Successfully reported this slideshow.

Social Determinants of Health Program Planning in Public Health: What’s the Evidence?

1

Share

1 of 46
1 of 46

More Related Content

More from Health Evidence™

Related Books

Free with a 14 day trial from Scribd

See all

Social Determinants of Health Program Planning in Public Health: What’s the Evidence?

  1. 1. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! Social Determinants of Health Program Planning: What’s the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  2. 2. What’s the evidence?  Fitzpatrick-Lewis, D., Ganann, R., Krishnaratne, S., Ciliska, D., Kouyoumdjian, F., Hwang, S.W. (2011). Effectiveness of interventions to improve the health and housing status of homeless people: A rapid systematic review. BMC Public Health, 11: 638.  http://www.health-evidence.ca/articles/show/21957
  3. 3. Housekeeping  Connection issues  Recommend you use a wired Internet connection rather than wireless, to help prevent connection challenges  Please contact the WebEx 24/7 help line: 1-866-229-3239
  4. 4. Side Panel in WebEx Housekeeping Feedback icon  How to post comments/questions Hand icon during the webinar Mic request  To write in CHAT or Q&A • Address questions to all Chat panelists • Raise hand using the ‘hand’ icon (indicated on the right) • Respond to general comments using the feedback icon Q&A  To talk: • If have a head set, you can ask to be passed the mic (mic request icon on right)
  5. 5. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! Social Determinants of Health Program Planning: What’s the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  6. 6. The Health Evidence Team Maureen Dobbins Kara DeCorby Daiva Tirilis Scientific Director Administrative Director Research Coordinator Tel: 905 525-9140 ext 22481 Tel: (905) 525-9140 ext. 20461 Tel: (905) 525-9140 ext. 20460 E-mail: dobbinsm@mcmaster.ca E-mail: kdecorby@health-evidence.ca E-mail: dtirilis@health-evidence.ca Lori Greco Heather Husson Robyn Traynor Lyndsey McRae Knowledge Broker Project Manager Research Coordinator Research Assistant
  7. 7. What is www.health-evidence.ca? Evidence inform Decision Making
  8. 8. Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  9. 9. Meetings, Planning & Dissemination Project CIHR Funded MOP-238541
  10. 10. CIHR-Funded Reviews  Hwang, S. W., Tolomiczenko, G., Kouyoumdjian, F. G., & Garner, R. E. (2005). Interventions to improve the health of the homeless: A systematic review. American Journal of Preventive Medicine, 29(4), 311-319.  UPDATE: Fitzpatrick-Lewis, D., Ganann, R., Krishnaratne, S., Ciliska, D., Kouyoumdjian, F., Hwang, S.W. (2011). Effectiveness of interventions to improve the health and housing status of homeless people: A rapid systematic review. BMC Public Health, 11: 638.
  11. 11. Rapid Reviews  Rapid reviews are literature reviews that use methods to accelerate or streamline traditional systematic review processes. (Ganann, 2010)
  12. 12. Questions?
  13. 13. Summary Statement: Fitzpatrick-Lewis (2011)
  14. 14. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General Implications Provision of housing for homeless or marginally housed populations leads to: • increased housing stability • small, but significant, decreases in substance/alcohol use • longer durations of abstinence • reduced emergency department or psychiatric inpatient use • improved quality of life
  15. 15. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General Implications Provision of housing for homeless or marginally housed populations leads to: • increased housing stability • small, but significant, decreases in substance/alcohol use • longer durations of abstinence • reduced emergency department or psychiatric inpatient use • improved quality of life Adding case management and/or day treatment services to housing provision for varying homeless populations leads to: • improved housing stability • less need for substance abuse treatment • improved antiretroviral adherence
  16. 16. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General Implications Public health programs should include and/or Provision of housing for homeless or marginally housed populations leads to: support: • increased housing stability • provision of housing with rent subsidy for • small, but significant, decreases in homeless people with mental illness substance/alcohol use • housing, preferably abstinent contingent, for • longer durations of abstinence homeless people with substance abuse • reduced emergency department or • individual counseling to reduce risk among psychiatric inpatient use homeless people with HIV/AIDS • improved quality of life • weekly educational sessions for homeless or runaway youth Adding case management and/or day treatment • the provision of housing and/or moderate- services to housing provision for varying consistent case management for homeless homeless populations leads to: people with HIV/AIDS • improved housing stability • less need for substance abuse treatment • improved antiretroviral adherence
