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1.
Can J Psychiatry ; : 706743720902616, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31994918

RESUMO

OBJECTIVES: Exposure to adverse childhood experiences (ACEs) is associated with increased risk of criminal justice involvement and repeated victimization among homeless individuals. This study aimed to (1) examine whether the relationship between cumulative ACE score and odds of experiencing criminal justice involvement and victimization remains significant over time after receiving the Housing First (HF) intervention and (2) investigate the moderating effect of cumulative ACE score on the effectiveness of the HF intervention on the likelihood of experiencing these outcomes among homeless individuals with mental illnesses. METHODS: We used longitudinal data over the 2-year follow-up period from the At Home/Chez Soi demonstration project that provided HF versus treatment as usual (TAU) to homeless adults with mental illness in five Canadian cities (N = 1,888). RESULTS: In all 4 follow-up time points, the relationship between cumulative ACE score and both outcomes remained significant, regardless of study arm (HF vs. TAU) and other confounding factors. However, cumulative ACE score did not moderate intervention effects on odds of experiencing either outcome, suggesting that the effectiveness of HF versus TAU, with regard to the odds of being victimized or criminal justice involvement, did not differ by cumulative ACE scores over the course of study. CONCLUSIONS: Findings suggest that providing services for homeless individuals with mental illness should be trauma informed and include specialized treatment strategies targeting the experience of ACEs and trauma to improve their treatment outcomes. An intensive approach is required to directly address the problem of criminal justice involvement and victimization in these individuals.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31925600

RESUMO

Frequent emergency department (ED) users experiencing homelessness are associated with high costs for healthcare systems yet interventions for this group have been minimally investigated. This study used 24-month data from a multisite randomized controlled trial of Housing First (HF) to examine how effective the intervention is in helping frequent ED users with a mental illness to achieve housing stability, improve behavioural health and functioning, and reduce their ED use. Findings showed that HF is effective in stably housing frequent ED users despite their complex health needs. Reductions in ED use and substance use problems, and improvements in mental health symptoms and community functioning were found for frequent ED users in both the HF and treatment as usual conditions.

3.
BMC Psychol ; 7(1): 57, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455404

RESUMO

BACKGROUND: Indigenous people are over represented among homeless populations worldwide and the prevalence of Indigenous homelessness appears to be increasing in Canadian cities. Violence against Indigenous women in Canada has been widely publicized but has not informed the planning of housing interventions. Despite historical policies leading to disenfranchisement of Indigenous rights in gender-specific ways, little is known about contemporary differences in need between homeless Indigenous men and women. This study investigated mental health, substance use and service use among Indigenous people who met criteria for homelessness and mental illness, and hypothesized that, compared to men, women would have significantly higher rates of trauma, suicidality, substance dependence, and experiences of violence. METHODS: This study was conducted using baseline (pre-randomization) data from a multi-site trial. Inclusion in the current analyses was restricted to participants who self-reported Indigenous ethnicity, and combined eligible participants from Vancouver, BC and Winnipeg, MB. Logistic regression analyses were used to model the independent associations between gender and outcome variables. RESULTS: In multivariable regression models among Indigenous participants (n = 439), female gender was predictive of meeting criteria for PTSD, multiple mental disorders, current high suicidality and current substance dependence. Female gender was also significantly associated with reported physical (AOR: 1.52, 95% CI = 1.10-2.23) and sexual (AOR: 6.31, 95% CI = 2.78-14.31) violence. CONCLUSIONS: Our analyses of Indigenous men and women who are homeless illustrate the distinct legacy of colonization on the experiences of Indigenous women. Our findings are consistent with the widely documented violence against Indigenous women in Canada. Housing policies and services are urgently needed that take Indigenous historical contexts, trauma and gender into account. TRIAL REGISTRATION: This trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374 ; ISRCTN57595077 ; ISRCTN66721740 .


