Suchergebnisse

Homelessness & Health in Canada explores, for the first time, the social, structural, and environmental factors that shape the health of homeless persons in Canada. Covering a wide range of topics from youth homelessness to end-of-life care, the authors strive to outline policy and practice recommendations to respond to the ongoing public health crisis. This book is divided into three distinct but complimentary sections. In the first section, contributors explore how homelessness affects the health of particular homeless populations, focusing on the experiences of hom.

As urban populations grow, new health problems evolve in tandem with longstanding issues. And as a welter of social, environmental, and access factors further complicate the picture, workable solutions require increasingly sophisticated understanding and innovative methods - generally beyond the scope of one professional field. Converging Disciplines introduces the concept of transdisciplinary research as a multidimensional, research-to-practice approach to urban health issues, not only bringing researchers together but also linking stakeholders, from practitioners to policymakers to community members. This immediately accessible volume differentiates transdisciplinary research from multi- and interdisciplinary strategies, as well as from popular community-based models, and brings a uniquely North American set of perspectives to the concept. Chapter authors explore the theory behind the methods as well as their application in meeting chronic problems (e.g., domestic violence, substance abuse) and working with vulnerable populations (e.g., homeless individuals, refugees) in ways that are ecologically based, ethically sound, and eminently practical. Key areas of coverage: - Benefits and challenges of transdisciplinary research in the urban health setting. - Transdisciplinary research process, including methodologies, collaboration, and information sharing. - Detailed case examples of transdisciplinary research used in addressing health issues among marginalized urban populations. - An overview of training programs in the U.S. and Canada. - The view from funding agencies. - Preparing the university, researchers, and the job market for a transdisciplinary future Researchers and graduate students in urban and public health will find inspiring reading in Converging Disciplines: a bold framework for transforming their fields, and the tools for meeting the new generation of urban health challenges.

IntroductionImprovements in the availability and effectiveness of highly active antiretroviral therapy (HAART) have prolonged the lives of people living with HIV/AIDS. However, mortality rates have remained high among populations that encounter barriers to accessing and adhering to HAART, notably people who use drugs. This population consequently has a high burden of illness and complex palliative and supportive care needs, but is often unable to access these services due to anti‐drug policies and discrimination. In Vancouver, Canada, the Dr. Peter Centre (DPC), which operates a 24‐bed residential HIV/AIDS care facility, has sought to improve access to palliative and supportive care services by adopting a comprehensive harm reduction strategy, including supervised injection services. We undertook this study to explore how the integration of comprehensive harm reduction services into this setting shapes access to and engagement with care.MethodsQualitative interviews were conducted with 13 DPC residents between November 2010 and August 2011. Interviews made use of a semistructured interview guide which facilitated discussion regarding how the DPC Residence's model of care (a) shaped healthcare access, (b) influenced healthcare interactions and (c) impacted drug use practices and overall health. Interview transcripts were analysed thematically.ResultsParticipant accounts highlight how the harm reduction policy altered the structural‐environmental context of healthcare services and thus mediated access to palliative and supportive care services. Furthermore, this approach fostered an atmosphere in which drug use could be discussed without the risk of punitive action, and thus increased openness between residents and staff. Finally, participants reported that the environmental supports provided by the DPC Residence decreased drug‐related risks and improved health outcomes, including HAART adherence and survival.ConclusionsThis study highlights how adopting comprehensive harm reduction services can serve to improve access and equity in palliative and supportive care for drug‐using populations.