  17. 17. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General Implications Public health programs should include and/or Provision of housing for homeless or marginally housed populations leads to: support: • increased housing stability • provision of housing with rent subsidy for • small, but significant, decreases in homeless people with mental illness substance/alcohol use • housing, preferably abstinent contingent, for • longer durations of abstinence homeless people with substance abuse • reduced emergency department or • individual counseling to reduce risk among psychiatric inpatient use homeless people with HIV/AIDS • improved quality of life • weekly educational sessions for homeless or runaway youth Adding case management and/or day treatment • the provision of housing and/or moderate- services to housing provision for varying consistent case management for homeless homeless populations leads to: people with HIV/AIDS • improved housing stability Non-abstinent contingent housing with case • less need for substance abuse treatment management is not recommended for • improved antiretroviral adherence homeless people with concurrent disorders to decrease psychiatric symptoms & substance, but is recommended to stabilize housing.
  18. 18. Homeless people with mental illness Studies Homelessness Definitions Forchuk et al., 2008 Patients being discharges from psychiatric wards to shelters and no fixed address.
  19. 19. Interpreting the Evidence Interventions for homeless people with mental illness (1 RCT) What’s the evidence? Implications for practice & policy • The provision of discharge support (i.e. assistance with finding housing and payment of first/last month’s rent) led to significant improvements in housing status up to 6 months post-discharge, compared to individuals receiving usual care (i.e. social work referral) (p < 0.001).
  20. 20. Interpreting the Evidence Interventions for homeless people with mental illness (1 RCT) What’s the evidence? Implications for practice & policy • The provision of discharge support (i.e. assistance • Public health decision makers should with finding housing and payment of first/last consider the positive impact month’s rent) led to significant improvements in supportive housing and rental housing status up to 6 months post-discharge, assistance has on housing status of compared to individuals receiving usual care (i.e. those discharged from psychiatric social work referral) (p < 0.001). care, while acknowledging the effect is based on a single study.
  21. 21. Homeless people with substance abuse issues Studies Homelessness Definitions Larimer et al., 2009 ‘Chronically homeless’ list of individuals with high local crisis services utilization patterns. Chronic homelessness is not further defined Milby et al., 2004; Milby Lacking a fixed overnight residence, including shelters et al., 2003; Milby et al., or temporary accommodations, or were at 2000; Milby et al., 2005; immediate risk of being homeless. Kertesz et al., 2007
  22. 22. Interpreting the Evidence Interventions for homeless people with substance abuse issues (3 studies) What’s the evidence? Implications for practice & policy • Housing + on-site case management minimally decreased the risk of alcohol consumption up to 12 months (RR 0.98; 95% CI 0.96 – 0.99) What is relative risk? Ratio of the risk of an event among an exposed population (intervention group) to the risk among the unexposed (control group). (DiCenso, Guyatt, & Ciliska, 2005)
  23. 23. Interpreting the Evidence Interventions for homeless people with substance abuse issues (3 studies) What’s the evidence? Implications for practice & policy • Housing + on-site case management minimally decreased the risk of alcohol consumption up to 12 months (RR 0.98; 95% CI 0.96 – 0.99) • Behavioural day treatment + abstinence- contingent housing and therapy (DT+) increased proportion of days abstinent at 2 months (71% vs. 41%) and 6 months (41% vs. 15%) vs. day treatment alone (DT). Relapse was lower in the DT+ vs DT group (55% vs. 81%).
  24. 24. Interpreting the Evidence Interventions for homeless people with substance abuse issues (3 studies) What’s the evidence? Implications for practice & policy • Housing + on-site case management minimally decreased the risk of alcohol consumption up to 12 months (RR 0.98; 95% CI 0.96 – 0.99) • Behavioural day treatment + abstinence- contingent housing and therapy (DT+) increased proportion of days abstinent at 2 months (71% vs. 41%) and 6 months (41% vs. 15%) vs. day treatment alone (DT). Relapse was lower in the DT+ vs DT group (55% vs. 81%). • Abstinence-contingent housing increased mean consecutive weeks of abstinence (7.32) vs. the no-housing group (5.28) (p = 0.024), and vs. the non-abstinent-contingent group (4.68) (p = 0.0031) with days housed increased for all groups (p < 0.0001).
