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Planning a Multi-site, Complex Intervention for Homeless People with Mental Illness: The Relationships Between the National Team and Local Sites in Canada’s At Home/Chez Soi Project

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American Journal of Community Psychology

Abstract

This research focused on the relationships between a national team and five project sites across Canada in planning a complex, community intervention for homeless people with mental illness called At Home/Chez Soi, which is based on the Housing First model. The research addressed two questions: (a) what are the challenges in planning? and (b) what factors that helped or hindered moving project planning forward? Using qualitative methods, 149 national, provincial, and local stakeholders participated in key informant or focus group interviews. We found that planning entails not only intervention and research tasks, but also relational processes that occur within an ecology of time, local context, and values. More specifically, the relationships between the national team and the project sites can be conceptualized as a collaborative process in which national and local partners bring different agendas to the planning process and must therefore listen to, negotiate, discuss, and compromise with one another. A collaborative process that involves power-sharing and having project coordinators at each site helped to bridge the differences between these two stakeholder groups, to find common ground, and to accomplish planning tasks within a compressed time frame. While local context and culture pushed towards unique adaptations of Housing First, the principles of the Housing First model provided a foundation for a common approach across sites and interventions. The implications of the findings for future planning and research of multi-site, complex, community interventions are noted.

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References

  • Allred, C. A., Burns, B. J., & Phillips, S. D. (2005). The assertive community treatment team as a complex dynamic system of care. Administration and Policy in Mental Health, 32, 211–220. doi:10.1007/s10488-004-0841-6.

    Article  PubMed  Google Scholar 

  • Aubry, T., Ecker, J., & Jetté, J. (accepted). Supported housing as a promising Housing First approach for people with severe and persistent mental illness. In M. Guirgius, R. McNeil, & S. Hwang (Eds.), Homelessness and health.

  • Barrera, M., Jr., Castro, F. G., & Hollerin Steiker, L. K. (2011). A critical analysis of approaches to the development of preventive interventions for subcultural groups. American Journal of Community Psychology, 48, 439–454. doi:10.1007/s10464-010-9422-x.

    Article  PubMed  Google Scholar 

  • Bond, M. A., & Keys, C. B. (1993). Empowerment, diversity, and collaboration: Promoting synergy on community boards. American Journal of Community Psychology, 21, 37–57.

    Article  Google Scholar 

  • Charmaz, K. (2006). Constructing grounded theory. London: Sage.

    Google Scholar 

  • Chinman, M., Hunter, S. B., Ebener, P., Paddock, S. M., Stillman, S., Imm, P., et al. (2008). The Getting to Outcomes demonstration and evaluation: An illustration of the prevention support system. American Journal of Community Psychology, 41, 206–224. doi:10.1007/s10464-008-9163-2.

    Article  PubMed  Google Scholar 

  • Dewa, C. S., Durbin, J., Wasylenki, D., Ochocka, J., Eastabrook, S., Boydell, K. M., et al. (2002). Considering a multisite study? How to take the leap and have a soft landing. Journal of Community Psychology, 30, 173–187.

    Article  Google Scholar 

  • Dudley, M., & Moradzadeh, F. (2010). Report on proposal development at the Winnipeg site: The Mental Health Commission of Canada’s At Home/Chez Soi Project. Winnipeg: Institute of Urban Studies, University of Winnipeg.

    Google Scholar 

  • Farquar, S. A., Parker, E. A., Schulz, A. J., & Israel, B. A. (2006). Application of qualitative methods in program planning for health promotion interventions. Health Promotion Practice, 7, 234–242. doi:10.1177/1524839905278915.

    Article  Google Scholar 

  • Fleury, M. -J., Vallée, C., Hurtubise, R., & et Grenier, G. (2010). Projet Chez Soi Montréal—Projet de recherche et de démonstration sur la santé mentale et l’itinérance: Rapport d’évaluation de la planification et du développement du projet (été 2008–automne 2009). Montréal: McGill University.

    Google Scholar 

  • Foster-Fishman, P. G., Berkowitz, S. L., Lounsbury, D. W., Jacobson, S., & Allen, N. A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241–261.

    Article  PubMed  Google Scholar 

  • Gaucher, C., Flowers, L., Prévost, N., & Tinney, W. (2010). Rapport de recherche: Phase I—Planification et développement du projet Chez-soi/At Home Moncton et volet rural. Moncton: Université de Moncton, Centre de recherche et de développement en éducation.

    Google Scholar 

  • Goering, P. N., Streiner, D. L., Adair, C., Aubry, T., Barker, J., Distasio, J., et al. (2011). The At Home/Chez Soi trial protocol: A pragmatic, multi-site, randomised trial of a housing first intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open, 1, e000323. doi:10.1136/bmjopen-2011-000323.

