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Handley M, Wheeler C, Duddy C, Wong G, Birt L, Fox C, Moniz-Cook E, Hackmann C, Teague B, West J. Operationalising the Recovery College model with people living with dementia: a realist review. Aging Ment Health 2024; 28:1078-1089. [PMID: 38850259 PMCID: PMC11262432 DOI: 10.1080/13607863.2024.2356878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/13/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES Post-diagnostic support is a significant factor in facilitating personal recovery following a diagnosis of dementia, but access is often inconsistent and insufficient. Recovery Colleges offer peer-led, co-produced courses that can support people to have meaningful lives and have been adapted for use in the context of dementia. A realist review was conducted to understand the application and sustainability of Recovery College dementia courses. METHOD An iterative, five-step process combined literature published to 2023 with knowledge from stakeholders with lived and professional experience of dementia involved with Recovery College dementia courses (PROSPERO registration CRD42021293687). RESULTS Thirty-five documents and discussions with 19 stakeholders were used to build the initial programme theory comprising of 24 context-mechanism-outcome configurations. Reoccurring factors included: attending to aspects of co-production and course delivery to ensure they promoted inclusion and were not compromised by organisational pressures; how stigma impacted access to course opportunities; and embedding personal recovery principles throughout course development to be relevant for people living with dementia and those who support them. CONCLUSION People struggling to reconcile their future alongside dementia need practical and emotional support to access and benefit from Recovery College dementia courses, ways to achieve this will be explored through a realist evaluation.
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Affiliation(s)
- Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Charlotte Wheeler
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Linda Birt
- School of Health Science University of East Anglia, Norwich, UK
- School of Healthcare, University of Leicester, Leicester, UK
| | - Chris Fox
- Medical School, University of Exeter, Exeter, UK
| | | | - Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Norwich Medical School, The University of East Anglia, Norwich, UK
| | - Bonnie Teague
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Norwich Medical School, The University of East Anglia, Norwich, UK
| | - Juniper West
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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Doroud N, King A, Zirnsak TM, Brasier C, Hall T, Jordan H, Brophy L. Creating "an oasis of hope, inclusion and connection": students and stakeholders' experiences of a pilot Recovery College. J Ment Health 2024; 33:92-100. [PMID: 37641410 DOI: 10.1080/09638237.2023.2245881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Recovery Colleges are an innovative approach to promoting personal recovery for people experiencing mental illness. AIMS This study was to explore experiences of students, supporters, staff, educators and external stakeholders (i.e. partner organisations) of a pilot Recovery College in the Australian Capital Territory (ACTRC), and the impact of participation in the College for students and supporters. METHODS ACTRC students, supporters, staff and educators, and external stakeholders were invited to participate in a mixed-method evaluation via an online survey, interviews and/or focus groups. The survey included questions regarding experiences and recovery-orientation of the College environment, and for students and supporters only, satisfaction with the College. Qualitative data from interviews and focus groups was inductively coded, thematically analysed and triangulated with survey responses. RESULTS The findings suggest that the ACTRC provides a safe space, promotes meaningful connections within and beyond the college, and offers steppingstones supporting recovery and growth. Participants spoke positively about cross institutional partnerships and collaboration with several organisations within the ACT. CONCLUSIONS This evaluation reiterates the role of Recovery Colleges as an innovative approach to promoting personal recovery for people living with mental illness. Adequate resourcing and collaboration are essential in realising the value of co-production whilst ensuring sustainability.
