Vicky Stergiopoulos1,2,3, Agnes Gozdzik3, Rosane Nisenbaum3,4, Janet Durbin1,5, Stephen W Hwang3,6,7, Patricia O'Campo3,4, Joshua Tepper8, Don Wasylenki2,9. 1. 1 Centre for Addiction and Mental Health, Toronto, Ontario. 2. 2 Department of Psychiatry, University of Toronto, Toronto, Ontario. 3. 3 Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario. 4. 4 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario. 5. 5 University of Toronto, Toronto, Ontario. 6. 6 Faculty of Medicine, University of Toronto, Toronto, Ontario. 7. 7 Division of General Internal Medicine, University of Toronto, Toronto, Ontario. 8. 8 Health Quality Ontario, Toronto, Ontario. 9. 9 St. Michael's Hospital, Toronto, Ontario.
Abstract
OBJECTIVE: This study examines health and service use outcomes and associated factors among homeless adults participating in a brief interdisciplinary intervention following discharge from hospital. METHOD: Using a pre-post cohort design, 223 homeless adults with mental health needs were enrolled in the Coordinated Access to Care for the Homeless (CATCH) program, a 4- to 6-month interdisciplinary intervention offering case management, peer support, access to primary psychiatric care, and supplementary community services. Study participants were interviewed at program entry and at 3- and 6-month follow-up visits and assessed for health status, acute care service use, housing outcomes, mental health, substance use, quality of life, and their working alliance with service providers. Linear mixed models and generalized estimating equations were performed to examine outcomes longitudinally. Additional post hoc analyses evaluated differences between CATCH participants and a comparison group of homeless adults experiencing mental illness who received usual services over the same period. RESULTS: In the pre-post analyses, CATCH participants had statistically significant improvements in mental and physical health status and reductions in mental health symptoms, substance misuse, and the number of hospital admissions. The strength of the working alliance between participants and their case manager was associated with reduced health care use and mental health symptoms. Post hoc analyses suggest that CATCH may be associated with statistically significant improvements in mental health symptoms in the study population. CONCLUSIONS: A brief interdisciplinary intervention may be a promising approach to improving health outcomes among homeless adults with unmet health needs. Further rigorous research is needed into the effectiveness of brief interventions following discharge from hospital.
OBJECTIVE: This study examines health and service use outcomes and associated factors among homeless adults participating in a brief interdisciplinary intervention following discharge from hospital. METHOD: Using a pre-post cohort design, 223 homeless adults with mental health needs were enrolled in the Coordinated Access to Care for the Homeless (CATCH) program, a 4- to 6-month interdisciplinary intervention offering case management, peer support, access to primary psychiatric care, and supplementary community services. Study participants were interviewed at program entry and at 3- and 6-month follow-up visits and assessed for health status, acute care service use, housing outcomes, mental health, substance use, quality of life, and their working alliance with service providers. Linear mixed models and generalized estimating equations were performed to examine outcomes longitudinally. Additional post hoc analyses evaluated differences between CATCH participants and a comparison group of homeless adults experiencing mental illness who received usual services over the same period. RESULTS: In the pre-post analyses, CATCH participants had statistically significant improvements in mental and physical health status and reductions in mental health symptoms, substance misuse, and the number of hospital admissions. The strength of the working alliance between participants and their case manager was associated with reduced health care use and mental health symptoms. Post hoc analyses suggest that CATCH may be associated with statistically significant improvements in mental health symptoms in the study population. CONCLUSIONS: A brief interdisciplinary intervention may be a promising approach to improving health outcomes among homeless adults with unmet health needs. Further rigorous research is needed into the effectiveness of brief interventions following discharge from hospital.
Entities:
Keywords:
addictions; case management; homeless persons; mental illness
Authors: Stephen W Hwang; Joanna J M Ueng; Shirley Chiu; Alex Kiss; George Tolomiczenko; Laura Cowan; Wendy Levinson; Donald A Redelmeier Journal: Am J Public Health Date: 2010-06-17 Impact factor: 9.308
Authors: Paula N Goering; David L Streiner; Carol Adair; Tim Aubry; Jayne Barker; Jino Distasio; Stephen W Hwang; Janina Komaroff; Eric Latimer; Julian Somers; Denise M Zabkiewicz Journal: BMJ Open Date: 2011-11-14 Impact factor: 2.692
Authors: Renée de Vet; Danielle A M Lako; Mariëlle D Beijersbergen; Linda van den Dries; Sarah Conover; Albert M van Hemert; Daniel B Herman; Judith R L M Wolf Journal: Adm Policy Ment Health Date: 2017-01
Authors: Megan Shepherd-Banigan; Connor Drake; Jessica R Dietch; Abigail Shapiro; Amir Alishahi Tabriz; Elizabeth E Van Voorhees; Diya M Uthappa; Tsai-Wei Wang; Jay B Lusk; Stephanie Salcedo Rossitch; Jessica Fulton; Adelaide Gordon; Belinda Ear; Sarah Cantrell; Jennifer M Gierisch; John W Williams; Karen M Goldstein Journal: J Gen Intern Med Date: 2022-03-02 Impact factor: 6.473
Authors: Maureen Anderson; Crawford W Revie; Jacqueline M Quail; Walter Wodchis; Claire de Oliveira; Meriç Osman; Marilyn Baetz; J McClure; Henrik Stryhn; David Buckeridge; Cordell Neudorf Journal: Can J Public Health Date: 2018-06-28
Authors: Dailys Garcia-Jorda; Gabriel E Fabreau; Queenie Kwan Wing Li; Alicia Polachek; Katrina Milaney; Patrick McLane; Kerry A McBrien Journal: BMC Health Serv Res Date: 2022-02-19 Impact factor: 2.655