Ending homelessness among people with mental illness: the At Home/Chez Soi randomized trial of a Housing First intervention in Toronto
Ending homelessness among people with mental illness: the At Home/Chez Soi randomized trial of a Housing First intervention in Toronto
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DOI：
10.1186/1471-2458-12-787
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发表时间：
2012-09-14
影响因子：
4.5
通讯作者：
Gozdzik, Agnes
中科院分区：
文献类型：
--
作者：
Hwang, Stephen W.;Stergiopoulos, Vicky;Gozdzik, Agnes
背景：At Home/Chez Soi (AH/CS) 项目是一项住房第一干预措施的随机对照试验，旨在满足加拿大五个城市患有精神疾病的无家可归者的需求。本文的目的是检查 AH/CS 项目多伦多站点的参与者招募和社区参与方法，并描述多伦多参与者的基线人口统计数据。 方法：通过多伦多市的服务提供商招募对心理健康支持有高需求 (n = 197) 或中度需求 (n = 378) 的无家可归者 (n = 575)。参与者被随机分为住房优先干预组或照常治疗组（对照组）。住房第一干预措施在两个不同的心理健康服务提供水平上提供：针对高需求参与者的自信社区治疗和针对中等需求参与者的强化病例管理。人口统计数据是通过基线访谈中的定量问卷收集的。结果：招聘策略的有效性受到精心设计的推荐系统、针对特定群体的有针对性的招聘以及广泛的现有服务网络的影响。社区成员、潜在参与者、服务提供商和其他利益相关者通过积极的外展和信息会议进行了参与。通过团队建设战略解决了与不同部门合作需要相关的挑战。随机化在高需求组和中度需求组的干预组和对照组中产生了相似的人口统计学、心理健康、认知和功能障碍特征。大多数参与者是男性（69%）、年龄>40岁（53%）、单身/从未结婚（69%）、没有受抚养子女（71%）、出生在加拿大（54%）和非白人（64%）。许多参与者患有物质依赖（38%）、精神障碍（37%）、重度抑郁发作（36%）、酒精依赖（29%）、创伤后应激障碍（PTSD）（23%）和具有精神病特征的情绪障碍（21%）。超过三分之二的参与者 (65%) 表示有一定程度的自杀倾向。结论：AH/CS 项目多伦多站点的招募产生了反映目标人群不同人口统计特征的参与者样本。这项研究将为如何最好地解决加拿大无家可归和精神疾病问题提供急需的数据。
Background: The At Home/Chez Soi (AH/CS) Project is a randomized controlled trial of a Housing First intervention to meet the needs of homeless individuals with mental illness in five cities across Canada. The objectives of this paper are to examine the approach to participant recruitment and community engagement at the Toronto site of the AH/CS Project, and to describe the baseline demographics of participants in Toronto.Methods: Homeless individuals (n = 575) with either high needs (n = 197) or moderate needs (n = 378) for mental health support were recruited through service providers in the city of Toronto. Participants were randomized to Housing First interventions or Treatment as Usual (control) groups. Housing First interventions were offered at two different mental health service delivery levels: Assertive Community Treatment for high needs participants and Intensive Case Management for moderate needs participants. Demographic data were collected via quantitative questionnaires at baseline interviews.Results: The effectiveness of the recruitment strategy was influenced by a carefully designed referral system, targeted recruitment of specific groups, and an extensive network of pre-existing services. Community members, potential participants, service providers, and other stakeholders were engaged through active outreach and information sessions. Challenges related to the need for different sectors to work together were resolved through team building strategies. Randomization produced similar demographic, mental health, cognitive and functional impairment characteristics in the intervention and control groups for both the high needs and moderate needs groups. The majority of participants were male (69%), aged >40 years (53%), single/never married (69%), without dependent children (71%), born in Canada (54%), and non-white (64%). Many participants had substance dependence (38%), psychotic disorder (37%), major depressive episode (36%), alcohol dependence (29%), post-traumatic stress disorder (PTSD) (23%), and mood disorder with psychotic features (21%). More than two-thirds of the participants (65%) indicated some level of suicidality.Conclusions: Recruitment at the Toronto site of AH/CS project produced a sample of participants that reflects the diverse demographics of the target population. This study will provide much needed data on how to best address the issue of homelessness and mental illness in Canada.