@article{pmid42413522,

title = {Return on investment of enhanced primary youth mental health services in a large Canadian urban centre: a retrospective cohort study},

author = {Jai L Shah and Nguyen Xuan Thanh and Shireen Surood and Surya Poudel and Liana Urichuk and Giuseppe D'Andrea and Eric Latimer and Neil Andersson and Patricia Boksa and Ridha Joober and Shalini Lal and Srividya N Iyer and Ashok Malla and Philip Jacobs and },

doi = {10.1016/S2215-0366(26)00165-3},

issn = {2215-0374},

year  = {2026},

date = {2026-08-01},

journal = {Lancet Psychiatry},

volume = {13},

number = {8},

pages = {657--668},

abstract = {BACKGROUND: Many youth mental health reforms aim to shift care away from acute, hospital, or institutional settings and into community-based services, but few such initiatives have been subject to economic evaluations. We aimed to examine service utilisation and the corresponding return on investment for individuals receiving care via an enhanced primary-care youth mental health service.nnMETHODS: We conducted a retrospective cohort study of an enhanced primary-care youth mental health service transformation in a major urban site of the pan-Canadian ACCESS Open Minds network, which provides assessment and interventions for all types and severities of mental health problems, with priorities co-designed by individuals with lived experience (young people, families, and carers). Administrative datasets were used to determine service utilisation and the associated costs, including programme implementation, for help-seeking youth aged 15-25 years with any mental health problem. A difference-in-differences approach compared outcomes pre-exposure with outcomes post-exposure to the ACCESS Open Minds service over 1 year, in relation to youth receiving a non-transformed service. Propensity score matching and sensitivity analyses ensured bias reduction and robustness of observations, respectively.nnFINDINGS: Between April 6, 2016, and Sept 30, 2019, 10 632 help-seeking youth (4821 [45·4%] males and 5801 [54·6%] females) were included. 1415 youths (mean age 20·1 years) received care from ACCESS Open Minds, and 9217 youths (19·3 years) received standard community mental health services. No ethnicity data were available in this administrative dataset. Compared with those receiving services in community mental health clinics, those receiving ACCESS Open Minds had more intensive service needs throughout the study period and had greater and statistically significant reductions in hospital admissions (CA$1961 savings); outpatient ($613 savings), specialist ($432 savings), and general practitioner visits ($47 savings); and public residential admissions ($1256 savings) per-person per-year. There were no significant differences in emergency department visits, the number of prescriptions dispensed, community mental health visits, or contracted residential admissions. Net cost reduction associated with ACCESS Open Minds was $4355 per-person per-year, with implementation costs of $448, representing a net benefit of $3907 (return on investment 9·7).nnINTERPRETATION: Consistent with principles of early intervention in mental health, ACCESS Open Minds implementation resulted in improved or equivalent outcomes but also shifted care towards community-based settings, with substantial net cost savings. These cost savings can be realised if novel services identify and treat not only new cases but also include those who were previously intensive users of standard services. The long-term return on investment of enhanced primary youth mental health models such as ACCESS Open Minds will likely rest on their commitment to including this population.nnFUNDING: Canadian Institutes of Health Research and the Graham Boeckh Foundation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41632632,

title = {Health-Related Outcome Improvements Via the ACCESS Open Minds Youth Mental Health Service Transformation Project in Edmonton, Canada: Amélioration des résultats en matière de santé grâce au projet de transformation des services de santé mentale jeunes d'ACCESS Open Minds/Esprits ouverts à Edmonton, Canada},

author = {Jai L Shah and Nguyen Xuan Thanh and Shireen Surood and April Gusnowski and Surya Poudel and Liana Urichuk and Giuseppe D'Andrea and Srividya N Iyer and Ashok K Malla and Eric Latimer and Philip Jacobs and },

doi = {10.1177/07067437251412570},

issn = {1497-0015},

year  = {2026},

date = {2026-05-01},

journal = {Can J Psychiatry},

volume = {71},

number = {5},

pages = {359--368},

abstract = {ObjectiveGrowing efforts to transform youth mental health (YMH) services rest on the assumption that they will produce superior outcomes to those of traditional services. We therefore aimed to determine whether implementation of a broad YMH service model in Edmonton, Alberta (the largest site in the pan-Canadian ACCESS Open Minds [AOM] network) resulted in greater improvements in individual-level outcomes compared to a matched control group seen at non-AOM community mental health services.MethodThis retrospective cohort study used data on the Health of Nation Outcomes Scale (HoNOS) collected by trained clinicians, in youth aged 15-25 attending AOM or comparator services for any mental health problem between April 2016 and September 2019. A difference-in-differences approach compared HoNOS outcomes pre- versus post-exposure to the AOM service over a 1-year time horizon, in relation to youth attending a non-transformed service. Propensity score matching and sensitivity analyses were conducted to ensure bias reduction and robustness of observations, respectively.ResultsThe number of referrals to AOM Edmonton increased over time (36.3% [95%CI = 11.0%-68.0%] per month), and the site met benchmarks for rapid assessment (within 72 hours) and time to appropriate care (within 30 days). Of 1,078 youth (344 in the intervention [AOM] group and 734 in the control [non-AOM] group) aged 15-25 visiting community mental health centres, the intervention group had statistically greater improvements (7.4% absolute improvement or 1.2× relative improvement) in total HoNOS scores and its behavioural and symptom subscales.ConclusionsIn addition to improving the reach and timeliness of YMH services, AOM Edmonton produced greater improvements in HoNOS total scores (and two of four subscale scores) compared to a matched control group. Comparative evaluations such as these are essential to demonstrating the value of such services and generating continuous cycles of learning and improvement.Plain Language Summary TitleWhat are the outcomes of transforming youth mental health services in community settings?},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41494308,

