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Purpose/Objective: Survey psychology postdoctoral training programs involving patients with disability receiving rehabilitation services, and compare with similar data from 2007. Research Method/Design: Public data sources identified 297 potential postdoctoral training programs. Of these, 100 programs (34%) provided services for patients with disability in rehabilitation settings, and 92% returned a survey (n = 92). Results: Programs reported having a primary rehabilitation involvement (42%), a secondary involvement (26%), or an optional involvement (23%). Programs were based in university settings (27%), VA/DoD settings (35%), or private/public health care settings (38%). A total of 433 faculty and 308 residents were involved in these programs. Fifty percent (50%) of programs had faculty with American Board of Rehabilitation Psychology (ABRP) certification, while 62% of programs had faculty with American Board of Clinical Neuropsychology (ABCN) certification. On average, programs formally taught 58% of the ABRP competencies. Conclusions: Compared to 2007, there has been a 200% increase in the number of training programs with rehabilitation involvement. However, there has been an overall decrease in the variety of populations with which residents work, and an overall decrease in the number of ABRP competencies that are formally taught, so that training has become more focused on specific populations and specific competencies to the exclusion of others. Many rehabilitation patients and teams receive services from psychologists whose professional concentration is not primarily in rehabilitation psychology, and many psychology residents involved with rehabilitation populations do not receive comprehensive training in rehabilitation psychology. There is an opportunity for rehabilitation psychologists to collaborate with these programs to enhance competent services to persons with disability. [ABSTRACT FROM AUTHOR]

BACKGROUND: Paramedics are a high-risk occupational group for posttraumatic stress injuries (PTSI), and increasingly, evidence suggests that organizational factors play a significant role. While several resources for paramedic services to address PTSI exist, there is limited knowledge as to which PTSI-related programs and practices are implemented and how they are perceived in the workplace. OBJECTIVES: This research aimed to explore key informants' perspectives on existing and desired organizational-wide initiatives for, as well as the challenges and potential solutions to, the primary prevention, early detection and intervention, and disability management of PTSI in Canadian paramedic services. METHODS: Semi-structured interviews were conducted with 12 key informants from jurisdictions across Canada who have over five years of work experience in prehospital care. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: Eight recurrent organizational elements (themes) for addressing PTSI emerged: psychologically safe and healthy work culture; consistent supervisor support, mental health training and awareness, opportunities for recovery and maintaining resiliency, recognition of PTSI and its diverse risk factors, access to a variety of support initiatives for PTSI, communication during medical leave, and meaningful work accommodations. CONCLUSIONS: While organizational-wide initiatives were in place for the primary prevention, early detection and intervention, and disability management of PTSI, systemic challenges with coordination, resource allocation, and worker engagement were also identified. These challenges prevented paramedic services from optimally addressing PTSI in their workplace. Integrating considerations from the eight organizational elements to address PTSI into broader existing management systems may have merit in overcoming the systemic challenges. [ABSTRACT FROM AUTHOR]

Introduction Differences in disability duration after work injury have been observed across jurisdictions, regions and urban and rural settings. A key aspect of effective disability management is the access and utilization of appropriate and high quality health care. This paper presents a framework for analyzing and thus understanding how health service spending and utilization vary across and within work disability management schemes and affect work disability management. Methods Our framework was developed through a literature review and policy analysis. Existing frameworks describing geographic variation in general health care systems identified factors believed to drive that variation. A review of policy and practice documents from Canada's no-fault cause-based work disability management system identified factors relevant to work disability systems. Results We expand on previous frameworks by taking a systems approach that centers on factors relevant to the work disability management system. We further highlight predisposing, enabling, workplace environment and need-based factors that could lead to variation in health care spending and utilization across and within jurisdictions. These factors are described as shaping the interactions between workers, health care providers, employers and work disability management system actors, and influencing work disability management health and employment outcomes. Conclusion Our systems-focused approach offers a guide for researchers and policymakers to analyze how various factors may influence spending and utilization across regions and to identify areas for improvement in health care delivery within work disability management systems. Next steps include testing the framework in an analysis looking at geographic variation in spending and utilization across and within Canadian work disability management systems. [ABSTRACT FROM AUTHOR]

In order to meet the crying needs of high-conflict families and professionals who work with them, a Canadian psycho-legal team developed an intervention protocol called Parentalité–Conflit–Résolution. Sixteen parents completed validated questionnaires to measure co-parenting, parental conflict, and psychological adjustment. Nonparametric analyses were performed to measure pre- and post-intervention effects. Results confirm the severity of communication problems and the high degree of hostility in families participating in the intervention protocol. Parents perceived fewer alienating behaviors in the other parent at the end of the intervention. Mothers perceived a more positive alliance with the other parent, whereas fathers perceived less parental conflict and fewer negative interactions. Longitudinal research should be conducted to measure the sustainability of changes over the long term. [ABSTRACT FROM AUTHOR]

