 804 admissions with a diagnosis of homelessness in London, United Kingdom, in 2011 through 2019. Results. There was a significantly increased risk of hospitalization associated with high temperature; at 25°C versus the minimum morbidity temperature (MMT), relative risks were 1.359 (95% confidence interval [CI] = 1.216, 1.580) and 1.351 (95% CI = 1.039, 1.757) for admissions with "no fixed abode" and admissions with a homelessness diagnosis, respectively. Between 14.5% and 18.9% of admissions were attributable to temperatures above the MMT. No significant associations were observed with cold. Conclusions. There is an elevated risk of hospitalization associated with even moderately high temperatures in individuals experiencing homelessness. Risks are larger than those reported in the general population. Public Health Implications. Greater emphasis should be placed on addressing homeless vulnerabilities during hot weather rather than cold. Activation thresholds for interventions such as the Severe Weather Emergency Protocol (SWEP) could be better aligned with health risks. Given elevated risks at even moderate temperatures, our findings support prioritization of prevention-oriented measures, rather than crisis response, to address homelessness. (Am J Public Health. 2023;113(9):981-984. https://doi.org/10.2105/AJPH.2023.307351).
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Affiliation(s)
- Shakoor Hajat
- Shakoor Hajat is with the London School of Hygiene & Tropical Medicine, London, UK. Christophe E. Sarran is with the Met Office, Exeter, UK. Mariya Bezgrebelna is with the Department of Psychology, York University, Toronto, Ontario, Canada. Sean A. Kidd is with the Centre for Addiction and Mental Health and the University of Toronto Department of Psychiatry, Toronto
| | - Christophe E Sarran
- Shakoor Hajat is with the London School of Hygiene & Tropical Medicine, London, UK. Christophe E. Sarran is with the Met Office, Exeter, UK. Mariya Bezgrebelna is with the Department of Psychology, York University, Toronto, Ontario, Canada. Sean A. Kidd is with the Centre for Addiction and Mental Health and the University of Toronto Department of Psychiatry, Toronto
| | - Mariya Bezgrebelna
- Shakoor Hajat is with the London School of Hygiene & Tropical Medicine, London, UK. Christophe E. Sarran is with the Met Office, Exeter, UK. Mariya Bezgrebelna is with the Department of Psychology, York University, Toronto, Ontario, Canada. Sean A. Kidd is with the Centre for Addiction and Mental Health and the University of Toronto Department of Psychiatry, Toronto
| | - Sean A Kidd
- Shakoor Hajat is with the London School of Hygiene & Tropical Medicine, London, UK. Christophe E. Sarran is with the Met Office, Exeter, UK. Mariya Bezgrebelna is with the Department of Psychology, York University, Toronto, Ontario, Canada. Sean A. Kidd is with the Centre for Addiction and Mental Health and the University of Toronto Department of Psychiatry, Toronto
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11
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Abramovich A, Pang N, Kim KV, Stark RK, Lange S, Chaiton M, Logie CH, Hamilton HA, Kidd SA. A longitudinal investigation of the effects of the COVID-19 pandemic on 2SLGBTQ+ youth experiencing homelessness. PLoS One 2023; 18:e0288591. [PMID: 37459299 PMCID: PMC10351701 DOI: 10.1371/journal.pone.0288591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The objective of this study was to examine the impacts of the coronavirus 2019 (COVID-19) pandemic on various dimensions of wellbeing among 2SLGBTQ+ youth experiencing homelessness over a 12-month period during the COVID-19 pandemic. METHODS 2SLGBTQ+ youth (recruited using a convenience sampling method) participated in three online surveys to assess mental health (depression, anxiety, suicidality), substance and alcohol use, health care access, and violence for 12-months between 2021-2022. Quantitative data analysis included non-parametric one-sample proportion tests, paired t-test and McNemar's test. Longitudinal data collected across all three timepoints were treated as paired data and compared to baseline data using non-parametric exact multinomial tests, and if significant, followed by pairwise post-hoc exact binomial tests. For the purposes of analysis, participants were grouped according to their baseline survey based on pandemic waves and public health restrictions. RESULTS 2SLGBTQ+ youth experiencing homelessness (n = 87) reported high rates of mental health challenges, including anxiety and depression, over 12-months during the pandemic. Youth participants reported experiencing poor mental health during the early waves of the pandemic, with improvements to their mental health throughout the pandemic; however, results were not statistically significant. Likewise, participants experienced reduced access to mental health care during the early waves of the pandemic but mental health care access increased for youth throughout the pandemic. CONCLUSION Study results showed high rates of mental health issues among 2SLGBTQ+ youth, but reduced access to mental health care, due to the COVID-19 pandemic. Findings highlight the need for 2SLGBTQ+ inclusive and affirming mental health care and services to address social and mental health issues that have been exacerbated by the pandemic.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Kawon Victoria Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rowen K. Stark
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Hayley A. Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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12
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Kidd SA, Galvao LAC, Hajat S, Bezgrebelna M, McKenzie K. Shelter is key to delivering on COP27 commitments. Lancet 2023; 401:1770-1771. [PMID: 37244687 DOI: 10.1016/s0140-6736(23)00722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/02/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON M6J 1H1, Canada.
| | - Luiz A C Galvao
- Oswaldo Cruz Foundation, Center for Global Health, Rio de Janeiro, Brazil
| | - Shakoor Hajat
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON M6J 1H1, Canada; Wellesley Institute, Toronto, ON, Canada
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13
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Kerman N, Kidd SA, Stergiopoulos V. Involuntary Hospitalization and Coercive Treatment of People With Mental Illness Experiencing Homelessness-Going Backward With Foreseeable Harms. JAMA Psychiatry 2023:2803752. [PMID: 37043217 DOI: 10.1001/jamapsychiatry.2023.0537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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Pishdadian S, Martins F, Milanovic M, Doell FK, Kidd SA, Grossman MJ. Emotion regulation relates to clinical characteristics and quality of life but not daily functioning in psychosis spectrum outpatients. J Psychiatr Res 2023; 161:289-297. [PMID: 36947960 DOI: 10.1016/j.jpsychires.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
Difficulties in emotion regulation (ER) can negatively impact the clinical course and outcomes of a range of psychiatric conditions, including psychosis spectrum disorders. Individuals with psychosis may exhibit poorer ER abilities, which have been associated with increased severity and distress of psychotic symptoms. A paucity of research has investigated the clinical correlates of ER in psychosis and the influence of these difficulties on indices of recovery, such as daily functioning and quality of life. In the present study, 59 outpatients presenting for Cognitive Behaviour Therapy for psychosis (CBTp) in a large psychiatric hospital completed an intake assessment of clinician-rated and self-reported measures prior to treatment. Poor ER abilities were positively correlated with positive symptoms (overall and delusions), social anxiety, depression, and self-reflectiveness and negatively correlated with quality of life and personal recovery. Multiple regression analyses showed ER was a significant predictor of quality of life but not daily functioning, which was predicted most by cognition and psychiatric symptoms. Overall, findings support the clinical utility of assessing emotion dysregulation in psychosis and provide a more nuanced understanding of how such challenges differentially influence recovery in psychosis, which can further inform treatment planning and intervention.
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Affiliation(s)
- Sara Pishdadian
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada; Department of Psychology, 4700 Keele Street, York University, Toronto, ON, M3J 1P3, Canada
| | - Felicia Martins
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada; Department of Psychology, 1265, Military Trail, University of Toronto Scarborough, Toronto, ON, M1C 1A4, Canada
| | - Melissa Milanovic
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Faye K Doell
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Sean A Kidd
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Michael J Grossman
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada.
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15
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Jordan G, Mutschler C, Kidd SA, Rowe M, Iyer SN. Making the case for citizenship-oriented mental healthcare for youth in Canada. JPMH 2023. [DOI: 10.1108/jpmh-06-2022-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Purpose
Varying stakeholders have highlighted how recovery-oriented mental health services such as youth mental health services have traditionally focused on supporting individual resources to promote recovery (e.g., agency) to the exclusion of addressing structural issues that influence recovery (e.g. poverty). One response to this criticism has been work helping people with mental health problems recover a sense of citizenship and sense of belonging in their communities. Work on citizenship has yet to influence youth mental healthcare in Canada’s provinces and territories. This paper aims to highlight ways that youth mental healthcare can better help youth recover a sense of citizenship.
Design/methodology/approach
The arguments described in this paper were established through discussion and consensus among authors based on clinical experience in youth mental health and an understanding of Canada’s healthcare policy landscape, including current best practices as well as guidelines for recovery-oriented care by the Mental Health Commission of Canada.
