John Sylvestre

Housing Choice and Control, Housing Quality, and Control over Professional Support as Contributors to the Subjective Quality of Life and Community Adaptation of People with Severe Mental Illness

This research examined two premises of supported housing: (a) that consumer choice/control over housing and support and the quality of housing are important contributors to the subjective quality of life and adaptation to community living of people with mental illness, and (b) that apartments provide mental health consumers with more choice/control over housing and support than group living arrangements. To test these two hypotheses, we collected data from participants with mental illness housed through a government initiative in Ontario, Canada. A total of 130 participants completed a baseline interview, and 91 of those participants also completed a follow-up interview 9-months later. Support was found for both hypotheses. The results were discussed in terms of the paradigm of supported housing, previous research, and implications for housing policy and program development in the community mental health sector.

Fidelity and Recovery-Orientation in Assertive Community Treatment

There has been increasing commentary about the degree to which Assertive Community Treatment (ACT) teams provide recovery-oriented services, often centered around the question of the use of coercion. The present study was designed to contribute to this discussion through an examination of recovery-oriented service provision and ACT fidelity among 67 teams in the province of Ontario, Canada. The findings indicated a moderate to high degree of recovery orientation in service provision, with no significant relationship between ACT fidelity and consumer and family/key support ratings of recovery orientation. A significant relationship was found, however, between the ‘nature of services’ domain of the Dartmouth Assertive Community Treatment Scale (DACTS) and ratings of recovery orientation provided by staff and ACT coordinators. These findings extend the existing dialogue regarding the evaluation of ACT intervention process factors and indicate that current measures of fidelity may not be adequately addressing dimensions of recovery-oriented service provision.

Housing for People with Serious Mental Illness: Challenges for System-Level Community Development

This paper discusses issues in the development of collaborative efforts among stakeholders in a community housing and support system dedicated to people with serious mental illness. Whereas community development efforts directed at localities are more common, the increasing recognition of the system‐level barriers facing marginalized groups requires community development efforts that are relevant to communities of stakeholders in service systems. The paper draws on work conducted by the authors to understand, to evaluate, and to support the development of a system of housing dedicated to people with serious mental illness in Ontario. Although these projects were not intended as community development, they have uncovered issues that are likely to arise in a community development effort in this context.

Housing First for Adults with Problematic Substance Use

ABSTRACT Objectives: This study explores the two-year housing- and non–housing-related outcomes for adults who are homeless with problematic substance use who received scattered-site housing and intensive case management services from a Housing First program in Ottawa, Canada, in comparison with a group of adults who are homeless with problematic substance use who had access to standard care in the community. Methods: Housing First clients (n = 89) and members of a comparison group (n = 89) completed structured interviews at baseline and were followed for two years. Results: Housing First clients moved into housing more quickly, reported a greater proportion of time housed, were more likely to spend the final six months housed, and had longer housing tenure at 24 months. There was a group by time interaction on problematic alcohol use with more rapid improvement for the comparison group; however, both groups improved over time. The comparison group had a greater decrease on problematic drug use by 24 months. There was no change in physical health and only the comparison group had improvements in mental health by 24 months. The groups had similar improvement on community functioning by 24 months. The comparison group had a greater increase in total quality of life. More specifically, the comparison group had an increase in the family relations–related quality of life, whereas the clients did not. There was a significant interaction for safety-related quality of life, but both groups experienced improvements over time and had comparable levels of satisfaction with safety at each time point. The Housing First clients reported higher levels of satisfaction with living conditions than the comparison group at baseline and 12 months, but not at 24 months. There was significant improvement over time and no main effect of group for finances, leisure, and social relations. Conclusions: Adults who are homeless with problematic substance use can successfully be housed using a Housing First approach. However, further targeted services might be required to address other areas of functioning, such as health, substance use, and quality of life.

The experiences of adolescents and young adults residing with their families in emergency shelters in Canada

ABSTRACT Emergency homeless shelters can be stressful environments for families. They can be associated with emotional distress and feelings of restriction for parents, and with behavioural, social, and developmental challenges for children. However, little is known about the experiences of accompanied youth residing in shelter with their families, as the literature about this age groups experiences of homelessness has mainly focused on unaccompanied youth. Findings from the current study are drawn from qualitative interviews with 16 adolescents and young adults (aged 16–21) who were homeless and living with their families in family homeless shelters in Ottawa, Ontario, Canada. Youth described family homeless shelters as stressful environments but also found that the shelters provided support to them and their families. Youth discussed the various strategies they used to cope in facing the challenges of shelter life. These findings add to our understanding of youth who are homeless and highlight the ways in which they adapt to the challenges of living in a family homeless shelter with their families. Recommendations are included for ways that shelter staff and policymakers can enact operational and systemic changes that could potentially improve the experiences of such youth and their families.

