Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs.

IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES
Nick Kerman, Timothy de Pass, Sean A Kidd, Christina Mutschler, Abe Oudshoorn, John Sylvestre, Tim Aubry, Benjamin F Henwood, Frank Sirotich, Vicky Stergiopoulos
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Abstract

Risk management is an important component of service delivery in supportive housing and Housing First programs. However, there is no evidence on the implementation of risk management approaches in these settings. This qualitative study examined what service providers working in supportive housing and Housing First programs in Canada identify as the programmatic and organizational factors that affect the prevention and management of high-risk behaviours and challenges (e.g., overdose, suicide attempts, non-suicidal self-injury, falls and fall-related injuries, fire-setting, hoarding, apartment takeovers, violence, property damage, drug selling) in their programs. In-depth interviews were completed with a purposive sample of 32 service providers. Data were analyzed using an integrative approach that incorporated techniques from qualitative description and thematic analysis. Four thematic factors, which were comprised of various barriers and facilitators, that affected management of high-risk issues in supportive housing and Housing First programs were identified: [1] flexibility in addressing risk issues; [2] early identification of risk issues; [3] built environment and housing location; and [4] resource availability. Overall, the findings underscore how service providers aim to identify high-risk issues promptly, beginning as early as referral, and that their capacity to effectively do this and intervene accordingly is dynamically shaped by various aspects of the program model, environment, and availability of internal and external resources. Yet, the findings also highlight how risk management approaches may conflict with other programmatic goals and values, and the importance of considering these collectively. Systems-level changes to strengthen programs' capacity to prevent risk and implications for future research are discussed.

在支持性住房和住房优先计划中解决高风险问题的计划和组织障碍与促进因素。
风险管理是支持性住房和住房优先计划中提供服务的重要组成部分。然而,目前还没有证据表明在这些环境中实施了风险管理方法。这项定性研究考察了在加拿大支持性住房和住房优先计划中工作的服务提供者认为哪些计划和组织因素会影响其计划中高风险行为和挑战(如用药过量、自杀未遂、非自杀性自伤、跌倒和与跌倒相关的伤害、纵火、囤积居奇、接管公寓、暴力、财产损失、贩毒)的预防和管理。对 32 名服务提供者进行了有目的的抽样深入访谈。数据分析采用了综合方法,融合了定性描述和专题分析的技术。确定了影响支持性住房和 "住房优先 "计划中高风险问题管理的四个主题因素,包括各种障碍和促进因素:[1] 解决风险问题的灵活性;[2] 早期识别风险问题;[3] 建筑环境和住房位置;以及 [4] 资源可用性。总体而言,研究结果强调了服务提供者如何致力于及时发现高风险问题,从转介开始,他们有效地做到这一点并采取相应干预措施的能力是由计划模式、环境以及内部和外部资源的可用性等各个方面动态决定的。然而,研究结果也强调了风险管理方法与其他计划目标和价值观的冲突,以及综合考虑这些因素的重要性。报告还讨论了为加强计划预防风险的能力而进行的系统层面的变革,以及对未来研究的影响。
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来源期刊
CiteScore
5.30
自引率
3.70%
发文量
133
期刊介绍: Community Mental Health Journal focuses on the needs of people experiencing serious forms of psychological distress, as well as the structures established to address those needs. Areas of particular interest include critical examination of current paradigms of diagnosis and treatment, socio-structural determinants of mental health, social hierarchies within the public mental health systems, and the intersection of public mental health programs and social/racial justice and health equity. While this is the journal of the American Association for Community Psychiatry, we welcome manuscripts reflecting research from a range of disciplines on recovery-oriented services, public health policy, clinical delivery systems, advocacy, and emerging and innovative practices.
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