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Affiliation(s)
- Nastaran Doroud
- Department of Nursing and Allied Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Alicia King
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tessa-May Zirnsak
- Department of Community and Clinical Health, La Trobe University, Melbourne, VIC, Australia
| | - Catherine Brasier
- Department of Community and Clinical Health, La Trobe University, Melbourne, VIC, Australia
| | - Teresa Hall
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Helen Jordan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Lisa Brophy
- Department of Community and Clinical Health, La Trobe University, Melbourne, VIC, Australia
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Hayes D, Hunter-Brown H, Camacho E, McPhilbin M, Elliott RA, Ronaldson A, Bakolis I, Repper J, Meddings S, Stergiopoulos V, Brophy L, Miyamoto Y, Castelein S, Klevan TG, Elton D, Grant-Rowles J, Kotera Y, Henderson C, Slade M. Organisational and student characteristics, fidelity, funding models, and unit costs of recovery colleges in 28 countries: a cross-sectional survey. Lancet Psychiatry 2023; 10:768-779. [PMID: 37739003 DOI: 10.1016/s2215-0366(23)00229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Recovery colleges were developed in England to support the recovery of individuals who have mental health symptoms or mental illness. They have been founded in many countries but there has been little international research on recovery colleges and no studies investigating their staffing, fidelity, or costs. We aimed to characterise recovery colleges internationally, to understand organisational and student characteristics, fidelity, and budget. METHODS In this cross-sectional study, we identified all countries in which recovery colleges exist. We repeated a cross-sectional survey done in England for recovery colleges in 28 countries. In both surveys, recovery colleges were defined as services that supported personal recovery, that were coproduced with students and staff, and where students learned collaboratively with trainers. Recovery college managers completed the survey. The survey included questions about organisational and student characteristics, fidelity to the RECOLLECT Fidelity Measure, funding models, and unit costs. Recovery colleges were grouped by country and continent and presented descriptively. We used regression models to explore continental differences in fidelity, using England as the reference group. FINDINGS We identified 221 recovery colleges operating across 28 countries, in five continents. Overall, 174 (79%) of 221 recovery colleges participated. Most recovery colleges scored highly on fidelity. Overall scores for fidelity (β=-2·88, 95% CI 4·44 to -1·32; p=0·0001), coproduction (odds ratio [OR] 0·10, 95% CI 0·03 to 0·33; p<0·0001), and being tailored to the student (OR 0·10, 0·02 to 0·39; p=0·0010), were lower for recovery colleges in Asia than in England. No other significant differences were identified between recovery colleges in England, and those in other continents where recovery colleges were present. 133 recovery colleges provided data on annual budgets, which ranged from €0 to €2 550 000, varying extensively within and between continents. From included data, all annual budgets reported by the college added up to €30 million, providing 19 864 courses for 55 161 students. INTERPRETATION Recovery colleges exist in many countries. There is an international consensus on key operating principles, especially equality and a commitment to recovery, and most recovery colleges achieve moderate to high fidelity to the original model, irrespective of the income band of their country. Cultural differences need to be considered in assessing coproduction and approaches to individualising support. FUNDING National Institute for Health and Care Research.
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Affiliation(s)
- Daniel Hayes
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK; Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Holly Hunter-Brown
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Elizabeth Camacho
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Merly McPhilbin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Rachel A Elliott
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Amy Ronaldson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sara Meddings
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Melbourne School of Public and Global Health, University of Melbourne, VIC, Australia
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, wGraduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Stynke Castelein
- Lentis Psychiatric Institute, Lentis Research, Groningen, Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Trude Gøril Klevan
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
| | - Dan Elton
- RECOLLECT Lived Experience Advisory Panel, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Jason Grant-Rowles
- RECOLLECT Lived Experience Advisory Panel, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Claire Henderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK; Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
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Briand C, Hakin R, Macario de Medeiros J, Luconi F, Vachon B, Drolet MJ, Boivin A, Vallée C, Montminy S. Learner Experience of an Online Co-Learning Model to Support Mental Health during the COVID-19 Pandemic: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2498. [PMID: 36767864 PMCID: PMC9915127 DOI: 10.3390/ijerph20032498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has had a negative impact on the mental health of the population such as increased levels of anxiety, psychological distress, isolation, etc. Access to mental health services has been limited due to the "overflow" of demands. The Recovery College (RC) model, an education-based approach, has addressed this challenge and provided online well-being and mental health courses to at-risk populations. The RC model proposes a co-learning space in an adult education program where learners from diverse backgrounds collectively learn and empower themselves to better address psychological well-being and mental health issues. The aim of this study was to document the experience of learners who participated in online RC courses during the COVID-19 pandemic and the perceived impact of these courses on their mental health. A qualitative interpretative descriptive study design was employed, and Miles and Huberman's stepwise content analysis method was used to mine the data for themes. Fourteen structured online interviews were conducted with a sample representative of the diversity of learners. Five categories of themes emerged: (1) updating and validating your mental health knowledge, (2) taking care of yourself and your mental health, (3) improving and modifying your behaviors and practices, (4) changing how you look at yourself and others, and (5) interacting and connecting with others. Results suggest that online RC courses can be an effective strategy for supporting individual self-regulation and empowerment, breaking social isolation, and reducing the effects of stress in times of social confinement measures and limited access to care.