Findings
Here, this study proposes several recommendations that can help young with mental health problems recover their sense of citizenship at the social, systems and service levels. These include addressing the social determinants of health; developing a citizenship-based system of care; addressing identity-related disparities; employing youth community health workers within services; adapting and delivering citizenship-based interventions; and connecting youth in care to civic-oriented organizations.
Originality/value
This paper provides the first discussion of how the concept of citizenship can be applied to youth mental health in Canada in multiple ways. The authors hope that this work provides momentum for adopting policies and practices that can help youth in Canada recover a sense of citizenship following a mental health crisis.
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16
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Lund JI, Toombs E, Mushquash CJ, Pitura V, Toneguzzi K, Bobinski T, Leon S, Vitopoulos N, Frederick T, Kidd SA. Cultural adaptation considerations of a comprehensive housing outreach program for indigenous youth exiting homelessness. Transcult Psychiatry 2022:13634615221135438. [PMID: 36567597 DOI: 10.1177/13634615221135438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Generalist health interventions that aim to reduce chronic health disparities between Indigenous and non-Indigenous populations can be culturally adapted to better meet the needs of Indigenous people in Canada; however, little is known regarding best practices in implementing these adaptations. The present study first provides a review of the research process used to adapt a previous evidence-based housing initiative for Indigenous youth in Northwestern Ontario. Second, it includes an overview of the adaptations that were made and the associated rationale for such adaptations. Third, it examines the experiences of participants and staff involved in the cultural adaptation of the Housing Outreach Program Collaborative (HOP-C), a health intervention re-designed to improve physical and mental health outcomes, wellbeing, and social support for formerly homeless Indigenous youth as they secure housing. Qualitative feedback from interviews with 15 participants and eight program staff, in addition to one focus group with an additional six frontline workers, described perceived outcomes of the program's cultural adaptations. Modifications to the overall program structure, specific roles within the program (including counseling services, peer mentorship, cultural services, and case management), and adaptations to general implementation within the health organization providing the intervention were described by participants and staff as effective and helpful adaptations. The focus of Indigenous values at an organizational level led to consistent adaptations in counseling and case management to best meet the unique needs of the youth involved. Based upon participant interviews, recommendations to future adaptations are provided.
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Affiliation(s)
- Jessie I Lund
- Department of Psychology, 7890Lakehead University, Canada
| | - Elaine Toombs
- Department of Psychology, 7890Lakehead University, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Canada
| | - Christopher J Mushquash
- Department of Psychology, 7890Lakehead University, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Canada
- Northern Ontario School of Medicine (NOSM), 7890Lakehead University, Canada
- Thunder Bay Regional Health Research Institute, Canada
| | | | | | - Tina Bobinski
- Dilico Anishinabek Family Care, Fort William First Nation, Canada
| | | | | | - Tyler Frederick
- Department of Criminology and Justice, 85458Ontario Tech University, Canada
| | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Canada
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17
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Karat BG, Narikuzhy S, Bonato S, Sanches M, Ahmed S, Liang L, Husain MI, Husain MO, Farooq S, Ayub M, Kidd SA, Mckenzie K, Ali F, Naeem F. The Effectiveness of Cognitive Behavioral Therapy Interventions on Depression and Anxiety in the Adult East Asian and Related Diaspora Populations: a Meta-analysis. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Kerman N, Ecker J, Tiderington E, Aykanian A, Stergiopoulos V, Kidd SA. “Systems trauma”: A qualitative study of work-related distress among service providers to people experiencing homelessness in Canada. SSM - Mental Health 2022. [DOI: 10.1016/j.ssmmh.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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19
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Polillo A, Voineskos AN, Foussias G, Kidd SA, Bromley S, Soklaridis S, Wang W, Stergiopoulos V, Kozloff N. Disengagement from early psychosis intervention services: an observational study informed by a survey of patient and family perspectives. Schizophrenia (Heidelb) 2022; 8:94. [PMID: 36369306 PMCID: PMC9651118 DOI: 10.1038/s41537-022-00300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Approximately one-third of patients with early psychosis disengage from services before the end of treatment. We sought to understand patient and family perspectives on early psychosis intervention (EPI) service engagement and use these findings to elucidate factors associated with early disengagement, defined as dropout from EPI in the first 9 months. Patients aged 16-29 referred to a large EPI program between July 2018-February 2020 and their family members were invited to complete a survey exploring facilitators and barriers to service engagement. A prospective chart review was conducted for 225 patients consecutively enrolled in the same EPI program, receiving the NAVIGATE model of coordinated specialty care, between July 2018-May 2019. We conducted a survival analysis, generating Kaplan-Meier curves depicting time to disengagement and Cox proportional hazards models to determine rate of disengagement controlling for demographic, clinical, and program factors. The survey was completed by 167 patients and 79 family members. The top endorsed engagement facilitator was related to the therapeutic relationship in both patients (36.5%) and families (43.0%). The top endorsed barrier to engagement was medication side effects in both patients (28.7%) and families (39.2%). In Cox proportional hazards models, medication nonadherence (HR = 2.37, 95% CI = 1.17-4.80) and use of individual psychotherapy (HR = .460, 95% CI = 0.220-0.962) were associated with early disengagement, but some of the health equity factors expected to affect engagement were not. Findings suggest that delivery of standardized treatment may buffer the effects of health disparities on service disengagement in early psychosis.
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Affiliation(s)
- Alexia Polillo
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sarah Bromley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sophie Soklaridis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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20
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Grossman MJ, Doell FK, Watson-Gaze J, Baer LH, Martins F, Kidd SA. Increasing Access to CBT for Psychosis: Development, Feasibility, and Acceptability of a Specialized Outpatient Service. Community Ment Health J 2022; 58:1448-1456. [PMID: 35301615 DOI: 10.1007/s10597-022-00956-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/01/2022] [Indexed: 01/27/2023]
Abstract
Despite the increasing demand for cognitive behavioural therapy for psychosis (CBTp), the existing literature is lacking in terms of models for sustainable implementation. The aims of this study were to: (a) describe the development of a specialized CBTp Service; (b) report demographic characteristics and referral patterns over 1 year to examine feasibility; and (c) review feedback from participants in group-based CBTp to examine acceptability. Data were analyzed from 126 referrals (M = 35.52, SD = 13.06, 59.5% men) to an outpatient CBTp Service at the Centre for Addiction and Mental Health (Toronto, Ontario) between January 2019 to January 2020. Anonymous feedback was obtained from 54 individuals who completed group-based CBTp. Positive symptoms and distressing emotions were the main reasons for referral. Over half of eligible referrals scheduled an intake assessment and 70% of individuals who completed this assessment attended further treatment. Primary reasons for service refusal were scheduling conflicts and illness-related barriers. The total service wait-time was two months, with the longest delay between dates of referral and initial contact. Satisfaction with the quality of CBTp and its components was rated high among group members. Although variable wait-times and engagement levels were identified across stages of the referral process, the CBTp Service demonstrates preliminary feasibility and acceptability, and provides a model of service delivery to incorporate within future CBTp implementation efforts in Canada.
