International Journal of Environmental Research and Public Health, 2020
Clinical practice guidelines can improve the clinical and social care for marginalized population... more Clinical practice guidelines can improve the clinical and social care for marginalized populations, thereby improving health equity. The aim of this study is to identify determinants of guideline implementation from the perspective of patients and practitioner stakeholders for a homeless health guideline. We completed a mixed-method study to identify determinants of equitable implementation of homeless health guidelines, focusing on the Grading of Recommendations Assessment, Development and Evaluation Feasibility, Acceptability, Cost, and Equity Survey (GRADE-FACE) health equity implementation outcomes. The study included a survey and framework analysis. Eighty-eight stakeholders, including practitioners and 16 persons with lived experience of homelessness, participated in the study. Most participants favourably rated the drafted recommendations’ priority status, feasibility, acceptability, cost, equity impact, and intent-to-implement. Qualitative analysis uncovered stakeholder conc...
Compared to the wealth of research on single homeless adults, there is little known about homeles... more Compared to the wealth of research on single homeless adults, there is little known about homeless families. This paper describes a study of 75 homeless families in Ottawa, Ontario, conducted in 2012-2013. This sample of homeless families includes a large number of newcomer families, including immigrants and refugees. Participants are poor and unemployed, but many are educated, and there is little evidence of alcohol or substance abuse. Nonetheless, participants report poor mental health and high levels of family stress. Whereas newcomer families tended to be larger and include more two-parent families than did Canadian-born families, there were no differences in the physical and mental health of the participants. These findings add to our growing understanding of homeless families and point to notable similarities and differences in homeless families in this city in Canada, and in the United States.
This study explores the two-year housing and non-housing outcomes for adults who are homeless wit... more This study explores the two-year housing and non-housing outcomes for adults who are homeless with problematic substance use that 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 that had access to standard care in the community. Housing First clients (n = 89) and members of a comparison group (n = 89) completed structured interviews at baseline and were followed for two years. 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 ...
The current longitudinal study evaluated the individual, housing, and neighborhood characteristic... more The current longitudinal study evaluated the individual, housing, and neighborhood characteristics predictive of feeling psychologically integrated within one's neighborhood among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada and participated in three in-person interviews, each approximately 1 year apart. Prospective and cross-sectional predictors of psychological integration at Follow-up 1 and Follow-up 2 were examined. There were 397 participants at baseline, 341 at Follow-up 1 and 320 at Follow-up 2. A hierarchical multiple regression uncovered several significant predictors of psychological integration. The most salient and common predictors were being older, having greater social support, living in high quality housing, and residing in a neighborhood with a positive impact. Implications for service provision and policy advancements are discussed.
American journal of community psychology, Mar 30, 2017
This research examined the sustainability of Canada's At Home/Chez Soi Housing First (HF) pro... more This research examined the sustainability of Canada's At Home/Chez Soi Housing First (HF) programs for homeless persons with mental illness 2 years after the end of the demonstration phase of a large (more than 2000 participants enrolled), five-site, randomized controlled trial. Qualitative interviews were conducted with 142 participants (key informants, HF staff, and persons with lived experience) to understand sustainability outcomes and factors that influenced those outcomes. Also, a self-report HF fidelity measure was completed for nine HF programs that continued after the demonstration project. A cross-site analysis was performed, using the five sites as case studies. The findings revealed that nine of the 12 HF programs (75%) were sustained, and that seven of the nine programs reported a high level of fidelity (achieving an overall score of 3.5 or higher on a 4-point scale). The sites varied in terms of the level of systems integration and expansion of HF that were achieve...
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jun 8, 2016
The purpose of this study was to examine whether homeless or vulnerably housed individuals experi... more The purpose of this study was to examine whether homeless or vulnerably housed individuals experienced response shift over a 12-month time period in their self-reported physical and mental health status. Data were obtained from the Health and Housing in Transition study, a longitudinal multi-site cohort study in Canada (N = 1190 at baseline). Multi-group confirmatory factor analysis (MG-CFA) and methods for response shift detection at the item level, based on the approach by Oort, were used to test for reconceptualization, reprioritization, and recalibration response shift on the SF-12 in four groups of individuals who were homeless (n = 170), housed (n = 437), or who reported a change in their housing status [from homeless to housed (n = 285) or housed to homeless (n = 73)] over a 12-month time period. Mean and variance adjusted weighted-least squares estimation was used to accommodate the ordinal and binary distributions of the SF-12 items. Using MG-CFA, a strict invariance model ...
Homelessness is a major concern in many urban communities across North America. Since vulnerably ... more Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness. Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year. Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, Jan 15, 2016
Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless... more Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless adults with mental illness. However, little is known about patterns of change and characteristics that predict different outcome trajectories over time. This article reports on latent trajectories of housing stability among 2140 participants (84% followed 24 months) of a multisite randomised controlled trial of HF. Data were analyzed using generalised growth mixture modeling for the total cohort. Predictor variables were chosen based on the original program logic model and detailed reviews of other qualitative and quantitative findings. Treatment group assignment and level of need at baseline were included in the model. In total, 73% of HF participants and 43% of treatment-as-usual (TAU) participants were in stable housing after 24 months of follow-up. Six trajectories of housing stability were identified for each of the HF and TAU groups. Variables that distinguished different trajecto...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2015
To provide a review of the extant research literature on Housing First (HF) for people with sever... more To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)-Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing. The AH-CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care. Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH-CS demonstratio...