Assuntos
Identidade de Gênero , Pessoas em Situação de Rua/psicologia , Índios Norte-Americanos , Transtornos Mentais/psicologia , Adulto , Canadá , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Relacionados ao Uso de Substâncias
4.
Qual Health Res ; : 1049732319862532, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31342845

RESUMO

Discourse in popular media, public policy, and academic literature contends that people who are homeless frequently make inappropriate use of hospital emergency department (ED) services. Although researchers have investigated the ED experiences of people who are homeless, no previous studies have examined how this population understands the role of the ED in their health care and in their day-to-day lives. In the present study, 16 individuals participated in semistructured interviews regarding their ED experiences, and narrative analysis was applied to their responses. Within the context of narratives of disempowerment and discrimination, participants viewed the ED in differing ways, but they generally interpreted it as a public, accessible space where they could exert agency. ED narratives were also paradoxical, depicting it as a fixed place for transient care, or a place where they were isolated yet felt a sense of belonging. Implications for policy and practice are discussed.

5.
J Community Psychol ; 47(6): 1548-1562, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212376

RESUMO

AIMS: Using an entrepreneurship lens, this study examined the narratives of urban adults experiencing homelessness and living with mental illness, to explore strategies used for day-to-day survival. METHODS: Semi-structured qualitative interviews were conducted with 14 females, 30 males, and one individual identifying as "other," living in a mid-sized Canadian city. The average age was 39 years. Data were transcribed verbatim and analyzed using thematic analysis informed by grounded theory. FINDINGS: Participants described creative and intentional strategies for managing life on the street without permanent shelter, including recognition of opportunities, mobilization of their own or acquired resources, and use of social connections and communication skills, and strategies that demonstrated entrepreneurial processes. CONCLUSIONS: Findings suggest that participants used survival entrepreneurship strategies and processes to navigate daily life while experiencing homelessness. Recognition and validation of the propensity for enterprise and self-sufficiency are central for both individual recovery and ending homelessness within similar populations.

6.
Eval Program Plann ; 75: 1-9, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30978474

RESUMO

We examined communities' expressed needs for capacity building in the implementation of Housing First (HF) for persons experiencing homelessness. The findings are based on thematic analyses of qualitative data obtained from participants (n = 77) in 11 focus groups conducted in seven Canadian cities. We identified capacity building needs in the areas of training (e.g., HF principles, clinical services, landlord engagement) and technical assistance (e.g., intake coordination, client prioritization, fidelity assessment). These findings were used to tailor training and technical assessment (TTA) to the stages of HF implementation in these cities. Limitations and implications for future theory, research, and practice are discussed.

7.
BMJ Open ; 9(4): e024748, 2019 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-30962229

RESUMO

OBJECTIVES: Indigenous people in Canada are not only over-represented among the homeless population but their pathways to homelessness may differ from those of non-Indigenous people. This study investigated the history and current status of Indigenous and non-Indigenous people experiencing homelessness and mental illness. We hypothesised that compared with non-Indigenous people, those who are Indigenous would demonstrate histories of displacement earlier in life, higher rates of trauma and self-medication with alcohol and other substances. DESIGN AND SETTING: Retrospective data were collected from a sample recruited through referral from diverse social and health agencies in Winnipeg and Vancouver. PARTICIPANTS: Eligibility included being 19 years or older, current mental disorder and homelessness. MEASURES: Data were collected via interviews, using questionnaires, on sociodemographics (eg, age, ethnicity, education), mental illness, substance use, physical health, service use and quality of life. Univariate and multivariable models were used to model the association between Indigenous ethnicity and dependent variables. RESULTS: A total of 1010 people met the inclusion criteria, of whom 439 self-identified as Indigenous. In adjusted models, Indigenous ethnicity was independently associated with being homeless at a younger age, having a lifetime duration of homelessness longer than 3 years, post-traumatic stress disorder, less severe mental disorder, alcohol dependence, more severe substance use in the past month and infectious disease. Indigenous participants were also nearly twice as likely as others (47% vs 25%) to have children younger than 18 years. CONCLUSIONS: Among Canadians who are homeless and mentally ill, those who are Indigenous have distinct histories and current needs that are consistent with the legacy of colonisation. Responses to Indigenous homelessness must be developed within the context of reconciliation between Indigenous and non-Indigenous Canadians, addressing trauma, substance use and family separations. TRIAL REGISTRATION NUMBER: ISRCTN42520374, ISRCTN57595077, ISRCTN66721740.

8.
J Community Psychol ; 47(1): 7-20, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30506925

RESUMO

In this study, we examine changes in the homeless-serving system in the context of a training and technical assistance initiative to scale up Housing First (HF) in 6 Canadian communities. Based on qualitative data from focus groups and individual interviews with key stakeholders (k = 7, n = 35) and field notes gathered over a 3-year period (n = 146), we found 2 main system changes: (a) changes in the capacity of the service delivery system at multiple levels of analysis (from individual to policy) to implement HF, and (b) changes in the coordination of parts of the service delivery system and collaboration among local stakeholders to enhance HF implementation. These changes were facilitated or constrained by the larger context of evidence, climate, policy, and funding. The findings were discussed in terms of systems change theory and implications for transformative systems change in the mental health and homelessness sectors.

9.
Can J Public Health ; 110(2): 127-138, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30547290

RESUMO

OBJECTIVE: This study investigated whether a move to public housing affects people's use of healthcare services. METHOD: Using administrative data from Manitoba, the number of hospitalizations, general practitioner (GP), specialist and emergency department (ED) visits, and prescription drugs dispensed in the years before and after the housing move-in date (2012/2013) were measured for a public housing and matched cohort. Generalized linear models with generalized estimating equations tested for differences between the cohorts in utilization trends. The data were modeled using Poisson (rate ratio, RR), negative binomial (incident rate ratio, IRR), and binomial (odds ratio, OR) distributions. RESULTS: GP visits (IRR = 1.04, 95% CI 1.01-1.06) and prescriptions (IRR = 1.04, 95% CI 1.02-1.05) increased, while ED visits (RR = 0.90, 95% CI 0.82-1.00) and hospitalizations (OR = 0.95, 95% CI 0.93-0.96) decreased over time. The public housing cohort had a significantly higher rate of GP visits (IRR = 1.08, 95% CI 1.04-1.13), ED visits (RR = 1.18, 95% CI 1.01-1.37), and prescriptions (IRR = 1.09, 95% CI 1.05-1.13), and was more likely to be hospitalized (OR = 1.39, 95% CI 1.21-1.61) compared to the matched cohort. The rate of inpatient days significantly decreased for the public housing cohort, but did not change for the matched cohort. CONCLUSION: Healthcare use changed similarly over time (except inpatient days) for the two cohorts. Public housing provides a basic need to a population who has a high burden of disease and who may not be able to obtain and maintain housing in the private market.

10.
Community Ment Health J ; 55(4): 631-640, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30519803

RESUMO

For people with mental illness, experiences of homelessness can complicate mental health recovery processes. This study used longitudinal data from a randomized controlled trial of housing first (HF) to examine predictors of recovery among homeless people with mental illness. Findings showed that health and community predictors were most strongly associated with mental health recovery. Receipt of HF did not have any effect on changes in recovery scores at follow-up. Overall, the findings suggest that interventions aimed at preventing chronic homelessness, strengthening social networks and community involvement, and providing case management services will facilitate mental health recovery.

11.
Am J Community Psychol ; 62(1-2): 135-149, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30106486

RESUMO

The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi-component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team-based practice, and facilitating case-based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system-practitioners, teams, and communities-while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Habitação/organização & administração , Transtornos Mentais/reabilitação , Canadá , Administração de Caso , Serviços Comunitários de Saúde Mental/organização & administração , Pessoas em Situação de Rua , Humanos , Modelos Organizacionais , Desenvolvimento de Programas/métodos
12.
BMC Health Serv Res ; 18(1): 411, 2018 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-29871635