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Affiliation(s)
- Michael J Grossman
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Faye K Doell
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - James Watson-Gaze
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lawrence H Baer
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Felicia Martins
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean A Kidd
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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21
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Kerman N, Goodwin JM, Tiderington E, Ecker J, Stergiopoulos V, Kidd SA. Towards the Quadruple Aim in permanent supportive housing: A mixed methods study of workplace mental health among service providers. Health Soc Care Community 2022; 30:e6674-e6688. [PMID: 36134703 DOI: 10.1111/hsc.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
The Quadruple Aim is a health policy framework with the objective of concurrently improving population health, enhancing the service experience, reducing costs and improving the work-life of service providers. Permanent supportive housing (PSH) is a best practice approach for stably housing people experiencing homelessness who have diverse support needs. Despite the intervention's strong evidence base, little is known about the work-life of PSH providers. This study explored the mental health and work challenges experienced by PSH providers in Canada. Using an explanatory sequential, equally weighted, mixed methods design, 130 PSH providers were surveyed, followed by semi-structured interviews with 18 providers. Quantitative findings showed that 23.1% of PSH providers had high psychological distress. Participants who were younger, spent all or almost all of their time in direct contact with service users and had less social support from coworkers were significantly more likely to have high psychological distress. Three themes were identified from the qualitative analysis that showed how PSH providers experience psychological distress from work-related challenges: (a) Sisyphean Endeavours: 'You Do What You Can', (b) Occupationally Unsupported: 'Everyone Is Stuck in Their Zone' and (c) Wear and Tear of 'Continuous Exposure to Crisis and Chaos'. The themes interacted with systemic (Sisyphean Endeavours) and organisational issues (Occupationally Unsupported), intensifying the emotional burden of day-to-day work, which involved frequent crises and uncertainty (Wear and Tear of 'Continuous Exposure to Crisis and Chaos'). The findings underscore how these challenges threaten providers' wellness at work and have implications for the care provided to service users. Accordingly, the Quadruple Aim is a potentially useful and applicable framework for measuring the performance of PSH programs, which warrants further consideration in research and policy.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jordan M Goodwin
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Emmy Tiderington
- School of Social Work, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - John Ecker
- Canadian Observatory on Homelessness, York University, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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22
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Goodwin JM, Tiderington E, Kidd SA, Ecker J, Kerman N. Gains and losses within the homeless service, supportive housing, and harm reduction sectors during the COVID-19 pandemic: A qualitative study of what matters to the workforce. Health Soc Care Community 2022; 30:e5765-e5774. [PMID: 36065589 PMCID: PMC9538798 DOI: 10.1111/hsc.14008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/24/2022] [Accepted: 08/21/2022] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has had deleterious effects on individuals experiencing homelessness; yet, less is known about how this global health crisis is impacting service providers that support the homeless population. This qualitative study examined the perceived impacts of the COVID-19 pandemic on the lives and work experiences of service providers in the homeless service, supportive housing, and harm reduction sectors in Canada. Further analyses were conducted to identify the occupational values that were represented in the work-related changes experienced by providers. A stratified purposive sample of 40 participants (30 direct service providers and 10 providers in leadership roles) were drawn from a pan-Canadian study of the mental health of service providers working with individuals experiencing homelessness. Reflexive thematic analysis was used to identify five themes of the work-related changes experienced by service providers during the pandemic: [1] "Everything was changing every day": Work role and responsibility instability; [2] "How on Earth do we do our job?": Challenges to working relationships with service users; [3] "It used to be a social environment": Transitions to impersonal and isolating workspaces; [4] "It all comes down the chute": Lack of organisational support and hierarchical conflict; and [5] "We've been supported as well as we could have": Positive organisational support and communication. The findings underscored how many of the occupational changes during the pandemic did not align with service providers' occupational values for collaboration, control, effective and safe service provision, and the importance of human relationships, among other values. As pre-existing sectoral problems were exacerbated by the pandemic, recovery efforts need to address these long-standing issues in ways that are aligned with service providers' values. Future research is warranted on how organisational approaches can promote supportive workplaces for service providers and improve outcomes for individuals experiencing homelessness.
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Affiliation(s)
- Jordan M. Goodwin
- School of Social Work, RutgersThe State University of New JerseyNew BrunswickNew JerseyUSA
| | - Emmy Tiderington
- School of Social Work, RutgersThe State University of New JerseyNewarkNew JerseyUSA
| | - Sean A. Kidd
- Centre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - John Ecker
- Canadian Observatory on HomelessnessYork UniversityTorontoOntarioCanada
| | - Nick Kerman
- Centre for Addiction and Mental HealthTorontoOntarioCanada
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23
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Kerman N, Wang R, Aubry T, Distasio J, Gaetz S, Hwang SW, Latimer E, O'Grady B, Schwan K, Somers JM, Stergiopoulos V, Kidd SA. Shelter Bans Among People Experiencing Homelessness: an Exploratory Study of Predictors in Two Large Canadian Datasets. J Urban Health 2022; 99:842-854. [PMID: 36070045 PMCID: PMC9561502 DOI: 10.1007/s11524-022-00680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
Emergency shelters are a core component of homeless service systems that address immediate basic needs. Service bans, which refer to temporary or permanent disallowances from a program or organization, are an underresearched phenomenon that can leave people experiencing homelessness without needed supports. This exploratory study examined the factors associated with shelter bans among people experiencing homelessness using secondary data from two Canadian studies: (1) a multisite randomized controlled trial of Housing First (At Home/Chez Soi Demonstration Project) and (2) a cross-sectional survey of youth experiencing homelessness across Canada (2019 Without a Home-National Youth Homelessness Survey). The two datasets were analyzed separately using logistic regression models with similar predictors to maximize the comparability of the results. Participants who experienced homelessness at an earlier age and had recent criminal justice system involvement were more likely to have shelter bans in both datasets. Impaired impulse control, more chronic medical conditions and living in Toronto were associated with increased likelihood of shelter bans in the At Home/Chez Soi dataset, whereas more adverse childhood experiences, physical violence victimization, engagement in survival sex behaviours and longer current episodes of homelessness were significant predictors of bans in the Without A Home dataset. Overall, the findings suggest that victimization and criminalization during homelessness may increase the risk of shelter loss from bans and further exclusion. The observed regional differences also highlight the potential limits of individual-level predictors. Further research is needed on shelter ban outcomes, as well as how capacity limits and organizational policies affect banning decisions.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Tim Aubry
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Jino Distasio
- Department of Geography, University of Winnipeg, Winnipeg, MB, Canada
| | - Stephen Gaetz
- Canadian Observatory on Homelessness and Faculty of Education, York University, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Latimer
- Douglas Research Centre and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Bill O'Grady
- Department of Sociology and Anthropology, University of Guelph, Guelph, ON, Canada
| | - Kaitlin Schwan
- Women's National Housing & Homelessness Network, Toronto, ON, Canada
| | - Julian M Somers
- Centre for Applied Research in Mental Health and Addiction, Vancouver, BC, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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24
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Minian N, Gayapersad A, Saiva A, Dragonetti R, Kidd SA, Strudwick G, Selby P. An e-Mental Health Resource for COVID-19-Associated Stress Reduction: Mixed Methods Study of Reach, Usability, and User Perceptions. JMIR Ment Health 2022; 9:e39885. [PMID: 35960596 PMCID: PMC9422265 DOI: 10.2196/39885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND COVID-19 and its public health response are having a profound effect on people's mental health. To provide support during these times, Canada's largest mental health and addiction teaching hospital (Centre for Addiction and Mental Health [CAMH]) launched the Mental Health and COVID-19 Pandemic website on March 18, 2020. This website was designed to be a nonstigmatizing psychoeducational resource for people experiencing mild to moderate distress due to COVID-19 and the public health response to the pandemic. OBJECTIVE The aim of this study was to examine the reach, usability, and user perceptions of the CAMH Mental Health and COVID-19 Pandemic website. METHODS This study used a mixed methods sequential explanatory design approach, which consisted of the following 2 distinct phases: (1) quantitative data collection and analysis and (2) qualitative semistructured interviews. In phase 1, we analyzed Google Analytics data to understand how many people visited the website and which were the most visited pages. We conducted a survey to identify users' sociodemographic backgrounds, and assess the usability of the website using the System Usability Scale and users' subjective stress levels using the Perceived Stress Scale (PSS-10). For phase 2, we conducted semistructured interviews to explore user experiences; user motivation, engagement, satisfaction, and perception of the stress reduction strategies; reflections of the website's functionality, ease of use, navigation, and design; and recommendations for improvement. RESULTS Google Analytics results showed 146,978 unique users from June 2020 to March 2021. Most users were from Canada (130,066, 88.5%). Between February 20, 2021, and June 4, 2021, 152 users completed the survey. Most users identified as white, female, and having at least a college degree. Based on the PSS-10 scores, most participants were experiencing moderate to high stress when they visited the website. Users rated the usability of the website as acceptable. Ten users completed in-depth interviews between May 2021 and June 2021. Positive feedback related to the content was that the website was a trustworthy source of mental health information with helpful evidence-based stress reduction strategies. Areas for improvement included the text heavy design of the website, wider dissemination/marketing, and greater accessibility of the website to meet the needs of diverse populations. CONCLUSIONS Adding stress reduction resources to a website from a well-respected institution may be a practical method to increase awareness and access to evidence-based stress reduction resources during times of crisis, where there is severe disruption to usual health care contacts. Efforts to ensure that these resources are more widely accessed, especially by diverse populations, are needed.