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Affiliation(s)
- Catherine Briand
- Research Center, Montreal University Institute of Mental Health, Montreal, QC H1N 3M5, Canada
- Department of Occupational Therapy, University of Quebec at Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada
| | - Regis Hakin
- Research Center, Montreal University Institute of Mental Health, Montreal, QC H1N 3M5, Canada
| | | | - Francesca Luconi
- Office for Continuing Professional Development, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada
| | - Brigitte Vachon
- Research Center, Montreal University Institute of Mental Health, Montreal, QC H1N 3M5, Canada
- School of Rehabilitation, Faculty of Medecine, University of Montreal, Montreal, QC H3N 1X7, Canada
| | - Marie-Josée Drolet
- Department of Occupational Therapy, University of Quebec at Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada
| | - Antoine Boivin
- Department of Family Medicine, Research Centre of University of Montreal Hospital Center, Montreal, QC H2X 0A9, Canada
| | - Catherine Vallée
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
- VITAM Research Centre on Sustainable Health, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Sarah Montminy
- Research Center, Montreal University Institute of Mental Health, Montreal, QC H1N 3M5, Canada
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van Everdingen C, Peerenboom PB, van der Velden K, Delespaul P. Vital Needs of Dutch Homeless Service Users: Responsiveness of Local Services in the Light of Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2546. [PMID: 36767905 PMCID: PMC9915996 DOI: 10.3390/ijerph20032546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Healthcare and social services aim to ensure health equity for all users. Despite ongoing efforts, marginalized populations remain underserved. The Dutch HOP-TR study intends to expand knowledge on how to enable the recovery of homeless service users. METHODS A naturalistic meta-snowball sampling resulted in a representative sample of homeless services (N = 16) and users (N = 436). Interviews collected health and needs from user and professional perspectives in a comprehensive, rights-based ecosystem strategy. We calculated the responsiveness to needs in four domains (mental health, physical health, paid work, and administration). RESULTS Most service users were males (81%) with a migration background (52%). In addition to physical (78%) and mental health needs (95%), the low education level (89%) and functional illiteracy (57%) resulted in needs related to paid work and administration support. Most had vital needs in three or four domains (77%). The availability of matching care was extremely low. For users with needs in two domains, met needs ranged from 0.6-13.1%. Combined needs (>2 domains) were hardly met. CONCLUSIONS Previous research demonstrated the interdependent character of health needs. This paper uncovers some causes of health inequity. The systematic failure of local services to meet integrating care needs demonstrates the urgency to expand recovery-oriented implementation strategies with health equity in mind.
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Affiliation(s)
- Coline van Everdingen
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Van Everdingen Health Care Consultancy, 6132 TP Sittard, The Netherlands
| | | | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Mondriaan Mental Health Trust, 6401 CX Heerlen, The Netherlands
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Reid N, Buchman D, Brown R, Pedersen C, Kozloff N, Stergiopoulos V. The acceptability of financial incentives to support service engagement of adults experiencing homelessness and mental illness: a qualitative study of key stakeholder perspectives Authorship. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1060-1071. [PMID: 36071341 DOI: 10.1007/s10488-022-01217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Evidence suggests financial incentives may effectively support service engagement among people experiencing homelessness, but literature related to their acceptability in this population is limited. This study used qualitative methods to explore stakeholder perspectives on the acceptability of using financial incentives to promote service engagement among homeless adults with mental illness. METHODS As part of a larger mixed-methods pragmatic trial of a community-based brief case management program in Toronto, Canada, twenty-two trial participants were purposefully recruited to participate in semi-structured qualitative interviews, and five service providers and seven key informants were purposefully recruited to participate in a focus group and interviews, respectively. Topics included perspectives of acceptability and lived experiences of using financial incentives to support engagement, health and well-being. Data collection occurred between April 2019 and December 2020. Data was audio-recorded and transcribed. Coding and interpretation of data was informed by grounded theory and inductive thematic analysis. RESULTS Stakeholders held diverse views on the acceptability of financial incentives to promote service engagement in this population. Main themes across groups included moralizing recipient motivation; tensions in how best to define and respect autonomy; and consideration of potential unintended consequences for both individuals and the service system. Significant group differences within some themes emerged. CONCLUSION Results highlight ongoing debates over using financial incentives to facilitate service engagement among adults experiencing homelessness and mental illness. Differences in stakeholder perspectives suggest the need for person-centredness in health and research settings, and balancing theoretical risks and long-term goals with likely potential for immediate benefits.
