Additional file 3: of Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre

Appendix W_Guide_Key Informant Interview Guide. (DOC 47 kb

The Impact of a 24 Month Housing First Intervention on Participants’ Body Mass Index and Waist Circumference: Results from the At Home / Chez Soi Toronto Site Randomized Controlled Trial

<div><p>Research suggests that individuals experiencing homelessness have high rates of overweight and obesity. Unhealthy weights and homelessness are both associated with increased risk of poor health and mortality. Using longitudinal data from 575 participants at the Toronto site of the At Home/Chez Soi randomized controlled trial, we investigate the impact of receiving a Housing First intervention on the Body Mass Index (BMI) and waist circumference of participants with moderate and high needs for mental health support services. The ANCOVA results indicate that the intervention resulted in no significant change in BMI or waist circumference from baseline to 24 months. The findings suggest a need for a better understanding of factors contributing to overweight, obesity, and high waist circumference in populations who have histories of housing precarity and experience low-income in tandem with other concerns such as mental illness and addictions.</p><p>Trial Registration</p><p>International Standard Randomized Control Trial Number Register <a href="http://www.isrctn.com/ISRCTN42520374" target="_blank">ISRCTN42520374</a></p></div

CONSORT Diagram.

<p>This figure displays the random assignment of participants to intervention and control groups based on need level and indicates the number of individuals who had data for inclusion in this particular study.</p

Baseline Characteristics of Toronto At Home/Chez Soi Participants (N = 561) stratified by Need Level.

<p>Baseline Characteristics of Toronto At Home/Chez Soi Participants (N = 561) stratified by Need Level.</p

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

<div><p>Objectives</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.</p><p>Conclusion</p><p>Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.</p></div

ANCOVA Results for Changes in Body Mass Index (BMI) and Waist Circumference from Baseline to 24 Months.

<p>*For BMI model, BMI at Baseline was used as a predictor whereas for the Waist Circumference models the Waist circumference at baseline was used</p><p>ANCOVA Results for Changes in Body Mass Index (BMI) and Waist Circumference from Baseline to 24 Months.</p

Changes in Overweight/Obesity status from Baseline to 24 Months.

<p>BMI was dichotomized into two categories: obese and overweight (BMI > 24.9) and not obese or overweight (BMI < = 24.9). BMI was calculated as weight in kilograms divided by height in meters squared (weight (kg)/height (m2)).</p><p>Changes in Overweight/Obesity status from Baseline to 24 Months.</p

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

<div><p>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. The primary outcome of effectiveness was the frequency of ED visits during 12 months after study enrolment. Secondary outcomes included days in hospital, mental health and addiction symptom severity and health-related quality of life, measured by the SF-12. Compared to usual care, CATCH-ED participants saw a 14% reduction in frequency of ED visits during the 12-month post-randomization period [rate ratio (RR) = 0.86, 95% CI 0.64–1.15)], however, this finding did not reach statistical significance. There were also no statistically significant differences between the groups at 12 months in the number of days spent in hospital (RR = 1.16, 95% CI 0.59–2.29), physical (1.50, 95% CI -2.15–5.15) or mental (-3.97, 95% CI -8.13–0.19) component scores of the SF-12, severity of psychiatric symptoms (-0.41, 95% CI -2.30–1.49), alcohol (0.053 95% -0.017–0.12) or drug (-0.0027, 95% CI -0.0028–0.023) use. Compared to usual care, a brief case management intervention did not result in significantly reduced ED use or improved health outcomes among frequent ED users with mental health or addictions challenges in a large urban centre in Canada. Future studies need to evaluate the availability and accessibility of community-based resources for individuals with frequent ED use.</p></div

Study outcomes at baseline and 12 months, intent-to-treat analysis.

<p>Study outcomes at baseline and 12 months, intent-to-treat analysis.</p

Additional file 1: Table S1. of The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial

Estimated outcome values at each study visit, by treatment group. (DOCX 13.9 kb