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Allison Gayapersad
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anika Saiva
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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25
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Mutschler C, Lichtenstein S, Yan S, Blair F, Davidson L, Mihalakakos G, Kidd SA. Personal recovery in the postdischarge period for individuals with schizophrenia spectrum diagnoses: The role of community integration and social support. Psychiatr Rehabil J 2022; 45:176-182. [PMID: 35343739 DOI: 10.1037/prj0000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The experience of personal recovery from mental health has been theorized to occur through several pathways. CHIME is a seminal theoretical framework of personal recovery that is widely endorsed by the existing literature. Few studies have examined the utility of the CHIME framework with those experiencing acute challenges in their engagement in the recovery process. The purpose of the present study was to examine part of the CHIME framework for individuals with schizophrenia spectrum diagnoses in the period immediately following hospitalization. Specifically, the impact of social support and community integration on personal recovery was examined. METHODS The present study involved a secondary analysis of a Phase 2 clinical trial. Assessment measures were administered to participants 1-month (n = 82) and 6-months (n = 72) postdischarge from a psychiatric hospital. Hierarchical regression and mediation analyses were conducted to assess the relationship between social support, community integration, and 1-month and 6-month personal recovery. RESULTS Hierarchical regression analysis indicated that community integration and social support significantly predicted personal recovery. Mediation analyses indicated social support partially accounts for the relationship between community integration and personal recovery at 1- and 6-months postdischarge, providing evidence for social support as a mechanism of personal recovery during this time. CONCLUSION AND IMPLICATIONS FOR PRACTICE This quantitative investigation of CHIME highlights the mechanism of social support for individuals who are experiencing acute challenges in their recovery. These findings point to the need for interventions that enhance community integration and social support postdischarge. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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26
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Kerman N, Ecker J, Gaetz S, Tiderington E, A. Kidd S. Mental Health and Wellness of Service Providers Working with People Experiencing Homelessness in Canada: A National Survey from the Second Wave of the COVID-19 Pandemic. Can J Psychiatry 2022; 67:371-379. [PMID: 34013774 PMCID: PMC9065493 DOI: 10.1177/07067437211018782] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study examined the scope of common mental health problems and perceived impacts of the COVID-19 pandemic among direct service providers working with people experiencing homelessness in Canada. METHOD This cross-sectional study used an online survey that was disseminated to homeless service, supportive housing, and harm reduction organizations and networks. Data were collected on depression, anxiety, stress, post-traumatic stress, compassion satisfaction and fatigue, and substance use problems as well as pandemic-related changes in mental health and wellness. A total of 701 service providers completed the survey and were included in data analysis. Descriptive statistics were used to examine the primary research questions, with hierarchical multiple regression models also being fit to explore mental health and wellness differences by occupational service setting. RESULTS Most direct service providers (79.5%) working with people experiencing homelessness reported a decline in their mental health during the pandemic. There were high rates of common mental health problems within the sample that are largely consistent with those found among health-care workers during the pandemic. Occupational service settings were not associated with the severity of mental health problems, indicating pervasive issues across the workforce, though providers who were younger and spent more time in direct service roles were at greater risk. CONCLUSIONS The common mental health problems and negative impacts of the pandemic among service providers working with people experiencing homelessness highlight a highly vulnerable workforce that could benefit from improved access to supports. Given the similarities between our findings and other studies examining essential workforces, it is recommended that initiatives that provide accessible mental health care to the health-care workforce during the pandemic be expanded to include homeless and social service providers.
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Affiliation(s)
- Nick Kerman
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - John Ecker
- Canadian Observatory on Homelessness, York University, Toronto, Ontario, Canada
| | - Stephen Gaetz
- Faculty of Education, York University, Toronto, Ontario, Canada
| | - Emmy Tiderington
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Ontario, Canada
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27
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Kerman N, Ecker J, Tiderington E, Gaetz S, Kidd SA. Workplace trauma and chronic stressor exposure among direct service providers working with people experiencing homelessness. J Ment Health 2022; 32:424-433. [PMID: 34983295 DOI: 10.1080/09638237.2021.2022629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Service providers working with people experiencing homelessness can be directly and indirectly exposed to trauma and other chronic stressors in their work. The types of individuals that are most at-risk of problematic outcomes from traumatic event exposure are unknown. AIM This study examined exposure to and effects of workplace traumas and stressors among service providers working with people experiencing homelessness in Canada. METHODS A cross-sectional survey was completed by 701 direct service providers working in the homeless service, supportive housing, and harm reduction sectors. Descriptive statistics, hierarchical multiple regression, and double moderation models were used in the analysis. RESULTS Employment in homeless service settings, service provision to single adults, and more time in direct contact with service users were each positively associated with the frequency of exposure to critical events and chronic stressors. Younger age, lived experience of behavioural health problems, more frequent exposure to chronic stressors, and less social support from coworkers were significantly correlated with post-traumatic stress and general psychological distress. Emotional support from supervision moderated the relationship between direct exposure to workplace critical events and post-traumatic stress. CONCLUSIONS More trauma-informed psychosocial supports tailored to the needs of direct service providers working with people experiencing homelessness are needed.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Canada
| | - John Ecker
- Canadian Observatory on Homelessness, York University, Toronto, Canada
| | - Emmy Tiderington
- School of Social Work, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Stephen Gaetz
- Faculty of Education, York University, Toronto, Canada
| | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Kidd SA, Gaetz S, O'Grady B, Schwan K, Zhao H, Lopes K, Wang W. The Second National Canadian Homeless Youth Survey: Mental Health and Addiction Findings: La Deuxième Enquête Nationale Auprès des Jeunes Sans Abri : Résultats en Matière De Santé Mentale et de Toxicomanie. Can J Psychiatry 2021; 66:897-905. [PMID: 33525910 PMCID: PMC8573707 DOI: 10.1177/0706743721990310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Youth experiencing homelessness represent a major social problem in Canada and, as demonstrated in the first national survey of this population conducted in 2015, are experiencing significant mental health challenges. The present study examines the findings of a second national survey completed in 2019. These findings afford the opportunity to examine the reliability of the findings of the first study with another large, representative sample and to attempt to articulate the unique characteristics of youth experiencing the greatest distress among this at-risk population. METHODS This study analyzed the mental-health-related data from the 2019 Without a Home-National Youth Homelessness Survey that was administered through convenience sampling at 98 agencies serving homeless youth in 49 communities across Canada. The survey was cross-sectional and self-administered, assessing a range of demographic information, pre- and post-homelessness variables, and mental health indicators. Multinomial logistic regression and linear regression were implemented to evaluate associations with distress level. RESULTS Survey data were obtained from 1,375 youth accessing Canadian homeless services in 9 provinces. Thirty-five percent reported at least 1 suicide attempt, and 33.1% reported a drug overdose requiring hospitalization. The findings of this survey replicated most of the key findings from the 2015 survey. The current findings emphasized, for this high-risk population, the heightened adversity faced by young women, Lesbian, Gay, Bisexual, Transgender, Queer, Two-Spirit (LGBTQ2S), and Indigenous subpopulations, as well as the centrality of violence exposure in determining risk and distress. Sexual violence, in particular, emerged as a key factor in the identification of youth experiencing the greatest distress with risk buffered by contact with family. CONCLUSIONS These findings can inform prevention and intervention policies and services and reinforce the importance of attending to violence exposure and trauma as central to the mental health trajectories of youth who have experienced homelessness.
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Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Stephen Gaetz
- Faculty of Education, York University, Toronto, Ontario, Canada
| | - Bill O'Grady
- Department of Sociology and Anthropology, University of Guelph, Ontario, Canada
| | - Kaitlin Schwan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Haoyu Zhao
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Katrini Lopes
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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29
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Abramovich A, Pang N, Moss A, Logie CH, Chaiton M, Kidd SA, Hamilton HA. Investigating the impacts of COVID-19 among LGBTQ2S youth experiencing homelessness. PLoS One 2021; 16:e0257693. [PMID: 34547037 PMCID: PMC8454954 DOI: 10.1371/journal.pone.0257693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/07/2021] [Indexed: 01/11/2023] Open
Abstract
Background LGBTQ2S youth are overrepresented among youth experiencing homelessness and experience significantly higher rates of mental health issues compared to heterosexual and cisgender youth. COVID-19 related challenges for LGBTQ2S youth experiencing homelessness remain unknown. To address this gap, this study aimed to understand the impacts of the COVID-19 pandemic on LGBTQ2S youth at risk of, and experiencing, homelessness in the Greater Toronto Area, Ontario, Canada and surrounding areas. Methods Utilizing a mixed-methods convergent parallel design, LGBTQ2S youth experiencing homelessness were recruited to participate in virtual surveys and in-depth one-on-one interviews. Surveys included standardized measures and were administered to measure mental health outcomes and collect information on demographic characteristics, and health service use. Survey data were analyzed with descriptive statistics and statistical tests for difference of proportions. Interviews were analyzed using an iterative thematic content approach. Results Sixty-one youth completed surveys and 20 youth participated in one-on-one interviews. Quantitative and qualitative data showed that youth have been significantly impacted by the COVID-19 pandemic in various ways, including experiencing poor mental health, such as suicidality, depression, anxiety, and increased substance use, and lack of access to health and social support services. Conclusion Our study highlights the need for LGBTQ2S inclusive and affirming health care and support services for precariously housed adolescents to address the pre-existing social and health issues that have been exacerbated by the pandemic.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Amanda Moss
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Hayley A. Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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30
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Cuperfain AB, Hui K, Berkhout SG, Foussias G, Gratzer D, Kidd SA, Kozloff N, Kurdyak P, Linaksita B, Miranda D, Soklaridis S, Voineskos AN, Zaheer J. Patient, family and provider views of measurement-based care in an early-psychosis intervention programme. BJPsych Open 2021. [PMCID: PMC8485347 DOI: 10.1192/bjo.2021.1005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background
Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspectives of providers and patients about MBC. Such perspectives are critical to understand facilitators and barriers to improve the integration of MBC into routine clinical practice.
