Simon Corneau

Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups

BackgroundThe literature on interventions addressing the intersection of homelessness, mental illness and race is scant. The At Home/Chez Soi research demonstration project is a pragmatic field trial investigating a Housing First intervention for homeless individuals with mental illness in five cities across Canada. A unique focus at the Toronto site has been the development and implementation of a Housing First Ethno-Racial Intensive Case Management (HF ER-ICM) arm of the trial serving 100 homeless individuals with mental illness from ethno-racial groups. The HF ER-ICM program combines the Housing First approach with an anti-racism/anti-oppression framework of practice. This paper presents the findings of an early implementation and fidelity evaluation of the HF ER-ICM program, supplemented by participant narrative interviews to inform our understanding of the HF ER-ICM program theory.MethodsDescriptive statistics are used to describe HF ER-ICM participant characteristics. Focus group interviews, key informant interviews and fidelity assessments were conducted between November 2010 and January 2011, as part of the program implementation evaluation. In-depth qualitative interviews with HF ER-ICM participants and control group members were conducted between March 2010 and June 2011. All qualitative data were analysed using grounded theory methodology.ResultsThe target population had complex health and social service needs. The HF ER-ICM program enjoyed a high degree of fidelity to principles of both anti-racism/anti-oppression practice and Housing First and comprehensively addressed the housing, health and sociocultural needs of participants. Program providers reported congruence of these philosophies of practice, and program participants valued the program and its components.ConclusionsAdapting Housing First with anti-racism/anti-oppression principles offers a promising approach to serving the diverse needs of homeless people from ethno-racial groups and strengthening the service systems developed to support them. The use of fidelity and implementation evaluations can be helpful in supporting successful adaptations of programs and services.Trial registrationCurrent Controlled Trials ISRCTN42520374

More than being against it: Anti-racism and anti-oppression in mental health services:

Anti-racism and anti-oppression frameworks of practice are being increasingly advocated for in efforts to address racism and oppression embedded in mental health and social services, and to help reduce their impact on mental health and clinical outcomes. This literature review summarizes how these two philosophies of practice are conceptualized and the strategies used within these frameworks as they are applied to service provision toward racialized groups. The strategies identified can be grouped in seven main categories: empowerment, education, alliance building, language, alternative healing strategies, advocacy, social justice/activism, and fostering reflexivity. Although anti-racism and anti-oppression frameworks have limitations, they may offer useful approaches to service delivery and would benefit from further study.

Differential experiences of discrimination among ethnoracially diverse persons experiencing mental illness and homelessness

BackgroundThis mixed methods study explored the characteristics of and experiences with perceived discrimination in an ethnically diverse urban sample of adults experiencing homelessness and mental illness.MethodsData were collected in Toronto, Ontario, as part of a 4-year national randomized field trial of the Housing First treatment model. Rates of perceived discrimination were captured from survey questions regarding perceived discrimination among 231 ethnoracially diverse participants with moderate mental health needs. The qualitative component included thirty six in-depth interviews which explored how individuals who bear these multiple identities of oppression navigate stigma and discrimination, and what affects their capacity to do so.ResultsQuantitative analysis revealed very high rates of perceived discrimination related to: homelessness/poverty (61.5%), race/ethnicity/skin colour (50.6%) and mental illness/substance use (43.7%). Immigrants and those who had been homeless three or more years reported higher perceived discrimination on all three domains. Analysis of qualitative interviews revealed three common themes related to navigating these experiences of discrimination among participants: 1) social distancing; 2) old and new labels/identities; and, 3) ‘homeland’ cultures.ConclusionsThese study findings underscore poverty and homelessness as major sources of perceived discrimination, and expose underlying complexities in the navigation of multiple identities in responding to stigma and discrimination.Trial registrationCurrent Controlled Trials ISRCTN42520374. Registered 18 August 2009.