title = {A cost-effectiveness analysis of a multidisciplinary model of care on hepatitis C care among people released from provincial prison in Quebec, Canada},

author = {Charlene Weight and Andrea Mambro and Camille Dussault and Sylvie Chalifoux and Lina Del Balso and Apostolia Petropoulos and Mona Lim and Alexandros Halavrezos and Bertrand Lebouche and Giada Sebastiani and Marina B Klein and Joseph Cox and Eric Latimer and Nadine Kronfli},

doi = {10.1016/j.drugpo.2025.105136},

issn = {1873-4758},

year  = {2026},

date = {2026-03-01},

journal = {Int J Drug Policy},

volume = {149},

pages = {105136},

abstract = {BACKGROUND: Many individuals are released from prison with untreated hepatitis C virus (HCV) and face challenges linking to care in the community. This study evaluated the cost-effectiveness of a multidisciplinary model of care compared to standard of care (SOC) across key steps along the HCV care cascade.nnMETHODS: A prospective, pre-post study was conducted among men incarcerated in Quebec's largest provincial prison. Intervention participants received care from a nurse, social worker, and patient navigator before release and were offered appointment accompaniment post-release by the patient navigator. SOC participants were encouraged to undergo HCV screening and those with current HCV received a pre-release discharge HCV appointment. The analysis adopted a healthcare system perspective. The primary outcome was sustained virologic response (SVR) within 180 days post-release. Secondary outcomes included linkage to care within 90 days post-release, treatment initiation, and treatment completion. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs (Canadian dollars, C$) divided by the difference in outcomes.nnRESULTS: Comparing 20 participants with current HCV infection (HCV RNA+) in both the intervention and the SOC arms, 16 vs. 12 were linked to care, 13 vs. 4 initiated treatment, 8 vs. 2 completed treatment, and 8 vs. 2 achieved SVR, respectively. The corresponding ICERs were C$1,242, C$10,481, C$25,577, and C$25,653 per additional person achieving the outcome.nnCONCLUSIONS: Our multidisciplinary model of care increased the proportion of HCV RNA+ people released from prison who subsequently achieved SVR, at an additional cost of C$25,653 per additional patient. This is only C$5,653 more than the estimated cost of direct-acting antivirals, providing an economic rationale for broader implementation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41803839,

title = {Evaluating primary health care utilization among lesbian, gay, and bisexual individuals in Canada with a view to inform more equitable health measures},

author = {Ivan Marbaniang and Erica E M Moodie and Eric Latimer and Joseph Cox},

doi = {10.1186/s12889-026-26949-6},

issn = {1471-2458},

year  = {2026},

date = {2026-03-01},

journal = {BMC Public Health},

volume = {26},

number = {1},

abstract = {BACKGROUND: Canada is advancing several reforms to strengthen primary health care. Although lesbian, gay, and bisexual (LGB) individuals experience a higher burden of some health conditions, they remain largely absent from these reforms, partly because of limited data. We assessed differences in primary care utilization between LGB and heterosexual individuals to address this gap.nnMETHODS: We used data from 91,172 heterosexual and 2,550 LGB participants in the 2015–2016 Canadian Community Health Survey. Guided by Andersen’s Behavioural Model of Health Services Use, we examined the association between primary care physician (PCP) consultation rates and our primary variables of interest: sex and sexuality. Estimates for heterosexual men, heterosexual women, gay and bisexual men (GBM), and lesbian and bisexual women (LBW) were obtained separately. Models were adjusted for additional covariates (predisposing, enabling, and need-based) identified in Andersen’s framework. Poisson regression was used for the main analysis, and results were compared with estimates from double-selection lasso models.nnRESULTS: GBM and LBW had higher PCP consultation rates over a 12-month period compared with heterosexual men. For every 100 PCP consultations among heterosexual men, there were an estimated 129 consultations (95% CI 112 to 148) among GBM and 123 consultations (95% CI 110 to 139) among LBW. In contrast, consultation rates for GBM and LBW were comparable with heterosexual women.nnCONCLUSION: Even after adjusting for several covariates, GBM and LBW had higher PCP consultation rates than heterosexual men. These findings suggest that PCP engagement among LGB adults differs from that of heterosexual men. The comparability with heterosexual women requires further investigation. More comprehensive data are needed to verify and clarify these findings to support equitable primary care planning.nnSUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-26949-6.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41390806,

title = {Economic data on interventions for reducing aggression and restrictive interventions in inpatient mental health: a systematic review},

author = {Mimosa Luigi and Arianne Imbeault and Anne G Crocker and Eric Latimer},

