Addressing human trafficking as a public health issue.

Human trafficking is increasingly recognized as a significant global public health issue. Human trafficking (HT) exists in all nations, including Canada, and is estimated to impact 25 million people globally. HT is a crime that is not always visible. It is associated with a myriad of deleterious health outcomes arising from adverse living and working conditions, and the physical, sexual, and/or psychological violence often accompanying it. Human trafficking also disproportionately affects people living under vulnerable circumstances, particularly those with intersecting vulnerabilities. Public health can advance health equity for trafficked persons and add value to existing anti-trafficking (AT) efforts. Among its many contributions, public health can bring its expertise in health promotion and surveillance. While efforts to incorporate a public health perspective are already underway in at least the United States and the United Kingdom, the nexus of public health and AT is still nascent and requires further development. A public health approach to trafficking focused on intervening on the upstream drivers of well-being can add value to the extant counter-trafficking paradigm. This commentary is intended to catalyze discussion in Canada and elsewhere as to what public health can contribute to this emergent field.

RéSUMé: Le trafic d'êtres humains (TEH) est de plus en plus reconnu comme un grave problème de santé publique dans le monde. Il est présent dans tous les pays, y compris au Canada, et toucherait 25 millions de personnes selon les estimations. Le TEH est un crime qui n'est pas toujours visible. Il est associé à d'innombrables résultats cliniques délétères découlant de mauvaises conditions de vie et de travail et de la violence physique, sexuelle et/ou psychologique qui l'accompagne souvent. Le trafic d'êtres humains touche aussi démesurément les personnes en situation de vulnérabilité, surtout celles ayant des vulnérabilités croisées. La santé publique peut favoriser l'équité en santé chez les victimes et ajouter de la valeur aux efforts existants de lutte contre ce fléau. Elle peut, entre autres, contribuer son savoir-faire en promotion et en surveillance de la santé. Une démarche d'intégration d'une perspective de santé publique est déjà entamée, du moins aux États-Unis et au Royaume-Uni, mais la jonction entre la santé publique et la lutte contre la traite est encore naissante et doit être développée. Une démarche de santé publique à l'égard du trafic d'êtres humains qui intervienne sur les facteurs favorisant le bien-être en amont pourrait ajouter de la valeur au paradigme existant de la lutte contre la traite. Notre commentaire se veut un moyen de susciter un débat au Canada et ailleurs dans le monde sur ce que la santé publique peut apporter à ce domaine en émergence.

Preventing homelessness after discharge from psychiatric wards: perspectives of consumers and staff.

After spending time in the hospital, psychiatric clients are often discharged to homeless shelters or the streets, which can place a burden on health care systems. This study examined the effects of an intervention in which psychiatric clients from acute (n = 219) and tertiary (n = 32) sites were provided with predischarge assistance in securing housing. A program evaluation design was used to examine the effectiveness of the intervention. Qualitative data were available through interviews, focus groups, and monthly meetings. The results highlight several benefits of the intervention and show that homelessness can be reduced by connecting housing support, income support, and psychiatric care.

Integrating the transitional relationship model into clinical practice.

BACKGROUND: The challenge of facilitating knowledge translation in clinical practice includes enabling practitioners and agencies to implement a common set of best practices, such as the Transitional Relationship Model (TRM). In 1992, a participatory action project implemented the TRM on a long-term psychiatric hospital ward in Ontario, Canada. All participants were successfully "bridged" to the community. Despite positive outcomes associated with the TRM, implementation of any best practice is difficult because it involves changing processes. OBJECTIVE: It was hypothesized that using multiple implementation strategies developed by wards that had already implemented the model would result in improved TRM implementation. METHOD: This study compared three groups of hospital wards; Group A wards had already adopted the TRM, Group B wards implemented the TRM in Year 1, and Group C wards implemented the TRM in Year 2. An iterative process was used in which strategies suggested by the A wards were used to enhance implementation on the B and C wards, respectively. These included enhancing staff participation, creating/maintaining supportive ward milieus, meeting specific educational needs, and supporting managers throughout the implementation process. The degree of actual implementation on each ward served as the primary outcome measure. RESULTS: Group C implemented the TRM model significantly quicker than the other groups. Sustainability in the initial A wards required the implementation of additional strategies used by the later wards.

Gaining ground, losing ground: the paradoxes of rural homelessness.