The present Canadian study sought to identify predictors of emergency department (ED) use in a sample of adults who are homeless. Four hundred eighty-three participants were interviewed quarterly for two years, reporting their housing status, income, food security, physical/mental health, and other social determinants of health. Survey data were linked to administrative health and social services data. Predictors of ED visits were analyzed using negative binomial longitudinal mixed modelling. Emergency department visits were positively and reliably predicted by pre-baseline ED use, as well as by concurrent increased social assistance, primary care visits, ratings of physical health, substance use problems, and case management visits. Increased concurrent housing instability and food insecurity, and decreased homelessness history, positively predicted ED visits, but effect reliability was lower. Participant ill health appears to be a primary driver of ED utilization. The findings challenge misconceptions about the appropriateness of ED use among people who are homeless. [ABSTRACT FROM AUTHOR]

Introduction: Canadian occupational therapists are employed as case managers on assertive community treatment (ACT) teams to support community living for individuals with severe and persistent mental illnesses. In this position, occupational therapists act primarily as generalists, typically attending appointments with clients, supervising medication adherence, supporting basic living needs, and managing client crises. Occupational therapists may also provide psychotherapy and coping skill groups, as well as profession-specific practices, such as skills training. Exploring how ACT occupational therapists describe their perceived ideal practice may support transformation in long-standing, occupational therapy practices on ACT teams. Method: This qualitative, interpretive description study involved 11 Canadian ACT team occupational therapists in one individual, semi-structured in-depth interview using an interview guide containing open-ended questions. Interview transcripts were analyzed to identify themes pertaining to therapists' descriptions of their perceived ideal occupational therapy practice on ACT teams. Results: Three themes emerged: (a) Engaging in practice "with intention"; (b) Finding the space for occupational therapy practice; and (c) Supporting clients in their recovery to find their best occupational self. Conclusions: The findings highlight practice possibilities for occupational therapist working on ACT teams and provide a foundation for advocating for better use of specific occupational therapy practices within community mental health settings. [ABSTRACT FROM AUTHOR]

Context The Canadian reality of dementia care may be complicated by the cultural diversity of patients and their informal caregivers. Objectives To what extent do needs differ between Canadian- and foreign-born patients and caregivers? What are their experiences with the illness in primary care case management? Methods Mixed methods, sequential explanatory design (a cross-sectional study, followed by a qualitative descriptive study), involving 15 pairs of patients and caregivers. Results Foreign-born patients had more needs compared to their Canadian-born counterparts. Foreign-born caregivers reported more stress, more problems, and increased need for services. However, the reported experiences of Canadian- vs. foreign-born individuals were similar. Conclusion The results remain hypothesis-generating. The present pilot illustrated the suitability of mixed methods to this area of study, which deserves further investigation to better serve all members of a population already vulnerable by age and disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: Workers with persistent disabling low back pain (LBP) often encounter difficulty staying at work. Self-management (SM) programs can offer interesting avenues to help workers stay at work. OBJECTIVE: To establish the plausibility of a logic model operationalizing a SM program designed to help workers with persistent disabling LBP stay at work. METHODS: We used a qualitative design. A preliminary version of the logic model was developed based on the literature and McLaughlin et al.'s framework for logic models. Clinicians in work rehabilitation completed an online survey on the plausibility of the logic model and proposed modifications, which were discussed in a focus group. Thematic analyses were performed. RESULTS: Participants (n = 11) found the model plausible, contingent upon a few modifications. They raised the importance of making more explicit the margin of maneuver or "job leeway" for a worker who is trying to stay at work and suggested emphasizing a capability approach. Enhancing the workers' perceived self-efficacy and communication skills were deemed essential tasks of the model. CONCLUSION: A plausible logic model for a SM program designed for workers with disabling LBP stay at work was developed. The next step will be to assess its acceptability with potential users. [ABSTRACT FROM AUTHOR]