International Journal of Environmental Research and Public Health, 2020
Clinical practice guidelines can improve the clinical and social care for marginalized population... more Clinical practice guidelines can improve the clinical and social care for marginalized populations, thereby improving health equity. The aim of this study is to identify determinants of guideline implementation from the perspective of patients and practitioner stakeholders for a homeless health guideline. We completed a mixed-method study to identify determinants of equitable implementation of homeless health guidelines, focusing on the Grading of Recommendations Assessment, Development and Evaluation Feasibility, Acceptability, Cost, and Equity Survey (GRADE-FACE) health equity implementation outcomes. The study included a survey and framework analysis. Eighty-eight stakeholders, including practitioners and 16 persons with lived experience of homelessness, participated in the study. Most participants favourably rated the drafted recommendations’ priority status, feasibility, acceptability, cost, equity impact, and intent-to-implement. Qualitative analysis uncovered stakeholder conc...
Compared to the wealth of research on single homeless adults, there is little known about homeles... more Compared to the wealth of research on single homeless adults, there is little known about homeless families. This paper describes a study of 75 homeless families in Ottawa, Ontario, conducted in 2012-2013. This sample of homeless families includes a large number of newcomer families, including immigrants and refugees. Participants are poor and unemployed, but many are educated, and there is little evidence of alcohol or substance abuse. Nonetheless, participants report poor mental health and high levels of family stress. Whereas newcomer families tended to be larger and include more two-parent families than did Canadian-born families, there were no differences in the physical and mental health of the participants. These findings add to our growing understanding of homeless families and point to notable similarities and differences in homeless families in this city in Canada, and in the United States.
This study explores the two-year housing and non-housing outcomes for adults who are homeless wit... more This study explores the two-year housing and non-housing outcomes for adults who are homeless with problematic substance use that 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 that had access to standard care in the community. Housing First clients (n = 89) and members of a comparison group (n = 89) completed structured interviews at baseline and were followed for two years. 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 ...
The current longitudinal study evaluated the individual, housing, and neighborhood characteristic... more The current longitudinal study evaluated the individual, housing, and neighborhood characteristics predictive of feeling psychologically integrated within one's neighborhood among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada and participated in three in-person interviews, each approximately 1 year apart. Prospective and cross-sectional predictors of psychological integration at Follow-up 1 and Follow-up 2 were examined. There were 397 participants at baseline, 341 at Follow-up 1 and 320 at Follow-up 2. A hierarchical multiple regression uncovered several significant predictors of psychological integration. The most salient and common predictors were being older, having greater social support, living in high quality housing, and residing in a neighborhood with a positive impact. Implications for service provision and policy advancements are discussed.
American journal of community psychology, Mar 30, 2017
This research examined the sustainability of Canada's At Home/Chez Soi Housing First (HF) pro... more This research examined the sustainability of Canada's At Home/Chez Soi Housing First (HF) programs for homeless persons with mental illness 2 years after the end of the demonstration phase of a large (more than 2000 participants enrolled), five-site, randomized controlled trial. Qualitative interviews were conducted with 142 participants (key informants, HF staff, and persons with lived experience) to understand sustainability outcomes and factors that influenced those outcomes. Also, a self-report HF fidelity measure was completed for nine HF programs that continued after the demonstration project. A cross-site analysis was performed, using the five sites as case studies. The findings revealed that nine of the 12 HF programs (75%) were sustained, and that seven of the nine programs reported a high level of fidelity (achieving an overall score of 3.5 or higher on a 4-point scale). The sites varied in terms of the level of systems integration and expansion of HF that were achieve...
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jun 8, 2016
The purpose of this study was to examine whether homeless or vulnerably housed individuals experi... more The purpose of this study was to examine whether homeless or vulnerably housed individuals experienced response shift over a 12-month time period in their self-reported physical and mental health status. Data were obtained from the Health and Housing in Transition study, a longitudinal multi-site cohort study in Canada (N = 1190 at baseline). Multi-group confirmatory factor analysis (MG-CFA) and methods for response shift detection at the item level, based on the approach by Oort, were used to test for reconceptualization, reprioritization, and recalibration response shift on the SF-12 in four groups of individuals who were homeless (n = 170), housed (n = 437), or who reported a change in their housing status [from homeless to housed (n = 285) or housed to homeless (n = 73)] over a 12-month time period. Mean and variance adjusted weighted-least squares estimation was used to accommodate the ordinal and binary distributions of the SF-12 items. Using MG-CFA, a strict invariance model ...
Homelessness is a major concern in many urban communities across North America. Since vulnerably ... more Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness. Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year. Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, Jan 15, 2016
Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless... more Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless adults with mental illness. However, little is known about patterns of change and characteristics that predict different outcome trajectories over time. This article reports on latent trajectories of housing stability among 2140 participants (84% followed 24 months) of a multisite randomised controlled trial of HF. Data were analyzed using generalised growth mixture modeling for the total cohort. Predictor variables were chosen based on the original program logic model and detailed reviews of other qualitative and quantitative findings. Treatment group assignment and level of need at baseline were included in the model. In total, 73% of HF participants and 43% of treatment-as-usual (TAU) participants were in stable housing after 24 months of follow-up. Six trajectories of housing stability were identified for each of the HF and TAU groups. Variables that distinguished different trajecto...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2015
To provide a review of the extant research literature on Housing First (HF) for people with sever... more To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)-Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing. The AH-CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care. Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH-CS demonstratio...
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Papers by Tim Aubry