Suchergebnisse

Anti-racism and anti-oppression frameworks of practice are being increasingly advocated for in efforts to address racism and oppression embedded in mental health and social services, and to help reduce their impact on mental health and clinical outcomes. This literature review summarizes how these two philosophies of practice are conceptualized and the strategies used within these frameworks as they are applied to service provision toward racialized groups. The strategies identified can be grouped in seven main categories: empowerment, education, alliance building, language, alternative healing strategies, advocacy, social justice/activism, and fostering reflexivity. Although anti-racism and anti-oppression frameworks have limitations, they may offer useful approaches to service delivery and would benefit from further study.

Background: The multiple challenges that ethnoracial homeless individuals experiencing mental illness face are well documented. However, little is known about how this homeless subpopulation copes with the compounding stressors of racial discrimination, homelessness and mental illness. Aims: This study is an in-depth investigation of the personal perceived strengths, attitudes and coping behaviors of homeless adults of diverse ethnoracial backgrounds experiencing homelessness and mental illness in Toronto, Canada. Method: Using qualitative methods, 36 in-depth semi-structured interviews were conducted to capture the perspectives of ethnoracial homeless participants with mental illness on coping and resilience. Transcripts were analyzed using thematic analysis. Results: Similar to prior findings in the general homeless population, study participants recognized personal strengths and attitudes as great sources of coping and resilience, describing hope and optimism, self-esteem and confidence, insight into their challenges and spirituality as instrumental to overcoming current challenges. In addition, participants described several coping strategies, including seeking support from family, friends and professionals; socializing with peers; engaging in meaningful activities; distancing from overwhelming challenges; and finding an anchor. Conclusion: Findings suggest that homeless adults with mental illness from ethnoracial groups use similar coping strategies and sources of resilience with the general homeless population and highlight the need for existing services to foster hope, recognize and support individual coping strategies and sources of resilience of homeless individuals experiencing complex challenges.

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.

Background:Recovery education centers (RECs) offer recovery supports through education rather than traditional health services. The Supporting Transitions and Recovery Learning Centre (STAR) in Toronto, Canada, is among the few that are internationally focused on individuals with histories of homelessness. Although research suggests that RECs positively impact participants, there is a paucity of rigorous studies and none address the engagement and impacts on homeless individuals.Aims:This protocol describes a realist-informed evaluation of STAR, specifically examining (1) if STAR participation is more effective in promoting 12-month recovery outcomes than participation in usual services for individuals experiencing housing instability and mental health challenges and (2) how STAR participation promotes recovery and other positive outcomes.Methods:This study uses a quasi-experimental mixed methods design. Personal empowerment (primary outcome) and recovery, housing stability, social functioning, health service use and quality of life (secondary outcomes) data were collected at baseline, and 6 and 12 months. Intervention group participants were recruited at the time of STAR registration while control group participants were recruited from community agencies serving this population after screening for age and histories of housing instability. Interviews and focus groups with service users and providers will identify the key intervention ingredients that support the process of recovery.Results:From January 2017 to July 2018, 92 individuals were recruited to each of the intervention and control groups. The groups were mostly similar at baseline; the intervention group's total empowerment score was slightly higher than the control group's ( M ( SD): 2.94 (0.23) vs 2.84 (0.28), p = .02), and so was the level of education. A subset of STAR participants ( n = 20) and nine service providers participated in the qualitative interviews and focus groups.Conclusion:This study will offer important new insights into the effectiveness of RECs, and expose how key REC ingredients support the process of recovery for people experiencing housing instability.

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.

AbstractBackgroundAdults with intellectual and developmental disabilities (IDD) have high rates of homelessness. This observational study evaluates Bridges to Housing, a cross‐sector intervention offering immediate access to housing and supports to this population in Toronto, Canada.MethodsTwenty‐six participants, enrolled between April 2016 and December 2017, were assessed at baseline, six and 12 months post‐enrolment. Descriptive statistics and generalized linear modelling evaluated quality of life (QOL) and service needs outcomes. Twenty‐one service users and providers participated in semi‐structured interviews between August 2017 and June 2018 to elicit their experiences of the intervention, which were analysed thematically.ResultsTwelve months post‐enrolment, 24 participants were successfully housed and reported increased QOL scores (F(2,43) = 13.73, p = <.001) and decreased perceived unmet service needs (Wald χ2(2) = 12.93, p = .002). Individual‐, intervention‐ and system‐level characteristics facilitated housing stability in this population.ConclusionsCross‐sector approaches can improve outcomes for homeless adults with IDD and may have an important role in supporting this marginalized population.