Population & Community Health Unit

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CURRENT RESEARCH

Anti-Social Behaviour and the Automobile

Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services

Marrying Knowledge Generation with Knowledge Diffusion and Utilization: The Consortium for Applied Research and Evaluation in Mental Health

Motor Vehicle Injuries: Predictors and Consequences. Phase II

Testing a Framework for Comprehensive Evaluation of Outcomes for Clients in Community Mental Health Services

Anti-Social Behaviour and the Automobile

R. Mann, R. Smart, R. Linden, M. Asbridge, C. Backhouse, P. Boase, P. Brantingham, J. Butters, B. Fischer, S. Macdonald J. Rehm, R. Solomon, E. Vingilis, and D. Wiesenthal.
Funded by Networks of Centres of Excellence: Auto 21: The Automobile of the 21st Century.

This project pursues three linked objectives. The first is to document the evolution of the impaired driving problem in Canada in recent years to understand how this social issue will affect road safety in the 21st century and its links to road rage. The second goal is to test specific hypotheses about the impact on traffic safety measures of various policy initiatives (for example 0 BAC requirements for all drinking driving). The third objective is to develop principles, which guide further social and policy initiatives to reduce drunk driving and road rage and improve road safety in Canada.

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Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services

E. Vingilis, C. Forchuk, C. Herbert, J. Weese, T. Sumsion, C. McWilliam, J. Garland, et al.
Funded by Health Canada IECPCP

The objectives of this project are to socialize health care faculty, students and practitioners in client-centred IP collaborative practice, specifically focusing on comprehensive mental health services to a vulnerable population; stimulate networking and sharing of best educational approaches for collaborative client-centred practice; increase the number of educators prepared to teach from an IP collaborative client-centered perspective; and to increase the number of health professionals trained for collaborative client-centred practice before, and after entry into practice.

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Marrying Knowledge Generation with Knowledge Diffusion and Utilization: The Consortium for Applied Research and Evaluation in Mental Health (CAREMH)

E. Vingilis, K. Hartford, B. Mitchell, T. Schrecker, M. Wiktorowicz, R. Velamoor and E. Latimer.
Funded by Canadian Institutes of Health Research (CIHR) - Institute for Health Services and Policy Research (IHSPR) and Institute of Neurosciences, Mental Health and Addiction (INMHA).

The Consortium for Applied Research and Evaluation in Mental Health (CAREMH) is an interactive, multi-disciplinary network of researchers and potential knowledge users, such as clinicians, managers, policy makers and mental health services consumers, mostly within southwestern Ontario. Together, they have been conducting mental health services research and informing policies, programs and services to improve access of persons with serious mental illness (SMI) to health and other services in southwestern Ontario and beyond. CAREMH seeks ICE funding to enhance and expand this collaborative process whereby the research that continues to be developed is high quality methodologically but is also useful and used by the community. This will be done by expanding CAREMH's "hub" model of local researchers to a "hub and spoke" model connecting with other similar researchers and potential knowledge users to develop similar network "nodes" across Canada.

The objectives of this ICE funding will continue to expand collaborative opportunities within southwestern Ontario and other mental health services research nodes across Canada so that for new research to be conducted and this knowledge can be widely disseminated and used. The funding is sought to realize these objectives.

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Motor Vehicle Injuries: Predictors and Consequences. Phase II

E. Vingilis, N. Wiesenthal, J. Seeley, P. Wilk.
Funded by SSHRC/CRSH and Auto 21

A research area for which there is a paucity of studies on large representative samples is motor vehicle collision (MVC) injury sequelae. Vingilis and colleagues conducted an NIH-funded study to examine psychosocial sequelae of trauma patients who were admitted to the Sunnybrook Medical Centre, Regional Trauma Unit. Our 1-year follow-up study indicated major post trauma problems such as depression, anxiety, family stress, financial problems, drinking and psychotropic medication use. Notably, about 14% of these injured persons re-crashed within a year of hospital discharge. However, again the study was limited in scope to a hospital-based sample and to southern Ontario, which could affect the generalizability of the study. Still, these findings are consistent with those of other studies, which suggest that following a motor vehicle collision, common sequelae include depression, anxiety, driving phobia, posttraumatic stress disorder, irritability, anger, sleep disturbance, and headache. Research suggests that women and individuals with pre-collision Anxiety, Depressive, or Personality Disorders are more likely to develop posttraumatic stress disorder, and that those who did not finish high school are at greater risk of disability. However, prior research is sparse and does not adequately demonstrate the role of precollision factors in predicting better or worse post-accident functioning, as no prior research has been truly prospective. Rather, previous research has asked patients to retrospectively recall pre-collision functioning, and such reports could be biased. Further, prior research has not used large, truly representative samples.

For these methodological reasons, the National Population Health Survey (NPHS) provides a unique opportunity. The NPHS allows analyses to be conducted on a nationally representative sample of households in Canada that is collected in a prospective manner. The longitudinal wave allows for predictors and sequelae to be determined. Moreover, the relationship between psychosocial indicators and MVC injuries needs to be further investigated as studies examining this relationship are old and rely on retrospective recollection of feeling stated at the time of injuries. The longitudinal wave of the NPHS is particularly appealing due to the high number of survey questions investigating respondents' psychosocial health and road safety.

This study aims to examine the role of several pre-MVC injury characteristics in predicting post-MVC injury functioning. Thus, Phase 2 seeks to understand the role of demographic characteristics (e.g., age, sex, education, income, labor force involvement), pre-MVC injury support variables (i.e., marital status, social support), pre-MVC injury psychological functioning (self-esteem, mastery, coherence, anxiety, depression, drug use, headache, sleep, pain), and pre-MVC injury medical status (e.g., previous injury, health status), on post-MVC injury outcomes over time (self-esteem, mastery, coherence, anxiety, depression, drug use, headache, sleep, pain, medical care usage, labor force involvement, and subsequent collision). Use of NPHS data would obviate most major methodological and conceptual problems of previous research studies of MVC sequelae. The proposed analyses would not rely on retrospective reporting of pre-MVC injury characteristics, and would thus be able to control pre-morbid characteristics, and would use a large and representative sample.

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Testing a Framework for Comprehensive Evaluation of Outcomes for Clients in Community Health Services

E. Vingilis, J. Bishop, C. Forchuk, B. Mitchell, J. Braun, W. He
Funded by Canadian Institutes of Health Research

The complexity of the needs of clients with severe mental illness (SMI) and their systems of care, presents a major challenge to evaluating outcomes of mental health services. Most evaluations are done at the individual client level, but interpretation must consider a wide array of factors such as client characteristics, staff, services, natural supports and external influences. Adequate evaluation requires a framework for identifying relevant variables, testing hypothesis about casual relations, identifying mediating and moderating factors that may influence these relations, and the use of appropriate advanced statistical modeling techniques.

The purpose of this study is to assess what factors influence outcomes of clients with SMI receiving care from a service called Assertive Community Treatment (ACT) and in so doing, to demonstrate, using advanced statistical modeling, the utility of a community mental health services outcomes evaluation framework.

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The Population & Community Health Unit, Family Medicine,
Schulich School of Medicine & Dentistry, 2nd Floor,
Dr. Don Rix Clinical Skills Building, London, ON, Canada N6A 5C1
Telephone: (519) 858-5063, Fax: (519) 661-3878,
The University of Western Ontario