    Article  PubMed  Google Scholar 

  • Green, L., & Kreuter, M. (2005). Health program planning: An educational and ecological approach (4th ed.). New York: McGraw-Hill.

    Google Scholar 

  • Guba, E. G., Lynham, S. A., & Lincoln, Y. S. (2011). Paradigmatic controversies, contradictions, and emerging confluences, revisited. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (4th ed., pp. 97–128). London: Sage.

    Google Scholar 

  • Hawe, P., Shiell, A., & Riley, T. (2004). Complex interventions: How “out of control” can a randomised controlled trial be? British Medical Journal, 328, 1561–1563.

    Article  PubMed  Google Scholar 

  • Hawe, P., Shiell, A., & Riley, T. (2009). Theorising interventions as events in systems. American Journal of Community Psychology, 43, 267–276. doi:10.1007/s10464-009-9229-9.

    Article  PubMed  Google Scholar 

  • Katz, D. L., Murimi, M., Gonzalez, A., Njike, V., & Green, L. W. (2011). From controlled trial to community adoption: The multisite community translational community trial. American Journal of Public Health, 101, e17–e27. doi:10.2105/AJPH.2010.300104).

    Article  PubMed  Google Scholar 

  • King, J. A., Ross, P. A., Callow-Heusser, C., Gullickson, A. R., Lawrenz, F., & Weiss, I. R. (2011). Reflecting on multisite evaluation practice. In: J. A. King & F. Lawrenz (Eds.), Multisite evaluation practice: Lessons and reflections from four cases. New Directions for Evaluation, 129, 59–71.

  • Kirst, M., Plenert, E. C., Harris, D. W., Kirsh, B., Hwang, S., O’Campo, P., et al. (2010). At Home/Chez Soi project planning and proposal development Toronto site report. Toronto: Centre for Inner City Health, St. Michael’s Hospital.

    Google Scholar 

  • Laverack, G., & Labonté, R. (2000). A planning framework for community empowerment goals within health promotion. Health Policy and Planning, 15, 255–262.

    Article  PubMed  Google Scholar 

  • Leykum, L. K., Pugh, J. A., Lanham, H. J., Harmon, J., & McDaniel, R. R. (2009). Implementation research design: Integrating participatory action research into randomized controlled trials. Implementation Science, 4(69). doi:10.1186/1748-5908-4-69.

  • MacNaughton, E., Nelson, G., & Goering, P. (under review). Problems, politics, evidence, and opportunity: Policy entrepreneurship and the conception of the At Home/Chez Soi initiative for addressing homelessness and mental illness in Canada.

  • Morse, J., & Field, P. A. (1995). Qualitative research methods for health professionals (2nd ed.). London: Sage.

    Google Scholar 

  • Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risk for mental disorders. Washington, D.C.: National Academy Press.

    Google Scholar 

  • Nelson, G., d’Ailly, H., Ochocka, J., Janzen, R., Maiter, S., & Jacobson, N. (under review). Planning transformative change for mental health services for cultural-linguistic communities. In G. Nelson, B. Kloos, & J. Ornelas (Eds.), Community psychology and community mental health: Towards transformative change (Society for Community Research and Action book series). New York: Oxford University Press.

  • Nelson, G., Goering, P., & Tsemberis, S. (2012a). Housing for people with lived experience of mental health issues: Housing First as a strategy to improve quality of life. In C. J. Walker, K. Johnson, & E. Cunningham (Eds.), Community psychology and the socio-economics of mental distress: International perspectives (pp. 191–205). Basingstoke: Palgrave MacMillan.

    Google Scholar 

  • Nelson, G., Van Andel, A. K., Eckerle Curwood, S., Hasford, J., Love, N., Pancer, S. M., et al. (2012b). Exploring outcomes through narrative: Long-term impacts of Better Beginnings, Better Futures on the turning point stories of youth ages 18–19. American Journal of Community Psychology, 49, 294–306.

    Article  PubMed  Google Scholar 

  • Patterson, M., Schmidt, D., & Zabkiewicz, D. (2010). The At Home/Chez Soi Project: A review of the proposal development and planning phase in Vancouver, B.C. Vancouver: Faculty of Health Sciences, Simon Fraser University.

    Google Scholar 

  • Peirson, L., & Prilleltensky, I. (1994). Understanding school change to facilitate prevention: A study of change in a secondary school. Canadian Journal of Community Mental Health, 13(2), 127–143.

    Google Scholar 

  • Peters, R. D. V., Bradshaw, A. J., Petrunka, K., Nelson, G., Herry, Y., Craig, W., et al. (2010). The “Better Beginnings, Better Futures” ecological, community-based early childhood prevention project: Findings from Grade 3 to Grade 9. Monographs of the Society for Research in Child Development, 75(3), 1–176.