Introduction: Vision rehabilitation therapists (VRTs) carry out many specific job tasks. This study seeks to better understand the VRT profession by organizing many tasks into a few specific roles in which VRT practitioners are involved. Methods: Using the results of the 2017 online survey, a principle component analysis was carried out to extract clusters of specific job tasks. The reliability of the resulting job role constructs was assessed using Cronbach's alpha. Results from this analysis are compared to a similar analysis of VRT job roles conducted 28 years ago. Results: Four job roles are extracted from the survey's frequency data: (1) teaching activities, (2) case management, (3) technology, and (4) low vision and assessment. Seventy specific job tasks are retained under the four roles. Discussion: Extracted job roles of teaching and case management are similar to Leja's (1990) findings, indicating that these roles remain important aspects of the VRT job. Two new roles have emerged since Leja's examination, and they are related to technology and low vision and assessment. The advancement, availability, and affordability of technologies and low vision interventions has increased the need for teaching the use of access technologies across the daily living spectrum. The availability of low vision devices has expanded the role of the VRT in the provision of functional low vision assessments, strategies for reading and daily tasks, appropriate use of optical and nonoptical aids, and environmental assessment for safety and optimal visual performance. Implications for practitioners: VRT survey participants are performing additional job roles in technology and low vision and assessment. This presents challenges related to resources and training for practitioners who already provide instruction across a broad set of skill domains. Issues include access to new technologies, adequate time to learn new devices and software, and standardized assessment tools. [ABSTRACT FROM AUTHOR]

The vast majority of research and efforts towards greater care coordination have taken place at the level of single, sovereign organizations, or at the level of networks formed to address the need for cross-organizational collaboration. The recently emerging ecosystem level of analysis and intervention is still under-researched, with few if any available innovation practices that match the complexity experienced at the level of care ecosystems. Beginning with the challenge of care coordination, we discuss what care ecosystems are and how they can be defined and describe the possibilities and opportunities that come when viewing care coordination through an ecosystem lens. We underpin our plea for an ecosystem approach to health and social care coordination with seven lessons, which we draw from an extensive study of 15 care ecosystem cases from seven different countries. We end the paper with an appeal for further research in this promising field. [ABSTRACT FROM AUTHOR]

Canada's population is aging, and by 2027, it is expected that 22 million people will be older than 65 years. Home care services were used by 2.2 million individuals, or 8% of Canadians 15 years of age and older in 2012. Home care programs are continually expanding to meet the needs of the growing number of clients, and goals include keeping people in their homes for as long as possible, delaying the need for institutional care, and maintaining quality of life. Case managers are the gatekeepers to home care in Canada. They collaborate with families to plan care, coordinate home care services and community supports, as well as monitor client progress and evaluate outcomes. The aim of our study was to conduct a qualitative secondary analysis to understand the factors that influence case manager work and workload in home care. We completed a secondary analysis of four data sets from four primary studies of related concepts that occurred between 2006 and 2013. Our study design was inductively driven using the tenets of interpretive description. Case managers' work and workloads are messy and affected by interrelated complex structures of home care programs within health care systems. The concept of a wicked problem, which describes a problem that is complex and intractable, is a useful construct we use to gain some clarity around the work and workload problems that case managers face. Case managers aim to make a positive difference in their client's lives, but are constantly dealing with change, and can experience feelings of being their client's last resort with the resulting pressure ultimately impacting their workload. In addition, case managers reported health system failures, including a lack of capacity and structural integration within home care programs that increase their work and workload. Case manager work and workload requires further research including the development and refinement of accurate workload measurement tools that consider the multiple aspects of professional responsibilities and case management activities. Workload and workload measurement tools are needed to account for the unplanned and unpredictable nature of case management work and assist with the distribution of more equitable caseloads among case managers and home care teams. [ABSTRACT FROM AUTHOR]

