Integrating Hospital and Community Care for Homeless People with Unmet Mental Health Needs: Program Rationale, Study Protocol and Sample Description of a Brief Multidisciplinary Case Management Intervention

Abstract

Always cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.This article was made openly accessible by U of T Faculty. Please tell us how this access benefits you. Your story matters. 1 ABSTRACTThe Coordinated Access to Care for Homeless People (CATCH) program is a brief multidisciplinary case management intervention for homeless adults discharged from hospital in Toronto, Canada. Here we describe the rationale for CATCH program development, details of the mixed methods evaluation underway, and the characteristics of 225 CATCH service users.Funded in 2010 by the local health authority, CATCH aimed to improve access, continuity of care, health and service use outcomes for homeless adults discharged from hospital. To assess the feasibility, acceptability and impact of the program, a mixed-methods case study was undertaken in 2013. In total, 225 CATCH program users were enrolled in the study and completed quantitative survey measures at program entry to assess key health and social outcomes using a pre-post cohort study design. Follow-up assessments took place at 3-and 6-months. At study entry, most participants were male (79%), white (65%), Canadian-born (74%), single or never married (60%), and their average age was 39.9 ± 12.0 years. Nearly all participants (88%) had at least one emergency department visit in the past six months, more than half (53%) indicated at least three chronic health conditions, and 44% indicated at least three mental health diagnoses. In addition, qualitative data was collected to evaluate the experiences of continuity of care and challenges during care transitions for this population using in-depth interviews with a sample of CATCH service users (n=22) and managers of partnered organizations (n=7), as well as focus groups with CATCH staff (n=8), other service providers (n=7) and people with lived experience of homelessness (n=8). Improving health and health service use outcomes among homeless adults with chronic health conditions are key priorities in many jurisdictions. Future findings can inform service delivery to homeless adults discharged 2 from hospital, by exposing factors associated with positive program outcomes, as well as barriers and facilitators to continuity of care for this disadvantaged population.

Bridging Hospital and Community Care for Homeless Adults with Mental Health Needs: Outcomes of a Brief Interdisciplinary Intervention

“…The CATCH sample characteristics are summarized in Table 1 and described in detail elsewhere. 29 Briefly, from January 1, 2013, to April 9, 2014, the program received 281 referrals, 240 of whom were eligible for the CATCH study and 225 of whom agreed to participate (94%). Data for 2 participants were removed due to interviewer comments regarding poor reliability of responses.…”

“…The study design and setting have been described in detail elsewhere. 29 Briefly, the study was designed as a mixed-methods case study evaluating the program’s uniqueness and complexity. 30 The current article focuses on participant self-reported quantitative survey data.…”

“…Study outcomes have been previously described in detail. 29 The primary study outcome was the change in participant health status from baseline to 6 months, evaluated by the physical and mental health component scores (PCS and MCS, respectively) of the Short-Form 36 (SF-36) health survey, 33 which has previously been used among homeless adults. 34,35 Secondary study outcomes included mental health symptoms, disease-specific quality of life, substance use, acute service use, and housing, assessed by the following instruments, respectively: hospital, other institution, or other places.…”

Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions

“…This work is a sub‐study within a larger mixed methods evaluation of the CATCH programme investigating health and service use outcomes among 225 programme participants over 6 months of follow‐up (Stergiopoulos et al., ). We chose mixed methods and a realist stance, particularly useful for its strength in linking quantitative measures of programme effectiveness with qualitative inquiry to expose complex social and structural factors (Pawson, Greenhalgh, Harvey, & Walshe, ).…”

“…Informed by earlier research into brief interventions for adults experiencing homelessness, Co‐ordinated Access to Care for Homeless People (CATCH) provides brief (up to 6 months) case management and access to interdisciplinary care for homeless adults discharged from hospital and lacking appropriate health and social supports (Stergiopoulos et al., ). “Homeless” is here defined as living on the street, in a crisis/emergency shelter or couch surfing.…”