A Comparison of the Use of Physical and Mental Health Services by Homeless People With Severe Mental Health Problems in the Moncton Area Through the At Home/Chez Soi Program

Pakzad, Sarah; Bourque, Paul; Bourque, Jimmy; Aubry, Tim; Gallant, Lise; LeBlanc, Stefanie R.; Tivendell, John

doi:10.7870/cjcmh-2017-024

Cited by 6 publications

(6 citation statements)

References 28 publications

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“…We identified 30 publications that reported on the cost‐effectiveness of our interventions (Aubry et al, 2016 ; Chalmers McLaughlin, 2011 ; Clark et al, 1998 ; Culhane et al, 2002 ; Dickey et al, 1997 ; Essock et al, 1998 ; Evans et al, 2016 ; Gilmer et al, 2009 , 2010 ; Holtgrave et al, 2013 ; Hunter et al, 2017 ; Larimer, 2009 ; Latimer et al, 2019 ; Lehman, 1999 ; Lenz‐Rashid, 2017 ; Lim et al, 2018 ; Mares & Rosenheck, 2011 ; Morse et al, 2006 ; Nyamathi et al, 2016 ; Okin et al, 2000 ; Pauley et al, 2016 ; Rosenheck et al, 2003 ; Sadowski et al, 2009 ; Schinka et al, 1998 ; Shumway et al, 2008 ; Srebnik et al, 2013 ; Stergiopoulos et al, 2015 ; Susser et al, 1997 ; Tsemberis et al, 2004 ; Wolff, 1997 ). Of these, 10 publications were also included as part of the effectiveness data (Aubry et al, 2016 ; Essock et al, 1998 ; Morse et al, 2006 ; Nyamathi et al, 2016 ; Rosenheck et al, 2003 ; Sadowski et al, 2009 ; Shumway et al, 2008 ; Stergiopoulos et al, 2015 ; Susser et al, 1997 ; Tsemberis et al, 2004 ).…”

Section: Resultsmentioning

confidence: 99%

“…For mental‐health interventions, twelve articles provided evidence on cost‐effectiveness: three on SCM (Nyamathi et al, 2016 ; Okin et al, 2000 ; Shumway et al, 2008 ), 6 on ACT (Aubry et al, 2016 ; Clark et al, 1998 ; Essock et al, 1998 ; Lehman, 1999 ; Morse et al, 2006 ; Wolff, 1997 ), 2 on ICM (Rosenheck et al, 2003 ; Stergiopoulos et al, 2015 ); and 1 for CTI (Susser et al, 1997 ). Eight of the mental‐health cost‐effectiveness articles were also included in the effectiveness analysis (Aubry et al, 2016 ; Essock et al, 1998 ; Nyamathi et al, 2016 ; Morse et al, 2006 ; Rosenheck et al, 2003 ; Shumway et al, 2008 ; Stergiopoulos et al, 2015 ; Susser et al, 1997 ).…”

Section: Resultsmentioning

confidence: 99%

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A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

Moledina

Magwood

Agbata

et al. 2021

Campbell Systematic Reviews

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Background: Homelessness has emerged as a public health priority, with growing numbers of vulnerable populations despite advances in social welfare. In February 2020, the United Nations passed a historic resolution, identifying the need to adopt social-protection systems and ensure access to safe and affordable housing for all.The establishment of housing stability is a critical outcome that intersects with other social inequities. Prior research has shown that in comparison to the general population, people experiencing homelessness have higher rates of infectious diseases, chronic illnesses, and mental-health disorders, along with disproportionately poorer outcomes. Hence, there is an urgent need to identify effective interventions to improve the lives of people living with homelessness.Objectives: The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.Search Methods: In consultation with an information scientist, we searched nine bibliographic databases, including Medline, EMBASE, and Cochrane CENTRAL, from database inception to February 10, 2020 using keywords and MeSH terms. We conducted a focused grey literature search and consulted experts for additional studies.Selection Criteria: Teams of two reviewers independently screened studies against our inclusion criteria. We included randomised control trials (RCTs) and quasi-experimental studies conducted among populations experiencing homelessness in high-income countries. Eligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

Moledina

Magwood

Agbata

et al. 2021

Campbell Systematic Reviews

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“…In a large multisite study in Canada with 5 concurrent randomized controlled trials (known as At Home/Chez Soi ), people with serious mental illness who were randomized to “housing first,” as compared to “treatment first,” experienced more rapid housing stability and improved psychological quality of life [ 42 ]. There is less evidence that “housing first” improves health status or severity of psychiatric symptoms, promotes recovery from substance use, or increases social capital or employment [ 41 , 42 , 45 , 46 ]. In contrast to “housing first” and to meet gaps in existing services, we used a fully integrated model in which baseline screening for medical, psychiatric, housing, vocational, and substance use treatment needs was followed by on-site delivery of services to meet all identified needs in a “one-stop shop.”…”

Section: Discussionmentioning

confidence: 99%

Experience delivering an integrated service model to people with criminal justice system involvement and housing insecurity

et al. 2023

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Background People returning to communities from prison or jail face stressors related to securing housing, including discrimination, restrictions based on prior felony convictions, and limited economic and social resources. Existing housing programs can effectively reduce housing instability but often do not fully address the needs of people involved in the criminal justice system experiencing homelessness who often have co-occurring chronic medical issues, and psychiatric and substance use disorders. Methods Project CHANGE is an ongoing program to deliver person-centered, integrated care and services to individuals involved with the criminal justice system and experiencing homelessness. Applying a Screening, Brief Intervention, (Referral to) Treatment framework, a comprehensive needs assessment is followed by delivery of intensive housing and vocational case management; and psychiatric, substance use, and medical services in a single location by an interdisciplinary team. Participants are followed with study interviews for 12 months. The current analysis was designed to assess the baseline characteristics and needs of the sample population, and the intensity of contact required for integrated service delivery. Results Between November 2019 and September 2021, 86 participants were enrolled, of whom 64% had been released from prison/jail in the past 6 months; the remainder were on parole, probation, or intensive pretrial supervision. Participants were unstably housed (64%) or residing outdoors (26.7%) or in a shelter (24.4%). Most participants had high medical need and frequent healthcare engagement through outpatient and emergency department visits. Most participants were at-risk for clinical depression, and half were diagnosed with anxiety, dissociative, stress-related, somatoform, and other non-psychotic psychiatric disorders. Over 12-month follow-up, the interdisciplinary team made over 500 contact encounters, over half of which resulted in direct services provided, including obtaining vital documents for homelessness verification, housing applications, and employment coaching. Conclusion Navigation of services can be particularly challenging for individuals experiencing criminal justice involvement, homelessness, and co-occurring medical, psychiatric, and substance use issues, which can be addressed holistically in an integrated service model. Integrated service delivery was time-, resource-, and staffing-intensive, and challenged by the COVID-19 pandemic, requiring innovative solutions to sustain participant engagement.

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“…Curiously, although HF recipients as a group were found to have more days of hospitalizations for psychiatric difficulties [23], this did not appear to produce better health outcomes than TAU. As previously mentioned, these findings were explained as being the result of support provided by the ACT team who were able to help participants access psychiatric hospital treatment when it was needed [22].…”

Section: Discussionmentioning

confidence: 99%

“…Also individuals with high needs receiving HF with ACT had a significantly lower number of criminal convictions than recipients of TAU [21]. At the site of the current study, previous research comparing HF and TAU recipients on use of health services showed HF recipients experiencing more days of hospitalizations for psychiatric problems over the course of the 2 year study [22]. These findings were interpreted as being the result of the intensive support provided by the ACT team that includes facilitating the access to psychiatric hospital treatment when it is needed.…”

Section: Introductionmentioning

confidence: 92%

A randomized controlled trial of the effectiveness of Housing First in a small Canadian City

et al. 2019

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Background The paper presents two-year findings from a study investigating the effectiveness of Housing First (HF) with assertive community treatment (ACT) in helping individuals with serious mental illness, who are homeless or precariously housed and living in a small city, to become stably housed. Methods The research design was a parallel group non-blinded RCT with participants randomly assigned after the baseline interview to receive HF with ACT ( N = 100) or treatment as usual (TAU; N = 101). Participants were interviewed every 3 months over 21/24 months to investigate changes on a range of housing and psychosocial outcomes. The primary outcomes were housing stability (as defined by a joint function of number of days housed and number of moves) and improvement in community functioning. Secondary predicted outcomes were improvements in self-rated physical and mental health status, substance use problems, quality of life, community integration, and recovery. Results An intent-to-treat analysis was conducted. Compared to TAU participants, HF participants who entered housing did so more quickly (23.30 versus 88.25 days, d = 1.02, 95% CI [0.50–1.53], p < 0.001), spent a greater proportion of time stably housed ( Z = 5.30, p < 0.001, OR = 3.12, 95% CI [1.96–4.27]), and rated the quality of their housing more positively ( Z = 4.59, p < 0.001, d = 0.43, 95% CI [0.25–0.62]). HF participants were also more likely to be housed continually in the final 6 months (i.e., 79.57% vs. 55.47%), χ 2 (2, n = 170) = 11.46, p = .003, Cramer’s V = 0.26, 95% CI [0.14–0.42]). HF participants showed greater gains in quality of life, ( Z = 3.83, p < 0.001, ASMD = 0.50, 95% CI [0.24–0.75]), psychological integration ( Z = 12.89, p < 0.001, pooled ASMD = 0.91, 95% CI [0.77–1.05]), and perceived recovery ( Z = 2.26, p = 0.03, ASMD = 0.39, 95% CI [0.05–0.74]) than TAU participants. Conclusions The study indicates that HF ends homelessness significantly more rapidly than TAU for a majority of individuals with serious mental illness who have a history of homelessness and live in a small city. In addition, compared to TAU, HF produces psychosocial benefits for its recipients that include an enhanced quality of life, a greater sense of belonging in the community, and greater improvements in perceived recovery from mental illness. Trial registration International Standard Randomized Control Trial Number Registe...

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A Comparison of the Use of Physical and Mental Health Services by Homeless People With Severe Mental Health Problems in the Moncton Area Through the At Home/Chez Soi Program

Cited by 6 publications

References 28 publications

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

Experience delivering an integrated service model to people with criminal justice system involvement and housing insecurity

A randomized controlled trial of the effectiveness of Housing First in a small Canadian City

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