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Affiliation(s)
- Nadine Reid
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada
| | - Daniel Buchman
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7, Toronto, ON, Canada
- Joint Centre for Bioethics, University of Toronto, 155 College St, M5T 1P8, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, 60 Leonard Ave, M5T 0S8, Toronto, ON, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada.
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7
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Reid N, Brown R, Pedersen C, Kozloff N, Sosnowski A, Stergiopoulos V. Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives. Health Expect 2022; 25:984-993. [PMID: 35104030 PMCID: PMC9122468 DOI: 10.1111/hex.13442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Homelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but studies investigating key stakeholder perspectives are lacking. This study aimed to elicit, using qualitative methods, nuanced service user and provider experiences by using financial incentives to support service engagement among adults experiencing homelessness and mental illness. Methods This qualitative study is part of a larger mixed‐methods pragmatic trial of financial incentives (Coordinated Access to Care for the Homeless—Financial Incentives [CATCH‐FI]) within a community‐based brief case management programme (CATCH) in Toronto, Ontario. Twenty‐two CATCH‐FI participants were purposefully recruited to participate in in‐depth, semi‐structured interviews; five CATCH service providers participated in a focus group and seven key informants in individual interviews. Data collection occurred between April 2019 and December 2020. All interviews and the focus group were audio‐recorded and transcribed. Topic guides prompted participant perspectives on and experiences of using financial incentives to support engagement, health and well‐being. Grounded theory and inductive thematic analysis guided coding and interpretation of transcripts. Triangulation and member‐checking enhanced the analytical rigour and validity of findings. Results CATCH service providers, key informants and subgroup of CATCH‐FI participants perceived financial incentives to directly facilitate service engagement. The majority of CATCH‐FI participants however highlighted that intrinsic motivation and service quality may be relatively more important facilitators of engagement. Most study participants across stakeholder groups perceived that financial incentives have direct positive influences on health and well‐being in enabling access to basic needs and simple pleasures. Conclusions Our data suggest that for some adults experiencing homelessness and mental illness, financial incentives can directly support service engagement. In addition, financial incentives may positively impact health and well‐being by easing financial stress and enabling deeper attention to individual health needs. Further research on the effectiveness and acceptability of financial incentives is needed to improve understanding and uptake of a promising intervention to support health and health service use outcomes in an underserved population. Patient or Public Contribution Study participants provided input into the study research questions, study design, interview guides and interpretation of findings.
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Affiliation(s)
- Nadine Reid
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Child, Youth and Emerging Adult Program, Centre of Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexandra Sosnowski
- Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Strong S, Letts L. Personal narratives of learning self-management: Lessons for practice based on experiences of people with serious mental illness. Aust Occup Ther J 2021; 68:395-406. [PMID: 34160086 DOI: 10.1111/1440-1630.12748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinicians are challenged to deliver self-management interventions in recovery-oriented services for individuals living with serious mental illnesses. Little is known about how people learn self-management skills and questions remain about how best to deliver support. To offer insights for delivery, this research describes the lived experiences of learning self-management and the meaning of those experiences within recovery journeys and the context of health-care delivery. METHODS Design followed van Manen's approach of phenomenology through an occupational therapist's lens. Using purposeful criterion sampling until saturation, 25 adults with psychosis experiences (8-40 years) from six community-based specialised mental health programs were interviewed. Conceptual maps were cocreated depicting key learning experiences, intersections with services, and recommendations. Data reduction, reconstruction and explication of meaning occurred concurrently, and multiple strategies were used to transparently support an open, iterative, reflexive process. FINDINGS Participants described eight essential tasks to live well, learned often serendipitously, taking up to 15-30 years to find the right combination of supports and self-management strategies to achieve what they felt was a life of quality. Self-management needs were not routinely addressed by services and extended beyond illness or crisis management while participants grappled with emotions, self-concept, relationships, and occupational issues. Participants asked providers to "teach us to teach ourselves"; "invite clients" to the decision table; and deal directly with emotions of fear, shame, and trust with respect to self and relationships. Findings challenge conventional conceptualisations of self-management to consider clients living interdependent lives with tasks performed in context, dynamically influenced by complex personal, socio-ecological relationships. CONCLUSIONS Participants' narratives compel increasing access to strategic personalised self-management learning opportunities as an effort to shorten the prolonged recovery paths. Findings offer ways providers can understand and address eight self-management learning tasks from the perspective of lived experiences. Self-management was enmeshed with recovery, health, and building a life.
