Susan Farrell

Bio: Susan Farrell is an academic researcher from University of Ottawa. The author has contributed to research in topics: Health care & Population. The author has an hindex of 9, co-authored 15 publications receiving 610 citations. Previous affiliations of Susan Farrell include Carleton University.

Neighborhoods and neighbors: Do they contribute to personal well-being?

Abstract: The present study examined the relationship between characteristics of neighborhoods (with set physical boundaries and relatively homogeneous populations) and personal well-being as mediated by sense of community and neighboring behavior. A randomly selected representative sample of 345 residents living in non-apartment dwellings in Winnipeg, Canada, completed a mail survey that included created measures of neighboring and sense of community and the General Health Questionnaire. Results demonstrated that sense of community mediates the relationship between neighborhood stability (as defined by the marital status and mobility) and residents' well-being. The frequency of engaging in neighboring behavior was not directly predictive of residents' sense of personal well-being, but was predictive of increased sense of community. Consistent with previous research, findings highlight the importance of building a sense of community among residents in a neighborhood. Implications of findings for neighborhood planning are discussed. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 9–25, 2004.

A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities

Abstract: Homeless persons experience a high burden of health problems; yet, they face significant barriers in accessing health care. Less is known about unmet needs for care among vulnerably housed persons who live in poor-quality or temporary housing and are at high risk of becoming homeless. The objectives of this study were to examine the prevalence of and factors associated with unmet needs for health care in a population-based sample of homeless and vulnerably housed adults in three major cities within a universal health insurance system. Participants were recruited at shelters, meal programs, community health centers, drop-in centers, rooming houses, and single room occupancy hotels in Vancouver, Toronto, and Ottawa, Canada, throughout 2009. Baseline interviews elicited demographic characteristics, health status, and barriers to health care. Logistic regression was used to identify factors associated with self-reported unmet needs for health care in the past 12 months. Of the 1,181 participants included in the analysis, 445 (37%) reported unmet needs. In adjusted analyses, factors associated with a greater odds of reporting unmet needs were having employment in the past 12 months (AOR = 1.40, 95% CI = 1.03–1.91) and having ≥3 chronic health conditions (AOR = 2.17, 95% CI = 1.24–3.79). Having higher health-related quality of life (AOR = 0.21, 95% CI = 0.09–0.53), improved mental (AOR = 0.97, 95% CI = 0.96–0.98) or physical health (AOR = 0.98, 95% CI = 0.96–0.99), and having a primary care provider (AOR = 0.63, 95% CI = 0.46–0.85) decreased the odds of reporting unmet needs. Homeless and vulnerably housed adults have a similar likelihood of experiencing unmet health care needs. Strategies to improve access to primary care and reduce barriers to accessing care in these populations are needed.

Substance use and access to health care and addiction treatment among homeless and vulnerably housed persons in three Canadian cities.

Abstract: Introduction We examined the prevalence of substance use disorders among homeless and vulnerably housed persons in three Canadian cities and its association with unmet health care needs and access to addiction treatment using baseline data from the Health and Housing in Transition Study. Methods In 2009, 1191 homeless and vulnerably housed persons were recruited in Vancouver, Toronto, and Ottawa, Canada. Interviewer administered questionnaires collected data on socio-demographics, housing history, chronic health conditions, mental health diagnoses, problematic drug use (DAST-10≥6), problematic alcohol use (AUDIT≥20), unmet physical and mental health care needs, addiction treatment in the past 12 months. Three multiple logistic regression models were fit to examine the independent association of substance use with unmet physical health care need, unmet mental health care need, and addiction treatment. Results Substance use was highly prevalent, with over half (53%) screening positive for the DAST-10 and 38% screening positive for the AUDIT. Problematic drug use was 29%, problematic alcohol use was lower at 16% and 7% had both problematic drug and alcohol use. In multiple regression models for unmet need, we found that problematic drug use was independently associated with unmet physical (adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI] 1.43–2.64) and unmet mental (AOR 3.06; 95% CI 2.17–4.30) health care needs. Problematic alcohol use was not associated with unmet health care needs. Among those with problematic substance use, problematic drug use was associated with a greater likelihood of accessing addiction treatment compared to those with problematic alcohol use alone (AOR 2.32; 95% CI 1.18–4.54). Conclusions Problematic drug use among homeless and vulnerably housed individuals was associated with having unmet health care needs and accessing addiction treatment. Strategies to provide comprehensive health services including addiction treatment should be developed and integrated within community supported models of care.

Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities

Abstract: Objectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barr...

Community treatment orders: profile of a Canadian experience.

Abstract: Objective:This study reports the first published Canadian profile of a sample of psychiatric patients from the Royal Ottawa Hospital in Ottawa, Ontario, who were issued community treatment orders (CTOs).Method:We undertook a population study of sociodemographic and health care use patterns from January 2001 to September 2003, using a standardized information collection tool.Results:The issuance of CTOs was associated with a statistically significant reduction in the number and length of hospital admissions and increased use of supportive community-based services and supportive housing.Conclusion:CTOs are effective tools for allowing patients to live in the least restrictive setting possible while they receive diverse services. They also effectively reduce rates and lengths of readmission to hospital.

Compulsory Community and Involuntary Outpatient Treatment for People With Severe Mental Disorders

Abstract: There is controversy as to whether compulsory community treatment (CCT) for people with severe mental illness (SMI) reduces health service use or improves clinical outcome and social functioning. To examine the effectiveness of CCT for people with SMI. We searched the Cochrane Schizophrenia Group’s Trials Register and Science Citation Index (2003, 2008, 2012, and 2013). We obtained all references of identified studies and contacted authors where necessary. All relevant randomized controlled clinical trials (RCTs) of CCT compared with standard care for people with SMI (mainly schizophrenia and schizophrenia-like disorders, bipolar disorder, or depression with psychotic features). Standard care could be voluntary treatment in the community or another preexisting form of compulsory community treatment such as supervised discharge. We found 3 trials with a total of 752 people. Two trials compared a form of CCT called ‘Outpatient Commitment’ (OPC) versus standard voluntary care, whereas the third compared Community Treatment Orders with intermittent supervised discharge. CCT was no more likely to result in better service use, social functioning, mental state, or quality of life compared with either standard voluntary or supervised care. However, people receiving CCT were less likely to be victims of crime than those on voluntary care. Further research is indicated into the effects of different types of CCT as these results are based on 3 relatively small trials.

Sense of Community and Community Participation: A Meta-Analytic Review

Abstract: Many studies indicate that participation and sense of community (SoC) are associated factors enhancing community development. However, research has almost completely ignored the magnitude of the association between the two and the stability of this relationship across contexts, populations and different forms of community participation. A meta-analysis was conducted to assess the following: (a) the strength and stability of the SoC-participation relationship; (b) variations in this relationship associated with different forms of participation (i.e., civic and political); and (c) the influence of population characteristics on the SoC-participation relationship. The results showed that the SoC-participation relationship is significant, positive and moderately strong for forms of participation in the adult population and specific cultural contexts. Implications for theory and applications are discussed.