Familiar Faces: Evaluating Outcomes of a Community Mental Health Program for Frequent Emergency Department Users

Abstract

This dissertation is composed of three studies that evaluated outcomes of a novel community-based mental health care program providing services to frequent emergency department users presenting with mental illness or addiction in Ottawa, Ontario, Canada. The publicly-funded program, known as Familiar Faces, provided a stepped-care intervention to clients, including system navigation and intensive case management. The program was designed to support client health and social needs while alleviating resource burden on hospital emergency departments.

Study 1 used a pre-test/post-test design to prospectively assess program outcomes. Quantitative data were obtained from self-report measures of 63 program clients regarding their experiences of psychosocial functioning, mental illness symptoms, and addiction symptoms, at baseline program intake and follow-up at least six months later. Results indicated improved client outcomes over time related to overall functioning and severity of anxious and depressive symptoms.

Study 2 used a qualitative design and pragmatic thematic analysis to retrospectively assess program outcomes. Data were obtained from interviews with 15 program clients and focus groups with six program case managers regarding their perceptions of program outcomes, mechanisms of change, and barriers to change. Results indicated perceptions of improved client outcomes related to quality of life and severity of mental illness symptoms. Perceived mechanisms of change included the importance of fostering positive working relationships between program clients and case managers, as well as the program's focus on supporting clients to develop practical skills.

Study 3 used a pre-test/post-test, nonequivalent groups design to retrospectively assess program outcomes. Quantitative data were obtained from longitudinal population-level public health care records for 278 program clients and three matched comparison groups regarding their frequency of emergency department visits, hospital admissions, days in hospital, general practice outpatient visits, and psychiatric outpatient visits, in the one year before and two years after program intake. Results indicated that both program clients and comparison participants improved on outcomes over time, including reduced frequency of emergency department visits and hospital admissions. No interaction effects were found on outcomes between groups over time, other than for psychiatric outpatient visits, with program clients experiencing greater increases in psychiatric outpatient visit frequency over time than comparison participants.

These dissertation studies employed varied research designs, different methods, multiple data sources, and diverse participant pools, enabling a comprehensive and rigorous evaluation of program outcomes. The dissertation findings contribute empirical evidence and practical insights to inform mental health care program and policy development for frequent emergency department users with mental illness or addiction and the health care systems that support them.