IntroductionHousing First is a complex housing and support intervention for homeless individuals with mental health problems. It has a sufficient knowledge base and interest to warrant a test of wide-scale implementation in various settings. This protocol describes the quantitative design of a Canadian five city, $110 million demonstration project and provides the rationale for key scientific decisions.MethodsA pragmatic, mixed methods, multi-site field trial of the effectiveness of Housing First in Vancouver, Winnipeg, Toronto, Montreal and Moncton, is randomising approximately 2500 participants, stratified by high and moderate need levels, into intervention and treatment as usual groups. Quantitative outcome measures are being collected over a 2-year period and a qualitative process evaluation is being completed. Primary outcomes are housing stability, social functioning and, for the economic analyses, quality of life. Hierarchical linear modelling is the primary data analytic strategy.Ethics and disseminationResearch ethics board approval has been obtained from 11 institutions and a safety and adverse events committee is in place. The results of the multi-site analyses of outcomes at 12 months and 2 years will be reported in a series of core scientific journal papers. Extensive knowledge exchange activities with non-academic audiences will occur throughout the duration of the project.Trial registration numberThis study has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374.

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Maternal-newborn bonding is the complex process of attachment between a mother and newborn. The authors used the Walker and Avant methodology to conduct a concept analysis regarding maternalnewborn bonding as it relates to advanced practice nurse (APN), the patient, and health care. The attributes of maternal-newborn bonding include affection, association, attachment, and relationship. The consequences of maternal-newborn bonding include love, trust, protection, and maternal-child relationship. The APN must be able to recognize and understand the importance of maternal-newborn bonding to have anoptimal outcome for the patient. A model case, borderline case, and contrary case were discussed to provide an example of the maternal-newborn bonding concept. Discussion regarding empirical referents is also included. Maternal-Newborn Bonding Concept Analysis Publication History:Received: January 27, 2017 Accepted: April 04, 2017 Published: April 06, 2017 Keywords:Love, Maternal-newborn bond, Protection, Relationship, Trust Concept AnalysisOpen Access Description of ConceptMaternal-newborn bonding is a concept used throughout the obstetrical and pediatric fields, but not widely known amongst all clinicians. The connection made after birth directly affects both the mother and newborn physiologically, psychologically and emotionally. A strong bond formed between a mother and infant leads to positive outcomes and impacts the maternal child relationship through the lifespan. "The parent-infant bond provides a foundation for future adaptation, relationships, and mental health for children and adults" (p. 246) [1]. Difficulty forming a bond could lead to detrimental problems for the mother, child, society and the healthcare system.The maternal-newborn bond directly influences the healthcare system in a variety of ways. The initial bond that occurs between the mother and child after delivery can play a fundamental role in many physiological and psychological aspects. Physiological or psychological instability could potentially lead to a prolonged length of stay, a higher level of care and increased medical costs. A positive bond leads to a positive home life and good health. Good health could be directly related the mother providing basic needs and medical care for the child. As a result, the children have improved health, a decreased number of medical visits and decreased medical care costs throughout the lifespan. Inversely, a study described a situation of impaired maternal-newborn attachment, a bonding disorder can occur [2]. The impaired bond could lead to a decline in basic needs of the child being met and decrease in necessary medical care needed for healthy growth and development.The concept of maternal-newborn bonding also directly influences advanced practice nurses (APN). Understanding the concept can give the APN an inside view of the relationship that the mother and child have whether positive or negative. A positive maternal-newborn bond detected by the APN provides assurance that needs of the newborn are ...

L’article décrit les contextes entourant les politiques qui soutiennent l’application du modèle d’intervention qui accorde la priorité au logement (Housing First) pour les personnes itinérantes présentant des troubles mentaux au Canada et en France. Le modèle consiste en une modalité d’intervention complexe qui élargit le concept de traitement en santé mentale pour y inclure la notion de logement. La démarche, axée sur le rétablissement, place le choix de l’usager quant au logement et aux services de soutien au centre de la philosophie de la prestation de soins. L’article décrit deux essais multicentriques liés à l’intervention qui se déroulent dans deux pays et précise en quoi ils se ressemblent ou diffèrent, compte tenu des particularités culturelles et sociales. Les essais pragmatiques portant sur des modalités d’intervention complexes représentent des défis et ont un pouvoir d’influence unique. C’est ce dont tiennent compte les deux études.This paper describes the policy environments supporting housing first as an intervention for those who are homeless and mentally ill in Canada and in France. Housing first is a complex intervention that expands mental health treatment to include a focus upon housing.  A recovery orientation places the consumer’s choice of housing and supports at the center of the philosophy of care. The design of two, large multi-site intervention trials underway in both countries are described, noting similarities and differences related to the cultural and social context. Pragmatic trials of complex interventions have unique challenges and potential for influence, which both studies are addressing

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