  25. 25. Interpreting the Evidence Interventions for homeless people with substance abuse issues (3 studies) What’s the evidence? Implications for practice & policy • Housing + on-site case management minimally • Public health decision makers should decreased alcohol consumption up to 12 months promote and support the provision of (RR 0.98; 95% CI 0.96 – 0.99) housing, preferably abstinence- • Behavioural day treatment + abstinence- contingent with on-site case contingent housing and therapy (DT+) management, to reduce substance use increased proportion of days abstinent at 2 among homeless people with months (71% vs. 41%) and 6 months (41% vs. substance abuse issues. DT+ can also 15%) vs. day treatment alone (DT). Relapse was be used to increase days abstinent and lower in the DT+ vs DT group (55% vs. 81%). also reduce relapse among homeless • Abstinence-contingent housing decreased mean people with substance abuse issues. consecutive weeks of abstinence (7.32) vs. the no-housing group (5.28) (p = 0.024), and vs. the non-abstinent-contingent group (4.68) (p = 0.0031) with days housed increased for all groups (p < 0.0001).
  26. 26. Interpreting the Evidence Interventions with no impact for homeless people with substance abuse issues What’s the evidence? Implications for practice & policy • No impact on days housed in those • Public health should not promote or use receiving DT+ compared to those receiving DT+ if the sole purpose is to increase the day treatment only; or, weeks of abstinence number of days housed. for the non-abstinent contingent housing group compared to the no housing group (p = 0.51)
  27. 27. Homeless people with concurrent disorders Studies Homelessness Definitions Gulcur et al., 2003; Spent 15 out of the last 30 days on the street (not Tsemberis et al., 2004; including shelters) and experienced period of ‘housing Tsemberis et al., 2003; instability’ (not defined) within last six months. Padgett et al., 2006; Greenwood et al., 2005; Stefancic et al., 2004
  28. 28. Interpreting the Evidence Interventions for homeless people with concurrent disorders (1 RCT) What’s the evidence? Implications for practice & policy • Study participants given independent apartments without requirement of abstinence/psychiatric care spent 66% fewer days homeless (p < 0.001), and had less need for substance abuse treatment at 36 months compared to participants receiving outreach/drop-in services plus group living (p = 0.05). The independent-living, group, however utilized health care services slightly more, at 48 months post-intervention (p = 0.025).
  29. 29. Interpreting the Evidence Interventions for homeless people with concurrent disorders (1 RCT) What’s the evidence? Implications for practice & policy • Study participants given independent apartments • Public health decision makers may without requirement of abstinence/psychiatric advocate non abstinence-contingent, care spent 66% fewer days homeless (p < 0.001), independent housing as a way to and had less need for substance abuse treatment improve housing stability and decrease at 36 months compared to participants receiving need for substance abuse treatment outreach/drop-in services plus group living (p = for homeless individuals with 0.05). The independent-living, group, however concurrent disorders, while utilized health care services slightly more, at 48 acknowledging that positive findings months post-intervention (p = 0.025). are limited to a single study.
  30. 30. Interpreting the Evidence Interventions with no impact for homeless people with concurrent disorders What’s the evidence? Implications for practice & policy • No difference between groups in • Non-abstinent contingent housing should psychiatric symptoms and substance use. not be used to improve psychiatric symptoms, decrease substance use rates, or decrease healthcare utilization.
  31. 31. Homeless people with HIV Studies Homelessness Definitions Woliski et al., HIV+ individuals living in the following housing contexts: having one’s 2009; Kidder et al., own place to live, being unstably housed (staying temporarily with 2007 others/living in a transitional setting and had not been homeless), or being homeless ≥ one night (e.g., sleeping in shelters or locations not suitable for human habitation) in the last 90 days. Rotheram-Borus HIV+ marginally housed individuals including reports of currently et al., 2009 being homeless, living in a shelter/welfare hotel, or having lived in other condition within the 12 months prior to each assessment. Kushel et al., 2006 HIV+ homeless and marginally housed individuals. Homeless was defined as ≥ one night on street or in shelter in the last quarter, whereas marginally housed was defined as ≥ 90% of nights in single- room occupancy dwelling in past quarter with no nights spent on street or in shelter. Schwarcz et al., HIV+ individuals. Cases were defined as homeless if medical records 2009 documented individuals were homeless or if addresses listed in chart were for shelters, health care clinics, or a general delivery address not connected to an address.