Aims
This study aimed to uncover the perspectives of various stakeholders towards MBC within a single treatment centre.
Method
Researchers conducted qualitative semi-structured interviews with patients (n = 15), family members (n = 7), case managers (n = 8) and psychiatrists (n = 6) engaged in an early-psychosis intervention programme. Data were analysed using thematic analysis, informed by critical realist theory.
Results
Analysis converged on several themes. These include (a) implicit negative assumptions; (b) relevance and utility to practice; (c) equity versus flexibility; and (d) shared decision-making. Providers assumed patients’ perspectives of MBC were negative. Patients’ perspectives of MBC were actually favourable, particularly if MBC was used as an instrument to engage patients in shared decision-making and communication rather than as a dogmatic and rigid clinical decision tool.
Conclusions
This qualitative study presents the views of various stakeholders towards MBC, providing an in-depth examination of the barriers and facilitators to MBC through qualitative investigation. The findings from this study should be used to address the challenges organisations have experienced in implementing MBC.
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Naeem F, Tuck A, Mutta B, Dhillon P, Thandi G, Kassam A, Farah N, Ashraf A, Husain MI, Husain MO, Vasiliadis HM, Sanches M, Munshi T, Abbott M, Watters N, Kidd SA, Ayub M, McKenzie K. Protocol for a multi-phase, mixed methods study to develop and evaluate culturally adapted CBT to improve community mental health services for Canadians of south Asian origin. Trials 2021; 22:600. [PMID: 34488853 PMCID: PMC8419942 DOI: 10.1186/s13063-021-05547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Canadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”. South Asian Canadians are disproportionately impacted by the social determinants of health, and this can result in high rates of mood and anxiety disorders. These factors can negatively impact mental health and decrease access to care, thereby increasing mental health inequities. Cognitive Behavioural Therapy (CBT) in its current form is not suitable for persons from the non-western cultural backgrounds. Culturally adapted Cognitive Behavioural Therapy (CaCBT) is an evidence-based practice. CaCBT is more effective than standard CBT and can reduce dropouts from therapy compared with standard CBT. Thus, CaCBT can increase access to mental health services and improve outcomes for immigrant, refugee and ethno-cultural and racialized populations. Adapting CBT for growing SA populations in Canada will ensure equitable access to effective and culturally appropriate interventions. Methods The primary aim of the study is to develop and evaluate CaCBT for Canadian South Asian persons with depression and anxiety and to gather data from stakeholders to develop guidelines to culturally adapt CBT. This mixed methods study will use three phases: (1) cultural adaptation of CBT, (2) pilot feasibility of CaCBT and (3) implementation and evaluation of CaCBT. Phase 1 will use purposive sampling to recruit individuals from four different groups: (1) SA patients with depression and anxiety, (b) caregivers and family members of individuals affected by anxiety and depression, (c) mental health professionals and (d) SA community opinion leaders. Semi-structured interviews will be conducted virtually and analysis of interviews will be informed by an ethnographic approach. Phase 2 will pilot test the newly developed CaCBT for feasibility, acceptability and effectiveness via quantitative methodology and a randomized controlled trial, including an economic analysis. Phase 3 will recruit therapists to train and evaluate them in the new CaCBT. Discussion The outcome of this trial will benefit health services in Canada, in terms of helping to reduce the burden of depression and anxiety and provide better care for South Asians. We expect the results to help guide the development of better services and tailor existing services to the needs of other vulnerable groups. Trial registration ClinicalTrials.gov NCT04010890. Registered on July 8, 2019
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.
| | - Andrew Tuck
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Baldev Mutta
- Punjabi Community Health Services, Toronto, Canada
| | | | - Gary Thandi
- Moving Forward Family Services, Vancouver, Canada
| | | | - Nimo Farah
- Somerset West Community Health Centre, Ottawa, Canada
| | - Aamna Ashraf
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Science, Université de Sherbrooke, Research Center Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Montreal, Canada
| | - Marcos Sanches
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Tariq Munshi
- Department of Psychiatry, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | | | | | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | | | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.,Wellesley Institute, Toronto, Canada
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Polillo A, Voineskos AN, Foussias G, Kidd SA, Sav A, Hawley S, Soklaridis S, Stergiopoulos V, Kozloff N. Using Digital Tools to Engage Patients With Psychosis and Their Families in Research: Survey Recruitment and Completion in an Early Psychosis Intervention Program. JMIR Ment Health 2021; 8:e24567. [PMID: 34057421 PMCID: PMC8204241 DOI: 10.2196/24567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/10/2021] [Accepted: 04/04/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Barriers to recruiting and retaining people with psychosis and their families in research are well-established, potentially biasing clinical research samples. Digital research tools, such as online platforms, mobile apps, and text messaging, have the potential to address barriers to research by facilitating remote participation. However, there has been limited research on leveraging these technologies to engage people with psychosis and their families in research. OBJECTIVE The objective of this study was to assess the uptake of digital tools to engage patients with provisional psychosis and their families in research and their preferences for different research administration methods. METHODS This study used Research Electronic Data Capture (REDCap)-a secure web-based platform with built-in tools for data collection and storage-to send web-based consent forms and surveys on service engagement via text message or email to patients and families referred to early psychosis intervention services; potential participants were also approached or reminded about the study in person. We calculated completion rates and timing using remote and in-person methods and compensation preferences. RESULTS A total of 447 patients with provisional psychosis and 187 of their family members agreed to receive the web-based consent form, and approximately half of the patients (216/447, 48.3%) and family members (109/187, 58.3%) consented to participate in the survey. Most patients (182/229, 79.5%) and family members (75/116, 64.7%) who completed the consent form did so remotely, with more family members (41/116, 35.3%) than patients (47/229, 20.5%) completing it in person. Of those who consented, 77.3% (167/216) of patients and 72.5% (79/109) of family members completed the survey, and most did the survey remotely. Almost all patients (418/462, 90.5%) and family members (174/190, 91.6%) requested to receive the consent form and survey by email, and only 4.1% (19/462) and 3.2% (6/190), respectively, preferred text message. Just over half of the patients (91/167, 54.5%) and family members (42/79, 53.2%) preferred to receive electronic gift cards from a coffee shop as study compensation. Most surveys were completed on weekdays between 12 PM and 6 PM. CONCLUSIONS When offered the choice, most participants with psychosis and their families chose remote administration methods, suggesting that digital tools may enhance research recruitment and participation in this population, particularly in the context of the COVID-19 global pandemic.
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Affiliation(s)
- Alexia Polillo
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andreea Sav
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Steve Hawley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sophie Soklaridis
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abstract
Recovery is the guiding vision of mental health systems and policy. However, skepticism has emerged about whether the paradigm can achieve its sought goals. We argue that embedding recovery within a quality improvement framework, such as the Triple Aim, would increase leverage for systems change and advance recovery practice. The Triple Aim's goals of improving healthcare outcomes, quality, and costs are pertinent to mental health systems, although action is also needed to address the social determinants of health. Accordingly, we propose the recovery-oriented Triple Aim, which could be used to guide policy development and evaluation of mental health services.