RESUMO

BACKGROUND: Residence in public housing, a subsidized and managed government program, may affect health and healthcare utilization. We compared healthcare use in the year before individuals moved into public housing with usage during their first year of tenancy. We also described trends in use. METHODS: We used linked population-based administrative data housed in the Population Research Data Repository at the Manitoba Centre for Health Policy. The cohort consisted of individuals who moved into public housing in 2009 and 2010. We counted the number of hospitalizations, general practitioner (GP) visits, specialist visits, emergency department visits, and prescriptions drugs dispensed in the twelve 30-day intervals (i.e., months) immediately preceding and following the public housing move-in date. Generalized linear models with generalized estimating equations tested for a period (pre/post-move-in) by month interaction. Odds ratios (ORs), incident rate ratios (IRRs), and means are reported along with 95% confidence intervals (95% CIs). RESULTS: The cohort included 1942 individuals; the majority were female (73.4%) who lived in low income areas and received government assistance (68.1%). On average, the cohort had more than four health conditions. Over the 24 30-day intervals, the percentage of the cohort that visited a GP, specialist, and an emergency department ranged between 37.0% and 43.0%, 10.0% and 14.0%, and 6.0% and 10.0%, respectively, while the percentage of the cohort hospitalized ranged from 1.0% to 5.0%. Generally, these percentages were highest in the few months before the move-in date and lowest in the few months after the move-in date. The period by month interaction was statistically significant for hospitalizations, GP visits, and prescription drug use. The average change in the odds, rate, or mean was smaller in the post-move-in period than in the pre-move-in period. CONCLUSIONS: Use of some healthcare services declined after people moved into public housing; however, the decrease was only observed in the first few months and utilization rebounded. Knowledge of healthcare trends before individuals move in are informative for ensuring the appropriate supports are available to new public housing residents. Further study is needed to determine if decreased healthcare utilization following a move is attributable to decreased access.


Assuntos
Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Áreas de Pobreza , Estudos Retrospectivos , Adulto Jovem
13.
BMC Health Serv Res ; 18(1): 190, 2018 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-29558927

RESUMO

BACKGROUND: Housing First is an effective intervention to stably house and alter service use patterns in a large proportion of homeless people with mental illness. However, it is unknown whether there are differences in the patterns of service use over time among those who do or do not become stably housed and what effect, if any, Housing First has on these differing service use patterns. This study explored changes in the service use of people with mental illness who received Housing First compared to standard care, and how patterns of use differed among people who did and did not become stably housed. METHODS: The study design was a multi-site randomized controlled trial of Housing First, a supported housing intervention. 2039 participants (Housing First: n = 1131; standard care: n = 908) were included in this study. Outcome variables include nine types of self-reported service use over 24 months. Linear mixed models examined what effects the intervention and housing stability had on service use. RESULTS: Participants who achieved housing stability, across the two groups, had decreased use of inpatient psychiatric hospitals and increased use of food banks. Within the Housing First group, unstably housed participants spent more time in prison over the study period. The Housing First and standard care groups both had decreased use of emergency departments and homeless shelters. CONCLUSIONS: The temporal service use changes that occurred as homeless people with mental illness became stably housed are similar for those receiving Housing First or standard care, with the exception of time in prison. Service use patterns, particularly with regard to psychiatric hospitalizations and time in prison, may signify persons who are at-risk of recurrent homelessness. Housing support teams should be alert to the impacts of stay-based services, such as hospitalizations and incarcerations, on housing stability and offer an increased level of support to tenants during critical periods, such as discharges. TRIAL REGISTRATION: ISRCTN. ISRCTN42520374 . Registered 18 August 2009.


Assuntos
Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prisões/estatística & dados numéricos
14.
Am J Community Psychol ; 61(1-2): 118-130, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29251344

RESUMO

We present interim findings of a cross-site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence-based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early implementation were conducted in six Canadian communities receiving HF TTA. The primary data are field notes gathered over 1.5 years and evaluations from site-specific training events (k = 5, n = 302) and regional network training events (k = 4, n = 276). We report findings related to: (a) the facilitators of and barriers to early implementation, (b) the influence of TTA on early implementation, and (c) the "levers" used to facilitate broader systems change. Systems change theory enabled us to understand how various "levers" created opportunities for change within the communities, including establishing system boundaries, understanding how systems components can function as causes of or solutions to a problem, and assessing and changing systems interactions. We conclude by arguing that systems theory adds value to existing implementation science frameworks and can be helpful in future research on the implementation of evidence-based practices such as HF which is a complex community intervention. Implications for community psychology are discussed.