This article examines the feasibility of a complex intervention designed to facilitate the transition of youth out of homelessness. It is intended to contribute to efforts to build out the youth homelessness intervention literature, which is underdeveloped relative to descriptive characterizations of risk. The 6-month intervention examined here, referred to as the Housing Outreach Program-Collaboration (HOP-C), is comprised of transitional outreach-based case management, individual and group mental health supports, and peer support. The intervention was delivered through a multiagency, interdisciplinary collaboration. Feasibility was assessed using a mixed methods design that included prepost intervention metrics and the study site was a large Canadian urban center. A total of 31 youth participated in the study with 28 completing the intervention. Overall, implementation and youth engagement was successful though patterns and intensity of engagement were quite variable. While prepost, self-report metrics improved modestly, substantial gains were observed in employment, education, and mental health service connectedness. Qualitative themes focused on the benefits of a flexible, multicomponent approach, close attention to seamless delivery and common factors, and supporting youth in the balance of isolation versus independence. These findings suggested that this tertiary prevention approach is feasible and warrants further investigation. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Despite the high prevalence of fetal alcohol spectrum disorder (FASD) in youth criminal justice settings, there is currently no research supporting the use of violence risk assessment tools in this population. This study examined the predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) and the Youth Level of Service/Case Management Inventory (YLS/CMI) in justice-involved youth with FASD. Participants were 100 justice-involved youth (ages 12-23; 81% male), including 50 diagnosed with FASD and 50 without FASD or prenatal alcohol exposure. The SAVRY and YLS/CMI were prospectively coded based on interview and file review, with recidivism (both any and violent specifically) coded 1-year post-baseline assessment. Results provide preliminary support for the validity of the SAVRY and YLS/CMI in predicting recidivism in justice-involved youth with FASD. Higher ratings across SAVRY and YLS/CMI domains were found in youth with FASD, underscoring a critical need for assessments and interventions to buffer recidivism risk and address clinical needs. (PsycINFO Database Record (c) 2018 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Elder abuse is a growing public health concern with serious and sometimes fatal consequences. Intervention research is lacking despite its potential value to victim protection. This study investigates the first and longest-running social work intervention programme for elder abuse in Canada. The aim of this study is to provide a better understanding of the scope of the problem and needs of the population to inform programme development through the recommendations made. One hundred and sixty-four cases of elder abuse reported from January 2012 to April 2014 were examined. Case characteristics and related recommendations are reported. Third parties reported most abuse, which was typically emotional and financial; polyvictimisation was present in most cases. Intake practices that may have facilitated reporting are described and recommendations to improve victim reporting and confidentiality are made. Victim health problems and dependency were common and many victims lacked support. Perpetrators often resided with victims and had mental health and social-functioning problems. Case management varied in length and several barriers were identified. Multi-agency work is recommended to better manage the needs of the victim, risk factors related to the perpetrator and victim–perpetrator cohabitation. Recommendations to improve the safety of the victim and that of professionals are also made. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation.Methods: We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients.Results: A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, P = .04), but did not have any significant effect on patient activation (P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health.Conclusions: Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs. [ABSTRACT FROM AUTHOR]

Abstract: Few studies pertain to caseworkers and their practices for supporting the development of self‐determination of adults with intellectual disabilities (ID). This research thus aims at describing the intervention practices of 12 caseworkers from Quebec (Canada). These caseworkers participated in five discussion groups over an 8‐month period. The data analysis helped identify a set of interventions conducted with people who have ID and with their environments. The majority of interventions are person‐specific, although natural and foster families are also targets for intervention. A number of person‐specific and environment‐specific variables influence these interventions. These variables concern people with ID, caseworkers, natural families, foster families, service organizations, and the community. The complexity of the intervention process is discussed. Recommendations are formulated for caseworkers, service organizations, and public decision makers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little is known about how healthcare providers (HCPs) in Canada manage mental health claims and the return to work (RTW) of injured workers OBJECTIVE: To examine HCPs' experience and challenges on the treatment of mental health conditions (MHCs) in the context of Workers' Compensation (WC) processes and their involvement in RTW. METHODS: Ninety-seven interviews with HCPs (general practitioners, n = 59; allied HCPs, n = 19; specialists, n = 19) were conducted in British Columbia, Manitoba, Ontario and Newfoundland. A thematic content analysis was used to analyze interviews. RESULTS: HCPs reported that while RTW is extolled at virtually all costs by WC boards, they did not always see it as beneficial. Most HCPs were convinced that successful recovery and RTW depend on being aware of how mental and physical health is intertwined and treating both issues. Organizational barriers within WC processes and adversarial relationships between injured workers (IWs) and WC boards made it difficult for HCPs to adequately treat patients and facilitate RTW. Dealing with IWs' MHCs and their emotional distress due to 'going through WC systems' was challenging. CONCLUSIONS: WC boards must identify how policies can be modified to mitigate compensation processes and RTW for WC claimants with MHC. [ABSTRACT FROM AUTHOR]

Promoting timely and continuous care for people experiencing homelessness has been a challenge in many jurisdictions, plagued by access barriers and service fragmentation. As part of a larger programme evaluation, this study used qualitative methods to examine the role of a brief interdisciplinary intervention in supporting continuity of care for this population in a large Canadian urban centre. The intervention provides time-limited case management, primary and psychiatric care, and peer accompaniment to homeless adults with unmet health needs discharged from hospital. Data were collected from 52 study participants between July 2013 and December 2014. Three focus groups were conducted with service providers and people with lived experience of homelessness, and 29 individual, semi-structured interviews were conducted with service users and other key informants. Transcripts were analysed using thematic analysis. Analysis was informed by existing frameworks for continuity of care, while remaining open to additional or unexpected findings. Findings suggest that brief interdisciplinary interventions can promote continuity of care by offering low-barrier access, timely and responsive service provision, including timely connection to long-term services and supports, appropriate individualised services and effective co-ordination of services. Although brief interdisciplinary interventions were perceived to promote access, timeliness and co-ordination of care for this population with complex health and social needs, gaps in the local service delivery context can present persisting barriers to care comprehensiveness and continuity. [ABSTRACT FROM AUTHOR]