  32. 32. Interpreting the Evidence Interventions for homeless people with HIV (4 studies) What’s the evidence? Implications • Rental assistance + case management improved self- reported physical/mental health, and housing status (88% intervention group housed at 18 months vs. 51% with no intervention, p ≤ 0.0001).
  33. 33. Interpreting the Evidence Interventions for homeless people with HIV (4 studies) What’s the evidence? Implications • Rental assistance + case management improved self- reported physical/mental health, and housing status (88% intervention group housed at 18 months vs. 51% with no intervention, p ≤ 0.0001). • Three individual counselling modules (five 90-minute sessions), led to significant decreases in: # days alcohol/marijuana use (35.77 to 27.54, p = 0.002); # of risky sexual acts (5.03 to 1.75, p = 0.037); and # days of hard drug use (27.76 to 24.00, p = 0.042), vs. no intervention.
  34. 34. Interpreting the Evidence Interventions for homeless people with HIV (4 studies) What’s the evidence? Implications • Rental assistance + case management improved self- reported physical/mental health, and housing status (88% intervention group housed at 18 months vs. 51% with no intervention, p ≤ 0.0001). • Three individual counselling modules (five 90-minute sessions), led to significant decreases in: # days alcohol/marijuana use (35.77 to 27.54, p = 0.002); # of risky sexual acts (5.03 to 1.75, p = 0.037); and # days of hard drug use (27.76 to 24.00, p = 0.042), vs. no intervention. • Moderate case management improved antiretroviral adherence (β = 0.13; 95% CI, 0.02-0.25) vs. none or minimal case management. Consistent and moderate case management led to 50% improvement in CD4+ cell count.
  35. 35. Interpreting the Evidence Interventions for homeless people with HIV (4 studies) What’s the evidence? Implications • Rental assistance + case management improved self- reported physical/mental health, and housing status (88% intervention group housed at 18 months vs. 51% with no intervention, p ≤ 0.0001). • Three individual counselling modules (five 90-minute sessions), led to significant decreases in: # days alcohol/marijuana use (35.77 to 27.54, p = 0.002); # of risky sexual acts (5.03 to 1.75, p = 0.037); and # days of hard drug use (27.76 to 24.00, p = 0.042), vs. no intervention. • Moderate case management improved antiretroviral adherence (β = 0.13; 95% CI, 0.02-0.25) vs. none or minimal case management. Consistent and moderate case management led to 50% improvement in CD4+ cell count. • Risk of death was 20% higher for those not receiving supportive housing post-HIV diagnosis (Relative Hazard 1.20; 95% CI 1.03, 1.41).
  36. 36. Interpreting the Evidence Interventions for homeless people with HIV (4 studies) What’s the evidence? Implications • Rental assistance + case management improved self- • Public health should support reported physical/mental health, and housing status (88% housing provision programs, intervention group housed at 18 months vs. 51% with no preferably with moderate to intervention, p ≤ 0.0001). consistent case management • Three individual counselling modules (five 90-minute to improve the health and sessions), led to significant decreases in: # days housing status of homeless alcohol/marijuana use (35.77 to 27.54, p = 0.002); # of people with HIV, and to risky sexual acts (5.03 to 1.75, p = 0.037); and # days of reduce HIV-risk behaviours hard drug use (27.76 to 24.00, p = 0.042), vs. no and risk of death. intervention. • Moderate case management improved antiretroviral adherence (β = 0.13; 95% CI, 0.02-0.25) vs. no or minimal case management. Consistent and moderate case management led to 50% improvement in CD4+ cell count. • Risk of death was 20% higher for those not receiving supportive housing post-HIV diagnosis (Relative Hazard 1.20; 95% CI 1.03, 1.41).