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Affiliation(s)
- Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health Crisis and Critical Care, Toronto, ON M6J 1H4, Canada.
| | - Shakoor Hajat
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Kwame McKenzie
- Wellesley Institute, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Kidd SA, Mutschler C, Lichtenstein S, Yan S, Virdee G, Blair F, Mihalakakos G, McKinney C, Collins A, Guimond T, George TP, Davidson L, Velligan D, Voineskos A. Randomized trial of a brief peer support intervention for individuals with schizophrenia transitioning from hospital to community. Schizophr Res 2021; 231:214-220. [PMID: 33895598 DOI: 10.1016/j.schres.2021.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
This phase 2 randomized trial examined the outcomes of a brief, transitional, peer support intervention designed to address the poor outcomes that are common for individuals with schizophrenia spectrum illnesses in the period immediately following hospitalization. In the context of treatment-as-usual, participants were provided with a peer support intervention, 'the Welcome Basket,' in which participants received 1-2 sessions of peer support in the two weeks before discharge and met weekly for a month post-discharge. The study also piloted a brief version of this intervention with only one community session post-discharge with the same pre-discharge process. It was hypothesized that the full intervention would improve community transition outcomes, with community functioning (Multnomah Community Ability Scale) being the primary measure and secondary measures including symptomatology, community integration, personal recovery, quality of life, and social support. The examination of the brief intervention was exploratory. Measures were completed at baseline, 1-month post-discharge, and follow-up at 6 months. A total of 110 participants were randomized to one of three interventions, with outcome data obtained from 82 and follow-up from 74. While feasible, we did not find that the Welcome Basket intervention was superior to treatment as usual for any of our primary or secondary outcome measures. Future work is needed to determine whether a more extended intervention is required and whether specific subgroups of patients may benefit (e.g. those without access to immediate psychiatric care or those better able to engage with a peer).
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Affiliation(s)
- Sean A Kidd
- University of Toronto Department of Psychiatry, Canada.
| | | | | | - Sandra Yan
- Centre for Addiction and Mental Health, Canada.
| | | | | | | | | | | | | | | | | | - Dawn Velligan
- University of Texas at San Antonio, Department of Psychiatry, United States.
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Kidd SA, Greco S, McKenzie K. Correction to: Global Climate Implications for Homelessness: A Scoping Review. J Urban Health 2021; 98:158. [PMID: 33340062 PMCID: PMC7873158 DOI: 10.1007/s11524-020-00505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A Correction to this paper has been published: 10.1007/s11524-020-00505-y
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Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Division Chief - Psychology, Centre for Addiction and Mental Health, 1001 Queen St. W., Unit 2-1, #161, Toronto, Ontario, M6J 1H4, Canada.
| | - Susan Greco
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Hawke LD, Darnay K, Brown M, Iyer S, Ben-David S, Khaleghi-Moghaddam M, Relihan J, Barbic S, Lachance L, Mathias S, Halsall T, Kidd SA, Soklaridis S, Henderson J. INNOVATE Research: Impact of a workshop to develop researcher capacity to engage youth in research. Health Expect 2020; 23:1441-1449. [PMID: 32902068 PMCID: PMC7752193 DOI: 10.1111/hex.13123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 12/03/2022] Open
Abstract
Background Engaging youth in research provides substantial benefits to research about youth‐related needs, concerns and interventions. However, researchers require training and capacity development to work in this manner. Methods A capacity‐building intervention, INNOVATE Research, was co‐designed with youth and adult researchers and delivered to researchers in three major academic research institutions across Canada. Fifty‐seven attendees participated in this research project evaluating youth engagement practices, attitudes, perceived barriers, and perceived capacity development needs before attending the intervention and six months later. Results The intervention attracted researchers across various career levels, roles and disciplines. Participants were highly satisfied with the workshop activities. Follow‐up assessments revealed significant increases in self‐efficacy six months after the workshop (P = .035). Among possible barriers to youth engagement, four barriers significantly declined at follow‐up. The barriers that decreased were largely related to practical knowledge about how to engage youth in research. Significantly more participants had integrated youth engagement into their teaching activities six months after the workshop compared to those who were doing so before the workshop (P = .007). A large proportion (71.9%) of participants expressed the need for a strengthened network of youth‐engaged researchers; other future capacity‐building approaches were also endorsed. Conclusions The INNOVATE Research project provided improvements in youth engagement attitudes and practices among researchers, while lifting barriers. Future capacity‐building work should continue to enhance the capacity of researchers to engage youth in research. Researchers notably pointed to the need to establish a network of youth‐engaged researchers to provide ongoing, sustainable gains in youth engagement.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Karleigh Darnay
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marion Brown
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Srividya Iyer
- McGill University, Montreal, Quebec, Canada.,ACCESS Open Minds, Canada.,Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | - Shelly Ben-David
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Skye Barbic
- University of British Columbia, Vancouver, British Columbia, Canada.,Foundry, British Columbia, Canada
| | - Lisa Lachance
- Dalhousie University, Halifax, Nova Scotia, Canada.,Wisdom2Action, Halifax, Nova Scotia, Canada
| | - Steve Mathias
- University of British Columbia, Vancouver, British Columbia, Canada.,Foundry, British Columbia, Canada
| | | | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Kidd SA, Vitopoulos N, Frederick T, Leon S, Wang W, Mushquash C, McKenzie K. Trialing the feasibility of a critical time intervention for youth transitioning out of homelessness. Am J Orthopsychiatry 2020; 90:535-545. [PMID: 32309974 DOI: 10.1037/ort0000454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known regarding the specific types of service models and collaborations that are necessary to support diverse populations of youth in transition out of homelessness. Transitional supports addressing the complex needs of this population are needed to stabilize the array of housing arrangements that youth access. This study was a pilot randomized controlled trial of one such critical time intervention, called the Housing Outreach Program-Collaboration (HOP-C). HOP-C is a multicomponent, multidisciplinary intervention that provides 6 months of mental health and peer support, along with transitional case management to youth who have transitioned into some form of stable housing out of homelessness. In this trial, 65 youth were randomized to receive HOP-C plus treatment as usual or transitional case management plus treatment as usual. Outcome assessments were completed by 30 treatment and 28 control participants. The findings suggest that this intervention is feasible with mental health, employment or education, and housing metrics favoring HOP-C with odds ratios ranging from 2.28 to 3.18 and better subjective housing stability. Other indicators showed less change. HOP-C appears feasible and should be tested in a fully powered trial, providing the intervention for a duration longer than 6 months. Overall, these data suggest the potential benefit in fostering city-level, multidisciplinary teams sourced from several organizations to support youth transitioning out of homelessness. Pragmatic trial method considerations for this population are also addressed as are the ethical considerations pertinent to engaging highly marginalized youth in clinical trials. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Wei Wang
- Centre for Addiction and Mental Health
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D'Arcey J, Collaton J, Kozloff N, Voineskos AN, Kidd SA, Foussias G. The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review. JMIR Ment Health 2020; 7:e16993. [PMID: 32238334 PMCID: PMC7163420 DOI: 10.2196/16993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Individuals experiencing psychosis are at a disproportionate risk for premature disengagement from clinical treatment. Barriers to clinical engagement typically result from funding constraints causing limited access to and flexibility in services. Digital strategies, such as SMS text messaging, offer a low-cost alternative to potentially improve engagement. However, little is known about the efficacy of SMS text messaging in psychosis. OBJECTIVE This review aimed to address this gap, providing insights into the relationship between SMS text messaging and clinical engagement in the treatment of psychosis. METHODS Studies examining SMS text messaging as an engagement strategy in the treatment of psychosis were reviewed. Included studies were published from the year 2000 onward in the English language, with no methodological restrictions, and were identified using 3 core databases and gray literature sources. RESULTS Of the 233 studies extracted, 15 were eligible for inclusion. Most studies demonstrated the positive effects of SMS text messaging on dimensions of engagement such as medication adherence, clinic attendance, and therapeutic alliance. Studies examining the feasibility of SMS text messaging interventions found that they are safe, easy to use, and positively received. CONCLUSIONS Overall, SMS text messaging is a low-cost, practical method of improving engagement in the treatment of psychosis, although efficacy may vary by symptomology and personal characteristics. Cost-effectiveness and safety considerations were not adequately examined in the studies included. Future studies should consider personalizing SMS text messaging interventions and include cost and safety analyses to appraise readiness for implementation.