First, we briefly feature the TIPP program (Treatment and Early Intervention in Psychosis Program) and early management general concepts in early psychosis. One intervention objective in the early phase of psychotic disorders is proposing specific care adapted to this phase of the illness. From the start, the care team and especially the case manager, the care conductor, are faced with a huge information load in which they have to discern lines of force in order to install an adapted management. This article proposes a model that can constitute a valuable work tool for early intervention teams wanting to produce a case formulation and summarize patient clinical situations, extract from it a meaningful history, and thus facilitate the implementation of a therapeutic project. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background The experience of having human immunodeficiency virus (HIV) is often associated with co-occurring mental health issues. Community mental health services are an important source of support for persons with HIV living in the community. Persons with intellectual disability (ID) are vulnerable to HIV and may have unique support needs beyond those without ID receiving community care. This study compared support needs of men with HIV in community mental health programmes, with and without ID. Methods The sample was composed of 138 HIV-positive men with and without ID receiving mental health case management from one community organisation in Ontario, Canada, on 31 March 2013. Staff-rated needs across 16 domains grouped into four clusters were measured using the Camberwell Assessment of Need: Basic needs (accommodation, food, public transportation, money and benefits); self-care/functional needs (looking after the home, self-care and daytime activities); health/safety needs (physical health, psychological distress, psychotic symptoms, safety to self and safety to others); and social needs (company, intimate relationships and sexual expression). Adjusted logistic regression models examined the association between ID and each need domain. Results One-quarter of the sample ( n = 34/138, 24.6%) had co-occurring ID. Those with ID were more likely to have needs in the basic cluster [odds ratios: food 4.05 (1.14, 14.44), P:0.031; benefits 2.58 (1.05, 6.32), P:0.038)] and self-care/functional cluster [looking after the home (2.75 (1.17, 6.49), P:0.021); self-care (2.72 (1.18, 6.27), P:0.019)], but were less likely to have need for sexual expression: 0.35 (0.14,0.90), P:0.030) (social cluster). There were no differences in the domains in the health/safety cluster. Conclusion Despite elevated cognitive needs in the basic and self-care/functional clusters for the ID group, limited other differences suggest that with moderate additional targeting, community mental health programmes for persons with HIV may be appropriate for men with ID. [ABSTRACT FROM AUTHOR]

Researchers, policy-makers, and political leaders in Canada and the US are championing the ‘Housing First’ (HF) intervention as a solution to homelessness. HF supplies people experiencing both homelessness and challenges around mental health with housing and a range of supports that can include case-coordination, psychiatry, and primary care. While HF’s impact on the housing status of individual participants has received considerable scientific and public consideration, less attention has been paid to its effects on societal conversations related to housing, public services, and social justice. We explore some of the impacts, not of HF the intervention, but of HF the conversation – the way public documents related to HF interact with broader discourses. Specifically, we examine the potential for this conversation to undermine the ultimate goal of ending homelessness in Canada. We conclude that positioning program interventions – no matter how important in the current context – as singular solutions to issues like homelessness or preventable chronic disease risks obscuring distal causes and marginalizing systemic responses. [ABSTRACT FROM PUBLISHER]

A Canadian sample was collected as an aspect of a large international project, with representation from Australia, Canada, China and Switzerland. In each country, interview and survey data were collected using team-created research tools. Canadian survey data on disability management (DM) perceptions were collected from 218 employees in both public and private organisations. Our Canadian employee sample reported perceived influence of disability prevention on job satisfaction, physical health, mental health and morale for both themselves and their coworkers. Return to work programs were seen as valuable for job satisfaction of both the employee and coworkers, as well as the physical health of coworkers. Similarly, stay at work programs were seen as valuable for mental health and morale of coworkers. There was no relationship between perceived influence of DM interventions and reduction of sickness absence. The influence of DM was perceived as more positive for private and/or nonunionised workplaces. No gender differences were evident. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: "Housing First" has been shown to improve housing stability in homeless individuals with mental illness, but had not been empirically tested in homeless youth. We aimed to evaluate the effect of "Housing First" on housing stability in homeless youth aged 18 to 24 years participating in At Home/Chez Soi, a 24-month randomized trial of "Housing First" in 5 Canadian cities. METHODS: Homeless individuals with mental illness were randomized to receive "Housing First" (combined with assertive community treatment or intensive case management depending on their level of need) or treatment as usual. We defined our primary outcome, housing stability, as the percent of days stably housed as a proportion of days for which residence data were available. RESULTS: Of 2148 participants who completed baseline interviews and were randomized, 7% (n = 156) were youth aged 18 to 24 years; 87 received "Housing First" and 69 received treatment as usual. In an adjusted analysis, youth in "Housing First" were stably housed a mean of 437 of 645 (65%) days for which data were available compared with youth in treatment as usual, who were stably housed a mean of 189 of 582 (31%) days for which data were available, resulting in an adjusted mean difference of 34% (95% confidence interval, 24%-45%; P < .001). CONCLUSIONS: "Housing First" was associated with improved housing stability in homeless youth with mental illness. Future research should explore whether adaptations of the model for youth yield additional improvements in housing stability and other outcomes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: 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. Method: 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. Results: 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 demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual. Conclusions: Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH-CS project and to scale up the HF approach across Canada. [ABSTRACT FROM AUTHOR]

