RESUMEN
Background This paper presents an assessment of the current emergency response to homeless people who use substances in Montreal, a major North American city. This project addresses the rising concern about homelessness in high-income countries. Several studies have shown that homeless people frequently use emergency services (i.e., police, paramedical, and hospital), especially in the context of substance use. Yet, the key actors' perspectives are poorly documented. Method Our team conducted a needs analysis using a deliberative democratic evaluation. Data collection strategies included an intersectoral World Café (n = 34, including police, specialized professionals, community stakeholders, political representatives, researchers, and people who have been homeless) and individual interviews with health professionals (n = 5) and homeless people (n = 8). We performed a thematic content analysis based on a conceptual framework of access to health care and of collaboration. Findings This study provided key information on the role of emergency services and the needs of key actors, in terms of the dimensions of access to health care (approachability, acceptability, availability, and appropriateness) and continuity. Our main results show that, according to the participants, the emergency response is relevant when homeless people are a danger to themselves or to others, and during episodes of acute physical and psychological care. However, emergency service providers still stigmatize homelessness and substance use, which negatively affects intervention quality. Finally, our main results highlight the interdependence between the emergency services and health, social, and community services. Conclusion The emergency response is necessary and appropriate in some situations. It remains important to intervene upstream and to improve the attitudes and practices of emergency service providers. Finally, it is necessary to adapt services to the needs of homeless substance users and improve service continuity, for example, by adopting a population-based approach.
Asunto(s)
Personas con Mala Vivienda , Trastornos Relacionados con Sustancias , Servicio de Urgencia en Hospital , Servicios de Salud , Humanos , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
Co-occurring disorders in mental health and addiction present a high prevalence, but services available to prevent and treat them are often fragmented. Cross-training activities have been used to help minimise breaks in service continuity. This study assesses to what extent positional clarification (a specific type of cross-training activity) can help bridge fragmented services for co-occurring disorders by providing information and promoting interactions to help professionals better orient and treat their clientele. A total of 2,107 participations were recorded for 11 positional clarification events taking place within the Montreal Cross-Training Program for mental health and substance use disorders between 2010 and 2016. The Kirkpatrick four-level training evaluation model was used to evaluate these activities. Evaluation questionnaires (n = 1,650) and interviews with a convenience sample of 32 participants were analysed using descriptive statistics and thematic analysis. More than three-quarters of participants reported that the activity met their expectations and was relevant to their practice. Respondents also reported receiving useful information to better orient their clientele, discovering new resources, learning about the functioning of other resources, identifying members of other networks who could orient them when needed, and learning more about the theme of the activity and the different mechanisms for collaboration among the related services. Among those who participated in more than one positional clarification event, roughly three-quarters reported that they were able to call upon new resources at least once as a result of their participation, and were able to establish referrals towards resources that were unknown or less familiar to them prior to their participation. Results suggest that the programme meets its service integration objectives and that positional clarification events can lead to changes that can help facilitate the integration of fragmented services by improving participants' knowledge of specific themes and available resources to better orient and treat their clientele.
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Servicios Comunitarios de Salud Mental/organización & administración , Capacitación en Servicio/organización & administración , Educación Interprofesional/organización & administración , Trastornos Mentales/rehabilitación , Actitud del Personal de Salud , Comorbilidad , Femenino , Humanos , Masculino , Grupo de Atención al PacienteRESUMEN
The maintenance of information in auditory short-term memory (ASTM) is accompanied by a sustained anterior negativity (SAN) in the event-related potential measured during the retention interval of simple auditory memory tasks. Previous work on ASTM showed that the amplitude of the SAN increased in negativity as the number of maintained items increases. The aim of the current study was to measure the SAN and observe its behavior beyond the point of saturation of auditory short-term memory. We used atonal pure tones in sequences of 2, 4, 6, or 8t. Our results showed that the amplitude of SAN increased in negativity from 2 to 4 items and then levelled off from 4 to 8 items. Behavioral results suggested that the average span in the task was slightly below 3, which was consistent with the observed plateau in the electrophysiological results. Furthermore, the amplitude of the SAN predicted individual differences in auditory memory capacity. The results support the hypothesis that the SAN is an electrophysiological index of brain activity specifically related to the maintenance of auditory information in ASTM.
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Percepción Auditiva/fisiología , Encéfalo/fisiología , Memoria a Corto Plazo/fisiología , Estimulación Acústica , Electroencefalografía , Potenciales Evocados , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Adulto JovenRESUMEN
We examined the electrophysiological correlates of retention in auditory short-term memory (ASTM) for sequences of one, two, or three tones differing in timbre but having the same pitch. We focused on event-related potentials (ERPs) during the retention interval and revealed a sustained fronto-central ERP component (most likely a sustained anterior negativity; SAN) that became more negative as memory load increased. Our results are consistent with recent ERP studies on the retention of pitch and suggest that the SAN reflects brain activity mediating the low-level retention of basic acoustic features in ASTM. The present work shows that the retention of timbre shares common features with the retention of pitch, hence supporting the notion that the retention of basic sensory features is an active process that recruits modality-specific brain areas.