    Article  Google Scholar 

  • Prilleltensky, I., Peirson, L., Gould, J., & Nelson, G. (1994). Planning mental health services for children and youth: Part I–A valued-based approach. Evaluation and Program Planning, 20, 163–172.

    Article  Google Scholar 

  • Raghavan, R., Bright, C. L., & Shadoin, A. L. (2008). Towards a policy ecology of implementation of evidence-based practices in mental health settings. Implementation Science, 3, 26. doi:10.1186/1748-5908-3-26.

    Article  PubMed  Google Scholar 

  • Sarason, S. B. (1972). The creation of settings and the future societies. Brookline, MA: Brookline Books.

    Google Scholar 

  • Sarason, S. B. (1993). The obligations of the moral-scientific stance. American Journal of Community Psychology, 31, 209–211.

    Article  Google Scholar 

  • Stake, R. E. (2005). Qualitative case studies. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed., pp. 443–466). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Sylvestre, J., Pancer, S. M., Brophy, K., & Cameron, G. (1994). The planning and implementation of government-sponsored community-based primary prevention: A case study. Canadian Journal of Community Mental Health, 13(2), 189–195.

    PubMed  Google Scholar 

  • Trickett, E. J. (2009). Multilevel community-based culturally situated interventions and community impact: An ecological perspective. American Journal of Community Psychology, 101, 1353–1355. doi:10.1007/s10464-009-9227-y.

    Google Scholar 

  • Trickett, E. J. (2011). Community-based participatory research as worldview or instrumental strategy: Is it lost in translation(al) research? American Journal of Public Health, 43, 257–266. doi:10.2105/AJPH.2011.300124.

    Google Scholar 

  • Trickett, E. J., Beehler, S., Deutsch, C., Green, L. W., Hawe, P., McLeroy, K., et al. (2011). Advancing the science of community-level interventions. American Journal of Public Health, 101, 1410–1419. doi:10.2105/AJPH.2010.300113.

    Article  PubMed  Google Scholar 

  • Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651–656.

    Article  PubMed  Google Scholar 

  • Wandersman, A., Duffy, J., Flaspohler, P., Noonan, R., Lubell, K., Stillman, L., et al. (2008). Bridging the gap between prevention research and practice: The interactive systems framework for dissemination and implementation. American Journal of Community Psychology, 41, 171–181. doi:10.1007/s10464-008-9174-z.

    Article  PubMed  Google Scholar 

  • Warburton, J., Everingham, J.-A., Cuthill, M., & Bartlett, H. (2008). Achieving effective collaborations to help communities age well. The Australian Journal of Public Administration, 67, 470–482. doi:10.1111/j.1467-8500.2008.00603.x.

    Article  Google Scholar 

  • Wolff, N. (2001). Randomised trials of social complex interventions: Promise or peril? Journal of Health Services Research and Policy, 6, 123–126.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Jayne Barker (2008–2011), Ph.D., and Cameron Keller (2011–present), Mental Health Commission of Canada At Home/Chez Soi national project leads, the national qualitative research team, the five qualitative site research teams, Site Coordinators, and the numerous service and housing providers, as well as persons with lived experience, who have contributed to this project and the research. This research has been made possible through a financial contribution from Health Canada. The views expressed herein solely represent the authors.

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Authors and Affiliations

  1. Wilfrid Laurier University, Waterloo, Canada

    Geoffrey Nelson

  2. Mental Health Commission of Canada, Vancouver, Canada

    Eric Macnaughton

  3. Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada

    Paula Goering

  4. University of Winnipeg, Winnipeg, Canada

    Michael Dudley

  5. Centre for Inner City Health, University of Toronto, Toronto, Canada

    Patricia O’Campo

  6. Simon Fraser University, Burnaby, Canada

    Michelle Patterson

  7. Douglas Hospital, McGill University, Montreal, Canada

    Myra Piat

  8. Université de Moncton, Moncton, Canada

    Natasha Prévost

  9. University of British Columbia, Vancouver, Canada

    Verena Strehlau

  10. Université Laval, Quebec, Canada

    Catherine Vallée

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  1. Geoffrey Nelson
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  4. Michael Dudley
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  10. Catherine Vallée
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Correspondence to Geoffrey Nelson.

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Nelson, G., Macnaughton, E., Goering, P. et al. Planning a Multi-site, Complex Intervention for Homeless People with Mental Illness: The Relationships Between the National Team and Local Sites in Canada’s At Home/Chez Soi Project. Am J Community Psychol 51, 347–358 (2013). https://doi.org/10.1007/s10464-012-9554-2

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