Purpose To determine the association between supervisors' leadership style and autonomy and supervisors' likelihood of supporting job accommodations for back-injured workers. Methods A cross-sectional study of supervisors from Canadian and US employers was conducted using a web-based, self-report questionnaire that included a case vignette of a back-injured worker. Autonomy and two dimensions of leadership style (considerate and initiating structure) were included as exposures. The outcome, supervisors' likeliness to support job accommodation, was measured with the Job Accommodation Scale (JAS). We conducted univariate analyses of all variables and bivariate analyses of the JAS score with each exposure and potential confounding factor. We used multivariable generalized linear models to control for confounding factors. Results A total of 796 supervisors participated. Considerate leadership style (β = .012; 95 % CI .009-.016) and autonomy (β = .066; 95 % CI .025-.11) were positively associated with supervisors' likelihood to accommodate after adjusting for appropriate confounding factors. An initiating structure leadership style was not significantly associated with supervisors' likelihood to accommodate (β = .0018; 95 % CI −.0026 to .0061) after adjusting for appropriate confounders. Conclusions Autonomy and a considerate leadership style were positively associated with supervisors' likelihood to accommodate a back-injured worker. Providing supervisors with more autonomy over decisions of accommodation and developing their considerate leadership style may aid in increasing work accommodation for back-injured workers and preventing prolonged work disability. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. DESIGN: A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. STUDY SAMPLE: Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. METHODOLOGY: Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. RESULTS: Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. CONCLUSIONS: This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions. [ABSTRACT FROM AUTHOR]

Purpose -- This article aims to document the process the province of Newfoundland and Labrador used to develop an innovative Physician Management and Leadership Program (PMLP). The PMLP is a collaborative initiative among Memorial University (Faculty of Medicine and Faculty of Business), the Government of Newfoundland and Labrador, and the Regional Health Authorities. As challenges facing health-care systems become more complex there is a growing need for management and leadership training for physicians. Design/methodology/approach -- Memorial University Faculty of Medicine and the Gardiner Centre in the Faculty of Business in partnership with Regional Health Authorities and the Government of Newfoundland and Labrador identified the need for a leadership and management education program for physician leaders. A provincial needs assessment of physician leaders was conducted to identify educational needs to fill this identified gap. A Steering Committee was formed to guide the design and implementation and monitor delivery of the 10 module Physician Management and Leadership Program (PMLP). Findings -- Designing management and leadership education programs to serve physicians who practice in a large, predominately rural geographic area can be challenging and requires efficient use of available resources and technology. Originality/value -- While there are many physician management and leadership programs available in Canada and abroad, the PMLP was designed to meet the specific educational needs of physician leaders in Newfoundland and Labrador. [ABSTRACT FROM AUTHOR]

Cirrhosis affects millions of people throughout the world. Two of the most serious complications of liver cirrhosis are ascites and spontaneous bacterial peritonitis (SBP). The development of ascites is related to the severity of portal hypertension and is an indicator of increased mortality. Although sodium restriction and diuretic therapy have proven effective, some patients may not respond appropriately or develop adverse reactions to diuretic therapy. In such cases, interventions such as transjugular intrahepatic portosystemic shunt (TIPS) placement are warranted. SBP is a complication of ascites that confers a very high mortality rate. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. Initiation of prophylaxis in SBP remains controversial. Given the burden of liver cirrhosis on the health care system, ascites and SBP will continue to provide challenges for the primary care provider, hospitalist, internist, and gastroenterologist alike. [ABSTRACT FROM AUTHOR]