doi = {10.1186/s13033-025-00692-8},

issn = {1752-4458},

year  = {2025},

date = {2025-12-01},

journal = {Int J Ment Health Syst},

volume = {20},

number = {1},

pages = {2},

abstract = {OBJECTIVE: Given the importance of economic considerations for the uptake of interventions into psychiatric policy and practice, this systematic review appraises existing economic evaluations of interventions that aim to reduce aggression and restrictive interventions in inpatient mental health settings.nnMETHODS: Eight economic and scientific databases, along with targeted Google Scholar searches, were surveyed for gray and peer-reviewed literature from 01/2000 to 08/2025. Selection criteria included: (1) quantitative studies in peer-reviewed journals or grey literature, (2) a broad range of economic evaluation methods (costs, cost analysis, cost-effectiveness, and cost-benefit), (3) non-geriatric adults and emerging adults (≥ 15 years old) in (4) psychiatric inpatient settings, and (5) non-pharmacological interventions targeting aggression, violence and/or restrictive interventions (e.g., seclusion, restraints, forced medication). Narrative synthesis is presented with a quality appraisal using the CHEERS reporting checklist 2022.nnRESULTS: Twenty studies were selected, with the majority conducted in acute wards. Eleven studies reported only the cost of interventions, prominently featuring the cost of restrictive interventions, sensory modulation, and staff training. Moreover, twelve studies reported savings, eight of which allowed cost-analyses. Two interventions yielded clinical benefits and net savings. Assessment of reporting quality revealed few sensitivity analyses to model uncertainty, heterogeneity or distributional effects.nnCONCLUSIONS: While this review intended to guide organizations in selecting interventions, the current state of evidence can provide some evidence on the cost-benefit of a handful of interventions and re-affirms the costliness of restrictive interventions. Future pre-post studies may benefit from methods featured in this review to estimate the cost of professional time and partner with organizations to access internal financial data. There remains a need for purposeful cost-effectiveness analyses and for demonstrated long-term clinical benefits to inform interventions for aggression management.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39041545,

title = {Comparison of concordance and predictive validity of head injuries from parental reports and medical records},

author = {Olivia E Gunther and Mathilde Garneau and Marie-Claude Geoffroy and Alexa Martin-Storey and Eric Latimer and Michèle Déry and Caroline E Temcheff},

doi = {10.1080/02699052.2024.2381046},

issn = {1362-301X},

year  = {2024},

date = {2024-12-01},

journal = {Brain Inj},

volume = {38},

number = {14},

pages = {1220--1226},

abstract = {OBJECTIVE: To examine agreement between parental reports of head injury and evidence of head injury in medical records and to compare these two measures in predicting early conduct disorder (CD).nnDESIGN AND SETTING: Parent survey data was compared with records of child head injury from the National Health Services Register (Régie de l'assurance maladie du Québec, RAMQ) administrative database.nnPARTICIPANTS: Children ( = 685) ages 6-9 with and without CD. There were 147 children with RAMQ recorded head injury and 39 children with parent-reported head injury.nnMAIN MEASURES: Indication of one or more head injury before 6 years of age as reported by parents and/or as noted in medical data. Early CD (present by age 9) according to parents and/or teachers.nnRESULTS: Results indicated poor agreement between the two forms of reporting κ = .161 (95% CI, .083 to .239),  < 0.001. Medical data significantly predicted the presence of CD in children, with a RAMQ coded head injury suggesting a child was 1.88 times more likely to have CD. Parent reports of head injuries did not significantly predict CD. Conclusion: Medical data should be prioritized in research addressing pediatric head injury, given that parent reports may fail to capture incidence of injury and therefore may be less predictive of other known correlates of head injury.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39620472,

title = {Childhood conduct problems and adolescent medical service use: serial mediating effects of peer victimization and internalizing problems},

author = {Olivia Crescenzi and Alexa Martin-Storey and Martine Poirier and Stéphanie Boutin and Annie Lemieux and Michèle Déry and Eric Latimer and Caroline E Temcheff},

doi = {10.1017/S0033291724002241},

issn = {1469-8978},

year  = {2024},

date = {2024-12-01},

journal = {Psychol Med},

volume = {54},

number = {15},

pages = {1--10},

abstract = {BACKGROUND: Adolescents with a history of conduct problems (CP) are at heightened risk of increased service utilization as they develop. While the mechanisms underlying this association are unclear, early CP have also been linked with peer victimization and internalizing problems. The goals of the current study were: (1) to examine peer victimization and internalizing problems as potential serial mediators explaining increased medical and psychiatric service use in adolescents with a history of childhood CP, and; (2) to explore whether the proposed mediation models vary by sex.nnMETHODS: Participants ( = 744; 53% boys, Mage = 8.39 years) from an ongoing longitudinal study that began in 2008 in Québec, Canada were recruited and assessed for CP, service use, and other behaviours via self-, parent- and teacher-reported questionnaires. Serial mediation analyses were conducted to examine the effects of peer victimization and internalizing problems on the association between childhood CP and adolescent medical and psychiatric service use, controlling for sex and household income.nnRESULTS: Adolescents with childhood CP reported higher medical and psychiatric service use than non-CP peers. Peer victimization and internalizing problems significantly mediated this association in both general medical and psychiatric service use models. The models did not vary by sex.nnCONCLUSIONS: Findings support higher levels of service use in adolescents with a history of CP, mediated by peer victimization and internalizing problems. Specifically, results highlight the importance of examining peer and socioemotional factors that may explain the increased service usage observed among youth with CP, to support better health outcomes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38353025,

