Bridging Hospital and Community Care for Homeless Adults with Mental Health Needs: Outcomes of a Brief Interdisciplinary Intervention.

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.

The effect of brief case management on emergency department use of frequent users in mental health: Findings of a randomized controlled trial.

Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. The Coordinated Access to Care from Hospital EDs (CATCH-ED) study examined the effectiveness of a brief case management intervention in reducing ED use and improving health outcomes among frequent ED users with mental health or addiction challenges in a large urban centre. Adults (≥18 years of age) who had five or more ED visits in the past 12-months, with at least one visit for mental health or addictions problems were randomized to either brief case management (N = 83) or usual care (N = 83) and followed for 12 months.

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.

Objectives: This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.

Methods: We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.

Brief case management versus usual care for frequent users of emergency departments: the Coordinated Access to Care from Hospital Emergency Departments (CATCH-ED) randomized controlled trial.

Background: Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. This article describes the rationale for a brief case management intervention for frequent ED users with mental health and/or addiction challenges and the design of a randomized trial assessing its effectiveness.

Methods/design: Eligible participants are adults in a large urban centre with five or more ED visits in the past year, with at least one prior visit for a mental health or addictions reason.

Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention.

Background: Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre.

Methods: Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions.

Improving continuity of care for frequent users of emergency departments: service user and provider perspectives.

Objective: This study explored service user and provider perspectives on barriers and facilitators of continuity of care for frequent users of emergency departments (ED) participating in a brief intensive case management intervention.

Method: We conducted semistructured interviews with 20 frequent ED users with mental health and addiction challenges participating in a brief intensive case management intervention, eliciting experiences of care and care continuity. We interviewed 13 service providers working with this population.

The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study.

Background: Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model.

Methods: In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months.

Reimagining the self at late-career transitions: how identity threat influences academic physicians' retirement considerations.

Purpose: There is scant empirical work exploring academic physicians' psychosocial adjustment during late-career transitions or on the factors that influence their retirement decisions. The authors examine these issues through the lens of sociopsychological identity theory, specifically examining how identity threat influences academic physicians' decisions about retirement.

Method: Participants were academic physicians at a Canadian medical school and were recruited via e-mail requests for clinical faculty interested in discussing late-career and retirement planning issues.

Psychotropic medication use in canadian long-term care patients referred for psychogeriatric consultation.

Unlabelled: BACKGROUND AND PUSPOSE: Prior studies have shown a high prevalence of psychotropic medication use among patients residing in long-term care homes (LTCHs). The purpose of this study was to examine psychotropic medication use by LTCH patients in a metropolitan Canadian city referred to outreach teams for psychiatric assessment.

Methods: A retrospective review of charts from specialized psychogeriatric outreach teams serving a large metropolitan city in Canada was undertaken.

Determining the impact of establishing a psychogeriatric outreach team network in long-term care.

Objectives: The primary objective of this study was to describe a model for specialized psychogeriatric consultation to long-term care homes in a large metropolitan Canadian city and to provide an overview of the diagnostic and demographic data of patients referred for assessment.

Methods: Forty long-term care homes and 13 geriatric mental health outreach teams were surveyed and provided feedback on the model. A retrospective chart review (N=88) was also conducted to confirm the survey results and to provide an overview of the types of patients being seen.

Understanding the challenges of integrating scientists and clinical teachers in psychiatry education: findings from an innovative faculty development program.

Objective: Medical schools and departments of psychiatry around the world face challenges in integrating science with clinical teaching. This project was designed to identify attitudes toward the integration of science in clinical teaching and address barriers to collaboration between scientists and clinical teachers.

Methods: The authors explored the interactions of 20 faculty members (10 scientists and 10 clinical teachers) taking part in a 1-year structured faculty development program, based on a partnership model, designed to encourage collaborative interaction between scientists and clinical teachers.

Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak.

Healthcare workers (HCWs) found the 2003 outbreak of severe acute respiratory syndrome (SARS) to be stressful, but the long-term impact is not known. From 13 to 26 months after the SARS outbreak, 769 HCWs at 9 Toronto hospitals that treated SARS patients and 4 Hamilton hospitals that did not treat SARS patients completed a survey of several adverse outcomes. Toronto HCWs reported significantly higher levels of burnout (p = 0.

Social disadvantage, mental illness and predictors of legal involvement.

The following study evaluates the complex association between legal involvement and mental illness. It describes a population of consumers of community mental health programs, comparing those with legal involvement to those without legal involvement, on a number of demographic, clinical and social indicators. It is a secondary analysis of data collected in studies making up the Community Mental Health Evaluation Initiative (CMHEI) in the province of Ontario, Canada.

Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto.

Objectives: A survey was conducted to measure psychological stress in hospital workers and measure factors that may have mediated acute traumatic responses.

Methods: A self-report survey was completed by 1557 healthcare workers at three Toronto hospitals in May and June 2003. Psychological stress was measured with the Impact of Event Scale.

Participant perspectives on satisfaction with assertive community treatment.

This report explores participants' satisfaction with Assertive Community Treatment Programs in Ontario, Canada through a general satisfaction questionnaire that includes three open-ended questions. Open-ended questions are a simple tool for obtaining more detail about areas of satisfaction and dissatisfaction, and responses seem to be less influenced by social desirability than quantitative ratings. Participants particularly used the opportunity of answering open-ended questions to express feelings about their relationships with the team workers.

A population health framework for inner-city mental health.

Dealing with mental health problems in the inner city presents a major challenge to planners and service providers. Traditional mental health service-oriented interventions often prove ineffective due to the complexity of individuals' needs. This article argues that a population health framework can be used to identify critical risk and protective factors and facilitate more effective, upstream, population-based interventions for mental health problems in the inner city.

Characteristics of persons who are homeless for the first time.

The Pathways Into Homelessness project in Toronto interviewed 300 unaccompanied adult users of homeless shelters to identify characteristics of individuals who are homeless for the first time. The sample reflected the total population of homeless shelter users in terms of age, sex, level of use, and type of shelter. Two fifths of the sample were homeless for the first time.

Tertiary mental health services: II. Subpopulations and best practices for service delivery.

Tertiary care subpopulations are characterized by having more than one significant condition, each of which has been traditionally dealt with by different systems of care. They experience severe and persistent mental illness and one or more of the following: age-related physical or medical conditions, substance use disorders, developmental handicaps, and acquired brain injury. This paper provides estimates of prevalence for each of these subgroups and discusses best practices which have developed in response to their special needs.

Tertiary mental health services: I. Key concepts.

There are some individuals with severe and persistent mental illnesses who cannot be managed by primary and secondary services and who require tertiary care. Such clients are characterized by aggressiveness, noncompliance with medication, and dangerousness. Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches.

Process and outcome in a hostel outreach program for homeless clients with severe mental illness.

A longitudinal study followed 55 homeless and severely mentally ill clients of a hostel outreach program to assess outcomes and their relationship to program elements. Results at 18-month follow-up indicated that, despite chronic histories of transiency and shelter use, housing stability had been achieved, and that initial gains in social functioning and symptom reduction had been increased. Development of a strong working alliance proved a key program element in the findings.