Evaluating the Impact of a Critical Time Intervention Adaptation on Health Care Utilization among Homeless Adults with Mental Health Needs in a Large Urban Center

Abstract

Objective: This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. Methods: Provincial population-based administrative data from Ontario, Canada, were used in a pre–post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. Results: Pre–post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. Conclusions: An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.

Identifying the Psychometric Properties of the Malay Version of the WHOQOL-BREF among Employees with Obesity Problem

“…The study found four domains of the WHOQOL that were consistent with previous research on the WHOQOL-BREF [ 77 , 78 , 79 ]. Although some earlier research indicated that, in some cases, the factor extraction of the WHOQOL-BREF could be a one-factor solution [ 80 , 81 ], the four-factor solution was deemed necessary for a better model fit, as the former has disadvantages in terms of inter-item correlations [ 82 , 83 ].…”

The Impact of Financial Incentives on Service Engagement Among Adults Experiencing Homelessness and Mental Illness: A Pragmatic Trial Protocol

“…Briefly, CATCH aims to support individuals in the critical period following hospital discharge by providing coordinated physical and mental medical care, peer support and intensive case management over a period of 3–6 months. Previous program evaluations have associated CATCH with improvements in mental health and substance use symptoms and health status ( 11 ), fewer and shorter hospitalizations, more frequent outpatient psychiatrist visits ( 46 ), and continuity of care ( 45 ).…”

“…The Coordinated Access to Care for the Homeless (CATCH) program is a multidisciplinary brief case management program for individuals experiencing homelessness and mental illness being discharged from hospital in Toronto, Canada. Informed by the Critical Time Intervention model, the program was launched in 2010 and has been described extensively elsewhere (11,12,(45)(46)(47)(48). Briefly, CATCH aims to support individuals in the critical period following hospital discharge by providing coordinated physical and mental medical care, peer support and intensive case management over a period of 3-6 months.…”

“…Qualitative study participants were purposefully selected to reflect a diversity of perspectives based on gender, ethnicity, study arm, and service engagement. Study staff invited individuals with the ability to reflect on their experiences, a strategy that has previously been used with success by our team in studies of adults experiencing homelessness and mental illness (11,12,(45)(46)(47)(48).…”

“…The PI and study team bring extensive experience in the design, implementation, and evaluation of interventions for the target population (11,12,(45)(46)(47)(48), providing a reliable foundation for early identification and prompt response to potential emergent challenges.…”