Bridging Hospital and Community Care for Homeless Adults with Mental Health Needs: Outcomes of a Brief Interdisciplinary Intervention.

OBJECTIVE: This study examines health and service use outcomes and associated factors among homeless adults participating in a brief interdisciplinary intervention following discharge from hospital. METHOD: Using a pre-post cohort design, 223 homeless adults with mental health needs were enrolled in the Coordinated Access to Care for the Homeless (CATCH) program, a 4- to 6-month interdisciplinary intervention offering case management, peer support, access to primary psychiatric care, and supplementary community services. Study participants were interviewed at program entry and at 3- and 6-month follow-up visits and assessed for health status, acute care service use, housing outcomes, mental health, substance use, quality of life, and their working alliance with service providers. Linear mixed models and generalized estimating equations were performed to examine outcomes longitudinally. Additional post hoc analyses evaluated differences between CATCH participants and a comparison group of homeless adults experiencing mental illness who received usual services over the same period. RESULTS: In the pre-post analyses, CATCH participants had statistically significant improvements in mental and physical health status and reductions in mental health symptoms, substance misuse, and the number of hospital admissions. The strength of the working alliance between participants and their case manager was associated with reduced health care use and mental health symptoms. Post hoc analyses suggest that CATCH may be associated with statistically significant improvements in mental health symptoms in the study population. CONCLUSIONS: A brief interdisciplinary intervention may be a promising approach to improving health outcomes among homeless adults with unmet health needs. Further rigorous research is needed into the effectiveness of brief interventions following discharge from hospital.

Reimagining the self at late-career transitions: how identity threat influences academic physicians' retirement considerations.

PURPOSE: There is scant empirical work exploring academic physicians' psychosocial adjustment during late-career transitions or on the factors that influence their retirement decisions. The authors examine these issues through the lens of sociopsychological identity theory, specifically examining how identity threat influences academic physicians' decisions about retirement. METHOD: Participants were academic physicians at a Canadian medical school and were recruited via e-mail requests for clinical faculty interested in discussing late-career and retirement planning issues. Participants included 15 males and 6 females (N = 21; mean age = 63, standard deviation = 7.54), representing eight specialties (clinical and surgical). Data were collected in October and November 2012 via facilitated focus groups, which were digitally recorded, transcribed verbatim, and anonymized, then analyzed using thematic analysis. RESULTS: Four primary themes were identified: centrality of occupational identity, experiences of identity threat, experiences of aging in an indifferent system, and coping with late-career transitions. Identity threats were manifested in apprehensions about self-esteem after retirement, practice continuity, and clinical competence, as well as in a loss of meaning and belonging. These identity challenges influenced decisions on whether to retire. Organizational and system support was perceived as wanting. Coping strategies included reimagining and revaluing various aspects of the self through assimilating new activities and reprioritizing others. CONCLUSIONS: Identity-related struggles are a significant feature of academic physicians' considerations about late-career transitions. Understanding these challenges, their antecedents, and their consequences can prepare faculty, and their institutions, to better manage late-career transitions. Individual- and institution-level implications are discussed.