Tim Aubry

• Ph.D.
• Professor (Full) at University of Ottawa

Objectives Individuals with lung cancer are living longer due to recent treatment advances such as immunotherapy and targeted therapy. The preferred label(s) of this new population are unknown. This is important as personal/advocacy benefits have been reported by using “survivor” or “thriver” by some groups; however, these same labels have been rej...

Homelessness presents numerous challenges for youth, including physical health issues, mental health problems, substance use, victimization, legal issues, and dropping out of school. Despite these challenges, youth display significant resilience. Using data from a randomized controlled trial on Housing First for Youth, this study examines qualitati...

Objective: Lung cancer is associated with the highest incidence and mortality of all cancers. New treatments, called targeted therapies (TT) and immunotherapies (IO), offer higher treatment efficacy and fewer side effects compared to traditional treatments but are accompanied by uncertainty and an unpredictable treatment course. There is a paucity...

Risk management is an important component of service delivery in supportive housing and Housing First programs. However, there is no evidence on the implementation of risk management approaches in these settings. This qualitative study examined what service providers working in supportive housing and Housing First programs in Canada identify as the...

Contribution Analysis (CA) is a promising theory-based evaluation approach for complex interventions, yet its application in health interventions remains largely unexplored. To bridge this gap, we conducted a scoping review to examine the extent of such applications and the methodologies, strengths, and limitations of this approach in health progra...

The main objective of this research was to qualitatively examine the impacts of Housing First (HF) specifically on those participants who identified themselves as female in response to question asking what their gender was. The data analyzed are from a larger, muti‐site, randomized controlled trial. χ ² analysis was used to compare the life changes...

Objective: The purpose of this study was to examine the characteristics of people who stay in intensive case management (ICM) for longer than 5 years. Method: We conducted a secondary analysis of client data collected by a community mental health organization from 2012 to 2022. Using the Gelberg–Andersen Model for Access to Health Services, we cond...

Frequent emergency department users with mental illness or addiction often struggle to find the services they need. A pre-test/post-test design assessed outcomes for these individuals after participating in a novel community-based stepped-care program delivering individualized intensive case management services. Results indicated improvement in ove...

Purpose of Study This study aimed to investigate the perceived outcomes and mechanisms of change of a community mental health service combining system navigation and intensive case management supports for frequent emergency department users presenting with mental illness or addiction. Primary Practice Setting The study setting was a community ment...

Social capital is a collective asset important for individual and population wellbeing. Individuals who experience homelessness may face barriers in accessing social capital due to health challenges, small social networks, and social exclusion. Data from a 4‐year longitudinal study was used to determine if housing stability predicted greater social...

BACKGROUND Municipalities play a crucial role in population health due to their community connections and influence on health determinants. Community-campus engagement (CCE), collaborations between academic institutions and communities, is a promising collaborative approach to addressing community health priorities. However, evidence of CCE's impac...

Background Municipalities play a crucial role in population health due to their community connections and influence on health determinants. Community-campus engagement (CCE), that is, collaboration between academic institutions and communities, is a promising approach to addressing community health priorities. However, evidence of CCE’s impact on p...

Covid-19 has presented challenges to community mental health organizations that have historically almost exclusively delivered in-person services. This study uses qualitative methods to examine the launch of tele-mental health case management delivery in response to the Covid-19 pandemic in a community mental health organization, from the perspecti...

Permanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the...

Objective: To examine the impacts of Housing First (HF) on parent–child relationships for Indigenous and non-Indigenous parents experiencing homelessness and mental illness. Method: Data on parent–child relationships were obtained through baseline and 18-month narrative interviews with parents (N = 43). Participants were randomly assigned to HF (N...

There has been little previous research that has examined factors related to housing stability and instability among Housing First (HF) tenants. Qualitative research was used to determine themes related to housing stability and instability for people with mental illness participating in a HF program implemented in five Canadian cities. Data were ga...

This study examined the characteristics of people who experienced housing instability and stability after 24 months of being enrolled in Housing First (HF). A companion study addresses the same objective using qualitative methods. A sequential logistic regression was conducted to determine predictors of unstable and stable housing at 24 months of e...

High level of mental health problems are a critical concern among youth experiencing or at-risk of homelessness. Using data from a randomized controlled trial on Housing First in Canada, this study examined the risk factors and protective resources associated with mental health recovery among 215 homeless youth with mental illness at baseline and a...

To evaluate the effectiveness of two different smoking cessation interventions for individuals with severe mental illness. Study participants (N = 61) randomly assigned to the SC-R group (n = 29) were offered 24 weeks of no cost Nicotine Replacement Treatment (NRT); participants assigned to the SC + group (n = 32) were offered 24 weeks of no cost N...

Background People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness. Methods Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a c...

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 facto...

The purpose of this study was to examine clients’ perceptions of the client-case manager working alliance in the context of receiving the Strengths Model of Case Management. Twenty people with severe mental illness, with a SMCM case manager, participated in semi-structured, qualitative interviews. Using first and second cycle coding, data were anal...

Usability studies are a crucial part of developing user-centered designs and they can be conducted using a variety of different methods. Unmoderated usability surveys are more efficient and cost-effective and lend themselves better to larger participant pools in comparison to moderated usability surveys. However, unmoderated usability surveys could...

Coordinated access and coordinated entry systems have become central features in community responses to homelessness in Canada and the United States. Coordinated systems assess individuals and families experiencing homelessness on their needs, prioritize them based upon these needs, and then match them to appropriate housing. Despite the widespread...

People experiencing homelessness are often considered frequent healthcare users. Although their service use is not uniform, it can be difficult to identify the highest-cost users without access to comprehensive cost data. This study validated a set of algorithms that apply healthcare encounter data to identify high-cost users among adults with a hi...

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 hospit...

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. Methods: In total, 311 people with severe mental illness, served at seven commu...

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. Objective: This paper presents factors that facilitate and impede the successful implement...

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. Paire...

When working with an agent-based system, it may be desirable to develop an algorithm that can predict future time periods for each individual. One such approach that works to accomplish this is the Markov decision process, which takes as its input available actions, unique agent reward functions, and a model of the overall environment. However, it...

Inappropriate emergency department (ED) use is costly. A system navigation service was developed to connect individuals with repeated ED presentations due to mental health or substance use to community services. Management, staff, and clients (n = 37) participated in interviews or focus groups to identify implementation challenges and associated so...

Background It is estimated that around 160,000 households in Britain experience homelessness each year, although no definitive statistics exist. Between March and September 2020, as part of the initial ‘Everyone In’ government response to COVID-19 in England, 10,566 people were living in emergency accommodation and nearly 18,911 people had been mov...

Purpose To conduct a multi-dimensional and time-patterned analysis to identify distinct well-being trajectory profiles over a 6-year follow-up period among adults experiencing homelessness and mental illness. Methods Data from 543 participants of the At Home Chez Soi study’s Toronto site were examined over a 6-year follow-up period, including meas...

The paper compares the results from the large multi-site trials that examined the effectiveness and cost-effectiveness of Pathways Housing First (HF) in Canada and France. Findings from the two trials on programme fidelity, housing, service utilisation, and other outcomes, and of cost-benefit and cost-effectiveness analyses are presented. Both tria...

The CMHA Ottawa Condo Program Toolkit provides a detailed look at the Housing First Condominium Program operated by the Ottawa branch of the Canadian Mental Health Association (CMHA Ottawa), a model well-suited for program replication and/or adaptation. See https://ottawa.cmha.ca/cmha-ottawa-condo-toolkit/ for more information and to access the Fre...

Introduction Pregnant and postpartum women face major psychological stressors that put them at higher risk of developing common mental disorders, such as depression and anxiety. Yet, their limited access to and uptake of traditional mental health care is inequitable, especially during the COVID-19 pandemic. Mobile interventions emerged as a potenti...

Impact of a journal club on the self-efficacy, expectations, and intentions of nursing students toward evidence-based results Introduction: Nursing associations require that nurses develop the skills to integrate evidence into practice to support the quality of care. Context: Lack of self-confidence in the operational steps of evidence-based practi...

This study examines the experiences of adults who identify as LGBTQ (lesbian, gay, bisexual, transgender, queer) and who have accessed emergency shelters in an urban Canadian city. Twenty LGBTQ adults who were currently or formerly homeless participated in one qualitative interview. The interview protocol included questions on the participants’ exp...

Purpose Much of the extant research on quality-of-life (QoL) in homelessness has focused narrowly on health-related QoL. Far less is known about broader subjective quality-of-life (SQoL). The purpose of this study was to examine levels and predictors of SQoL among homeless and vulnerably housed individuals in a 4-year longitudinal study. Methods D...

Objective: The Patient Generated Index (PGI) is a personalized quality of life (QOL) measure. This secondary analysis examined its psychometric properties with people with severe mental illness. Methods: Three hundred and eleven people with severe mental illness participated in structured interviews at baseline, 9 months, and 18 months. Results...

Abstract Up to 15% of mothers experience postpartum depression (PPD) symptoms. Using a pre—post design, results from two 8-week psychoeducational group programs for mothers with moderate levels of PPD symptoms are presented. Findings show the low-cost program to be a promising secondary preventative intervention for an undertreated population. Rés...

Background Homelessness has emerged as a public health priority, with growing numbers of vulnerable populations despite advances in social welfare. In February 2020, the United Nations passed a historic resolution, identifying the need to adopt social‐protection systems and ensure access to safe and affordable housing for all. The establishment of...

Mise en contexte. L’efficacité des services psychologiques scolaires reste une préoccupation majeure dans le domaine de la psychologie et de l’éducation (Kratochwill, Feld, & Van Someren, 2017). Les milieux minoritaires y sont particulièrement touchés ; c’est pourquoi le conseil scolaire des écoles fransaskoises (CÉF) a fait appel à une évaluation...

Background Healthcare costs are disproportionately incurred by a relatively small group of people often described as high-cost users. Understanding the factors associated with high-cost use of health services among people experiencing homelessness could help guide service planning. Methods Survey data from a general cohort of adults with a history...

This study identifies time-patterned trajectories of housing stability among homeless and vulnerably housed individuals who participated in a multisite four-year longitudinal study in Canada. Findings show four distinct trajectories for the homeless and vulnerably housed: high levels of sustained housing stability, improving levels over time leadin...

Background: Individuals who are homeless have complex health care needs, which contribute to the frequent use of health services. In this study, we investigated the relationship between housing and health care utilization among adults with a history of homelessness in Ontario. Methods: Survey data from a 4-year prospective cohort study were link...

Successful implementation of Housing First requires a good supply of affordable housing. Since 2002, the Canadian Mental Health Association, Ottawa Branch, has purchased 40 condominium units in regular buildings scattered across Ottawa, Canada, to rent to their clients with severe mental illnesses who have a history of homelessness. Seeking to shar...

Résumé Une évaluation des besoins a été menée dans un conseil scolaire francophone en Saskatchewan (ayant une minorité linguistique) pour identifier des interventions basées sur des données probantes. Coping Cat et Incredible Years ont été identifiés comme les interventions les plus pertinentes et faisables pour aider les élèves ayant des difficul...

Objective: The associations between adverse childhood experiences (ACEs) and psychopathology have been well-established in the general population. Research on ACEs in the homeless population has been limited. This study examined whether ACE exposure is associated with specific mental health outcomes among a national sample of homeless adults with m...

There is growing evidence that diversion to a mental health court program (MHC) can reduce recidivism rates and improve the quality of life of clients. However, there is less known about MHC client characteristics and factors associated with recidivism. Yet, this information would be useful to increase the effectiveness of these programs. Cross-sec...

Almost 30 years ago, Beth Shinn argued that individual-level analyses and person-centered approaches favored by psychology are limited in understanding the causes and solutions to homelessness. At the same time, community psychology has contributed significantly to the research base and the development of interventions and policy on homelessness ov...

During the period 2010–2011, when the At Home project was conducted, a questionnaire was sent to 420 non-governmental organization (NGO) key managers in six Canadian cities to enquire about their collaboration with public services and their perspective on the services for homeless people with serious mental illness (SMI). NGOs constituted a dense n...

We developed, tested, and operationalized a comprehensive objective measurement tool, the Observer-rated Housing Quality Scale (OHQS), to assess housing unit, building, and neighbourhood characteristics in a large trial of Housing First (HF) in 5 Canadian cities. The OHQS provided an opportunity to explore the role of neighbourhood and its contribu...

Clinical practice guidelines can improve the clinical and social care for marginalized populations, thereby improving health equity. The aim of this study is to identify determinants of guideline implementation from the perspective of patients and practitioner stakeholders for a homeless health guideline. We completed a mixed-method study to identi...

The purpose of this study is to examine the parent-child experiences of Indigenous and non-Indigenous mothers and fathers experiencing homelessness, mental illness, and separation from their children. A qualitative thematic analysis of baseline and 18-month follow-up narrative interviews was used to compare 12 mothers (n = 8 Indigenous and n = 4 no...

The At Home/Chez Soi trial for homeless individuals with mental illness showed scattered-site Housing First with Assertive Community Treatment (ACT) to be more effective than treatment as usual. This study evaluated the cost-effectiveness of Housing First with ACT and treatment as usual. Conclusions: Housing First with ACT appeared about as cost-ef...

Objective: The At Home/Chez Soi trial for homeless individuals with mental illness showed scattered-site Housing First with Assertive Community Treatment (ACT) to be more effective than treatment as usual. This study evaluated the cost-effectiveness of Housing First with ACT and treatment as usual. Methods: Between October 2009 and June 2011, a...

Frequent emergency department (ED) users experiencing homelessness are associated with high costs for healthcare systems yet interventions for this group have been minimally investigated. This study used 24-month data from a multisite randomized controlled trial of Housing First (HF) to examine how effective the intervention is in helping frequent...

Background Permanent supportive housing and income assistance are valuable interventions for homeless individuals. Homelessness can reduce physical and social wellbeing, presenting public health risks for infectious diseases, disability, and death. We did a systematic review, meta-analysis, and narrative synthesis to investigate the effectiveness a...

Depuis la dernière décennie, l’efficacité des services psychologiques offerts dans les milieux scolaires est devenue un aspect important à considérer pour améliorer le bien-être des enfants et des adolescents. Les milieux minoritaires y sont particulièrement touchés ; c’est pourquoi le conseil scolaire des écoles fransaskoises(CÉF) a fait appel à u...

Context. Between 10 and 15% of mothers who gave birth will experience significant symptoms of postpartum depression (PPD; Brummelte et al., 2016), however, the majority of medical staff report insufficient training to identify and provide some type of counselling to mothers with PPD (Wittenburg et al., 2018).Objective. The purpose of the consultati...

Background Homelessness is one of the most disabling and precarious living conditions. The objective of this Delphi consensus study was to identify priority needs and at-risk population subgroups among homeless and vulnerably housed people to guide the development of a more responsive and person-centred clinical practice guideline. Methods We used...

KEY POINTS • Clinical assessment and care of homeless and vulnerably housed populations should include tailoring approaches to a person’s gender, age, Indigenous heritage, ethnicity and history of trauma; and advocacy for comprehensive primary health care. • As initial steps in the care of homeless and vulnerably housed populations, permanent suppo...

The present study examined the association of residential instability with hospitalizations among homeless and vulnerably housed individuals over a 4-year time period. Survey data were linked to administrative records on hospitalizations. Specifically, we used data from the Health and Housing in Transition study, a prospective cohort study that tra...

At Home/Chez Soi was a Canadian research demonstration project that tested the impacts of the Pathways Housing First model on people experiencing serious mental illness and homelessness in 5 cities across the country. In this article, we tell the 10-year story of At Home/Chez Soi, its positive outcomes, and how it contributed to transformative chan...

Objectives Exposure to adverse childhood experiences (ACEs) is associated with increased risk of criminal justice involvement and repeated victimization among homeless individuals. This study aimed to (1) examine whether the relationship between cumulative ACE score and odds of experiencing criminal justice involvement and victimization remains sig...

Background: The paper presents two-year findings from a study investigating the effectiveness of Housing First (HF) with assertive community treatment (ACT) in helping individuals with serious mental illness, who are homeless or precariously housed and living in a small city, to become stably housed. Methods: The research design was a parallel g...

For people with mental illness, experiences of homelessness can complicate mental health recovery processes. This study used longitudinal data from a randomized controlled trial of housing first (HF) to examine predictors of recovery among homeless people with mental illness. Findings showed that health and community predictors were most strongly a...

Background and aims Chronic pain (CP) management presents a challenge for the healthcare system as many individuals experiencing CP cannot access appropriate services. Consequently, individuals may visit emergency departments (EDs) to address their CP, even though this setting is not the most appropriate. CP was identified as a common factor amongs...

This article examines entries into homelessness among adults who identify as LGBTQ2S (lesbian, gay, bisexual, transgender, queer, two-spirit). Twenty LGBTQ2S adults who were currently or formerly homeless participated in one qualitative interview. The interview protocol included questions on the participants’ history of homelessness, causes of home...

Objectives To determine the relationship between housing instability, as measured by the number of residential moves, with problematic substance use, unmet healthcare needs, and acute care utilization. Methods A cohort of homeless or vulnerably housed persons from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396) completed interviewer-a...

The concept of “programme fidelity” refers to the extent that a programme is delivered as planned by programme developers (Caroll et al., 2007). Reaching a high level of fidelity has emerged as an important area of research focus for evidence-based interventions like Housing First (HF) because of its demonstrated relationship to programme outcomes...

The international fidelity study was conceived through the International Network of Housing First, an informal body that spawned the First International Conference on Housing First held in Lisbon, Portugal in 2014. The objectives of the study were twofold: (1) Investigate the fidelity of Housing First programmes in different countries in Europe and...

Homelessness continues to be a pressing concern across the United States. On a given night, 564,708 people are either sleeping outside, in an emergency shelter, or in a transitional housing bed (National Alliance to End Homelessness, 2016). The Pathways Housing First model, which combines immediate access to permanent housing with community-based s...

The purpose of this study was to examine the perceptions of the Outcome Questionnaire (OQ) following its implementation in a university-based psychological services training centre. Participants were doctoral-level student clinicians (N=49), clinical supervisors (N=17), and clients (N=24). Data was collected through surveys, semi-structured intervi...

This article presents the findings of a fidelity assessment conducted with a Housing First programme in Canada that supported clients with problematic substance use. A mixed-methods (quantitative and qualitative) evaluation design was used. A fidelity assessment survey, fidelity rating conciliation session, and interviews were conducted with progra...

Highlights Housing First can be implemented beyond demonstration sites without new resources. Using an intentional implementation strategy communities implemented high‐fidelity programs. One key implementation challenge was accessing affordable housing and housing subsidies. By helping develop housing specialists and reflective practice, the TTA fa...

Purpose Foreign-born families face challenges following migration to Canada that may impact their well-being and lead them to homelessness. Yet, there is limited research on the experience of homelessness in this population. The purpose of this paper is to examine the health of foreign-born families staying in the emergency shelter system in Ottawa...

In this study, we examine changes in the homeless‐serving system in the context of a training and technical assistance initiative to scale up Housing First (HF) in 6 Canadian communities. Based on qualitative data from focus groups and individual interviews with key stakeholders (k = 7, n = 35) and field notes gathered over a 3‐year period (n = 146...

Objectives: The purpose of this study was to determine the prevalence of tobacco use and overall smoking behaviors within a sample of individuals with a serious mental illness who were homeless or vulnerably housed and receiving community mental health services. Methods: In 2010, individuals (N = 639) were interviewed, and identified smokers com...

Emergency homeless shelters can be stressful environments for families. They can be associated with emotional distress and feelings of restriction for parents, and with behavioural, social, and developmental challenges for children. However, little is known about the experiences of accompanied youth residing in shelter with their families, as the l...

The purpose of this article is to present a framework outlining competencies required for effective clinical supervision within the context of community-based multidisciplinary service agencies. The clinical supervision competency framework was developed through a literature review and input from the supervisors and senior managers of a community-b...

Background Housing First is an effective intervention to stably house and alter service use patterns in a large proportion of homeless people with mental illness. However, it is unknown whether there are differences in the patterns of service use over time among those who do or do not become stably housed and what effect, if any, Housing First has...

Objective Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorder, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having a concurrent disorder on health care utilization among homeless...

Homelessness is related to poorer mental health, yet, there is limited understanding of the predictors of mental health of men and women experiencing homelessness. To support service providers in identifying individuals who might be at particular risk of poor mental health, this study investigated the predictors of mental health in 501 single men a...

The purpose of this study was to test the construct validity of the Evaluation Capacity in Organizations Questionnaire (ECOQ). Conceptually, the ECOQ examines the role of evaluation in organizational development and, most notably in organizational learning. In this model, evaluation capacity building (ECB) initiatives are assumed to contribute to t...

Objective: This study compares the effect of Housing First on older (≥50 years old) and younger (18-49 years old) homeless adults with mental illness participating in At Home/Chez Soi, a 24-month multisite randomized controlled trial of Housing First. Method: At Home/Chez Soi, participants (n = 2148) were randomized to receive rent supplements w...

We present interim findings of a cross-site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence-based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to...