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Affiliation(s)
- Susan Strong
- St. Joseph's Healthcare Hamilton, Ontario, Canada.,McMaster University, Ontario, Canada
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Durbin A, Nisenbaum R, Wang R, Hwang SW, Kozloff N, Stergiopoulos V. Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation. Front Psychiatry 2021; 12:763396. [PMID: 34880792 PMCID: PMC8645597 DOI: 10.3389/fpsyt.2021.763396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Grounded in principles of adult education, Recovery Education Centres (RECs) hold promise in promoting recovery for adults with mental health challenges, but research on recovery outcomes for hard-to-reach populations participating in RECs is scant. This quasi-experimental study compares 12-month recovery outcomes of adults with histories of homelessness and mental health challenges enrolled in a REC, to those of participants of other community services for this population. Methods: This pre-post quasi-experimental study compared participants enrolled in a REC for people with histories of homelessness and mental health challenges (n = 92) to an age-and-gender frequency matched control group participating in usual services (n = 92) for this population in Toronto, Ontario. Changes from program enrollment to 12 months in personal empowerment (primary outcome), disease specific quality of life, recovery, health status, health related quality of life, and mastery were assessed. Post-hoc analyses compared subgroups with 1-13 h (n = 37) and 14+ h (n = 37) of REC participation during the study period to the control group. Linear mixed models estimated mean changes and differences in mean changes and 95% confidence intervals. Results: Mean change in perceived empowerment from program enrollment to 12 months in the intervention group [0.10 (95% CI: 0.04, 0.15)] was not significantly different from the control group [0.05 (-0.01, 0.11)], mean difference, 0.05 [(-0.03, 0.13), P = 0.25]. In the post-hoc analysis, the mean change in perceived empowerment for the intervention subgroup with 14+ h of REC participation [0.18 (0.10, 0.26)] was significantly different than in the control group [0.05 (-0.01, 0.11)] mean difference, 0.13 [(0.03, 0.23), P < 0.01]. Mean change in mastery was also significantly different for the intervention subgroup with 14+ h of REC participation [2.03 (1.04, 3.02)] vs. controls [0.60 (-0.15, 1.35)], mean difference, 1.43 [(0.19, 2.66), P = 0.02]. There were no significant differences in other outcomes. Conclusion: With sufficient hours of participation, recovery education may be a helpful adjunct to health and social services for adults with mental health challenges transitioning from homelessness.
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Affiliation(s)
- Anna Durbin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluatives Sciences, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluatives Sciences, Toronto, ON, Canada.,Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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Khan BM, Reid N, Brown R, Kozloff N, Stergiopoulos V. Engaging Adults Experiencing Homelessness in Recovery Education: A Qualitative Analysis of Individual and Program Level Enabling Factors. Front Psychiatry 2020; 11:779. [PMID: 32848944 PMCID: PMC7424067 DOI: 10.3389/fpsyt.2020.00779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/22/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Recovery Education Centres (REC) in mental health offer a new model of providing recovery supports through emancipatory adult education and recovery-oriented service principles. Despite the widespread adoption of RECs, there is limited evidence regarding factors enabling engagement and participation, particularly for unique subpopulations or service delivery contexts. The Supporting Transitions and Recovery Learning Centre (STAR) in Toronto, Ontario is the first REC in Canada and one of few worldwide supporting adults transitioning out of homelessness. This research aimed to investigate individual and program level enablers of engagement and participation in a REC for this population. METHODS Qualitative methods were used to explore the experiences of 20 service user participants through semi-structured interviews exploring their experiences of REC participation and perceived key program features. Interviews were conducted between July 2017 and June 2018, six to 14 months following REC enrollment, and analyzed using inductive thematic analysis. RESULTS In contrast to past experiences with health and social services, participants described a welcoming and respectful physical and interpersonal environment with low-barrier seamless access facilitating their engagement and participation. Although the realities of homelessness presented barriers for some, participants described that the involvement of peers, as role models, and the self-directed, strengths, and skills-based curriculum, co-produced and co-delivered by peers and professionals, were instrumental in activating the process of recovery through education. CONCLUSIONS/IMPLICATIONS Findings are consistent with the growing evidence base of the defining features of RECs and suggest this model can be successfully extended to support recovery among adults transitioning out of homelessness. This unique examination of Canada's first REC for adults exiting homelessness can help guide program and policy development to better support this disadvantaged population.
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Affiliation(s)
- Bushra M Khan
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nadine Reid
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rebecca Brown
- Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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