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Hoarded homes can pose a threat to public safety, with heightened risks of fire hazards, pest infestations and noxious odours in both the home and neighbouring dwellings. Communities across North America are responding to these public safety concerns through a harm reduction approach. This descriptive study explores the implementation and outcomes of the City of Vancouver's approach involving a partnership between fire prevention and public health. Data were collected from the team's 2016–2018 case tracking systems, consisting of health records and team intervention record, as well as notes taken from case briefing meetings. Study objectives included describing the intervention model, providing descriptive statistics on clients and their clutter volume, the interventions undertaken, and exploring predictors of clutter volume and case outcome through exploratory analyses. The sample included 82 cases involving severely hoarded conditions or more moderate hoarding conditions paired with additional client vulnerabilities (e.g. health conditions, frailty). Results from paired samples t‐tests and regression analysis, suggest the Hoarding Action Response Team's (HART) model of a community‐based intervention for hoarding was associated with clutter reduction and tenancy preservation. HART successfully maintained engagement with most clients, and most cases were closed within six home visits. Despite these successes, the team dealt with several barriers including client avoidance and limited resources. This paper provides guidance for communities who are working to develop a coordinated response to problems associated with hoarding and begins to establish expectations for what can be achieved through a community‐based hoarding intervention model. [ABSTRACT FROM AUTHOR]

The effects of the coronavirus disease‐2019 (COVID‐19) pandemic on the lives of underserved populations are underexplored. This study aimed to identify the impacts of the COVID‐19 pandemic and associated public health responses on the health and social well‐being, and food security of users of Housing First (HF) services in Toronto (Canada) during the first wave of the COVID‐19 pandemic. This qualitative descriptive study was conducted from July to October 2020 in a subsample of 20 adults with a history of homelessness and serious mental disorders who were receiving HF services in Toronto. A semi‐structured interview guide was used to collect narrative data regarding health and social well‐being, food security and access to health, social and preventive services. A thematic analysis framework guided analyses and interpretation of the data. The COVID‐19 pandemic and response measures had a variable impact on the health, social well‐being and food security of participants. Around 40% of participants were minimally impacted by the COVID‐19 pandemic. Conversely, among the remaining participants (impacted group), some experienced onset of new mental health problems (anxiety, stress, paranoia) or exacerbation of pre‐existing mental disorders (depression, post‐traumatic stress disorder and obsessive‐compulsive disorder). They also struggled with isolation and loneliness and had limited leisure activities and access to food goods. The pandemic also contributed to disparities in accessing and receiving healthcare services and treatment continuity for non‐COVID‐19 health issues for the negatively impacted participants. Overall, most participants were able to adhere to COVID‐19 public health measures and get reliable information on COVID‐19 preventive measures facilitated by having access to the phone, internet and media devices and services. In conclusion, the COVID‐19 pandemic and associated response measures impacted the health, social well‐being, leisure and food security of people with experiences of homelessness and mental disorders who use supportive social and housing services in diverse ways. [ABSTRACT FROM AUTHOR]

Patient‐centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision‐making (SDM) is recognised as promoting patient‐centred care. We explore this relationship by studying SDM in the context of integrating novel patient‐centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co‐investigators led study co‐design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient‐centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early‐adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set–collect–reflect method to document patient perspectives. Researchers captured provider perspectives using a semi‐structured question guide. We completed 11 focus groups and 18 interviews (n = 45 providers, n = 17 patients). We found that most early‐adopter providers spoke in a shared, patient‐first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision‐making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long‐term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term. [ABSTRACT FROM AUTHOR]

Foot care is a common problem for homeless adults in cities, who often receive fragmented foot care services, resulting in increased foot problems, health complications, hospitalisation, limb removal and disabilities. Among the health factors that negatively affect the homeless, foot health is essential, but often neglected. This study employed a descriptive, cross‐sectional research design to assess the foot care of homeless people and develop recommendations for clinical practice. Using Inlow's 60‐s foot screening method, the foot conditions of a purposive sample of 65 homeless adults were examined in British Columbia, Canada, in 2019–2020. Descriptive and inferential statistics were used to analyse the data. Determinants, such as sex and years of homelessness significantly contributed to homeless individuals' risk of developing foot problems. Differences in perceived and observed foot problems were influenced by equitable access to social health and healthcare services. Foot assessment is not well‐covered by homeless health services and should be implemented as part of the standard medical review of homeless patients. Furthermore, foot assessment should be conducted by healthcare professionals, rather than relying on the standard practice of service users' self‐report. Finally, foot care should be based on tailoring assessments and interventions for the individualised needs of homeless service users. Future research must seek ways to integrate homeless individuals' voices in the development, implementation and evaluation of foot care services. [ABSTRACT FROM AUTHOR]

Introduction. With community-dwelling elders waiting to adapt their bathroom, Health and Social Services Centers in Quebec (Canada) combined human resources through cross-skilling within interdisciplinary teams. To this end, occupational therapists implemented in-house "tools" to support nonoccupational therapists in selecting bathing equipment. However, unknown psychometric properties of those in-house "tools" cast doubt on the quality of service provided to elders. Little is also known about the best processes to use to support the deimplementation of such nonevidence-based practices. This study presents the effect of a knowledge transfer and exchange intervention designed to deimplement in-house "tools" and replace them with an evidence-based tool (Algo). Methods. Censuses were conducted with the 94 Health and Social Services Centers of Quebec providing homecare services, before and after the knowledge transfer and exchange intervention (2009-2013). In 2013, the deimplementation of in-house "tools" and their replacement by Algo were measured with Knott and Wildavsky's levels of utilization. Results. Cross-skilling within interdisciplinary teams increased between censuses (87% to 98%), as did use of in-house "tools" (67% to 81%). Algo's uptake started during the knowledge transfer and exchange process as 25 Health and Social Services Centers achieved the first level of utilization. Nonetheless, no Health and Social Services Center deimplemented the in-house "tools" to use Algo. Conclusion. The knowledge transfer and exchange process led to the development of a scientifically sound clinical tool (Algo) and challenged the status quo in clinical settings regarding the use of nonevidence-based practices. However, the deimplementation of in-use practices has not yet been observed. This study highlights the need to act proactively on the deimplementation and implementation processes. [ABSTRACT FROM AUTHOR]