Background Accountable, continuous and patient-centred care in community-based settings is increasingly needed to reduce fragmented care, especially to reduce patient readmission rates. Case management has been proven effective in reducing healthcare costs and in increasing continuity of care, but its effectiveness in community-based settings is not clear. Aim The aim of this integrative review is to examine the effectiveness of community-based case management programmes in improving patient outcomes. Methods An integrative review of articles from PubMed, CINAHL and PsycInfo databases was undertaken to synthesize and analyse research about community-based case management and its outcomes. Studies looking for patient outcomes and empirical studies published since 2000 were included. A total 18 articles were retrieved from 2000 to 2013. Results Most of the included studies were conducted in the USA, but international studies with quantitative approaches were reviewed ( n = 6). The review revealed that community-based case management significantly reduced hospital access outcomes, especially readmissions and increased cost effectiveness, patient clinical outcomes and patient satisfaction. Limitations This study did not isolate studies of patients with diseases or demographic characteristics in common, resulting in large variations in disease and demographic factors. Conclusion There is a base of evidence that community-based case management is effective. Because it provides quality, patient-centred care, case management should be used for major care coordination. Implications for Nursing and Health Policy The benefits of community-based case management need to be announced to healthcare leaders and policymakers. [ABSTRACT FROM AUTHOR]

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 program's 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. [ABSTRACT FROM AUTHOR]

Fillion et al. (2012) recently designed a conceptual framework for professional cancer navigators describing key functions of professional cancer navigation. Purpose: Building on this framework, this study defines the core areas of practice and associated competencies for professional cancer navigators. Methods: The methods used in this study included: literature review, mapping of navigation functions against practice standards and competencies, and validation of this mapping process with professional navigators, their managers and nursing experts and comparison of roles in similar navigation programs. Findings: Associated competencies were linked to the three identified core areas of practice, which are: 1) providing information and education, 2) providing emotional and supportive care, and 3) facilitating coordination and continuity of care. Conclusion: Cancer navigators are in a key position to improve patient and family empowerment and continuity of care. Implications: This is an important step for advancing the role of oncology nurses in navigator positions and identifying areas for further research. [ABSTRACT FROM AUTHOR]

This article reviews the effectiveness of community treatment orders (CTOs), a community-based treatment program initiated to improve compliance with treatment plans and address societal concerns regarding seriously mentally ill individuals. It assesses the impact of CTOs on individuals who have participated in this treatment and addresses the question of whether CTOs have the potential to resolve mental health problems in the community. This article examines the use of CTOs in a number of countries, and in particular, the outcomes of a CTO program in Toronto, Canada. Finally, it looks at advanced directives, intensive case management, and recovery-oriented service system reform as viable and empowering alternatives to CTOs. [ABSTRACT FROM AUTHOR]

The article describes how the Pratt & Whitney Canada (P&WC) company runs its disability management at work program. It mentions that the P&WC has Health & Wellbeing Service (H&WS) division; its Disability Management (DM) program has been in place for over 25 years. The P&WC DM program has moved from an illness based approach to a functional model; H&WS has the responsibility of managing DM and return to work (RTW) program.

Transitions between various healthcare services are potential points for fragmented care and can be confusing and complicated for patients, formal and informal caregivers. These challenges are compounded for older adults with chronic disease, as they receive care from many providers in multiple care settings. System navigation has been suggested as an innovative strategy to address these challenges. While a number of navigation models have been developed, there is a lack of consensus on the desired characteristics and effectiveness of this role. We conducted a systematic literature review to describe existing navigator models relevant to chronic disease management for older adults and to investigate the potential impact of each model. Relevant literature was identified using five electronic databases - Medline, CINAHL, the Cochrane database, Embase and PsycINFO between January 1999 and April 2011. Following a recommended process for health services research literature reviews, exclusion and inclusion criteria were applied to retrieved articles; 15 articles documenting nine discrete studies were selected. This review suggests that the role of a navigator for the chronically ill older person is a relatively new one. It provides some evidence that integrated and coordinated care guided by a navigator, using a variety of interventions such as care plans and treatment goals, is beneficial for chronically ill older adults transitioning across care settings. There is a need to further clarify and standardise the definition of navigation, as well as a need for additional research to assess the effectiveness and cost of different approaches to the health system. [ABSTRACT FROM AUTHOR]

While rapid changes in the treatment of cancer have been driven by research-based evidence, innovations in cancer care delivery have lagged behind that seen in cancer treatment. A literature review and ten semi-structured interviews were conducted to identify models of care in the ambulatory oncology setting to be adopted by a comprehensive cancer center. Four models were identified from the literature review but none were widely recognized or adopted by administrators. Findings suggested some common themes that should be included in an optimal model of care. These themes are in support of the burgeoning efforts seen in the promotion of interprofessional education and practice for quality improvement. Unique challenges related to the contextual factors in the ambulatory oncology settings suggest quality improvement interventions should be tailored to meet the specific needs of the care facility and its workforce. [ABSTRACT FROM AUTHOR]