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Affiliation(s)
- Jessica D'Arcey
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - Joanna Collaton
- Department of Clinical Psychology, University of Guelph, Guelph, ON, Canada
| | - Nicole Kozloff
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean A Kidd
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
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40
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Hawke LD, Darnay K, Relihan J, Khaleghi-Moghaddam M, Barbic S, Lachance L, Ben-David S, Brown M, Iyer S, Chaim G, Soklaridis S, Kidd SA, Halsall T, Mathias S, Henderson J. Enhancing researcher capacity to engage youth in research: Researchers' engagement experiences, barriers and capacity development priorities. Health Expect 2020; 23:584-592. [PMID: 32170902 PMCID: PMC7321719 DOI: 10.1111/hex.13032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/03/2020] [Accepted: 01/21/2020] [Indexed: 11/28/2022] Open
Abstract
Background There is increasing emphasis on engaging youth in research about youth, their needs, experiences and preferences, notably in health services research. By engaging youth as full partners, research becomes more feasible and relevant, and the validity and richness of findings are enhanced. Consequently, researchers need guidance in engaging youth effectively. This study examines the experiences, needs and knowledge gaps of researchers. Methods Eighty‐four researchers interested in youth engagement training were recruited via snowball sampling. They completed a survey regarding their youth engagement experiences, attitudes, perceived barriers and capacity development needs. Data were analysed descriptively, and comparisons were made based on current engagement experience. Results Participants across career stages and disciplines expressed an interest in increased capacity development for youth engagement. They had positive attitudes about the importance and value of youth engagement, but found it to be complex. Participants reported requiring practical guidance to develop their youth engagement practices and interest in a network of youth‐engaged researchers and on‐going training. Those currently engaging youth were more likely to report the need for greater appreciation of youth engagement by funders and institutions. Conclusions Engaging youth in research has substantial benefits. However, skills in collaborating with youth to design, conduct and implement research have to be learned. Researchers need concrete training and networking opportunities to develop and maximize these skills. They also need mechanisms that formally acknowledge the value of engagement. Researchers and those promoting youth engagement in research are encouraged to consider these findings in their promotion and training endeavours.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health.,University of Toronto
| | | | | | | | - Skye Barbic
- Foundry.,University of British Columbia.,Centre for Health Evaluation Outcome Sciences
| | | | | | | | - Srividya Iyer
- Department of psychiatry, McGill University.,ACCESS Open Minds.,Douglas Hospital Research Centre
| | - Gloria Chaim
- Centre for Addiction and Mental Health.,University of Toronto
| | | | - Sean A Kidd
- Centre for Addiction and Mental Health.,University of Toronto
| | - Tanya Halsall
- University of Ottawa.,The Royal's Institute of Mental Health Research, affiliated with the University of Ottawa
| | - Steve Mathias
- Foundry.,University of British Columbia.,Centre for Health Evaluation Outcome Sciences
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Mutschler C, Lichtenstein S, Kidd SA, Davidson L. Transition Experiences Following Psychiatric Hospitalization: A systematic Review of the Literature. Community Ment Health J 2019; 55:1255-1274. [PMID: 31104176 DOI: 10.1007/s10597-019-00413-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
The period immediately following discharge after inpatient stay for mental illness has been found to be the time of greatest risk for adverse outcomes (e.g., rehospitalization, relapse, suicide). However, the experiences of patients as they transition from the hospital to the community are not well understood. The purpose of the present review was to systematically search and synthesize the literature examining the transition experiences of individuals following inpatient psychiatric stay. A systematic search was conducted for studies examining the experiences of patients as they transition back into their communities, using qualitative or quantitative methods. Qualitative articles were analyzed using thematic content analysis. Quantitative articles were extracted and summarized. The search identified 1614 abstracts, of which 27 (18 qualitative; 9 quantitative) were included in the review. The results of the analysis identified themes necessary for transition including safety, supported autonomy, and the opportunity to engage in a number of reintegration activities. A number of barriers were found that prevent integration, such as poverty, interpersonal difficulties, and stigma. The results highlight the disconnect that occurs for patients as they transition from hospital, pointing to the need for effective transitional interventions that target these challenges.
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Affiliation(s)
- Christina Mutschler
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | | | - Sean A Kidd
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Larry Davidson
- Program for Recovery and Community Health, Yale University, 319 Peck Street, New Haven, CT, 06513, USA
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Kidd SA, Herman Y, Virdee G, Bowie CR, Velligan D, Plagiannakos C, Voineskos A. A comparison of compensatory and restorative cognitive interventions in early psychosis. Schizophr Res Cogn 2019; 19:100157. [PMID: 31832341 PMCID: PMC6889589 DOI: 10.1016/j.scog.2019.100157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 11/02/2022]
Abstract
This randomized trial examined the relative effectiveness of primarily compensatory and primarily restorative cognitive interventions in an early psychosis population. A total of 56 patients were randomized to one of two treatments which were applied for four months with a five month follow up assessment. Comparisons were between (1) Cognitive Adaptation Training (CAT) - a treatment that uses environmental supports and weekly home visits to compensate for cognitive challenges and improve community functioning and (2) Action Based Cognitive Remediation (ABCR) - a treatment involving computerized cognitive drill and practice exercises, simulations, goal setting, and behavioral activation. Linear mixed effects models demonstrated significant effects on community functioning for both CAT and ABCR without a difference between conditions (n = 39), with an indication of greater gains at follow up in the ABCR group (n = 31). Improvements in symptomatology were less robust with mixed findings across neurocognition metrics. This study concluded that both CAT and ABCR hold promise as interventions for early intervention psychosis populations but more work is needed to identify illness severity, subtype and contextual considerations that might indicate an emphasis on more compensatory versus more restorative cognitive interventions.
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Affiliation(s)
- Sean A Kidd
- University of Toronto Department of Psychiatry, Canada
| | - Yarissa Herman
- Toronto Centre for Addiction and Mental Health, CAMH, 1001 Queen St. W., Toronto, Ontario M6J1H1, Canada
| | - Gursharan Virdee
- Toronto Centre for Addiction and Mental Health, CAMH, 1001 Queen St. W., Toronto, Ontario M6J1H1, Canada
| | - Christopher R Bowie
- Queens University, Department of Psychology, 219 Craine Hall, Kingston K7L 3N6, Ontario, Canada
| | - Dawn Velligan
- University of Texas at San Antonio, Department of Psychiatry, 7526 Louis Pasteur Dr, San Antonio, TX 78229, USA
| | | | - Aristotle Voineskos
- University of Toronto Department of Psychiatry, CAMH, 250 College St., Toronto M5T1R8, Ontario, Canada
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Kidd SA, Feldcamp L, Adler A, Kaleis L, Wang W, Vichnevetski K, McKenzie K, Voineskos A. Feasibility and outcomes of a multi-function mobile health approach for the schizophrenia spectrum: App4Independence (A4i). PLoS One 2019; 14:e0219491. [PMID: 31306439 PMCID: PMC6629069 DOI: 10.1371/journal.pone.0219491] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 06/15/2019] [Indexed: 12/19/2022] Open
Abstract
Relative to the large investments in mobile health (mHealth) strategies for mental illnesses such as anxiety and depression, the development of technology to facilitate illness self-management for people with schizophrenia spectrum illnesses is limited. This situation falls out of step with the opportunity mHealth represents for providing inexpensive and accessible self-care resources and the routine use of mobile technologies by people with schizophrenia. Accordingly, the focus of this study was upon the feasibility of a schizophrenia-focused mobile application: App4Independence (A4i). A4i is a multi-feature app that uses feed, scheduling, and text-based functions co-designed with service users to enhance illness self-management. This study was completed in a large urban Canadian centre and employed pre-post assessments over a 1-month period that examined medication adherence, personal recovery, and psychiatric symptomatology. App use metrics were assessed as was qualitative feedback through semi-structured interview. Findings are reported in line with the World Health Organization mHealth Evidence and Assessment (mERA) checklist. Among the 38 individuals with a primary psychosis who participated, there was no research attrition and classic retention on the app was 52.5%. Significant improvement was observed in some psychiatric symptom domains with small-medium effects. Significant change in recovery engagement and medication adherence were not observed after controlling for multiple comparisons. Those who interacted with the app more frequently were more depressed and had higher hostility and interpersonal sensitivity at baseline. Satisfaction with the app was high and qualitative feedback provided insights regarding feature enhancements. This research suggested that A4i is feasible in terms of outcome and process indicators and is a technology that is ready to move on to clinical trial and validation testing. This study contributes to the small but emergent body of work investigating digital health approaches in severe mental illness populations.
