In Canada, about 235,000 people experience homelessness each year. The number of homeless people, and the length of time they spend homeless, continues to rise. Homelessness is not a choice and anyone can become homeless. 

Although the root cause is poverty, some underlying issues are poor physical or mental health; violence or abuse in the home; lack of employment or income; and, a shortage of affordable housing. 

A group of researchers at Lawson Health Research Institute (Lawson), working at both London Health Sciences (LHSC) and St. Joseph’s Health Care London (St. Joseph’s), are committed to tackling the issue of homelessness from within hospital walls, where some patients face the risk of being discharged into homelessness. 

“Many of our patients with lived experience of homelessness were saying that their journey started with a hospital discharge,” says Lawson clinician researcher Dr. Cheryl Forchuk. “Often, they were experiencing major transitions in their lives and then experienced a hospital stay. Normally a relatively short visit, they aren’t able to gather the information and make a plan to be able to leave the hospital with somewhere to stay.”

On September 10, Adam Vaughan, Canadian MP and Parliamentary Secretary (Housing and Urban Affairs), on behalf of the Honourable Jean-Yves Duclos, Minister of Families, Children and Social Development, announced that Lawson will receive $223,572 from the Homelessness Partnering Strategy’s (HPS) Innovative Solutions to Homelessness funding stream to support the project “No Fixed Address Version 2 Expansion” research project. 

Image

“This is a brilliant approach. It supports an augmented duty of care where hospitals have the means to transfer people into stable settings where they can continue to heal and move towards self-sufficiency,” says Parliamentary Secretary Vaughan. 

Taking place at London Health Sciences Centre, this research will further refine the No Fixed Address strategy for reaching and supporting patients during the crucial transitional period when they are being discharged from the hospital and re-integrated into the community. 

“Lawson’s expanded No Fixed Address research project is the first evaluation anywhere of a strategy to reduce the number of patients being discharged into homelessness. There is almost no literature on any aspect of this troublesome issue,” explains Dr. Forchuk who is the study’s Principal Investigator. Dr. Forchuk is also the Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery and Assistant Director at Lawson.

Image

This project is an extension of three previous studies conducted by Dr. Forchuk’s research team, which developed and tested this novel approach. They demonstrated the efficacy, feasibility and cost-effectiveness of using the No Fixed Address strategy in acute and tertiary psychiatric care in the London region, at both LHSC and St. Joseph’s. In the first phase, they found that the interventions used prevented homelessness in 95 per cent of cases. 

The researchers are now taking a solution proven to have worked in the mental health units and applying it in selected medical departments at LHSC. Through the study, the services will be available to all patients in those units who are at risk of homelessness. There have already been 17 patients who have accessed this support since the project got underway this summer. 

Three community partners from London are supporting implementation of the strategy - Canadian Mental Health Association Middlesex, Ontario Works in the City of London and the Salvation Army’s Housing Stability Bank. They will provide assistance in areas like securing appropriate private-sector housing, provision of income and employment supports, and financial assistance. 

“In many ways London, Ontario is the high water mark of solving and tackling homelessness. This community has a lot of be proud of given the way that the municipality is stepping up to the plate and how many different organizations are working together towards a common goal,” says Parliamentary Secretary Vaughan. 

This kind of collaboration showcases the important partnership between the Canadian Government, research-intensive hospitals and community organizations to translate innovative solutions from the research stage to the front line of care. 

“The hope is that the findings will be even more robust, leading to the development of a best-practice model of hospital discharge that can be adopted throughout Canada. This will reinforce the need for a systemic change in the way hospital discharges occur and ensuring the person is transitioning to a secure housing arrangement,” says Dr. Forchuk. 

Learn more about the Government of Canada’s Homelessness Partnering Strategy. 

News Coverage

• CBC London - Helping medical patients in London avoid homelessness when they leave hospital 
• CTV London - Expanded research hopes to break the cycle of homelessness that psychiatric patients sometimes face when discharged
• Global News, AM 980 - Program that finds housing for homeless patients in hospital gets $223K in federal funding
• London Free Press - 'Brilliant approach' to homelessness gets federal grant
   

The Canadian Institutes of Health Research (CIHR) announced more than $11.3 million in funding through their project grants program for 17 health research projects across Lawson Health Research Institute and Western University.

“The funded projects represent a wide range of research and expertise from London’s health research community, with real impacts for health and health care,” says Dr. David Hill, Lawson Scientific Director. “Congratulations to those successful applicants who have secured this funding on a very tough competition.”

Projects include a national study on transgender health; a community-based family treatment program for children with epilepsy; imaging of blood clots in the brain; equity in mental health care for children and youth; and, a smartphone intervention focused on diet and food literacy.

See the full list of successful applicants. 

Cooling the Brain after Resuscitated Cardiac Arrest to Prevent Brain Injury

There are 40,000 cardiac arrests each year in Canada. A high number of patients won’t survive the event and nearly half of the survivors suffer from brain damage that can have a huge impact on their ability to live independently. The current guidelines recommend cooling of the whole body to protect the brain against the damaging effects of cardiac arrest. However, in the clinic there are several hurdles for this treatment that can create complications. Enhanced brain protection may be achieved by selectively cooling the brain but a simple, effective and non-invasive method to do so is needed.