title = {Risk factors for homelessness and housing instability in the first episode of mental illness: Initial findings from the AMONT study},

author = {Laurence Roy and Marichelle Leclair and Anne G Crocker and Amal Abdel-Baki and Luigi de Benedictis and Felix-Antoine Bérubé and Esther Thibeault and Eric Latimer and Marc-André Roy},

doi = {10.1111/eip.13495},

issn = {1751-7893},

year  = {2024},

date = {2024-07-01},

journal = {Early Interv Psychiatry},

volume = {18},

number = {7},

pages = {561--570},

abstract = {AIM: People living with mental illness are more likely than the general population to experience adverse housing outcomes, including homelessness. The aim of the current study is to examine residential status when participants have their first contact with mental health services, and the correlates of residential status at that moment.nnMETHODS: First-time mental health service users were recruited from seven clinical sites across Québec. Data on residential status at entry in the project, as well as demographic, clinical and social variables, were collected using self-report and interviewer-rated questionnaires. Participants were classified as 'Homeless', 'At risk of homelessness' and 'Stably Housed', and correlates of residential status were identified through multivariate logistic regression and unbiased recursive partitioning.nnRESULTS: Among the 478 participants, 206 (43.1%) were in stable housing, 171 (35.8%) were at risk of homelessness and 101 (21.1%) were classified as homeless. Placement in a youth protection facility was strongly associated with adverse housing outcomes, while having a high school diploma and more social support were associated with more stable housing situations.nnCONCLUSIONS: First-time mental health service users are likely to experience a range of adverse housing situations, indicating the potential for clinical sites to implement homelessness primary prevention strategies. Factors related to family, foster care and schooling seem to be particularly salient in understanding risk of homelessness in first-time mental health service users, calling for intersectoral action to prevent adverse psychosocial outcomes in this population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38438301,

title = {Using an intersectionality-based approach to evaluate mental health services use among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver},

author = {Ivan Marbaniang and Erica E M Moodie and Eric Latimer and Shayna Skakoon-Sparling and Trevor A Hart and Daniel Grace and David M Moore and Nathan J Lachowsky and Jody Jollimore and Gilles Lambert and Terri Zhang and Milada Dvorakova and Joseph Cox and },

doi = {10.1017/S2045796024000143},

issn = {2045-7979},

year  = {2024},

date = {2024-03-01},

journal = {Epidemiol Psychiatr Sci},

volume = {33},

pages = {e10},

abstract = {AIMS: To cope with homonegativity-generated stress, gay, bisexual and other men who have sex with men (GBM) use more mental health services (MHS) compared with heterosexual men. Most previous research on MHS among GBM uses data from largely white HIV-negative samples. Using an intersectionality-based approach, we evaluated the concomitant impact of racialization and HIV stigma on MHS use among GBM, through the mediating role of perceived discrimination (PD).nnMETHODS: We used baseline data from 2371 GBM enrolled in the Engage cohort study, collected between 2017 and 2019, in Montreal, Toronto and Vancouver, using respondent-driven sampling. The exposure was GBM groups:  ( = 1376): white HIV-negative;  ( = 327): white living with HIV;  ( = 577): racialized as non-white HIV-negative;  ( = 91): racialized as non-white living with HIV. The mediator was interpersonal PD scores measured using the Everyday Discrimination Scale (5-item version). The outcome was MHS use (yes/no) in the prior 6 months. We fit a three-way decomposition of causal mediation effects utilizing the imputation method for natural effect models. We obtained odds ratios (ORs) for pure direct effect (PDE, unmediated effect), pure indirect effect (PIE, mediated effect), mediated interaction effect (MIE, effect due to interaction between the exposure and mediator) and total effect (TE, overall effect). Analyses controlled for age, chronic mental health condition, Canadian citizenship, being cisgender and city of enrolment.nnRESULTS: Mean PD scores were highest for racialized HIV-negative GBM (10.3, SD: 5.0) and lowest for white HIV-negative GBM (8.4, SD: 3.9). MHS use was highest in white GBM living with HIV (GBMHIV) (40.4%) and lowest in racialized HIV-negative GBM (26.9%). Compared with white HIV-negative GBM, white GBMHIV had higher TE (OR: 1.71; 95% CI: 1.27, 2.29) and PDE (OR: 1.68; 95% CI: 1.27, 2.24), and racialized HIV-negative GBM had higher PIE (OR: 1.09; 95% CI: 1.02, 1.17). Effects for racialized GBMHIV did not significantly differ from those of white HIV-negative GBM. MIEs across all groups were comparable.nnCONCLUSIONS: Higher MHS use was observed among white GBMHIV compared with white HIV-negative GBM. PD positively mediated MHS use only among racialized HIV-negative GBM. MHS may need to take into account the intersecting impact of homonegativity, racism and HIV stigma on the mental health of GBM.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39208222,

