abstract: 'The Quadruple Aim is a health policy framework with the objective of

  concurrently improving population health, enhancing the service

  experience, reducing costs and improving the work-life of service

  providers. Permanent supportive housing (PSH) is a best practice

  approach for stably housing people experiencing homelessness who have

  diverse support needs. Despite the intervention''s strong evidence base,

  little is known about the work-life of PSH providers. This study

  explored the mental health and work challenges experienced by PSH

  providers in Canada. Using an explanatory sequential, equally weighted,

  mixed methods design, 130 PSH providers were surveyed, followed by

  semi-structured interviews with 18 providers. Quantitative findings

  showed that 23.1\% of PSH providers had high psychological distress.

  Participants who were younger, spent all or almost all of their time in

  direct contact with service users and had less social support from

  coworkers were significantly more likely to have high psychological

  distress. Three themes were identified from the qualitative analysis

  that showed how PSH providers experience psychological distress from

  work-related challenges: (a) Sisyphean Endeavours: `You Do What You

  Can'', (b) Occupationally Unsupported: `Everyone Is Stuck in Their Zone''

  and (c) Wear and Tear of `Continuous Exposure to Crisis and Chaos''. The

  themes interacted with systemic (Sisyphean Endeavours) and

  organisational issues (Occupationally Unsupported), intensifying the

  emotional burden of day-to-day work, which involved frequent crises and

  uncertainty (Wear and Tear of `Continuous Exposure to Crisis and

  Chaos''). The findings underscore how these challenges threaten

  providers'' wellness at work and have implications for the care provided

  to service users. Accordingly, the Quadruple Aim is a potentially useful

  and applicable framework for measuring the performance of PSH programs,

  which warrants further consideration in research and policy.'
affiliation: 'Kerman, N (Corresponding Author), Ctr Addict \& Mental Hlth, 1051 Queen
  St West, Toronto, ON, Canada.

  Kerman, Nick; Stergiopoulos, Vicky; Kidd, Sean A., Ctr Addict \& Mental Hlth, 1051
  Queen St West, Toronto, ON, Canada.

  Goodwin, Jordan M., Rutgers State Univ, Sch Social Work, New Brunswick, NJ USA.

  Tiderington, Emmy, Rutgers State Univ, Sch Social Work, Newark, NJ USA.

  Ecker, John, York Univ, Canadian Observ Homelessness, Toronto, ON, Canada.

  Stergiopoulos, Vicky; Kidd, Sean A., Univ Toronto, Dept Psychiat, Toronto, ON, Canada.'
author: Kerman, Nick and Goodwin, Jordan M. and Tiderington, Emmy and Ecker, John
  and Stergiopoulos, Vicky and Kidd, Sean A.
author-email: nick.kerman@camh.ca
author_list:
- family: Kerman
  given: Nick
- family: Goodwin
  given: Jordan M.
- family: Tiderington
  given: Emmy
- family: Ecker
  given: John
- family: Stergiopoulos
  given: Vicky
- family: Kidd
  given: Sean A.
da: '2023-09-28'
doi: 10.1111/hsc.14033
earlyaccessdate: SEP 2022
eissn: 1365-2524
files: []
issn: 0966-0410
journal: HEALTH \& SOCIAL CARE IN THE COMMUNITY
keywords: 'Housing First; permanent supportive housing; Quadruple Aim; secondary

  traumatization; service provision; social support; workplace mental

  health'
keywords-plus: 'HIGH-INCOME COUNTRIES; HOMELESS INDIVIDUALS; SUBSTANCE USE; CARE;
  1ST;

  EPIDEMIOLOGY; DISORDER; BARRIERS; CULTURE; ILLNESS'
language: English
month: NOV
number: '6'
number-of-cited-references: '59'
orcid-numbers: Tiderington, Emmy/0000-0001-7934-0961
pages: E6674-E6688
papis_id: f560d71b07b9e9c69712404211d586e6
ref: Kerman2022quadrupleaim
researcherid-numbers: Tiderington, Emmy/AAF-7137-2020
times-cited: '1'
title: 'Towards the Quadruple Aim in permanent supportive housing: A mixed methods
  study of workplace mental health among service providers'
type: Article
unique-id: WOS:000856075000001
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '30'
web-of-science-categories: Public, Environmental \& Occupational Health; Social Work
year: '2022'