Assuntos
Pessoas em Situação de Rua , Habitação , Serviços de Saúde Mental , Canadá , Prática Clínica Baseada em Evidências , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
15.
CMAJ Open ; 5(3): E576-E585, 2017 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-28724726

RESUMO

BACKGROUND: Limited evidence on the costs of homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that homeless people with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs. METHODS: As part of the At Home/Chez Soi trial of Housing First for homeless people with mental illness, 990 participants were assigned to the usual-treatment (control) group in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montréal and Moncton) between October 2009 and June 2011. They were followed for up to 2 years. Questionnaires ascertained service use and income, and city-specific unit costs were estimated. We adjusted costs for site differences in sample characteristics. We used generalized linear models to identify individual-level characteristics associated with higher costs. RESULTS: Usable data were available for 937 participants (94.6%). Average annual costs (excluding medications) per person in Vancouver, Winnipeg, Toronto, Montréal and Moncton were $53 144 (95% confidence interval [CI] $46 297-$60 095), $45 565 (95% CI $41 039-$50 412), $58 972 (95% CI $52 237-$66 085), $56 406 (95% CI $50 654-$62 456) and $29 610 (95% CI $24 995-$34 480), respectively. Net costs ranged from $15 530 to $341 535. Distributions of costs across categories varied significantly across cities. Lower functioning and a history of psychiatric hospital stays were the most important predictors of higher costs. INTERPRETATION: Homeless people with mental illness generate very high costs for society. Programs are needed to reorient this spending toward more effectively preventing homelessness and toward meeting the health, housing and social service needs of homeless people.

16.
Can J Psychiatry ; 62(7): 473-481, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28683228

RESUMO

OBJECTIVE: This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour. METHOD: The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF ( n = 1265) and TAU ( n = 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up. RESULTS: Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate = -.57, SE = .05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate = -.04, SE = .06, P = 0.51). Furthermore, there was no effect of treatment status (estimate = -.10, SE = .16, P = 0.52) on prevalence of suicide attempts (HF = 11.9%, TAU = 10.5%) during the 2-year follow-up period. CONCLUSION: This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention.


Assuntos
Administração de Caso , Pessoas em Situação de Rua , Transtornos Mentais/reabilitação , Habitação Popular , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Adulto , Canadá , Administração de Caso/estatística & dados numéricos , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Habitação Popular/estatística & dados numéricos
17.
Public Health Nutr ; 20(11): 2023-2033, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28560947

RESUMO

OBJECTIVE: Individuals experiencing homelessness are particularly vulnerable to food insecurity. The At Home/Chez Soi study provides a unique opportunity to first examine baseline levels of food security among homeless individuals with mental illness and second to evaluate the effect of a Housing First (HF) intervention on food security in this population. DESIGN: At Home/Chez Soi was a 2-year randomized controlled trial comparing the effectiveness of HF compared with usual care among homeless adults with mental illness, stratified by level of need for mental health services (high or moderate). Logistic regressions tested baseline associations between food security (US Food Security Survey Module), study site, sociodemographic variables, duration of homelessness, alcohol/substance use, physical health and service utilization. Negative binomial regression determined the impact of the HF intervention on achieving levels of high or marginal food security over an 18-month follow-up period (6 to 24 months). SETTING: Community settings at five Canadian sites (Moncton, Montreal, Toronto, Winnipeg and Vancouver). SUBJECTS: Homeless adults with mental illness (n 2148). RESULTS: Approximately 41 % of our sample reported high or marginal food security at baseline, but this figure varied with gender, age, mental health issues and substance use problems. High need participants who received HF were more likely to achieve marginal or high food security than those receiving usual care, but only at the Toronto and Moncton sites. CONCLUSIONS: Our large multi-site study demonstrated low levels of food security among homeless experiencing mental illness. HF showed promise for improving food security among participants with high levels of need for mental health services, with notable site differences.


Assuntos
Abastecimento de Alimentos , Pessoas em Situação de Rua , Transtornos Mentais , Adolescente , Adulto , Canadá/epidemiologia , Feminino , Seguimentos , Habitação , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
18.
J Urban Health ; 93(4): 682-97, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27402549