title = {[Housing experiences of new mental health service users: Specific characteristics and developmental issues]},

author = {Laurence Roy and Amal Abdel Baki and Anne Crocker and Luigi De Benedictis and Éric Latimer and Esther Thibeault and Félix-Antoine Bérubé and Marc-André Roy},

issn = {1708-3923},

year  = {2024},

date = {2024-01-01},

journal = {Sante Ment Que},

volume = {49},

number = {1},

pages = {123--144},

abstract = {Objectives Access to stable, safe, and affordable housing is an important determinant of health and community integration among people living with mental illness. Previous studies on housing stability, housing satisfaction and residential preferences among people living with mental illness have primarily been conducted among those with extensive service use experiences. First-time mental health service users, and youth in particular, are likely to present with distinct housing needs. The current study aimed to explore the housing experiences of new mental health service users, as well as the perceived obstacles and facilitators to their residential stability. Methods Projet AMONT is a longitudinal mixed-methods cohort study on the residential trajectories of service users in the 36 months after their initial contact with psychiatric services. The qualitative component consisted in a qualitative descriptive study. Semi-structured individual interviews were conducted with fourteen individuals at the beginning of their service use trajectory. Findings The thematic analysis uncovered how the emergence of mental illness and initial contacts with psychiatric services are associated with transformations in the area of housing and, for many, with housing instability. This instability might occur in continuity with adverse early life trajectories, or through the disruption caused by the emergence of mental illness. Informal social support emerged as the main protective factor against housing instability. Housing satisfaction was associated with multiple and sometimes conflicting needs regarding privacy, safety, social interactions, response to basic needs, performance of activities of daily living, and community integration. The specific developmental issues of youth at the beginning of their service use trajectories influence housing stability and satisfaction. Their housing then becomes a reflection of and laboratory for identity exploration and consolidation. Conclusion The findings highlight the importance of adopting a homelessness prevention lens among people living with a first episode of mental illness, particularly youth with adverse early life trajectories. Many existing approaches could be implemented or strengthened: cross-sector partnerships with all actors present in the trajectories of people with emerging mental illness; family approaches in early intervention, peer support, and screening for unstable housing situations. Adapting practices to the specific developmental characteristics of youth seem to be a key for homelessness prevention for this population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37156495,

title = {Housing trajectories and the risk of homelessness among new mental health service users: Protocol for the AMONT study},

author = {Laurence Roy and Amal Abdel-Baki and Félix-Antoine Bérubé and Anne Crocker and Luigi de Benedictis and Mathieu Dostie and Eric Latimer and Marc-André Roy},

doi = {10.1111/eip.13344},

issn = {1751-7893},

year  = {2023},

date = {2023-05-01},

journal = {Early Interv Psychiatry},

volume = {17},

number = {5},

pages = {495--501},

abstract = {AIMS: High rates of mental illness among individuals experiencing homelessness, as well as documented contacts with psychiatric services prior to episodes of homelessness, indicate that early intervention could play a key role in homelessness prevention. Decision-makers and clinical teams need longitudinal data on housing trajectories following initial contact with psychiatric services, as well as on predictors of risk of housing instability and homelessness. This paper describes the AMONT study, a mixed-methods naturalistic longitudinal cohort study of individuals identified as new psychiatric service users in seven clinical sites across the province of Québec (Canada).nnMETHODS: The goal of AMONT is to examine the housing situations of individuals over 36 months after their initial contact with psychiatric services, and to identify environmental and individual correlates and predictors of housing outcomes. Participants complete a broad battery of instruments at baseline and follow-up assessments after 24 and 36 months. We explore housing stability following an initial episode of psychiatric service use from the perspective of service users, family members, and service providers, through qualitative interviews.nnRESULTS AND CONCLUSIONS: The findings from the AMONT study will yield a better understanding of the residential pathways of individuals with mental illness, from their first contact with psychiatric services and for 3 years subsequently. This will inform service providers, decision-makers and managers on the specific housing concerns and issues that affect first-time mental health service users. This in turn can lead to the development and implementation of evidence-informed practices and policies that aim to prevent instability and homelessness.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36938661,

title = {Benefits of the PRISM Shelter-Based Program for Attainment of Stable Housing and Functional Outcomes by People Experiencing Homelessness and Mental Illness: A Quantitative Analysis},

author = {Ghassen Soufi and Brigitte Voisard and Eric A Latimer and Lavina Matai and Erica E M Moodie and Vincent Laliberté},