Dr. Ting-Yim Lee and his research team are studying a simple means to cool down the brain by blowing compressed air into the nostrils which would essentially chill the warm blood coming through the nasal cavity on its way to the brain. Using an animal model, their aim is to show that the method can be used safely and is able to protect the brain after cardiac arrest.

Image

 

The DECIPHER Study

Shoulder fractures are becoming increasingly common for older adults and cause considerable limitations and impacts for their daily life. While different approaches are taken to treat shoulder fractures, there is a lack of knowledge and evidence to show which of those methods are the most effective and for which patients.

Dr. Emil Schemitsch and his research team are proposing the first nation-wide, multi-centre observational study with over 600 patients with the ultimate goal of determining what specific factors influence important outcomes for patients. The DECIPHER study will seek to answer important questions about which treatment and rehabilitation strategies are best for different patients, strengthening the clinical strategy for managing these difficult and prevalent injuries. It will also provide an economic analysis to understand the impact for healthcare system costs.

Image

Congratulations to all of the successful applicants:

• Greta Bauer and Ayden Scheim - Trans PULSE Canada: A National Study of Transgender Health
• Maria Drangova - Characterizing cerebral thrombus composition with Phase‐based MRI
• David Edgell, Bogumil Karas, and Gregory Gloor - ConCRISPR: Conjugative delivery of a hybrid CRISPR/Tev nuclease system for specific microbiota modulation in the mammalian gut
• Jason Gilliland - Evaluation of a Smartphone Based  Intervention for Improving Food Literacy, Food Purchasing, and Diet Quality Among Youth in Urban, Suburban, and Rural Environments
• Douglas Hamilton - Novel Biomaterials‐Based Strategies to Stimulate Periodontal Tissue Regeneration
• David Haniford - Regulation of Salmonella pathogenesis by transposon‐encoded small regulatory RNAs 
• Steven Laviolette - Effects of Neurodevelopmental Exposure to Cannabinoids on Prefrontal Cortical Function:  Implications for Neuropsychiatric Disorders
• Ting-Yim Lee - Selective Brain Hypothermia via Intranasal Cooling to Limit Brain Injury  Post Cardiac Arrest (Funded through Lawson Health Research Institute)
• Stephen Lomber - Cortical Plasticity Following Deafness
• Vania Prado - Cholinergic influence in aging and brain pathology
• Graham Reid and William Gardner - Equity in Mental Health Care for Children and Youth
• Jason Roberts - The Role of Electrophysiology Testing in Survivors of Unexplained Cardiac Arrest: The EPS ARREST Study
• Emil Schemitsch - The DECIPHER Study: DEterminants of Function and Clinically Important outcomes in Proximal Humerus Fractures in the Elder Population: A National CohoRt (Funded through Lawson Health Research Institute)
• Walter Siqueira and Elizabeth Gillies - Novel Drug Delivery System for the Combat of Dental Caries by using Salivary Peptides
• Kathy Speechley and Karen Bax - A Community-Based Family Treatment Program for Children with Epilepsy: A Randomized Controlled Trial
• Andrew Watson - Understanding and Treating Obesity Related loss of Embryo Developmental Competence
• Donald Welsh - Kir Channel Regulation by Membrane Lipids:  An Enabler of Hemodynamic Sensing in the  Cerebral Circulation

LONDON, ON- Strokes affect approximately 400,000 Canadians each year and can be debilitating. They can negatively affect a person’s cognition and mobility, and severely impact mental health and wellbeing.

 

A team at Lawson Health Research Institute are looking to improve mental health treatments and resources for patients who have experienced a stroke. The team will recruit 100 stroke patients to assess whether the completion of a guided therapy program can improve mental health and quality of life.

“More than sixty per cent of patients experience depression after stroke,” says Dr. Robert Teasell, Lawson Scientist and Physiatrist at St. Joseph’s Health Care London’s Parkwood Institute. “Having a stroke itself makes people more vulnerable and makes people feel their lives have changed negatively.”

During stroke rehabilitation, patients are typically offered mental health treatments, but the research team say it is post rehabilitation that stroke patients tend to experience worsening depression.

“Publicly funded allied health care services are available at inpatient and outpatient care; however, psychology is often limited across the rehabilitation continuum from acute to community care,” says Dr. Swati Mehta, Lawson Scientist. “We are looking at how we can provide a program that is cost effective to help those who have these barriers to access mental health services.”

“Patients have described to me that they feel like they have been dropped off a cliff because of the lack of resources once their programs have ended,” adds Dr. Teasell.

The study will examine the use of cognitive behavioral therapy (CBT), which is an evidence based psychological intervention that aims to provide people with increased coping ability and self-efficacy. Participants will complete a 10-week guided program with specific targeted lessons, tailored to the needs of those post stroke, delivered virtually through a trained clinician. They will then complete a questionnaire to see if there have been any improvements to self-efficacy and emotional wellbeing.

“We have found this form of therapy (CBT) has been very effective and feasible for spinal cord injury patients with mild traumatic brain injury and we want to see how a modified version could potentially help those with stroke and depression,” says Randy Upper, Clinical Research Associate at Lawson.

If CBT is proven effective through this study, Dr. Mehta hopes it will encourage similar programming that would be available to stroke patients after rehab.

“We are hoping we can connect with community organizations and work with them to implement this program in a service delivery model that would be easily accessible for stroke patients living in the community.”

Recruitment for this study is currently underway, those interested in taking part can email Dr. Swati Mehta at: @email