Reducing Service and Substance Use Among Frequent Service Users: A Brief Report From the Toronto Community Addictions Team

The Toronto Community Addictions Team (TCAT) is an intensive case management intervention designed to serve people with addictions who are frequent service users, thus addressing a health system priority. Questionnaires given to 65 participants at baseline, 3 months, and 6 months and semi-structured interviews of 10 program participants explored participants’ outcomes and experiences with the program. Qualitative findings, analyzed using thematic content analysis, suggest that participants value the programs commitment to harm reduction, financial trusteeship, and recovery orientation. Quantitative findings from paired t-tests reveal that participants improved in community functioning and decreased days of problematic substance use and money spent on alcohol and drugs as early as 3 months after program participation. Future research should used a controlled design and explore predictors of positive outcomes in this vulnerable population.

Some Like It Mellow: On Gay Men Complicating Pornography Discourses

Despite the proliferation of writing on pornography generally, much of the literature that focuses on gay pornography specifically conforms to either a pro- or anti-porn framework. This overly simplistic dichotomy positions pornography as a homogeneous construct, albeit one that is either “good” or “bad.” Even theorists who situate pornography on a continuum, with erotica at one end and hardcore at the other, tend to reify these discourses. Further, it is not uncommon for researchers to draw conclusions about the effects of pornography consumption without defining exactly what pornography is. This ethnographic research draws on qualitative interviews with 20 consumers’ of gay pornography in Toronto, Canada. By using a thematic analysis to document the ways in which gay men define, distinguish, and conceptualize gay pornography, five definitional categories were developed: Mellow; Commercial; Raunch; Amateur; and Bareback. These broad conceptualizations are discussed in reference to writing on gay pornography. Our research results emphasize the importance of clear definitions of pornography within pornography research.

Coping and resilience among ethnoracial individuals experiencing homelessness and mental illness

Background: The multiple challenges that ethnoracial homeless individuals experiencing mental illness face are well documented. However, little is known about how this homeless subpopulation copes with the compounding stressors of racial discrimination, homelessness and mental illness. Aims: This study is an in-depth investigation of the personal perceived strengths, attitudes and coping behaviors of homeless adults of diverse ethnoracial backgrounds experiencing homelessness and mental illness in Toronto, Canada. Method: Using qualitative methods, 36 in-depth semi-structured interviews were conducted to capture the perspectives of ethnoracial homeless participants with mental illness on coping and resilience. Transcripts were analyzed using thematic analysis. Results: Similar to prior findings in the general homeless population, study participants recognized personal strengths and attitudes as great sources of coping and resilience, describing hope and optimism, self-esteem and confidence, insight into their challenges and spirituality as instrumental to overcoming current challenges. In addition, participants described several coping strategies, including seeking support from family, friends and professionals; socializing with peers; engaging in meaningful activities; distancing from overwhelming challenges; and finding an anchor. Conclusion: Findings suggest that homeless adults with mental illness from ethnoracial groups use similar coping strategies and sources of resilience with the general homeless population and highlight the need for existing services to foster hope, recognize and support individual coping strategies and sources of resilience of homeless individuals experiencing complex challenges.

Gay male pornography: a study of users’ perspectives

ABSTRACT Gay male pornography (GMP) occupies contentious discursive ground and is subject to polarising moral, theoretical and political discourses. However, few empirical studies employ these discourses as a point of departure. Using social representations and attitudes as theoretical tools, our study documents GMP users’ positionalities towards GMP on both a personal and a more social level. Data were collected via an online survey of 974 GMP users in Québec, Canada. An iterative exploratory factor analysis yielded five social representation scales (perceived racial and gender stereotypes, negative perception of bareback pornography, validation and educational utility, negative perception of gay pornography and perceived role of gay pornography in norm formation) and five attitude scales (perceived pressure to conform, preference for bareback pornography, acquired sexual knowledge, racialised sexual desire and problematic use). A hierarchical cluster analysis of the scales identified four main respondent profiles: pro-bareback standpoint (28%), gay affirmative standpoint (40%), harms-based standpoint (21%) and detached harms-based standpoint (10%). Our findings demonstrate that GMP is a complex topic and that conceiving its use solely from a gay affirmative or harms-based dichotomy may not do justice to users’ experiences, since various levels of agreement are present in users’ perspectives when confronted with contrasting and often contradictory arguments.