doi = {10.1177/07067437231162494},

issn = {1497-0015},

year  = {2023},

date = {2023-03-01},

journal = {Can J Psychiatry},

pages = {7067437231162494},

abstract = {OBJECTIVE: To explore the housing trajectory, personal recovery, functional level, and quality of life of clients at discharge and 1 year after completing  (PRISM), a shelter-based mental health and rehabilitation program intended to provide individuals experiencing homelessness and severe mental illness with transition housing and to reconnect them with mental health and social services.nnMETHOD: Housing status, psychiatric follow-up trajectory, personal recovery (Canadian Personal Recovery Outcome Measure), functional level (Multnomah Community Ability Scale), and quality of life (Lehman Quality of Life Interview) were assessed at program entry, at program discharge and 1 year later.nnRESULTS: Of the 50 clients who participated in the study from May 31, 2018, to December 31, 2019, 43 completed the program. Of these, 76.7% were discharged to housing modalities and 78% were engaged with psychiatric follow-up at the program's end. Housing stability, defined as residing at the same permanent address since discharge, was achieved for 62.5% of participants at 1-year follow-up. Functional level and quality of life scores improved significantly both at discharge and at 1-year follow-up from baseline.nnCONCLUSIONS: Admission to PRISM helped clients secure long-term stable housing and appropriate psychiatric follow-up. Stable housing was maintained for most clients at 1-year follow-up, and they benefited from sustained functional and quality of life outcomes in long-term follow-up.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36896344,

title = {Return on investment from service transformation for young people experiencing mental health problems: Approach to economic evaluations in ACCESS Open Minds (Esprits ouverts), a multi-site pan-Canadian youth mental health project},

author = {Jai L Shah and Zeinab Moinfar and Kelly K Anderson and Hayley Gould and Daphne Hutt-Macleod and Philip Jacobs and Stephen Mitchell and Thanh Nguyen and Rebecca Rodrigues and Paula Reaume-Zimmer and Heather Rudderham and Sharon Rudderham and Rebecca Smyth and Shireen Surood and Liana Urichuk and Ashok K Malla and Srividya N Iyer and Eric Latimer},

doi = {10.3389/fpsyt.2023.1030407},

issn = {1664-0640},

year  = {2023},

date = {2023-01-01},

journal = {Front Psychiatry},

volume = {14},

pages = {1030407},

abstract = {INTRODUCTION: Mental health problems are common globally, and typically have their onset in adolescence and early adulthood-making youth (aged 11-25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation  the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings.nnAPPROACH: As a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses.nnANTICIPATED RESULTS: Across urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care.nnDISCUSSION: Complex interventions such as AOM aim to shift care "upstream": away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35996750,

title = {Trajectories of systemic agent use and associated depression- and anxiety-related health care costs among patients with psoriasis},

author = {Raymond Milan and Jacques LeLorier and Eric A Latimer and Marie-Josée Brouillette and Anne Holbrook and Ivan V Litvinov and Elham Rahme},

doi = {10.1016/j.jdin.2022.06.018},

issn = {2666-3287},

year  = {2022},

date = {2022-12-01},

journal = {JAAD Int},

volume = {9},

pages = {11--22},

abstract = {BACKGROUND: Systemic treatment patterns and related mental health disorders and economic burden among patients with psoriasis are largely unknown.nnOBJECTIVE: To assess systemic treatment patterns and associated depression and anxiety-related health care costs among patients with psoriasis initiating a conventional systemic treatment (CST).nnMETHODS: Using a retrospective cohort design with sequence and cluster analyses, we assessed systemic treatment trajectories (CST and tumor necrosis factor inhibitors or ustekinumab, [TNFi/UST]) over a 2-year period following CST initiation. We compared health care costs between trajectories using 2-part models.nnRESULTS: We included 781 patients and identified 8 trajectories: persistent methotrexate users, persistent acitretin users, early CST discontinuation, late methotrexate discontinuation, switch to TNFi/UST, adding TNFi/UST, discontinuation then restart on methotrexate, and discontinuation then restart on acitretin or multiple CST switches. Overall, 165 (21%) patients incurred depression- and anxiety-related health care costs (median annual cost, CAN$56; quartiles, $14-$127). Compared with persistent methotrexate users, adding a TNFi/UST (cost ratio, 3.63; 95% CI, 1.47-5.97) and discontinuation then restart on acitretin or multiple switches between systemic agents (cost ratio, 13.3; 95% CI 5.76-22.47) had higher costs.nnLIMITATIONS: Trajectory misclassification may have occured. These date represent an association, and causality cannot be inferred, particularly given the risk of confounding.nnCONCLUSION: Depression- and anxiety-related health care costs were high among patients adding TNFi/UST and those discontinuing then restarting on acitretin or experiencing multiple switches between systemic agents.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35560475,

title = {Implementation of strengths model case management in seven mental health agencies in Canada: Direct-service practitioners' implementation experience},

author = {Catherine Briand and Maryann Roebuck and Catherine Vallée and Christiane Bergeron-Leclerc and Terry Krupa and Janet Durbin and Tim Aubry and Rick Goscha and Eric Latimer},

