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Permanent supportive housing (PSH) is the main approach advocated in Western countries for eradicating homelessness. Considering that PSH residents are not a homogeneous group and that their quality of life (QoL) and community integration (CI) might differ in this setting, improving our understanding of these residents' profiles may help stakeholders formulate informed recommendations to improve PSH. This study identified PSH resident profiles based on their QoL, CI, and sociodemographic and clinical characteristics and associated these profiles with housing features and service use. A total of 308 PSH residents were recruited in Montreal (Canada) in 2020–2022. Structured interviews were conducted. PSH resident profiles were produced with cluster analysis and subsequently compared using chi‐square, Fisher's, and t‐tests, taking into account housing features and service use. Three PSH resident profiles were found. Profile 1 residents (22% of the sample) had low QoL and CI, were younger, and had major social and health issues and unmet needs. Showing moderate QoL and CI, Profile 2 residents (27%) were more educated, had little foster care history, were older on their first homelessness episode, and had few co‐occurring MD‐SUD. Profile 3 residents (51%) had the best QoL and CI and mostly included men with little education, affected by co‐occurring MD‐SUD and satisfied with services. More intensive housing support and care coordination may be recommended for Profile 1 PSH residents in response to their diverse needs. Work integration may be beneficial to Profile 2 residents, with programs such as Individual Placement and Support, along with increased rehabilitation activities. A better integration of MD‐SUD treatments may be promoted for Profile 3 residents. Considering most PSH residents had multiple health issues and unmet needs, satisfaction with care could be monitored better, as it was found to be a key variable in measuring care adequation. [ABSTRACT FROM AUTHOR]

How adults with intellectual disability fare in the parenting role depend, to varying degrees, on the adequacy of supports and services provided. The available research suggests that service providers are often ill‐equipped to accommodate their support needs. The purpose of this qualitative descriptive study was to explore the perspectives of Canadian social service workers on what is required to improve services and build systems capacity to more effectively support parents with intellectual disability, their children and families. A total of 39 workers, identified by parents with intellectual disability as their key workers, were interviewed. To build systems capacity to support these parents and families, and to address institutionalised discrimination, key workers highlighted the need for entry‐to‐practice and continuing professional education to develop worker capabilities for reflective practice, relationship‐building and research utilisation; accommodative caseload management, giving workers the time, flexibility and the professional supervision they need to deal with complexity and fashion individualised service responses; and, a common framework, with defined service pathways, to facilitate interagency case planning and, in turn, continuity in service provision. The question is not whether adults with intellectual disability can be effectively supported in the parenting role; the question is whether the political will exists to do what is necessary to ensure they are. [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]

There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi‐structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person‐centered; (2) provided by PSW with dementia‐specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia‐specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front‐line workers' perspectives and how they can help revise current healthcare policies and inform future policy development. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe executive skills in clients experiencing social vulnerability in the context of COVID‐19 from the perspective of social service agency staff. COVID‐19 has required transformational changes to livelihood and day‐to‐day living. Socially vulnerable individuals are likely to be disproportionally impacted because many have experienced serious early childhood adversity, which may compromise their executive skills in adulthood. Using a cross‐sectional survey, we collected data between 05 May 2020 and 03 July 2020, for this mixed methods study of 53 staff in two agencies in western Canada serving clients experiencing social vulnerability. The first case of COVID‐19 in this jurisdiction was identified 05 March 2020. Using investigator‐designed survey items, we captured executive skills in five areas: (a) planning tasks of daily living, (b) managing time, (c) keeping track of information and appointments, (d) managing emotions, and (e) managing self‐control. Staff reported their clients struggled with executive skills and these struggles increased during COVID‐19, particularly in the areas of managing daily tasks and emotional regulation. COVID‐19 restrictions overwhelmed clients with the decisions required to maintain health, employment, and childcare. With the loss of structure and routine, clients lost track of time and delayed completion of tasks, which further increased stress. Disrupted goals and uncertainty about the future contributed to hopelessness for clients who were trying to regain control over their lives, which made it difficult to manage emotions. Some clients acted more impulsively because of the added stressors, lack of routine and access to friends and extended family. A better understanding of the impact of COVID‐19 on socially vulnerable clients will inform social service agencies about areas to focus programming to support their socially vulnerable clients. [ABSTRACT FROM AUTHOR]

The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n = 10) and increasing delivery options (n = 8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n = 15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co‐production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery. [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]

Deficit models of care for clients experiencing social vulnerability have become increasingly unsustainable; and there is a shift towards models of care that promote and protect resiliency for lifelong health. We defined clients as socially vulnerable if they were living with poverty, mental health problems and addictions, disability, and social isolation. Scales to measure outcomes of resiliency‐focused programming have limited reliability and have not been validated with vulnerable populations. The aim of this study was to develop and conduct preliminary psychometric assessment of two measures: CUPS (formerly Calgary Urban Project Society) Resiliency Interview Schedule (RIS) and Resiliency Questionnaire (RQ) for adults experiencing social vulnerability. To engage clients who were seeking integrated services at a social services agency, we developed the RIS and accessed data collected between April 2017 and December 2018. In a structured intake interview, the client and staff prioritised goals and identified resiliency in three domains: (a) economic, (b) social‐emotional, and (c) health. On average, clients (N = 545) who completed the CUPS‐RIS were 45.9 years old (SD = 12.62). For the CUPS‐RIS, Cronbach's alphas at intake and outcome assessments were 0.80. Exploratory factor analysis demonstrated a four‐factor solution with two unexpected results: executive functioning/self‐regulation loaded with mental and physical health, and client education failed to load on any factor. We found significant improvements between client intake and outcome measurement points on eight of 12 sub‐domains. As a brief self‐report measure of resiliency, we developed the CUPS‐RQ and accessed data collected between November 2018 and May 2019. Clients (N = 29) who completed the CUPS‐RQ concurrently with the Resilience Research Centre‐Adult Resilience Measure (RRC‐ARM) were, on average, 42.46 years old (SD = 12.87). The CUPS‐RQ was correlated with RRC‐ARM, r = 0.819. In preliminary psychometric assessment, the CUPS‐RIS and CUPS‐RQ demonstrated satisfactory reliability and validity and show promise as measures of resiliency for agencies serving clients experiencing social vulnerability. [ABSTRACT FROM AUTHOR]