  37. 37. Interpreting the Evidence Interventions for homeless people with HIV (4 studies) What’s the evidence? Implications • Rental assistance + case management improved self- • Public health should support reported physical/mental health, and housing status (88% housing provision programs, intervention group housed at 18 months vs. 51% with no preferably with moderate to intervention, p ≤ 0.0001). consistent case management • Three individual counselling modules (five 90-minute to improve the health and sessions), led to significant decreases in: # days housing status of homeless alcohol/marijuana use (35.77 to 27.54, p = 0.002); # of people with HIV, and to risky sexual acts (5.03 to 1.75, p = 0.037); and # days of reduce HIV-risk behaviours hard drug use (27.76 to 24.00, p = 0.042), vs. no and risk of death. intervention. • Decision makers should • Moderate case management improved antiretroviral advocate for case adherence (β = 0.13; 95% CI, 0.02-0.25) vs. no or minimal management support for case management. Consistent and moderate case homeless people with HIV, to management led to 50% improvement in CD4+ cell count. promote adherence to anti- • Risk of death was 20% higher for those not receiving retroviral therapy and supportive housing post-HIV diagnosis (Relative Hazard improve CD4+ cell counts. 1.20; 95% CI 1.03, 1.41).
  38. 38. Interpreting the Evidence Interventions with no impact for homeless people with HIV What’s the evidence? Implications for practice & policy • No impact of multiple individual counselling • Public health should not rely on multiple sessions compared to no intervention on individual counselling sessions to achieve abstinence, or provision of rental assistance substance use abstinence. with case management on # of sexual • Public health should not use rental subsidy partners, condom use, or sex trading. with case management to impact # of sexual partners, condom use or sex trading
  39. 39. Homeless or runaway youth Studies Homelessness Definitions Gulcur et al., 2003; Spent 15 out of the last 30 days on the street (not Tsemberis et al., 2004; including shelters) and experienced period of ‘housing Tsemberis et al., 2003; instability’ (not defined) within last six months. Padgett et al., 2006; Greenwood et al., 2005; Stefancic et al., 2004
  40. 40. Interpreting the Evidence Interventions for homeless or runaway youth (1 RCT) What’s the evidence? Implications for practice & policy • 12 weekly sessions covering life skills and psychiatric issues plus HIV/AIDS education led to a greater reduction in substance use from baseline (37%) compared with usual care (17%) (time effect p < 0.001).
  41. 41. Interpreting the Evidence Interventions for homeless or runaway youth (1 RCT) What’s the evidence? Implications for practice & policy • 12 weekly sessions covering life skills and • Public health decision makers should psychiatric issues plus HIV/AIDS education consider weekly education sessions led to a greater reduction in substance use covering life skills, mental health and from baseline (37%) compared with usual HIV/AIDS education to reduce substance care (17%) (time effect p < 0.001). use among homeless youth, while acknowledging that positive findings are limited to a single study.
  42. 42. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General Implications Public health programs should include and/or Provision of housing for homeless or marginally housed populations leads to: support: • increased housing stability • provision of housing with rent subsidy for • small, but significant, decreases in homeless people with mental illness substance/alcohol use • housing, preferably abstinent contingent, for • longer durations of abstinence homeless people with substance abuse • reduced emergency department or • individual counseling to reduce risk among psychiatric inpatient use homeless people with HIV/AIDS • improved quality of life • weekly educational sessions for homeless or runaway youth Adding case management and/or day treatment • the provision of housing and/or moderate- services to housing provision for varying consistent case management for homeless homeless populations leads to: people with HIV/AIDS • improved housing stability Non-abstinent contingent housing with case • less need for substance abuse treatment management is not recommended for • improved antiretroviral adherence homeless people with concurrent disorders to decrease psychiatric symptoms & substance, but is recommended for stable housing.
  43. 43. Questions?
  44. 44. What is the most important thing you learned today?
  45. 45. Discussion Forum Please continue to discuss this topic and other topics on our discussion forum. www.health-evidence.ca/forum/ Login with your health-evidence username and password or register if you aren’t a member yet. Join us for a LIVE on Monday, December 12 at 1:00 pm EST to have your questions answered in real time!
  46. 46. Evaluation Please check your email for the evaluation link. It take 5 minutes to complete! If you’ve been watching with someone else and did not personally register for the webinar, please e-mail Jennifer McGugan at mcgugj@mcmaster.ca to be sent the survey. Thank you for your participation!

×