doi = {10.1111/jep.13696},

issn = {1365-2753},

year  = {2022},

date = {2022-12-01},

journal = {J Eval Clin Pract},

volume = {28},

number = {6},

pages = {1127--1137},

abstract = {RATIONALE: Implementation of strengths model case management is increasing internationally. However, few studies have focused on its implementation process, and none have specifically addressed the implementation experience of direct-service practitioners.nnOBJECTIVE: This paper presents factors that facilitate and impede the successful implementation of the strengths model, with a specific focus on practitioners who deliver the intervention directly to service recipients.nnMETHOD: To address this objective, a qualitative study of seven mental health agencies that implemented the model was conducted, involving a combination of participant observations and qualitative semistructured interviews with case managers, team supervisors, and senior managers. Qualitative data were analyzed using open coding followed by axial coding. Finally, the findings were aligned with an adapted Consolidated Framework for Implementation Research.nnRESULTS: Implementation of the strengths model involved a significant change in practice for case management practitioners. The results confirm that at the beginning of implementation, the strengths model was perceived as complex and not always adaptable to on-the-ground realities. With time, and with support from management, ongoing training and supervision sessions, and reflection and discussion, practitioners regained feelings of competence and resistance to the model diminished. The use of the model's structured team-based supervision tools was fundamental to supporting the implementation process by enabling an interactive and concrete training approach.nnCONCLUSIONS: The more an approach leads to changes in daily practice and is perceived as complex, the more concrete support is needed during implementation. This article highlights the importance of attending to a practitioner's sense of personal effectiveness and competence in the adoption of new practices.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35397721,

title = {Implementing the Strengths Model of Case Management: Assessing Practice Three Years After Initial Implementation},

author = {Janet Durbin and Tim Aubry and Beverley Barrett and Christiane Bergeron-Leclerc and Catherine Briand and Rick Goscha and Terry Krupa and Jennifer Rae and Maryann Roebuck and Alissa Setliff and Jonathan Scaccia and Catherine Vallée and Eric Latimer},

doi = {10.1007/s10597-022-00968-0},

issn = {1573-2789},

year  = {2022},

date = {2022-11-01},

journal = {Community Ment Health J},

volume = {58},

number = {8},

pages = {1535--1543},

abstract = {While strengths approaches are important to recovery-oriented practice, implementation can be challenging. This study implemented the strengths model of case management (SMCM) in 11 CM teams and assessed the fidelity of delivery and staff perceptions of the model after 36 months using the SMCM fidelity scale and the Readiness Monitoring Tool. Paired sample t-tests assessed change in fidelity from baseline to 36 months. Adjusted regression analyses compared survey responses of direct and management staff. While fidelity ratings significantly improved across all domains, at 36 months they remained suboptimal in supervision practices and use of model tools. Staff perceptions were generally positive but consistently lower for front-line than management staff. Implementing SMCM into existing case management practice with good fidelity is feasible. However, clear support from management may strengthen staff motivation and delivery. A review of practice later in implementation can flag challenges for sustainability and guide implementation support.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35502516,

title = {The Working Alliance as a Mediator Between Fidelity to Strengths Model Case Management and Client Outcomes},

author = {Maryann Roebuck and Eric Latimer and Christiane Bergeron-Leclerc and Catherine Briand and Janet Durbin and Rick Goscha and Terry Krupa and Alissa Setliff and Catherine Vallée and Tim Aubry},

doi = {10.1176/appi.ps.202100387},

issn = {1557-9700},

year  = {2022},

date = {2022-11-01},

journal = {Psychiatr Serv},

volume = {73},

number = {11},

pages = {1248--1254},

abstract = {OBJECTIVE: The purpose of this study was to examine how the client–case manager working alliance in strengths model case management (SMCM) mediates the relationship between fidelity to the SMCM intervention and clients’ quality of life, hope, and community functioning.nnMETHODS: In total, 311 people with severe mental illness, served at seven community mental health agencies in Canada, participated in the study. They were new to SMCM and participated in five structured interviews every 4.5 months for 18 months to measure the quality of the client–case manager working alliance and clients’ quality of life, hope, and community functioning. The team-level SMCM fidelity scale was administered six times over 3 years. Ordinary least-squares path analysis was used to test simple mediation models.nnRESULTS: Higher fidelity to SMCM was associated with better client outcomes indirectly through the working alliance. Higher SMCM fidelity predicted a stronger working alliance, which in turn predicted greater improvements in client quality of life (at 9 months and 18 months), hope (at 18 months), and community functioning (at 9 months).nnCONCLUSIONS: The results support the view that SMCM is an effective intervention. When the intervention was implemented as planned, it fostered stronger working alliances between clients and case managers and contributed to greater improvements in the quality of life, hope, and functioning of people with severe mental illness. The findings of this study highlight the value of ongoing monitoring of implementation fidelity to achieve high-fidelity interventions that may lead to positive client outcomes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36070045,

title = {Shelter Bans Among People Experiencing Homelessness: an Exploratory Study of Predictors in Two Large Canadian Datasets},

author = {Nick Kerman and Ri Wang and Tim Aubry and Jino Distasio and Stephen Gaetz and Stephen W Hwang and Eric Latimer and Bill O'Grady and Kaitlin Schwan and Julian M Somers and Vicky Stergiopoulos and Sean A Kidd},

