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Permanent supportive housing and income assistance are valuable interventions for homeless individuals. Homelessness can reduce physical and social wellbeing, presenting public health risks for infectious diseases, disability, and death. We did a systematic review, meta-analysis, and narrative synthesis to investigate the effectiveness and cost-effectiveness of permanent supportive housing and income interventions on the health and social wellbeing of individuals who are homeless in high-income countries.We searched MEDLINE, Embase, CINAHL, PsycINFO, Epistemonikos, NIHR-HTA, NHS EED, DARE, and the Cochrane Central Register of Controlled Trials from database inception to Feb 10, 2020, for studies on permanent supportive housing and income interventions for homeless populations. We included only randomised controlled trials, quasi-experimental studies, and cost-effectiveness studies from high-income countries that reported at least one outcome of interest (housing stability, mental health, quality of life, substance use, hospital admission, earned income, or employment). We screened studies using a standardised data collection form and pooled data from published studies. We synthesised results using random effects meta-analysis and narrative synthesis. We assessed certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.Our search identified 15 908 citations, of which 72 articles were included for analysis (15 studies on permanent supportive housing across 41 publications, ten studies on income interventions across 15 publications, and 21 publications on cost or cost-effectiveness). Permanent supportive housing interventions increased long-term (6 year) housing stability for participants with moderate support needs (one study; rate ratio [RR] 1·13 [95% CI 1·01-1·26]) and high support needs (RR 1·42 [1·19-1·69]) when compared with usual care. Permanent supportive housing had no measurable effect on the severity of psychiatric symptoms (ten studies), substance use (nine studies), income (two studies), or employment outcomes (one study) when compared with usual social services. Income interventions, particularly housing subsidies with case management, showed long-term improvements in the number of days stably housed (one study; mean difference at 3 years between intervention and usual services 8·58 days; p0·004), whereas the effects on mental health and employment outcomes were unclear.Permanent supportive housing and income assistance interventions were effective in reducing homelessness and achieving housing stability. Future research should focus on the long-term effects of housing and income interventions on physical and mental health, substance use, and quality-of-life outcomes.Inner City Health Associates.

We examined communities' expressed needs for capacity building in the implementation of Housing First (HF) for persons experiencing homelessness. The findings are based on thematic analyses of qualitative data obtained from participants (n = 77) in 11 focus groups conducted in seven Canadian cities. We identified capacity building needs in the areas of training (e.g., HF principles, clinical services, landlord engagement) and technical assistance (e.g., intake coordination, client prioritization, fidelity assessment). These findings were used to tailor training and technical assessment (TTA) to the stages of HF implementation in these cities. Limitations and implications for future theory, research, and practice are discussed.

The purpose of this study was to test the construct validity of the Evaluation Capacity in Organizations Questionnaire (ECOQ). Conceptually, the ECOQ examines the role of evaluation in organizational development and, most notably in organizational learning. In this model, evaluation capacity building (ECB) initiatives are assumed to contribute to the development of a culture of systematic self-assessment and reflection, which, in turn, leads to increased organizational learning. Our sample consisted of internal evaluators within the federal, provincial or municipal government, not-for-profit organizations, private firms, and colleges or universities in Canada. Exploratory factor analysis (EFA) and latent path analysis (LPA) were conducted to better understand the underlying structural aspect of the organizational capacity to do and use evaluation construct as measured by the ECOQ. The results of our study indicate that the ECOQ effectively assesses an organization's capacity to do and use evaluation. Furthermore, evidence provided by the LPA statistical analysis suggests that an organization's capacity to learn is enhanced by the relationships among the various factors. Implications of using a validated model of an organization's capacity to do and use evaluations in both research and practice are discussed.

There is growing evidence that diversion to a mental health court program (MHC) can reduce recidivism rates and improve the quality of life of clients. However, there is less known about MHC client characteristics and factors associated with recidivism. Yet, this information would be useful to increase the effectiveness of these programs. Cross-sectional quantitative data were collected on MHC clients in three consecutive years. Of the 155 program clients that were successfully interviewed, only 154 were included in the analysis due to one non-consent to collect further data from their case manager. The purpose of this secondary analysis was to examine “What individual factors are associated with recidivism among MHC program clients?” This analysis specifically explored the association of sex, age, low functional ability, homelessness, court site, and criminal history. From the multiple logistic regression results, the increased risk of recidivism was found to be significantly associated with younger clients and a prior criminal history. The results of this study suggest programs tailored to young adults and repeat offenders may be areas that MHCs could potentially focus on to increase their effectiveness.

We developed, tested, and operationalized a comprehensive objective measurement tool, the Observer-rated Housing Quality Scale (OHQS), to assess housing unit, building, and neighbourhood characteristics in a large trial of Housing First (HF) in 5 Canadian cities. The OHQS provided an opportunity to explore the role of neighbourhood and its contribution to housing stability among formerly homeless individuals. A subset of 423 participants who had become housed in the second year of the trial were systematically selected. The psychometric properties of the neighbourhood quality (NQ) items were assessed within the OHQS. The association between NQ and housing stability was explored using ordinal logistic regression, adjusting for group, site, demographic, housing unit and building quality variables. Inter-rater reliability and internal consistency were very good for the NQ items and subscale. Although NQ was not predictive of housing stability after considering other residence and building features in the multivariable analysis, we assert further analysis is required to explore this relationship, especially for HF programs offering clients choice in housing and neighbourhood.