ObjectivesTo describe COVID-19 vaccine coverage (i.e., the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent experience of homelessness in Ontario, Canada.
ApproachWe conducted a retrospective, population-based cohort study of 23,247 individuals (≥18 years) with a recent experience of homelessness as recorded in routinely collected healthcare databases. Participants were followed from December 14, 2020 to September 30, 2021 for the receipt of a COVID-19 vaccine. Using modified Poisson regression, we identified sociodemographic, healthcare usage, and clinical factors associated with the receipt of one or more doses of a COVID-19 vaccine.
ResultsBy September 30, 14,271 (61.4%) of participants with a recent experience of homelessness had received a first dose of a COVID-19 vaccine and 11,082 (47.7%) had received two doses. Over the same period, 86.6% and 81.6% of the total adult population of Ontario had received a first dose and second dose, respectively. In multivariable analysis, factors associated with increased COVID-19 uptake included ≥1 visit to a general practitioner (adjusted Risk Ratio [aRR]:1.37[95% CI 1.31-1.42]), older age (vs. 18-29 years: 50-59 years, aRR:1.18[1.14-1.22]; 60+ years, aRR:1.27[1.22-1.31]), receipt of an influenza vaccine (aRR:1.25[1.23-1.28]), receipt of ≥1 SARS-CoV-2 test (aRR:1.23[1.20-1.26]) and the presence of chronic health conditions (vs. 0 conditions: 1 condition, aRR:1.05[1.03, 1.08]; 2+ conditions, aRR:1.11[1.08-1.14]). In contrast, living in a smaller metropolitan region (aRR:0.92[0.90-0.94]) or rural location (aRR:0.93[0.90-0.97]) compared to a large metropolitan region was associated with lower uptake.
ConclusionsAs of September 30, 2021, COVID-19 vaccine coverage among individuals with a recent experience of homelessness in Ontario was substantially lower than the general adult population of Ontario for a first and second dose. Findings underscore the importance of leveraging organizations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery.

We examine the long-term housing trajectories of 543 program participants at the Toronto site of the At Home/Chez-Soi project, a randomized controlled trial of a Housing First (HF) intervention for adults with mental disorders. The average follow-up period for our study was 5.5 years. We find that the HF approach, which includes housing subsidies and support services, was strongly associated with rapid transitions to sustained housing (70.4 percent of HF participants vs. 27.9 percent of treatment as usual participants). Mood disorders with psychotic features and primary psychotic disorders were negatively associated with the rapid and sustained housing trajectory, and alcohol use disorders were positively associated with a rapid then declining housing trajectory. We argue that to understand the long-term impacts of housing programs, research needs to better explore comprehensive and personalized care to support individuals with severe mental disorders.

Objectives: Although Housing First (HF) is a popular evidence-based intervention for persons experiencing homelessness and mental illness, research exploring its sustainability over time is scant. This mixed methods study captures practitioners' perspectives on key shifts in implementation of Housing First in a large urban center, and factors affecting fidelity to the model over time. Methods: This study uses fidelity assessments, at baseline and 18-months later, completed as part of the largest field trial of Housing First to date, and qualitative data from 28 front-line service providers and their managers. Results: Our findings reveal how the shifting landscape of implementation morphed some early troublespots into persistent challenges and exposed key factors facilitating fidelity to the model in a dynamic context. Conclusions: This study supports the importance of gathering provider perspectives over time to optimize the fit between the model and its changing local contexts and ensure maximal benefit of the intervention.

Background: People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness. Methods: Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness. Binary and count models were used to identify factors associated with hospital admissions, emergency department visits and physician visits for comparison across the 2 cohorts. Results: During the 1-year follow-up period, a higher proportion of people in the cohort with a mental illness used any inpatient (27% vs 14%), emergency (63% vs 53%), or physician services (90% vs 76%) compared to the general homeless cohort. People from racialized groups were less likely use nearly all health services, most notably physician services. Other factors, such as reporting of a regular source of care, poor perceived general health, and diagnosed chronic conditions were associated with higher use of all health services except psychiatric inpatient care Conclusion: When implementing interventions for patients with the greatest health needs, we must consider the unique factors that contribute to higher healthcare use, as well as the barriers to healthcare access.

This study identifies time-patterned trajectories of housing stability among homeless and vulnerably housed individuals who participated in a multisite four-year longitudinal study in Canada. Findings show four distinct trajectories for the homeless and vulnerably housed: high levels of sustained housing stability, improving levels over time leading to high levels of housing stability, decreasing levels of housing stability over time, and low levels of housing stability over time. The presence of resources rather than risk factors differentiated the trajectories of participants who achieved housing stability from those who had low levels of housing stability. Participants who had better housing stability were more likely to live in subsidized housing. Findings highlight the need for programs and policies directed at addressing the housing affordability problem through income support strategies and the creation of affordable housing.