doi = {10.1007/s11524-022-00680-0},

issn = {1468-2869},

year  = {2022},

date = {2022-10-01},

journal = {J Urban Health},

volume = {99},

number = {5},

pages = {842--854},

abstract = {Emergency shelters are a core component of homeless service systems that address immediate basic needs. Service bans, which refer to temporary or permanent disallowances from a program or organization, are an underresearched phenomenon that can leave people experiencing homelessness without needed supports. This exploratory study examined the factors associated with shelter bans among people experiencing homelessness using secondary data from two Canadian studies: (1) a multisite randomized controlled trial of Housing First (At Home/Chez Soi Demonstration Project) and (2) a cross-sectional survey of youth experiencing homelessness across Canada (2019 Without a Home-National Youth Homelessness Survey). The two datasets were analyzed separately using logistic regression models with similar predictors to maximize the comparability of the results. Participants who experienced homelessness at an earlier age and had recent criminal justice system involvement were more likely to have shelter bans in both datasets. Impaired impulse control, more chronic medical conditions and living in Toronto were associated with increased likelihood of shelter bans in the At Home/Chez Soi dataset, whereas more adverse childhood experiences, physical violence victimization, engagement in survival sex behaviours and longer current episodes of homelessness were significant predictors of bans in the Without A Home dataset. Overall, the findings suggest that victimization and criminalization during homelessness may increase the risk of shelter loss from bans and further exclusion. The observed regional differences also highlight the potential limits of individual-level predictors. Further research is needed on shelter ban outcomes, as well as how capacity limits and organizational policies affect banning decisions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35306862,

title = {Economic Evaluation of Early Psychosis Interventions From A Canadian Perspective},

author = {Jean-Eric Tarride and Gord Blackhouse and Amal Abdel-Baki and Eric Latimer and Gillian Mulvale and Brian Cooper and Gord Langill and Deborah Milinkovic and Rosain Stennett and Jeremiah Hurley},

doi = {10.1177/07067437221087044},

issn = {1497-0015},

year  = {2022},

date = {2022-10-01},

journal = {Can J Psychiatry},

volume = {67},

number = {10},

pages = {768--777},

abstract = {BACKGROUND: Compared to treatment as usual (TAU), early psychosis intervention programs (EPI) have been shown to reduce mortality, hospitalizations and days of assisted living while improving employment status.nnAIMS: The study aim was to conduct a cost-benefit analysis (CBA) and a cost-effectiveness analysis (CEA) to compare EPI and TAU in Canada.nnMETHODS: A decision-analytic model was used to estimate the 5-year costs and benefits of treating patients with a first episode of psychosis with EPI or TAU. EPI benefits were derived from randomized controlled trials (RCTs) and Canadian administrative data. The cost of EPI was based on a published survey of 52 EPI centers in Canada while hospitalizations, employment and days of assisted living were valued using Canadian unit costs. The outcomes of the CBA and CEA were expressed in terms of net benefit (NB) and incremental cost per life year gained (LYG), respectively. Scenario analyses were conducted to examine the impact of key assumptions. Costs are reported in 2019 Canadian dollars.nnRESULTS: Base case results indicated that EPI had a NB of $85,441 (95% CI: $41,140; $126,386) compared to TAU while the incremental cost per LYG was $26,366 (95% CI: EPI dominates TAU (less costs, more life years); $102,269). In all sensitivity analyses the NB of EPI remained positive and the incremental cost per LYG was less than $50,000.nnCONCLUSIONS: In addition to EPI demonstrated clinical benefits, our results suggest that large-scale implementation of EPI in Canada would be desirable from an economic point of view .},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35511509,

title = {Association between fidelity to the strengths model of case management and client outcomes: A quasi-experimental study},

author = {Eric Latimer and Tim Aubry and Beverley Barrett and Christiane Bergeron-Leclerc and Catherine Briand and Janet Durbin and Rick Goscha and Terry Krupa and Maryann Roebuck and Catherine Vallée and Alissa Setliff and Mamadou Yauck},

doi = {10.1037/prj0000519},

issn = {1559-3126},

year  = {2022},

date = {2022-09-01},

journal = {Psychiatr Rehabil J},

volume = {45},

number = {3},

pages = {280--290},

abstract = {OBJECTIVE: Evidence concerning strengths model of case management (SMCM) remains mixed. This study aimed to test the hypotheses that higher fidelity to SMCM is associated with improved quality of life (QoL), hope, community participation, community functioning, more days of competitive employment and of independent living, and fewer days of hospitalization.nnMETHODS: SMCM was implemented over a 3-year period, at seven sites in the Canadian provinces of Newfoundland and Labrador, Québec, and Ontario. Independent assessors visited 14 teams at the seven sites to evaluate fidelity at baseline and 6, 12, 18, 24, and 36 months later. Participants ( = 311) answered standardized questionnaires at 4.5-month intervals up to 18 months. Fidelity assessments were interpolated so they could be associated with questionnaire responses. Linear mixed-effects models and generalized linear models were estimated.nnRESULTS: Fidelity increased significantly, with all sites except one achieving or approaching good fidelity within 36 months. Fidelity was not significantly associated with any of the outcome measures, although all estimated directions of relationships were consistent with our hypotheses.nnCONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In a pragmatic study of real-world implementation of the strengths model at seven sites, no statistically significant relationships between fidelity and outcomes were found. Low variation in fidelity across individuals, modest sample size, and limited ability to detect change over 18 months, may have contributed to these null findings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}