Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data.

Background: Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth's impacts on SMI care outcomes is mixed, necessitating further investigation. Objective: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI. Methods: We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt). Results: Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=-4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=-4.49; P<.001; z=-3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=-3.74; P<.001), and continuity of care after a high-risk event (z=-2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=-4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized. Conclusions: Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation-selected through a health equity lens-may improve quality of care among patients with SMI.

The Importance of Social Support in Recovery Populations: Toward a Multilevel Understanding.

Although social support is commonly investigated in the context of substance recovery, researchers have widely neglected its multilevel nature, thus limiting what we know about its measurement across levels of observation. The current study used multilevel confirmatory factor analyses (MCFA) on 229 individuals living in 42 recovery homes to investigate the structure of single factor of social support at the individual and house-levels. Multilevel structural equation model (MSEM) was then conducted to examine whether the social support factor was associated with stress at the individual and house-levels. MCFA results showed that within individuals, all social support measures were significant and positive while at the house-level, there were a few discrepancies (e.g., IP was negative). Stress was significantly negatively related to the social support factor at the individual-level, but this association was positive at the house-level. These findings suggest that on an individual-level, a person's perception and source of social support is particularly important -even if the source of support comes from someone who is not abstinent. On a house-level, social support is more sensitive to outside influences than within individuals. Implications for future research and substance use interventions targeting social support are discussed.

Women's Friendships: A Basis for Individual-Level Resources and Their Connection to Power and Optimism.

The study examined how friendships among women in recovery from substance use disorders are related to individual resources (e.g., social support, self-esteem, and hope) and empowerment (e.g., power and optimism). Findings from a path analysis of 244 women in recovery revealed that friendships among women were positively related to individual resources; that is, the stronger the relationships with other women, the higher women perceived their resources to be. Further, individual-level resources mediated the relations between friendships and empowerment, with higher levels of individual resources related to higher levels of empowerment constructs of power and optimism. Results point to the importance of developing and sustaining empowering relationships for women in recovery. Findings have implications for gender-specific treatment practices and recommendations impacting substance use recovery outcomes.

Social support and networks among people experiencing chronic homelessness: A systematic review.

The objectives of this systematic review were to synthesize available information on social support and social networks among individuals experiencing chronic homelessness, examine the measurement of social support, the impact of social support on outcomes, and the impact of interventions on social support. The authors searched Academic Search Complete, PsycArticles, Pubmed, PsycINFO, ScienceDirect, Cinahl, and ProQuest for English-language empirical articles published between 1998 and 2019. Studies were included if they sampled single and unaccompanied adults experiencing chronic homelessness and examined the impact of social support and/or social networks. The search yielded 29 studies. Results were synthesized according to research questions and patterns of findings that emerged from included studies. Wide variability in the measurement of social support was found across studies. Nearly all studies found changes in social support associated with housing interventions. A substantial evidence base indicated intervention effects on social support are largely positive. Review findings suggest individuals with substance use disorders may require additional social functioning support once housed. Indigenous people may require tailored interventions to center their cultural values and facilitate existing community strengths. Overall, the results from this review suggest social support plays a key role in the housing experiences and outcomes of individuals experiencing chronic homelessness. Future studies should include qualitative and mixed methods work as these methods revealed important insights about social support. More evidence is needed to inform the development of specific interventions targeting social support to facilitate community integration of formerly homeless individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Attempting Randomized Housing First Research in a Community Context: Reflections on Failure.

The Housing First (HF) model of permanent supportive housing for individuals experiencing chronic homelessness has a strong evidence base that has largely been driven by researchers in the field of community psychology in partnership with community-based organizations. However, important gaps in the HF literature remain. Implementing rigorous research designs to further the evidence for HF requires immense resources to fund both the housing intervention and the research activities. In the absence of such resources, university-community partnerships may be established to integrate research within business-as-usual services and utilize existing housing units. This first person account presents a "post-mortem" exploration of an attempt to conduct a randomized trial of scattered-site and single-site approaches to HF within a community context from the perspectives of multiple stakeholders involved in the endeavor. Despite strengths of the research collaborative, the project did not come to completion due to a series of both insurmountable and avoidable barriers. Yet, the experience illuminated several potential challenges researchers and housing providers conducting work in this area may encounter, such as ever-changing homeless service system policies that may impact research and organizational procedures. Lessons learned and recommendations for preventing or overcoming systems-level barriers and potential challenges within the university-community partnership are described.

Psychometric properties of the self-sufficiency matrix among homeless and vulnerably housed individuals and families.

Homeless service systems have been implementing assessment tools to inform service provision for individuals and families. Although a variety of assessments are available, their psychometric evidence base is limited. The self-sufficiency matrix (SSM) is one assessment that demonstrates promising reliability and validity. However, the SSM's factor structure has been inconsistent across studies. This study explored the factor structure of the SSM, using exploratory factor analysis and confirmatory factor analysis in a sample of individuals (N = 427) and families ( N = 428) at risk of or experiencing homelessness. Data were derived from a midwestern city's Homeless Management Information System and included all participants from the Homelessness Prevention and Rapid Re-Housing Program. Results suggest the SSM is multidimensional and the factor structure differs across individuals and families. Additionally, the SSM demonstrates measurement invariance across racial and gender groups. Further development and testing of the SSM is necessary to better serve individuals experiencing homelessness.

Housing status among single adults following Homelessness Prevention and Rapid Re-housing Program participation in Indianapolis.

The Homelessness Prevention and Rapid Re-housing Program (HPRP) was a federally-funded program in the United States that provided short-term financial and support services to individuals and families who were at-risk or currently experiencing homelessness. There is limited research on factors that predict placement in permanent housing following prevention and rapid rehousing interventions, particularly for single adult populations. The present study examined demographic and program-related predictors of permanent housing upon program exit among two groups of adults enrolled in HPRP in Indianapolis, IN: Homelessness Prevention (HP) recipients (n = 219) and Rapid Re-housing (RRH) recipients (n = 296). Results revealed that 76.3% of HP and 68.8% of RRH recipients were living in permanent housing when they exited HPRP. For HP recipients, completion of HPRP and outreach and engagement services were significant predictors of remaining in permanent housing. For RRH recipients, individuals who were African American, did not have a disabling condition, completed HPRP, received a greater amount of financial assistance, and received case management services had significantly greater odds of permanent housing. Findings have implications for informing short-term housing support programs for precariously housed or homeless single adults and highlight the need for future research on prevention and rehousing interventions.