Grant: Partnerships for Health System Improvement (PHSI)

Athabasca University (Alberta); Institute for Clinical Evaluative Sciences-Toronto; Centre for Addiction and Mental Health (Toronto); Centre for Addiction and Mental Health (Toronto); Centre for Addictions Research of BC (Victoria); Centre for Addictions Research of BC (Victoria); Michael Smith Health Research BC

<html> <body> <p>While there is robust evidence for strategies to reduce harms of illicit drug use, much less research attention has been paid to alcohol harm reduction. This proposal addresses the needs of people with severe alcohol use disorders (AUDs) and unstable housing, many of whom identify as indigenous. We propose to expand a multisite, mixed method evaluation of Managed Alcohol Programs (MAPs) as a strategy to improve health and well-being for this population while reducing social costs. The first phase of this CIHR funded PHSI project yielded two pilot studies and implementation of a rigorous research protocol in 5 MAP sites in Ontario and BC. Renewed funding will allow us to expand to 5 new sites in Toronto, Edmonton and Vancouver including a non-residential, peer run program and an indigenous developed program. It would also permit additional years follow-up of 367 MAP participants and controls recruited to date to investigate how MAP participation influences their trajectories through the health and criminal justice systems, undertake economic costing and analyze program impacts on MAP participants.<br> <br> MAPs are a uniquely Canadian response to the complex needs of people who do not respond to abstinence programs and experience homelessness or housing instability. MAPs offer regulated access to beverage alcohol, alongside meals, healthcare and accommodation. Our pilot studies found evidence of improved well-being, more stable housing and reduced demands on the health and criminal justice systems for MAP participants^{[1, 2]}. Management issues including clear eligibility criteria and tailoring programs to individual needs were identified. A formal Community of Practice (CofP) was established to connect a network of MAP providers with the research team for mutual support, learning and knowledge exchange.<br> </p> <p>We have established strong national and international research-practitioner collaborations, obtained multi-site ethical approvals, provided research training, and developed successful strategies for maintaining contact with a growing cohort of MAP participants obtaining a 90% six month follow-up rate. We have obtained consent from the existing cohort to access health and police data for before and after study entry as well as police and health system approvals to access administrative data. We propose extending the research to new sites to: (i) increase statistical power across more diverse programs; (ii) incorporate cost-benefit analyses; (iii) investigate interactions between individual characteristics, MAP setting (housing, shelter, day program) and program philosophies/policies with health and social outcomes; and iv) inform culturally appropriate programming.<br> <br> We will combine quantitative and qualitative methods and analyses to evaluate the effectiveness of MAPs for individuals with severe AUDs and homelessness. Specifically, we will investigate:</p> <p>1. Whether MAP participation impacts physical and mental health, housing satisfaction and stability, patterns of alcohol use and related harms and trajectories through health care and criminal justice systems.<br> <br> 2. How different types of MAP settings, program philosophies and policies influence outcomes and experiences for different clients (e.g. severity of AUDs, indigenous identity, gender).<br> <br> 3. Whether participation in MAPs result in economic benefits in terms of impacts on health care and criminal justice systems.<br> <br> 4. Best practices and policies for development and implementation of MAP programs.<br> </p> </body> </html>