Delivering collaborative mental health care within supportive housing: implementation evaluation of a community-hospital partnership

Abstract

Background Approaches to address unmet mental health care needs in supportive housing settings are needed. Collaborative approaches to delivering psychiatric care have robust evidence in multiple settings, however such approaches have not been adequately studied in housing settings. This study evaluates the implementation of a shifted outpatient collaborative care initiative in which a psychiatrist was added to existing housing, community mental health, and primary care supports in a women-centered supportive housing complex in Toronto, Canada. Methods The initiative was designed and implemented by stakeholders from an academic hospital and from community housing and mental health agencies. Program activities comprised multidisciplinary support for tenants (e.g. multidisciplinary care teams, case conferences), tenant engagement (psychoeducation sessions), and staff capacity-building (e.g. formal trainings, informal ad hoc questions). This mixed methods implementation evaluation sought to understand (1) program activity delivery including satisfaction with these activities, (2) consistency with team-based tenant-centered care and with pre-specified shared lenses (trauma-informed, culturally safe, harm reduction), and (3) facilitators and barriers to implementation over a one-year period. Quantitative data included reporting of program activity delivery (weekly and monthly), staff surveys, and tenant surveys (post-group surveys following tenant psychoeducation groups and an all-tenant survey). Qualitative data included focus groups with staff and stakeholders, program documents, and free-text survey responses. Results All three program activity domains (multidisciplinary supports, tenant engagement, staff capacity-building) were successfully implemented. Main program activities were multidisciplinary case conferences, direct psychiatric consultation, tenant psychoeducation sessions, formal staff training, and informal staff support. Psychoeducation for tenants and informal/formal staff support were particularly valued. Most activities were team-based. Of the shared lenses, trauma-informed care was the most consistently implemented. Facilitators to implementation were shared lenses, psychiatrist characteristics, shared time/space, balance between structure and flexibility, building trust, logistical support, and the embedded evaluation. Barriers were that the initial model was driven by leadership, confusion in initial processes, different workflows across organizations, and staff turnover; where possible, iterative changes were implemented to address barriers. Conclusions This evaluation highlights the process of successfully implementing a shifted outpatient collaborative mental health care initiative in supportive housing. Further work is warranted to evaluate whether collaborative care adaptations in supportive housing settings lead to improvements in tenant- and program-level outcomes.

The Systematic Integrative Narrative Review on Community Support Practices and Outcomes in Social and Community Housing

“…Findings in this study can contribute to future work on emerging issues. 2,3 Lastly, in all three tenures, the development of services seems an important avenue (Chirisa et al, Freedman et al, 2012, Barker et al, 2022. Engaging tenants and mobilising strategies (public - Grier et al, 2015;public -Mmako et al, 2019) do face challenges in participation and self-deter- (Suto et al, 2021).…”

“…Prevention. Authors refer to the Ottawa charter for health promotion, social inclusion, • and community development theories (Mmako, Capetola, & Henderson-Wilson, 2019), proximity intervention (Parent, Tourillon-Gingras, & Smith-Lauzon, 2019); crime prevention through environmental design principles (Sheppard, Gould, Austen, & Hitzig, 2021), harm reduction and tenant-centred care lenses (Barker, Lee-Evoy, Butt, Wijayasinghe, Nakouz, Hutcheson, et al, 2022), housing first model (Adame, Perry & Pierce, 2020), and the health impact pyramid (Ortega & Mata, 2020).…”

“…All qualitative and mixed studies reported on psychosocial outcomes for tenants, except one qualitative (Linz et al, 2022) and one mixed study (Barker et al, 2022). Psychosocial outcomes comprise 13 themes presented in Table 3.…”

’God is the one who give child’: An abductive analysis of barriers to postnatal care using the Health Equity Implementation Framework

“…Additionally, future studies could test assessment of cultural safety 74 and evaluation of cultural safety programs in LMICs. [75][76][77] This will add to calls for clear clinical de nitions of cultural safety so that interventions can be more culturally safe. 78 Utilizing these tools at every level of the health system will takes emphasis off patient, who, as nonexperts, cannot be expected to state their health needs thoroughly.…”

Interventions Intended to Alleviate Emergency Department Overcrowding

“…This supportive, preventive approach stands to decrease incidents of mental health instability that may require those affected to seek help in EDs. 128…”