RESUMO

Housing quality (HQ) is associated with mental health, and may mediate outcomes in housing interventions. However, studies of housing interventions rarely report HQ. The purpose of this study was to describe HQ in a multi-site randomized controlled trial of Housing First (HF) in five Canadian cities and to examine possible differences by treatment group (HF recipients and treatment-as-usual (TAU) participants who were able to find housing through other programs or on their own). We also examined the association between HQ and the primary trial outcome: housing stability. The performance of a new multi-dimensional standardized observer-rated housing quality scale (the OHQS) in a relatively large cross-site sample was also of interest. HQ was rated by trained research assistants for 204 HF participants and 228 TAU participants using the OHQS. General linear regression models were used to examine unit/building quality scores by group and site adjusting for other group differences, and as a predictor of housing stability outcomes after 24 months of follow-up. The OHQS was found to have good reliability and validity, but because most of the neighborhood subscale items were negatively correlated with the overall scale, only unit and building items were included in the total HQ score (possible scores ranging from 13.5 to 135). Unit/building HQ was significantly better for the HF group overall (91.2 (95 % CI = 89.6-92.9) vs. 88.3 (95 % CI = 86.1-90.5); p = .036), and in one site. HQ in the TAU group was much more variable than the HF group overall (W (mean) = 24.7; p < .001) and in four of five sites. Unit/building HQ scores were positively associated with housing stability: (73.4 (95 % CI 68.3-78.5) for those housed none of the time; 91.1 (95 % CI 89.2-93.0) for those housed some of the time; and 93.1 (95 % CI 91.4-94.9)) for those housed all of the time (F = 43.9 p < .001). This association held after adjusting for site, housing characteristics, participant ethnocultural status, community functioning, and social support. This study demonstrates that HQ can be as good or better, and less variable, in HF programs in Canada that systematically and predominantly source housing stock from the private sector compared to housing procured outside of an HF program. HQ is also an important predictor of housing stability outcomes.


Assuntos
Pessoas em Situação de Rua/psicologia , Habitação/normas , Transtornos Mentais/psicologia , Adulto , Canadá , Feminino , Humanos , Modelos Lineares , Masculino , Psicometria
19.
J Epidemiol Community Health ; 70(12): 1229-1235, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27225679

RESUMO

BACKGROUND: Residents of public housing are often in poor health. However, it is unclear whether poor health precedes residency in public housing. We compared the health of people who applied to public housing to people who did not apply and had similar socioeconomic characteristics. METHODS: Population-based administrative databases from Manitoba, Canada, containing health, housing and income assistance information were used to identify a cohort of individuals who applied to public housing and a matched cohort from the general population. Conditional logistic regression was used to test the association between a public housing application and health status and health service use, after controlling for income. RESULTS: There were 10 324 individuals in each of the public housing applicant and matched cohorts; the majority were women, young, urban residents, and received income assistance. A higher per cent of the public housing cohort had physician-diagnosed physical and mental health conditions compared to the matched cohort. Physical health, mental health and health service use were significantly associated with applying to public housing, after controlling for individual and area-level income. CONCLUSIONS: Applicants to public housing were in poorer health compared to people of the same income level who did not apply to public housing. These health issues may affect the long-term stability of their tenancy if appropriate services and supports are not provided. Additionally, preventing ill health, better management of mental health and additional supports may reduce the need for public housing, which, in turn, would alleviate the pressure on governments to provide this form of housing.

20.
Psychiatr Serv ; 67(6): 603-9, 2016 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-26876657

RESUMO

OBJECTIVE: Housing First is emerging as an evidence-based practice for housing and supporting people who are homeless and have a mental illness. The objective of this study was to determine whether Housing First increases the odds of obtaining competitive employment in this population and affects income, including income from informal and illegal sources. METHODS: A total of 2,148 people with a mental illness were recruited from five Canadian cities while they were homeless, classified as having moderate or high needs, and randomly assigned to Housing First or usual care. Housing First participants with high needs received assertive community treatment (ACT), and those with moderate needs received intensive case management (ICM). Every three months, participants were interviewed about employment and earnings in the previous months (median follow-up=745 days). Regression models were estimated via generalized estimating equations. RESULTS: ICM recipients had lower odds of obtaining employment compared with the control group with moderate needs. The odds of obtaining employment among ICM recipients increased but their employment rate never exceeded that of the control group. For ACT recipients, the odds of obtaining employment were not significantly different from those of the control group. Among Housing First participants, persons employed at baseline, men, and younger participants had greater odds of employment compared with control participants. Housing First did not appear to significantly increase income. CONCLUSIONS: This was the first large-scale randomized controlled study of Housing First's effects on employment. Further research is needed to determine how Housing First may be enhanced to increase odds of obtaining employment.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Emprego , Pessoas em Situação de Rua/psicologia , Habitação , Renda , Transtornos Mentais/reabilitação , Adulto , Canadá/epidemiologia , Administração de Caso , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Qualidade de Vida , Análise de Regressão
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