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Affiliation(s)
- Sean A. Kidd
- University of Toronto, Department of Psychiatry, Toronto, Canada
- * E-mail:
| | | | | | | | - Wei Wang
- University of Toronto, Department of Psychiatry, Toronto, Canada
| | | | - Kwame McKenzie
- University of Toronto, Department of Psychiatry, Toronto, Canada
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Abstract
Hospitals, with their unique practice constraints and opportunities, are one of the most important arenas wherein the field of clinical psychology has developed throughout its history. However, there have been few efforts to comprehensively examine the literature on this topic. This is a literature worth examining, not only out of historical interest but also in the effort to provide direction for the field. Accordingly, systematic, scoping review methods were used to address the question: What does the psychology literature tell us about the nature and evolution of psychology practice in hospitals? The review identified 115 papers on this topic dating from 1916-2017, primarily in the form of practice commentaries and case studies. Analysis of the papers revealed 2 broad themes. One involved the nature of hospital practice, which concentrated on the major domains of assessment, psychotherapy and research activities along with issues related to training. The second involved structural and policy-related considerations such as cost-effectiveness and reimbursement models, leadership, the structure of practice, relationship to physicians, and hospital privileges. Implications of the review include the need for better data on the hospital practices of psychologists and continued work on role definition and the unique value of psychology. Other implications include direction for training models, practice models such as stepped care and a compromise between program and department-based management, privileges, and mental health reform. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, Centre for Addiction and Mental Health
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Kidd SA, Vitopoulos N, Frederick T, Leon S, Karabanow J, McKenzie K. More than four walls and a roof needed: A complex tertiary prevention approach for recently homeless youth. Am J Orthopsychiatry 2018; 89:248-257. [PMID: 30382726 DOI: 10.1037/ort0000335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article examines the feasibility of a complex intervention designed to facilitate the transition of youth out of homelessness. It is intended to contribute to efforts to build out the youth homelessness intervention literature, which is underdeveloped relative to descriptive characterizations of risk. The 6-month intervention examined here, referred to as the Housing Outreach Program-Collaboration (HOP-C), is comprised of transitional outreach-based case management, individual and group mental health supports, and peer support. The intervention was delivered through a multiagency, interdisciplinary collaboration. Feasibility was assessed using a mixed methods design that included prepost intervention metrics and the study site was a large Canadian urban center. A total of 31 youth participated in the study with 28 completing the intervention. Overall, implementation and youth engagement was successful though patterns and intensity of engagement were quite variable. While prepost, self-report metrics improved modestly, substantial gains were observed in employment, education, and mental health service connectedness. Qualitative themes focused on the benefits of a flexible, multicomponent approach, close attention to seamless delivery and common factors, and supporting youth in the balance of isolation versus independence. These findings suggested that this tertiary prevention approach is feasible and warrants further investigation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, University of Toronto
| | - Nina Vitopoulos
- Department of Psychology, Centre for Addiction and Mental Health
| | - Tyler Frederick
- Faculty of Social Sciences and Humanities, University of Ontario Institute of Technology
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Kidd SA, Frederick T, Tarasoff LA, Virdee G, Lurie S, Davidson L, Morris D, McKenzie K. A qualitative description of community service, business, and organization perspectives on mental illness and inclusion. American Journal of Psychiatric Rehabilitation 2018. [DOI: 10.1080/15487768.2017.1374219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sean A. Kidd
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Tyler Frederick
- Faculty of Social Science and Humanities, University of Ontario Institute of Technology, Oshawa, Canada
| | - Lesley A. Tarasoff
- Schizophrenia Division, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gursharan Virdee
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Steve Lurie
- Canadian Mental Health Association – Toronto Branch, Lawrence Square Shopping Centre, Toronto, Canada
| | - Larry Davidson
- Department of Psychiatry, Yale Program for Recovery and Community Health, Yale University, New Haven, Connecticut, USA
| | - David Morris
- School of Social Work, University of Central Lancashire, Preston, Lancashire, England
| | - Kwame McKenzie
- Schizophrenia Division, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Haarmans M, McKenzie K, Kidd SA, Bentall RP. Gender role strain, core schemas, and psychotic experiences in ethnically diverse women: A role for sex‐ and gender‐based analysis in psychosis research? Clin Psychol Psychother 2018; 25:774-784. [DOI: 10.1002/cpp.2307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Maria Haarmans
- Synergi Collaborative Centre, Cathie Marsh Institute for Social ResearchUniversity of Manchester Manchester UK
| | - Kwame McKenzie
- Centre for Addiction and Mental Health Toronto ON Canada
- Wellesley Institute Toronto ON Canada
| | - Sean A. Kidd
- Centre for Addiction and Mental Health Toronto ON Canada
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Chen S, Collins A, Kidd SA. Thirty-Day and 5-Year Readmissions following First Psychiatric Hospitalization: A System-Level Study of Ontario's Psychiatric Care. Can J Psychiatry 2018; 63:410-415. [PMID: 29592532 PMCID: PMC5971409 DOI: 10.1177/0706743717751667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Analyses of representative, system-level data to examine trends in short- and longer-term readmission rates for psychiatric illnesses are largely absent. The objective of this article is to examine key trends and variables with implications for inpatient care as indicated by 30-day readmission and outpatient care as reflected by readmission within 5 years. METHODS Using OMHRS data from 2005 to 2015, patients who had their first inpatient admission were followed for 5 years to examine their subsequent 30-day and overall admission rates stratified by discharge time and diagnosis. RESULTS The study cohort consisted of 42,280 patients. The 30-day and 5-year readmission rates for the entire cohort were 7.2% and 35.1%, respectively. Using a time course analysis of readmission for discharges in different years, both 30-day readmission and 5-year readmission rates decreased in a linear manner from 2005 to 2010, primarily because of readmission patterns for patients diagnosed with mood disorders and schizophrenia/other psychotic disorders. It was also evident that both demographic considerations such as age and gender and variables reflective of social determinants such as education level and employment were predictive of rehospitalization risk. CONCLUSIONS The trends of decreasing readmission rates may be reflective of improvements in the quality of hospital and community-based outpatient care. Such system-level indicators warrant tracking and may inform more effective tertiary prevention.
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Affiliation(s)
- Sheng Chen
- 1 Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - April Collins
- 1 Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean A Kidd
- 2 University of Toronto Department of Psychiatry, Toronto, Ontario, Canada
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Kidd SA, Kerman N, Ernest D, Maples N, Arthur C, de Souza S, Kath J, Herman Y, Virdee G, Collins A, Velligan D. A pilot study of a family cognitive adaptation training guide for individuals with schizophrenia. Psychiatr Rehabil J 2018; 41:109-117. [PMID: 27547853 DOI: 10.1037/prj0000204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There is a paucity of accessible, evidence-based tools for caregivers of individuals with schizophrenia. This study examines changes in the self-assessed and caregiver-assessed outcomes of people with schizophrenia after exposure to a cognitive adaptation training (CAT) guide that addressed pragmatic, in-home approaches to offset the cognitive impacts of the illness. METHOD This study examined the 4-month, pre-post outcomes of a CAT guide, as compared with a popular, general manual, for families of individuals with schizophrenia. A total of 17 caregiver-supported individual dyads completed all measures, having been randomized to either a CAT-guide group or a support-manual group. Measures included medication adherence, adaptive functioning, quality of life, and caregiver burden. Semistructured interviews assessed use and utility questions. RESULTS Caregiver-assessed improvements in community functioning with medium-high effect sizes were observed in both study conditions. Self-report ratings by supported individuals did not change from baseline to 4 months and no change was observed in medication adherence or quality of life for either condition. Caregiver-burden ratings significantly declined with a large effect size, again with no difference as a function of manual type. CONCLUSION AND IMPLICATIONS FOR PRACTICE These findings suggest that there is some promise in providing families with evidence-based information in manual form. Further research informed by this study's findings should include assessments of whether and how environmental cognitive supports can be of specific benefit to families affected by schizophrenia. (PsycINFO Database Record
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Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, University of Toronto
| | - Nick Kerman
- Department of Psychology, University of Ottawa
| | | | - Natalie Maples
- Department of Psychiatry, University of Texas at San Antonio
| | | | | | | | | | | | | | - Dawn Velligan
- Department of Psychiatry, University of Texas at San Antonio
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Barbic SP, Kidd SA, Durisko ZT, Yachouh R, Rathitharan G, McKenzie K. What Are the Personal Recovery Needs of Community-Dwelling Individuals with Mental Illness? Preliminary Findings from the Canadian Personal Recovery Outcome Measurement (C-PROM) Study. ACTA ACUST UNITED AC 2018. [DOI: 10.7870/cjcmh-2018-005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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