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      Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions

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          Most cited references 42

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          Health interventions for people who are homeless.

          Homelessness has serious implications for the health of individuals and populations. Primary health-care programmes specifically tailored to homeless individuals might be more effective than standard primary health care. Standard case management, assertive community treatment, and critical time intervention are effective models of mental health-care delivery. Housing First, with immediate provision of housing in independent units with support, improves outcomes for individuals with serious mental illnesses. Many different types of interventions, including case management, are effective in the reduction of substance misuse. Interventions that provide case management and supportive housing have the greatest effect when they target individuals who are the most intensive users of services. Medical respite programmes are an effective intervention for homeless patients leaving the hospital. Although the scientific literature provides guidance on interventions to improve the health of homeless individuals, health-care providers should also seek to address social policies and structural factors that result in homelessness.
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            Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial.

            Scattered-site housing with Intensive Case Management (ICM) may be an appropriate and less-costly option for homeless adults with mental illness who do not require the treatment intensity of Assertive Community Treatment.
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              Treatment engagement of individuals experiencing mental illness: review and update.

              Individuals living with serious mental illness are often difficult to engage in ongoing treatment, with high dropout rates. Poor engagement may lead to worse clinical outcomes, with symptom relapse and rehospitalization. Numerous variables may affect level of treatment engagement, including therapeutic alliance, accessibility of care, and a client's trust that the treatment will address his/her own unique goals. As such, we have found that the concept of recovery-oriented care, which prioritizes autonomy, empowerment and respect for the person receiving services, is a helpful framework in which to view tools and techniques to enhance treatment engagement. Specifically, person-centered care, including shared decision making, is a treatment approach that focuses on an individual's unique goals and life circumstances. Use of person-centered care in mental health treatment models has promising outcomes for engagement. Particular populations of people have historically been difficult to engage, such as young adults experiencing a first episode of psychosis, individuals with coexisting psychotic and substance use disorders, and those who are homeless. We review these populations and outline how various evidence-based, recovery-oriented treatment techniques have been shown to enhance engagement. Our review then turns to emerging treatment strategies that may improve engagement. We focus on use of electronics and Internet, involvement of peer providers in mental health treatment, and incorporation of the Cultural Formulation Interview to provide culturally competent, person-centered care. Treatment engagement is complex and multifaceted, but optimizing recovery-oriented skills and attitudes is essential in delivery of services to those with serious mental illness.
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                Author and article information

                Journal
                Health & Social Care in the Community
                Health Soc Care Community
                Wiley
                09660410
                January 2018
                January 2018
                June 01 2017
                : 26
                : 1
                : 56-64
                Affiliations
                [1 ]Centre for Urban Health Solutions; Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto Ontario Canada
                [2 ]Centre for Addiction and Mental Health; Toronto Ontario Canada
                [3 ]Department of Psychiatry; University of Toronto; Toronto Ontario Canada
                [4 ]Performance Measurement and Evaluation Research; Provincial System and Support Program; Centre for Addiction and Mental Health; Toronto Ontario Canada
                [5 ]Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
                [6 ]Institute of Mental Health; Singapore Singapore
                [7 ]Department of Family and Community Medicine; University of Toronto; Toronto Ontario Canada
                Article
                10.1111/hsc.12461
                © 2017

                http://doi.wiley.com/10.1002/tdm_license_1.1

                http://onlinelibrary.wiley.com/termsAndConditions#vor

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