The study examined rural housing and homelessness issues and looked at similarities and differences between rural and urban areas. It involved a secondary analysis of focus group data collected in a 2001-06 Community University Research Alliance study of mental health and housing. The findings highlight concerns regarding the lack of services, which can precipitate a move from a rural to an urban community. Inadequate transportation services often posed a challenge to rural residents attempting to access services. Many participants preferred rural living but felt they had to choose between residing where they wanted to and having access to essential services. In some cases entire families were uprooted in pursuit of services. Once in an urban environment, rural participants had ongoing difficulty obtaining employment, housing, and services, which in turn led to disappointment in their new environment. The primary reason given for entering the shelter system was lack of alternatives and supports. Increased services need to be allocated to rural communities so that a health promotion and illness-prevention model of care can replace the current emphasis on crisis management.

Exploring differences between community-based women and men with a history of mental illness.

Relatively little is understood concerning the role of gender in persons with a history of mental illness residing in the community. This paper aims to explore gender's effect using data from the Community Research University Alliance project entitled, Mental Health and Housing. The primary five-year longitudinal study examined housing situations for psychiatric consumer/survivors in a mid-size, central Canadian region in an effort to improve the number and quality of appropriate housing situations. Data from 887 subjects in the original research underwent secondary analysis with particular relevance to differences between gender and indicators of health status including psychiatric history, levels of functioning, personal strengths and resources, and illness severity. Results of the secondary analysis found male and female differences that corroborated previous research. More women are housed than men, more women with mental illness were coupled than men, men have fewer social supports, and men have more substance abuse issues than women. These findings suggest health services within the community must consider these sex differences if they wish to properly assist Canadian individuals diagnosed with mental illnesses.

The Transitional Discharge Model: comparing implementation in Canada and Scotland.

Effective discharge planning is needed to facilitate clients' transition from psychiatric hospital wards to community care. Previous studies have shown that client outcomes can be improved by using a Transitional Discharge Model (TDM) that includes peer support and an extension of inpatient-practitioner relationships that are introduced prior to discharge. However, countries vary in many ways that may affect implementation of the model. This article describes some of the similarities and differences related to introducing transitional discharge in two countries: Canada and Scotland. It is important to elucidate facilitators and challenges in implementing the TDM to identify and disseminate strategies to aid implementation. Implications for future implementation of the model are also discussed.

Transitional discharge based on therapeutic relationships: state of the art.

The Transitional Discharge Model (TDM) has been used to facilitate effective discharge from psychiatric hospital to community. A summary of the research to date on TDM is given. The model is based on the provision of therapeutic relationships to provide a safety net throughout the discharge and community reintegration processes. These relationships include both staff and peer involvement; hospital inpatient staff continue to remain involved with the client until a therapeutic relationship is established with a community care provider, and peer support is offered from a former consumer of mental health services who is currently living in the community. Studies found that the TDM facilitates increased discharge rates, lower readmission rates, and cost savings--making it a collaborative, cost-effective method of providing quality patient care and positive health care outcomes. The TDM Plan of Research is presented and reflects the collaboration between stakeholders and the integration of consumer advocacy, clinical practice, education, policy, and research in various countries.

Integrating an evidenced-based research intervention in the discharge of mental health clients.

The purpose of this Canadian qualitative study was to explore the experiences of clinical staff who implemented a research intervention: the Transitional Discharge Model (TDM). The TDM provided mental health clients who were hospitalized with peer support and an inpatient staff member to bridge the therapeutic transitioning from hospital staff to the community care provider. Staff from three tertiary care mental health facilities in Canada identified their learning needs in regard to providing the intervention. An educational program was developed and delivered to the clinical staff to support and facilitate the implementation of the new TDM. The extent of the utilization of knowledge and implementation of the TDM varied across the three tertiary care mental health facilities. Focus groups (N=49) with clinical staff were conducted to explore various factors related to the training process as well as the challenges and benefits of implementing the TDM. Data were analyzed using Leininger's Phases of Ethnonursing Qualitative Data Analysis [Leininger, M. (2002). The theory of culture care and the ethnonursing research method. In M. Leininger & M. McFarland (eds.), Transcultural nursing: Concepts, theories, research, and practice (3rd ed.). New York: McGraw-Hill]. Findings revealed that clinical staff experienced challenges in roles and responsibilities, relationships with others, values and beliefs of clients, staff and community, resources, and the processes of care. From the findings, strategies were identified to support the integration of knowledge about the TDM into practice and to increase clinical staff's skills in implementing research interventions. These included support from others, as well as support of practice, policy, and education.