Aim: This study aims at better understanding the relationships between nurses' enacted scope of practice, work environment and work satisfaction, missed care, and organizational indicators of performance. Background: The enacted scope of practice model describes the determinants and consequences of the actual enactment of the nursing scope of practice. Method: A correlational design was used to investigate nurses' enacted scope of practice in five Canadian healthcare centres. Results: Suboptimal enacted scope of practice were found in the current sample. Significant positive correlations were found between the total enacted scope of practice score, use of qualification, control over tasks, decisional latitude and psychological demand as well as role ambiguity. Moreover, a higher enacted scope of practice was correlated with lower organizational indicators of short‐term absenteeism. Conclusion: Results suggest an insufficient deployment of nurses' enacted scope of practice, likely caused by some job characteristics, leading to lower work satisfaction and negative patients and organizational outcomes. Implications for nursing management: Optimizing nurses' enacted scope of practice would be a significant integrated strategy for improving organizational performance, patient care and nurses' satisfaction and well‐being. Nurses and frontline managers must be involved in the decision‐making process necessary to improve nurses' enacted scope of practice. [ABSTRACT FROM AUTHOR]

Aim: To explore emergency nurses' perceptions of how a nurse‐driven patient needs assessment tool, the synergy tool, influenced their workload management. Background: Quadruple Aim, particularly the fourth aim of improved staff work experiences, served as the conceptual framework to engage nurses in a participatory action research project. This project took place between 2017 and 2020 in two tertiary care emergency departments in one large Canadian city. Method: This study employed a qualitative descriptive component, focus group interviews and nurse comments on two open‐ended survey questions. Results: Use of the synergy tool heightened nurses' awareness of patients' holistic care needs. Nurses also stated how patient needs assessment data helped them identify unsafe workloads. Conclusions: The synergy tool, adapted for emergency department use by nurses, was a means to engage and empower nurses. Patient needs assessment data from the tool identified staffing gaps, resulting in additional nursing staff for both emergency departments. Implications for Nursing Management: A focus on patient needs assessment can be an effective way to address nurses' workload concerns. [ABSTRACT FROM AUTHOR]

Aim: Initial testing of England's Safer Nursing Care Tool for adult in‐patient acute care wards in a university‐affiliated Canadian hospital. Background: Safe‐nursing staffing decisions have significant impacts on patients' safety and quality of care. The Safer Nursing Care Tool was developed in England to provide managers with a validated formula for making appropriate nursing staffing decisions. The tool has been widely used and studied in the UK but has yet to be tested in a Canadian context. Method: Ten high service quality acute care wards from a university‐affiliated Canadian hospital tested the use of the Safer Nursing Care Tool. Service quality, patients' dependency/acuity and staff activity data were benchmarked against information collected in 726 comparable UK wards. Results: Higher bed occupancy and patient dependency/acuity mix were found in the 10 Canadian wards compared to their UK counterparts. Overall staff activity was comparable between UK and Canadian wards. Conclusion: The Safer Nursing Care Tool can be applied in this Canadian hospital, and further testing in other hospitals and specialties is required. Implication for Nursing Management: The Safer Nursing Care Tool is a valid staffing tool to use that, when combined with professional judgement, can help managers to properly establish nursing staff in acute care wards. [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]

Transgender (trans) women experience barriers to access to HIV care, which result in their lower engagement in HIV prevention, treatment and support relative to cisgender people living with HIV. Studies of trans women's barriers to HIV care have predominantly focused on perspectives of trans women, while barriers are most often described at provider, organisation and/or systems levels. Comparing perspectives of trans women and service providers may promote a shared vision for achieving health equity. Thus, this qualitative study utilised focus groups and semi‐structured interviews conducted 2018–2019 to understand barriers and facilitators to HIV care from the perspectives of trans women (n = 26) and service providers (n = 10). Barriers endorsed by both groups included: (a) anticipated and enacted stigma and discrimination in the provision of direct care, (b) lack of provider knowledge of HIV care needs for trans women, (c) absence of trans‐specific services/organisations and (d) cisnormativity in sexual healthcare. Facilitators included: (a) provision of trans‐positive trauma‐informed care, (b) autonomy and choice for trans women in selecting sexual health services and (c) models for trans‐affirming systems change. Each theme had significant overlap, yet nuanced perspective, between trans women and service providers. Specific recommendations to improve HIV care access for trans women are discussed. These recommendations can be used by administrators and service providers alike to work collaboratively with trans women to reduce barriers and facilitators to HIV care and ultimately to achieve health equity for trans women. [ABSTRACT FROM AUTHOR]