title: Evaluation of an Integrated Cluster Care and Supportive Housing Model for Unstably Housed Persons Using the Shelter System.
abstract: OBJECTIVE
  To evaluate the feasibility of an integrated cluster care and supportive housing model.
  
  
  METHODS
  Community shelters.
  
  
  METHODS
  The Inner City Access Program (ICAP) is a new service delivery model employed by the Toronto Central Community Care Access Centre, which combines supportive housing services and health care for homeless, underhoused, and marginalized populations using the shelter system. We evaluated the effectiveness of the ICAP in facilitating access to health services, supporting goal-setting, and promoting interprofessional case management. Client interviews examined care goals, goal achievement, and satisfaction; staff interviews determined client-centeredness of staff-identified care goals/planning; document reviews were conducted to obtain service utilization and process data.
  
  
  RESULTS
  Twenty clients received service during a 15-month period before implementation. This increased to 147 clients during a 16-month period post-implementation at a 60% reduction in cost/client. Results indicated that regular interdisciplinary team meetings promoted greater service delivery efficiency; greater client satisfaction was associated with goal achievement (p < .01); and a trend toward greater perceived goal achievement (as reported separately by clients and staff) and client satisfaction when staff- and client-stated goals were more closely aligned.
  
  
  CONCLUSIONS
  The ICAP proved an efficient and cost-effective model in engaging marginalized populations. There was a trend toward greater client satisfaction when clients perceived success related to "education, employment, activities, and programs" goals.
authors.affiliation: Tim Pauley, MSc, is Manager, Research and Evaluation, at the Toronto Central Community Care Access Center. He is winner of two international research awards (ISPRM; ISPO) and author of numerous journal articles. His work includes amputee and stroke rehabilitation, support of informal caregivers, community-based self-management, and engagement of clients/caregivers in knowledge mobilization. Judith Gargaro, MEd, BSc, has worked as a research coordinator and clinical program evaluator for the last 23 years in the areas of diabetes, spinal cord injury, mental health, and acquired brain injury. Her research interests are in models of service delivery, community living, clinical intervention effectiveness, and marginalized populations. Akin Falode, MScN, RN, is Client Services Manager of the Urban Health at the Toronto Central Community Care Access Center. She has a breadth of experience developing and implementing inpatient and outpatient programs, with a focus on improving health outcomes for people grappling with a variety of chronic health issues, housing instability, and mental health and/or addiction problems. Nicole Beben, MA, was Vice President, Knowledge and Care Exchange Programs, at Saint Elizabeth Health Care from 2012 to 2014. Her current role is Vice President, Strategy at the Canadian Partnership Against Cancer. She has extensive experience leading crosscutting strategic initiatives to advance social and health outcomes and knowledge mobilization and communications activities. Liana Sikharulidze, BScN, MBA, is Director, Professional Services, at Circle of Care with previous experience in Telehomecare, Rapid Response Nursing, Mental Health, and Visiting Nursing programs. She has extensive community nursing experience where she managed and led programs such as acquired brain injury and seniors care. Barbara Mekinda, MSW, RSW, is a care coordinator on Urban Health Team at Toronto Central Community Care Access Centre. He has extensive clinical experience in wo
authors.forename: Tim
authors.initials: T
authors.lastname: Pauley
authors.forename: Judith
authors.initials: J
authors.lastname: Gargaro
authors.forename: Akin
authors.initials: A
authors.lastname: Falode
authors.forename: Nicole
authors.initials: N
authors.lastname: Beben
authors.forename: Liana
authors.initials: L
authors.lastname: Sikharulidze
authors.forename: Barbara
authors.initials: B
authors.lastname: Mekinda
mesh_terms: D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational