Social Impact Bonds as a Funding Method for Health and Social Programs: Potential Areas of Concern.

Social Impact Bonds (SIBs) represent a new way to finance social service and health promotion programs whereby different types of investors provide an upfront investment of capital. If a given program meets predetermined criteria for a successful outcome, the government pays back investors with interest. Introduced in the United Kingdom in 2010, SIBs have since been implemented in the United States and across Europe, with some uptake in other jurisdictions.

Online Versus Face-To-Face Training of Critical Time Intervention: A Matching Cluster Randomized Trial.

This study examined the effectiveness of online education to providers who serve people experiencing homelessness, comparing online and face-to-face training of Critical Time Intervention (CTI), an evidence-based case management model. The authors recruited 184 staff from 19 homeless service agencies to participate in one of two training conditions: (a) or (b) . Each group received 24 hours of instruction and support.

Research Assistants Caught in Limbo: Considering Their Role in Quantitative, Longitudinal Research with Vulnerable Populations.

Research assistants (RAs) play a variety of roles that are critical in making research happen and in determining its quality and effectiveness. Yet their locus of power in the production of knowledge stands in sharp contrast to their relative powerlessness in the hierarchical research organization. This article explores the experiences of RAs engaged in a randomized controlled longitudinal field trial of a Housing First intervention for individuals experiencing homelessness and mental illness in Toronto.

Shrinking the language accessibility gap: a mixed methods evaluation of telephone interpretation services in a large, diverse urban health care system.

Introduction: Language interpretation services for patients who are not proficient in a country's official language(s) are essential for improving health equity across diverse populations, and achieving clinical safety and quality for both patients and providers. Nevertheless, overall use of these services remains low, regardless of how they are delivered. In Toronto, Ontario, one of the most ethnically diverse urban centres, the regional local health integration network which oversees the highest concentration of health care organizations servicing 1.

Strategies to balance fidelity to Housing First principles with local realities: lessons from a large urban centre.

The importance of program implementation in achieving desired outcomes is well-documented, but there remains a need for concrete guidance on how to achieve fidelity to evidence-based models within dynamic local contexts. Housing First (HF), an evidence-based model for people experiencing homelessness and mental illness, provides an important test-case for such guidance; it targets a uniquely underserved subpopulation with complex needs, and is delivered by practitioners with varying knowledge and skill levels. Scientific evidence affirms HF's effectiveness, but its rapid dissemination has outpaced the ability to monitor not only whether it is being implemented with fidelity, but also how this can be achieved within variable local contexts and challenges.

Differential experiences of discrimination among ethnoracially diverse persons experiencing mental illness and homelessness.

Background: This mixed methods study explored the characteristics of and experiences with perceived discrimination in an ethnically diverse urban sample of adults experiencing homelessness and mental illness.

Methods: Data were collected in Toronto, Ontario, as part of a 4-year national randomized field trial of the Housing First treatment model. Rates of perceived discrimination were captured from survey questions regarding perceived discrimination among 231 ethnoracially diverse participants with moderate mental health needs.

The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness.

Background: There is strong evidence that Housing First interventions are effective in improving housing stability and quality of life among homeless people with mental illness and addictions. However, there is very little evidence on the effectiveness of Housing First in improving substance use-related outcomes in this population. This study uses a randomized control design to examine the effects of scatter-site Housing First on substance use outcomes in a large urban centre.

Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings.

Background: Research on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups. Little is known about discrimination experiences of other marginalized populations, particularly groups facing multiple disadvantages who may be subjected to other/multiple forms of discrimination.

Objectives: (1) To examine the prevalence of perceived discrimination due to homelessness/poverty, mental illness/alcohol/drug related problems, and race/ethnicity/skin color while seeking healthcare in the past year among racially diverse homeless adults with mental illness; (2) To identify whether perceiving certain types of discrimination is associated with increased likelihood of perceiving other kinds of discrimination; and (3) To examine association of these perceived discrimination experiences with socio-demographic characteristics, self-reported measures of psychiatric symptomatology and substance use, and Emergency Department utilization.

The role and meaning of interim housing in housing first programs for people experiencing homelessness and mental illness.

The housing first (HF) model for individuals experiencing homelessness and mental illness differs by design from traditional models that require consumers to achieve "housing readiness" by meeting program or treatment prerequisites in transitional housing settings prior to permanent housing placement. Given a growing body of evidence for its favorable outcomes and cost effectiveness, HF is increasingly seen as an alternative to and argument against these traditional programs. As such, it is important that the elements and implementation challenges of the HF model be clearly understood and articulated.

Understanding Housing Delays and Relocations Within the Housing First Model.

This study explores factors contributing to delays and relocations during the implementation of the Housing First model in Toronto, Ontario. While interruptions in housing tenure are expected en route to recovery and housing stability, consumer and service provider views on finding and keeping housing remain largely unknown. In-person interviews and focus groups were conducted with 48 study participants, including 23 case managers or housing workers and 25 consumers.

The promise of recovery: narratives of hope among homeless individuals with mental illness participating in a Housing First randomised controlled trial in Toronto, Canada.

Objectives: Hope is widely embraced as an important factor in the recovery process. The role of housing in inspiring hope and facilitating recovery has been explored with homeless populations but is not well understood. This study explores perspectives on hopes for recovery and the role of housing on these hopes from the perspective of homeless adults experiencing mental illness participating in a multisite Housing First randomised controlled trial in Canada.

Health care for the homeless: what we have learned in the past 30 years and what's next.

In the 1980s, the combined effects of deinstitutionalization from state mental hospitals and the economic recession increased the number and transformed the demographic profile of people experiencing homelessness in the United States. Specialized health care for the homeless (HCH) services were developed when it became clear that the mainstream health care system could not sufficiently address their health needs. The HCH program has grown consistently during that period; currently, 208 HCH sites are operating, and the program has become embedded in the federal health care system.

Medical respite programs for homeless patients: a systematic review.

Medical respite programs provide care to homeless patients who are too sick to be on the streets or in a traditional shelter, but not sick enough to warrant inpatient hospitalization. They are designed to improve the health of homeless patients while also decreasing costly hospital use. Although there is increasing interest in implementing respite programs, there has been no prior systematic review of their effectiveness.

Hepatitis C among clients of health care for the homeless primary care clinics.

Objectives: To describe the prevalence, distribution and risk factors for hepatitis C virus (HCV) infection among homeless adults using eight Health Care for the Homeless (HCH) clinics nationally.

Methods: Data were collected for 387 participants through blood draws, structured interviews, chart reviews.

Results: Overall prevalence of HCV-antibody positivity was 31.

Provision of contraceptive services to homeless women: results of a survey of health care for the homeless providers.

Homeless women have both a higher rate of pregnancy and a higher proportion of unintended pregnancies than other American women. The authors sought to learn about contraception services offered by providers of health care to homeless women and barriers to provision of long-acting, reversible contraception in these settings. A survey of the 31 member organizations in the national Health Care for the Homeless Practice-Based Research Network was conducted, inquiring about services provided and barriers to service provision.

Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review.

Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children.

Medical respite care for homeless people: a growing national phenomenon.

The first known respite care facilities for homeless people emerged in the mid-1980s, but recent trends in health systems and services have driven their rapid proliferation across the country within the past decade. This report is the first attempt to describe these respite programs comprehensively.

Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs.

For almost two decades, the US Health Care for the Homeless (HCH) Program has funded clinics across the country for homeless populations. Between October and December 2003, for the first time ever, a nationally representative sample of the almost 200 HCH clinics with a response rate of approximately 71% (the HCH User Visit Survey) was created to examine the health status of its users (n = 1017). This study employed the HCH User Visit Survey's cross-sectional data set to evaluate health indicators of individuals using HCH Services with the US population, and compare individuals who reported they routinely used HCH clinics ('usual' HCH users) to those who did not ('non-usual' users).

Health care for the homeless assesses the use of adapted clinical practice guidelines.

This article describes a process of evaluating and adapting existing clinical practice guidelines (CPGs) for homeless individuals by different healthcare providers in multiple healthcare settings across the country. Data were collected using a standardized evaluation tool in nine sites across the United States. Clinicians completed an evaluation of the CPG after every use.