Jimmy Bourque

Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness A Randomized Trial

IMPORTANCE Scattered-site housing with Intensive Case Management (ICM) may be an appropriate and less-costly option for homeless adults with mental illness who do not require the treatment intensity of Assertive Community Treatment. OBJECTIVE To examine the effect of scattered-site housing with ICM services on housing stability and generic quality of life among homeless adults with mental illness and moderate support needs for mental health services. DESIGN, SETTING, AND PARTICIPANTS The At Home/Chez Soi project was an unblinded, randomized trial. From October 2009 to July 2011, participants (N = 1198) were recruited in 4 Canadian cities (Vancouver, Winnipeg, Toronto, and Montreal), randomized to the intervention group (n = 689) or usual care group (n = 509), and followed up for 24 months. INTERVENTIONS The intervention consisted of scattered-site housing (using rent supplements) and off-site ICM services. The usual care group had access to existing housing and support services in their communities. MAIN OUTCOMES AND MEASURES The primary outcome was the percentage of days stably housed during the 24-month period following randomization. The secondary outcome was generic quality of life, assessed by a EuroQoL 5 Dimensions (EQ-5D) health questionnaire. RESULTS During the 24 months after randomization, the adjusted percentage of days stably housed was higher among the intervention group than the usual care group, although adjusted mean differences varied across sites. [table: see text] The mean change in EQ-5D score from baseline to 24 months among the intervention group was not statistically different from the usual care group (60.5 [95%CI, 58.6 to 62.5] at baseline and 67.2 [95%CI, 65.2 to 69.1] at 24 months for the intervention group vs 62.1 [95% CI, 59.9 to 64.4] at baseline and 68.6 [95%CI, 66.3 to 71.0] at 24 months for the usual care group, difference in mean changes, 0.10 [95%CI, −2.92 to 3.13], P=.95). CONCLUSIONS AND RELEVANCE Among homeless adults with mental illness in 4 Canadian cities, scattered site housing with ICM services compared with usual access to existing housing and community services resulted in increased housing stability over 24 months, but did not improve generic quality of life. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN42520374.

A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness

OBJECTIVE Housing First with assertive community treatment (ACT) is a promising approach to assist people with serious mental illness to exit homelessness. The article presents two-year findings from a multisite trial on the effectiveness of Housing First with ACT. METHODS The study design was a randomized controlled trial conducted in five Canadian cities. A sample of 950 participants with serious mental illness who were absolutely homeless or precariously housed were randomly assigned to receive either Housing First with ACT (N=469) or treatment as usual (N=481). RESULTS Housing First participants spent more time in stable housing than participants in treatment as usual (71% versus 29%, adjusted absolute difference [AAD]=42%, p<.01). Compared with treatment-as-usual participants, Housing First participants who entered housing did so more quickly (73 versus 220 days, AAD=146.4, p<.001), had longer housing tenures at the study end-point (281 versus 115 days, AAD=161.8, p<.01), and rated the quality of their housing more positively (adjusted standardized mean difference [ASMD]=.17, p<.01). Housing First participants reported higher quality of life (ASMD=.15, p<.01) and were assessed as having better community functioning (ASMD=.18, p<.01) over the two-year period. Housing First participants showed significantly greater gains in community functioning and quality of life in the first year; however, differences between the two groups were attenuated by the end of the second year. CONCLUSIONS Housing First with ACT is an effective approach in various contexts for assisting individuals with serious mental illness to rapidly exit homelessness.

(Re)-introduction to French: four education models to revitalise an endangered group in Eastern Canada

This study explores early francization models for a linguistic minority currently struggling to preserve its language. The French Acadians of New Brunswick, Canada, represent 30% of the provinces total population, yet their numbers and their linguistic vitality are decreasing. New Brunswick has two public school systems: the English language schools cater for the majority while the French language schools have been created for the minority, with the goal of this separate, homogeneous school system being to preserve the French language. However, for some children who are members of this linguistic minority, the language is no longer spoken at home, and thus, when parents in such situations opt for the French school, their children are immersed. Data were collected from nine schools in order to examine the particular Early Francization Model they operate, and how they manage their mixed intake. Four different models of early francization (sheltered class, mainstream class with pull-out, mainstream class with pull-out plus in-class support and integrated model) for this revitalization effort are described and group interviews were carried out to assess how the schools organise their francization programme. In addition, French language outcomes were measured for students enrolled in the programme in the kindergarten year (five years old). The quantitative data indicate that children who participated in the integrated model fared better in terms of French vocabulary outcomes.

Effect of Housing First on Suicidal Behaviour: A Randomised Controlled Trial of Homeless Adults with Mental Disorders

Objective: This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour. Method: The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF (n = 1265) and TAU (n = 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up. Results: Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate = –.57, SE = .05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate = –.04, SE = .06, P = 0.51). Furthermore, there was no effect of treatment status (estimate = –.10, SE = .16, P = 0.52) on prevalence of suicide attempts (HF = 11.9%, TAU = 10.5%) during the 2-year follow-up period. Conclusion: This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention.

Richesse des problèmes posés et créativité des solutions soumises dans la Communauté d'apprentissages scientifiques et mathématiques interactifs (CASMI)

ResumeCette etude s’interesse a la richesse des problemes mathematiques poses et a la creativite des solutions soumises par les membres de la Communaute d’apprentissages scientifiques et mathematiques interactifs (CASMI), une ressource virtuelle destinee aux eleves francophones du Nouveau-Brunswick et d’ailleurs. L’exploration des problematiques identifiees par les chercheurs preoccupes par les rares occasions qu’ont les eleves de resoudre des problemes riches et de developper leur creativite en classe nous amene a construire un cadre conceptuel afin 1) d’analyser la richesse des problemes proposes dans la CASMI, 2) d’evaluer la creativite des solutions soumises par les membres de cette communaute virtuelle et 3) de determiner s’il existe une relation entre la richesse des problemes poses et la creativite des solutions soumises. Les resultats revelent que les problemes plus riches semblent susciter plus de solutions originales et des reponses divergentes. Cependant, ces resultats mettent aussi en evidence le besoin d’elargir le cadre conceptuel sous-jacent a la formulation des problemes mathematiques riches offerts aux eleves et de mener des recherches plus approfondies dans ce domaine.AbstractThis research focuses on the richness of mathematical problems posted and the creativity of the solutions submitted by members of the CASMI (Communaute d’apprentissages scientifiques et mathematiques interactifs), a virtual resource used by Francophone students from New Brunswick and elsewhere. After reviewing issues identified by researchers preoccupied by the few opportunities offered to students to solve rich mathematical problems and develop their creativity in the classroom, we develop a conceptual framework in order to : 1) analyze the richness of the mathematical problems posted on the CASMI website; 2) assess the creativity of the solutions to the problems submitted on this website; and 3) verify the link between the richness of the problems and the mathematical creativity of the solutions. Our results suggest that rich mathematical problems bring more original solutions and multiple answers. These results also reveal the need for a broader conceptual framework in order to enhance the richness of mathematical problems offered to students, as well as for continuing research in this area.