We conducted a randomized effectiveness trial to test the hypothesis that foster children of primary-school age who were exposed to an individualized direct-instruction tutoring intervention delivered by their foster parents would experience significantly greater pre-test to post-test gains in reading and math than would foster children in a wait-list control group. The sample consisted of 77 foster children in 9 local Children's Aid Societies in Ontario, Canada. At the pre-test, the foster children were aged 6 to 13 years (M = 10.7 years, SD = 1.6) and were in primary-school grades 2 through 7. Forty-two foster children were randomly assigned to the experimental (tutoring) group and 35 to the wait-list control group. The sub-tests of the Wide Range Achievement Test—Fourth edition (WRAT4; Wilkinson & Robertson, 2006) served as the outcome measures. At the post-test, the foster children in the experimental group had made statistically and practically greater gains than those in the control group on the WRAT4 sub-tests of Sentence Comprehension (Hedges' g = 0.38, p

Community mental health services benefit from measuring clinical outcomes relevant to a community-based context in contrast to medically modeled outcomes. The Multnomah Community Ability Scale (MCAS) addresses broad dimensions of community functioning and was developed for clinical and evaluation purposes. We assessed the structural consistency and fit of the scale as a measure of community functioning through confirmatory factor analysis using a longitudinal sample of individuals (n=408) with severe and persistent mental illness receiving services from community mental health programs. None of the previously hypothesised factor solutions achieved a good fit and a high degree of invariance over time was observed. Through exploratory factor analysis, the possibility of alternative solutions was explored. After exclusion of two of the 17 items, four models--including four-, three-, two- and one-factor solutions--were tested for fit and invariance with no improvement. We discuss our findings of poor fit under the assumption that the MCAS should psychometrically behave as a scale. Alternative interpretations for the tool and suggestions for the use of its items as an index that measures aspects of disability are proposed.

This article describes the planning of a multi-agency and multi-stakeholder evaluation of the implementation of supportive housing. The Ottawa HousingPlus Collaborative Communities project is a collaboration between university-based evaluators and members of a local network of supportive housing providers. The objectives of the initiative are (1) to develop tools and methods for evaluating the implementation of supportive housing by network members, (2) to evaluate program implementation, and (3) to use evaluation findings to assist network members to collaborate in finding solutions to shared implementation challenges. This article examines the early planning of the project. It describes the process used to engage stakeholders in the conception and planning of the project, the challenges and successes in the early planning efforts, and the issues that will need to be addressed over the course of the 3-year project term. These challenges and successes of engaging stakeholders are discussed in the context of adapting educational concepts to the evaluation of social services and in engaging multiple agencies, at multiple levels, in a collaborative evaluation.

The following study evaluates the complex association between legal involvement and mental illness. It describes a population of consumers of community mental health programs, comparing those with legal involvement to those without legal involvement, on a number of demographic, clinical and social indicators. It is a secondary analysis of data collected in studies making up the Community Mental Health Evaluation Initiative (CMHEI) in the province of Ontario, Canada. Legal involvement was a significant issue among community mental health program consumers; about one in five consumers had at least some contact with the legal system in the preceding nine months. Legally involved consumers were more likely to be in receipt of social assistance and be unstably housed than those legally uninvolved. However, there were no significant differences between legally involved and uninvolved consumers with respect to severity of symptomatology, current medication use or number of hospitalization days in the past 9 months. A predictive model compared the differential impact of clinical and social determinants upon legal involvement. Analyses failed to uncover a significant relationship between severity of psychiatric symptomatology and legal involvement. Significant predictors of legal involvement included gender, race, drug use as well as housing instability, and receipt of social assistance. Legal involvement was attributable to factors other than the severity of mental illness; these results challenge assumptions that the most symptomatically severe consumers are most at risk of legal involvement. Accordingly, the rate of legal involvement in a sample of community mental health program users must be considered in a broad context, with particular emphasis on social disadvantage.

Social autopsy methodology has been useful in uncovering patterns leading to untimely deaths in many different contexts. Although patterns of early deaths have often been detected among individuals who are homeless, social autopsies are particularly difficult to carry out in this population. This paper provides a template for carrying out a social autopsy of persons who died while homeless. The logistical, ethical, and methodological challenges associated with implementing this methodology are discussed with suggested responses. In addition, this article aims to provide procedures and lessons learned for researchers embarking on this type of work. The described procedures are based on an investigation intended to develop a social autopsy methodology to investigate early mortality among homeless persons.

Despite increasing interest in process evaluation and the development of a variety of approaches to assess program implementation, several methodological challenges remain. Of particular concern is the development of ways not only to adequately determine the extent to which programs are implemented as intended but the provision of effective means to use such information in explaining observed variation in program outcomes. Following a review and critique of the process evaluation literature, particularly in the domain of community mental health, the paper introduces the use of ‘key component profiles’ (KCP) as an alternative methodological approach to evaluating program implementation. A case application in the context of an intensive case management program for meeting the needs of clients with severe mental illness who are homeless is described. The steps in developing the multiple dimension profile of program implementation are detailed and validation data provided. The results are discussed in terms of their implications for use within the local context and, more generally, the use of KCPs for process evaluation.