Objectives: To quantify the current availability and use of bedside emergency department ultrasonography (EDUS) for blunt trauma at Canadian pediatric centres and to identify any perceived barriers to the use of bedside EDUS in such centres. Methods: An electronic survey was sent to 162 pediatric emergency physicians and 12 site directors from the 12 pediatric emergency departments across Canada. Results: Ninety-two percent (11 of 12) of centres completed the survey. The individual physician response rate was 65% (106 of 162), with 100% of site directors responding. Ultrasound machines were available in 45% (5 of 11) of centres. Forty-two percent (32 of 77) of emergency physicians working in equipped pediatric centres used bedside EDUS to evaluate blunt abdominal trauma (BAT). In the subgroup of staff who also worked at adults sites, the frequency of ultrasonography use for the evaluation of pediatric BAT was 75%. In the 55% (6 of 11) of centres without ultrasonography, 88% of staff intend to incorporate its use in the future and 81% indicated that they believed the incorporation of ultrasonography would have a positive impact on patient care. The main perceived barriers to the use of ultrasonography in the evaluation of BAT were a lack of training (41%) and a lack of equipment (26%). Conclusion: Bedside EDUS is currently used in almost half of pediatric trauma centres, a frequency that is significantly lower than adult centres. Physicians in pediatric centres who use ultrasonography report that it has a high utility, and a great majority of physicians at pediatric centres without EDUS plan to incorporate it in the future. The main reported barriers to its use are a lack of training and a lack of equipment availability. [ABSTRACT FROM AUTHOR]

Around the world, adults with serious illnesses or chronic conditions account for a disproportionate share of national health care spending. We surveyed patients with complex care needs in eleven countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) and found that in all of them, care is often poorly coordinated. However, adults seen at primary practices with attributes of a patient-centered medical home-where clinicians are accessible, know patients' medical history, and help coordinate care-gave higher ratings to the care they received and were less likely to experience coordination gaps or report medical errors. Throughout the survey, patients in Switzerland and the United Kingdom reported significantly more positive experiences than did patients in the other countries surveyed. Reported improvements in the United Kingdom tracked with recent reforms there in health care delivery. Patients in the United States reported difficulty paying medical bills and forgoing care because of costs. Our study indicates a need for improvement in all countries through redesigning primary care, developing care teams accountable across sites of care, and managing transitions and medications well. The United States in particular has opportunities to learn from diverse payment innovations and care redesign efforts under way in the other study countries. [ABSTRACT FROM AUTHOR]

Background Healthcare transition (HCT) for youth with disabilities is a complex phenomenon influenced by multiple interacting factors, including health, personal and environmental factors. Current research on the transition to adulthood for disabled youth has primarily focused on identifying these multilevel factors to guide the development of interventions to improve the HCT process. However, little is known about how this complex array of factors interacts and contributes to successful HCT. Systems thinking provides a theoretically informed perspective that accounts for complexity and can contribute to enhanced understanding of the interactions among HCT factors. The objective of this paper is to introduce general concepts of systems thinking as applied to HCT practice and research. Methods Several systems thinking concepts and principles are introduced and a discussion of HCT as a complex system is provided. Systems dynamics methodology is described as one systems method for conceptualizing HCT. A preliminary systems dynamics model is presented to facilitate discourse on the application of systems thinking principles to HCT practice, policy and research. Conclusions An understanding of the complex interactions and patterns of relationships in HCT can assist health policy makers and practitioners in determining key areas of intervention, the impact of these interventions on the system and the potential intended and unintended consequences of change. This paper provides initial examination of applying systems thinking to inform future research and practice on HCT. [ABSTRACT FROM AUTHOR]

This paper examines the sources of practice variations and definitions of unwarranted variation, as derived from the literature. The literature suggests variables/factors related to patient health needs, doctor 'practice style' and environmental constraints/opportunities as sources of practice variations. However, this list is likely to be incomplete because of significant unexplained variation in each study. Furthermore, it is unclear which factors are sources of unwarranted variation because the reviewed studies do not clearly discriminate between those variations that are unwarranted and those that are not. It is also unclear if context plays a role in determining if and when a factor is unwarranted. The literature contains few frameworks of what constitutes unwarranted variation. Among those offered, more information is needed regarding the scientific basis for including the selected factors, and how to operationalize the framework provided a particular one is chosen. A clear and consistent framework for unwarranted variation, and a clear indication how each component factor could be measured and integrated can help investigators determine which variables should be included in their studies, such that the sources of unwarranted variations may be identified. A better understanding of the role of patient preference as a potential source of practice variations is also required. [ABSTRACT FROM AUTHOR]

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