Engaging Adults Experiencing Homelessness in Recovery Education: A Qualitative Analysis of Individual and Program Level Enabling Factors

Khan, Bushra; Reid, Nadine; Brown, Rebecca; Kozloff, Nicole; Stergiopoulos, Vicky

doi:10.3389/fpsyt.2020.00779

Cited by 5 publications

(7 citation statements)

References 33 publications

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“…Improvements in recovery outcomes among REC participants were also noted in qualitative findings from this evaluation (38), highlighting perceived improvements in health and wellbeing, self-esteem and confidence, interpersonal skills, and goal orientation (4).…”

Section: Discussionmentioning

confidence: 76%

Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation

et al. 2021

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Objective: Grounded in principles of adult education, Recovery Education Centres (RECs) hold promise in promoting recovery for adults with mental health challenges, but research on recovery outcomes for hard-to-reach populations participating in RECs is scant. This quasi-experimental study compares 12-month recovery outcomes of adults with histories of homelessness and mental health challenges enrolled in a REC, to those of participants of other community services for this population.Methods: This pre-post quasi-experimental study compared participants enrolled in a REC for people with histories of homelessness and mental health challenges (n = 92) to an age-and-gender frequency matched control group participating in usual services (n = 92) for this population in Toronto, Ontario. Changes from program enrollment to 12 months in personal empowerment (primary outcome), disease specific quality of life, recovery, health status, health related quality of life, and mastery were assessed. Post-hoc analyses compared subgroups with 1–13 h (n = 37) and 14+ h (n = 37) of REC participation during the study period to the control group. Linear mixed models estimated mean changes and differences in mean changes and 95% confidence intervals.Results: Mean change in perceived empowerment from program enrollment to 12 months in the intervention group [0.10 (95% CI: 0.04, 0.15)] was not significantly different from the control group [0.05 (−0.01, 0.11)], mean difference, 0.05 [(−0.03, 0.13), P = 0.25]. In the post-hoc analysis, the mean change in perceived empowerment for the intervention subgroup with 14+ h of REC participation [0.18 (0.10, 0.26)] was significantly different than in the control group [0.05 (−0.01, 0.11)] mean difference, 0.13 [(0.03, 0.23), P < 0.01]. Mean change in mastery was also significantly different for the intervention subgroup with 14+ h of REC participation [2.03 (1.04, 3.02)] vs. controls [0.60 (−0.15, 1.35)], mean difference, 1.43 [(0.19, 2.66), P = 0.02]. There were no significant differences in other outcomes.Conclusion: With sufficient hours of participation, recovery education may be a helpful adjunct to health and social services for adults with mental health challenges transitioning from homelessness.

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Section: Discussionmentioning

confidence: 76%

Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation

et al. 2021

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“…Eligibility criteria and recruitment efforts were adapted throughout to improve the representativeness of the study sample; for example, efforts were made to include participants with low levels of engagement and minority groups. This recruitment approach has been used by the research team in previous studies among people experiencing homelessness and mental illness 48 , 49 and within this particular programme. 40 In addition to CATCH‐FI participants, 12 CATCH service providers and key informants were purposefully recruited based on their role in the CATCH programme or the local healthcare system.…”

Section: Methodsmentioning

confidence: 99%

Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives

Reid

Brown

Pedersen

et al. 2022

Health Expectations

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Introduction: Homelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but studies investigating key stakeholder perspectives are lacking. This study aimed to elicit, using qualitative methods, nuanced service user and provider experiences by using financial incentives to support service engagement among adults experiencing homelessness and mental illness. Methods: This qualitative study is part of a larger mixed-methods pragmatic trial of financial incentives (Coordinated Access to Care for the Homeless-Financial Incentives [CATCH-FI]) within a community-based brief case management programme (CATCH) in Toronto, Ontario. Twenty-two CATCH-FI participants were purposefully recruited to participate in in-depth, semi-structured interviews; five CATCH service providers participated in a focus group and seven key informants in individual interviews. Data collection occurred between April 2019 and December 2020. All interviews and the focus group were audio-recorded and transcribed. Topic guides prompted participant perspectives on and experiences of using financial incentives to support engagement, health and well-being. Grounded theory and inductive thematic analysis guided coding and interpretation of transcripts. Triangulation and member-checking enhanced the analytical rigour and validity of findings.Results: CATCH service providers, key informants and subgroup of CATCH-FI participants perceived financial incentives to directly facilitate service engagement.

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“…The qualitative arm provided a detailed understanding of STAR, including perceived key ingredients, participant outcomes, and as in this paper, recommendations for adaptations to better serve homeless populations (Durbin et al, 2019;Khan et al, 2020;Reid et al, 2020). Semistructured participant, key informant (KI), and focus group (FG) interview guides were used.…”

Section: Research Ethicsmentioning

confidence: 99%

“…RECs were first established in the early 1990s in the United States and have since expanded to over 20 countries including the United Kingdom, Canada, Europe, Australia, and New Zealand, with approximately 75 operating worldwide currently (Whitley et al., 2019). Key features, mechanism of action, and fidelity measures of RECs have recently been described (Khan et al., 2020; Reid et al., 2020; Toney et al., 2019), although there is variability in the enrolment criteria and pathways, program duration, funding sources, and curriculum content in diverse service delivery contexts (Chodos et al., 2015).…”

Section: Introductionmentioning

confidence: 99%

“…An early qualitative process evaluation by Whitley and Siantz (2012) of an REC in New York for individuals with histories of homelessness and mental illness reported perceived participant educational and functional improvements. A study examining an REC for individuals transitioning out of homelessness in Toronto, Canada's largest urban centre (Chung et al., 2016), found the REC to be welcoming, offering low‐barrier seamless access, and facilitating engagement with peers and a co‐produced skills‐based curriculum (Khan et al., 2020). Prior research also indicated that mechanisms supporting recovery for this population include a judgement‐free environment, supportive relationships, mutuality, role modelling, and deconstructing of self‐stigma (Reid et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

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Advancing recovery education for people experiencing housing instability: A qualitative analysis of service user and provider perspectives in Canada

Khan

Reid

Stergiopoulos

2021

Health Social Care Comm

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The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n = 10) and increasing delivery options (n = 8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n = 15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co‐production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery.

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Engaging Adults Experiencing Homelessness in Recovery Education: A Qualitative Analysis of Individual and Program Level Enabling Factors

Abstract: examination of Canada's first REC for adults exiting homelessness can help guide program and policy development to better support this disadvantaged population.

Cited by 5 publications

References 33 publications

Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation

Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation

Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives

Advancing recovery education for people experiencing housing instability: A qualitative analysis of service user and provider perspectives in Canada

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