The health of foreign-born homeless families living in the family shelter system

Foreign-born families face challenges following migration to Canada that may impact their well-being and lead them to homelessness. Yet, there is limited research on the experience of homelessness in this population. The purpose of this paper is to examine the health of foreign-born families staying in the emergency shelter system in Ottawa, Ontario, Canada, and compare their experiences to Canadian-born homeless families who are also living in shelters.,Interviews were conducted with 75 adult heads of families who were residing in three family shelters. This study focused on mental and physical health functioning, chronic medical conditions, access to care and diagnoses of mental disorders.,Foreign-born heads of families reported better mental health than did Canadian-born heads of families with a significantly lower proportion of foreign-born participants reporting having been diagnosed with a mental disorder. Foreign-born heads of families also reported fewer chronic medical conditions than did Canadian-born heads of families.,This study relied on self-reported health and access to healthcare services. Data were drawn from a small, non-random sample.,This study is one of the first studies to examine the health and well-being of homeless foreign-born heads of families. Moreover, this paper also focuses on disparities in health, diagnoses of mental disorders, and access to healthcare services between foreign-born and Canadian-born families – a comparison that has not been captured in the existing literature.

Living in Two Cultures: Chinese Canadians’ Perspectives on Health

Chinese people have distinctive perspectives on health and illness that are largely unrecognized in Western society. The purpose of this descriptive study was to develop a profile of Chinese immigrants’ beliefs and practices related to diet, mental and social health, and sexual health. A quantitative survey with descriptive and correlational analyses was employed to examine 100 first-generation Chinese immigrants living in four urban centres across Canada (Vancouver, Toronto, Halifax, and St. Catharines). Although most Chinese immigrants preferred a Chinese diet, where they resided affected the groceries they bought and the meals they ate. Almost all participants reported their mental health was important to them and most felt comfortable discussing mental health issues with others. However, only a third would see a psychiatrist if they believed they had a mental health problem. Most participants believed social relationships were important for their health. Only a small number of participants, however, preferred making friends with mainstream Caucasian Canadians. More men than women believed sexuality contributed to health and were comfortable talking about sexual health. Chinese immigrants should be encouraged to be more engaged in the larger community in order to fully integrate themselves into Canadian society while still being encouraged to retain their healthy practices. These findings may help educators and practitioners enhance their understandings of Chinese immigrants’ perspectives on health and develop culturally competent education and services in health care and health promotion.

A Review of the Literature on LGBTQ Adults Who Experience Homelessness

ABSTRACT Little is known about lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults who experience homelessness. The current review critically analyzes the scant literature on LGBTQ adults who experience homelessness, with a particular focus on: (1) pathways into homelessness; (2) support needs; (3) targeted programming; and (4) exits out of homelessness. A total of 143 articles were identified, and 16 articles met the criteria of appropriate age range, article quality, and relevance of topic. Results from this review demonstrate that homeless LGBTQ adults have unique physical and mental health challenges, largely concerning HIV and substance use. Transgender and gender non-conforming adults who experience homelessness encounter several challenges in the homelessness system, particularly in regard to safety and gender-affirming supports. Recommendations focus on practical implications for support and suggestions for future research.

A Qualitative Study of the Pathways Into and Impacts of Family Homelessness

Homelessness has consequences for families, including risk of deterioration in the health of their members, disruption of family dynamics, and separation of parents and children. This study used qualitative interviews to explore pathways into and perceived consequences of homelessness among 18 families living in an emergency family shelter system in Canada. Findings showed that families’ experiences prior to their homelessness were characterized by vulnerability, instability, and isolation. In the emergency shelter system, families faced new challenges in environments that were restrictive, noisy, chaotic, and afforded little privacy. Participants described a further disruption of relationships and described having to change their family practices and routines. Despite the challenges that families encountered, some participants felt optimistic and hopeful about the future. Future research is needed on ways in which shelters can be more hospitable, supportive, and helpful for parents and their families to minimize negative impacts and facilitate timely rehousing of families.

How different approaches to taking pictures influences participation in a photovoice project

Photovoice involves participants using cameras to document their thoughts and experiences related to an important theme in their everyday lives. Photovoice places the critical data collection tool, a camera, in the control of the participants themselves. Thus, the knowledge that is generated from a photovoice project is likely to directly reflect the interests and concerns of the participants. This project offers a unique view of how participants’ varying approaches to photography influenced their experiences of participation as well as the photographs they took.