Vicky Stergiopoulos
Biographic Data
| ID | 208253 |
|---|---|
| NAME | Vicky Stergiopoulos |
| GIVEN NAMES | Vicky |
| FAMILY NAME | Stergiopoulos |
| SIGNATURE | STERGIOPOULOS V |
| AFFILIATIONS | Centre for Addiction and Mental Health |
| ORCID | 0000-0003-3941-9434 |
| VERIFIED | Yes |
| TOTAL WORKS | 73 |
| TOTAL CITATIONS | 107 |
| AUTHOR COUNT | 73 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2012 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 7 |
Assessing the Needs of Community Mental Health Service Users with Chronic Physical Health Conditions: A Cross-Sectional Study
Forensic supportive housing programs: A scoping review
Research on FSH, an essential support for the successful community reintegration of forensic patients, is limited. Although existing literature highlights promising health, housing, and justice outcomes associated with FSH settings, more research is needed to establish best practices and support mental health recovery and safeguard the human rights of this population
Family members’ perspectives of laws, policies and practices in substance use disorder treatment: Systemic alienation of the family in Canada
Complexity among people experiencing homelessness: A scoping review of definitions and measurement approaches
People experiencing homelessness are often described as having "complex needs" for whom various health and housing interventions have been developed. However, there is no consensus on how this and similar terms are defined or measured. A prospectively registered scoping review was conducted to examine how "complexity" is defined and measured with people experiencing homelessness. Six academic databases were searched, along with several techniques…
Ethno-Racial Differences in the Effectiveness of Housing First on Healthcare Utilization Among Homeless Adults with Mental Illness: At Home Chez-Soi, a Pragmatic Randomized Trial
This study evaluates the impact of the Housing First (HF) intervention on healthcare utilization among homeless adults with mental illness, comparing ethno-racial (ER) and non-ER groups with moderate mental health support needs. We linked data from the At Home/Chez-Soi (AH/CS) randomized controlled trial with health administrative data from Ontario, including the Ontario Health Insurance Plan and several healthcare databases (e.g., Discharge Abst…
Strengthening the Delivery of Physical Healthcare for Adults Living With Serious Mental Illness – A Qualitative Description of Patient and Family Member Perspectives
BACKGROUND: Individuals with serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10-20 years earlier than the general population. This qualitative study aimed to explore the perspectives and experiences of adults living with SMI and family members with accessing physical healthcare within primary and mental health settings in Canada. METHODS: We conducted a q…
“Making a homeless person even more homeless … it’s a necessary evil”: The health and safety complexities of service restrictions as perceived by emergency shelter staff
Service restrictions involve people experiencing homelessness being banned from an emergency shelter in response to a violation of program policies. Their use can be a pathway into unsheltered homelessness and reliance on other institutional services. However, the prevalence of service restriction use and the perspectives of shelter staff toward the practice are unknown. Accordingly, this mixed methods study used a one-phase QUAL(quan) embedded d…
Heat-Related Health Risks for People Experiencing Homelessness: A Rapid Review
Programmatic, Environmental, and Temporal Predictors of Violence, Overdose, and Self-Injury in Homeless Shelters in Toronto, Canada, 2012–2021
We Have to Evict Certain People Sometimes”: A Descriptive Mixed-Methods Study of Service Providers’ Perceptions of the Impacts of High-Risk Issues in Supportive Housing and Housing First
Causes and decision paths of employee turnover in the homeless service sector
Community-based service providers working with people experiencing homelessness encounter many occupational challenges and high turnover rates are a challenge in the sector. This qualitative study examined the perceived causes and decision paths of turnover among service providers working with people experiencing homelessness in Canada. In-depth interviews were completed with 40 service providers working in homeless service, supportive housing, a…
Effect of a housing intervention on major cardiovascular events among homeless adults with mental illness
Homelessness is associated with excess cardiovascular morbidity and mortality. This study reports on the long-term effects of a Canadian housing first initiative, compared to treatment as usual, on major cardiovascular events among adults experiencing homelessness and mental illness. Over the 7-year follow-up period, 34 of 527 participants (6.5%) experienced at least one cardiovascular event. There was no significant difference in the incidence o…
Cross-Cultural Insights from Two Global Mental Health Studies: Self-Enhancement and Ingroup Biases
This commentary highlights two cross-cultural issues identified from our global mental health (GMH) research, RECOLLECT (Recovery Colleges Characterisation and Testing) 2: self-enhancement and ingroup biases. Self-enhancement is a tendency to maintain and express unrealistically positive self-views. Ingroup biases are differences in one’s evaluation of others belonging to the same social group. These biases are discussed in the context of GMH res…
Cross-cultural Comparison of Recovery College Implementation Between Japan and England: Corpus-based Discourse Analysis
The online version contains supplementary material available at 10.1007/s11469-024-01356-3
Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs
Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry
Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among…
“Everyone means well but the one person who's really going to go to bat” - experiences and perspectives of substitute decision makers in caring for their loved ones with serious mental illness
Using healthcare encounter data to identify high-cost users among adults with a history of homelessness: A validation study
People experiencing homelessness are often considered frequent healthcare users. Although their service use is not uniform, it can be difficult to identify the highest-cost users without access to comprehensive cost data. This study validated a set of algorithms that apply healthcare encounter data to identify high-cost users among adults with a history of homelessness. Administrative healthcare cost data were compared across common frequent user…
Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition
Medical assistance in dying (MAiD) was introduced into Canadian federal legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is currently excluded from eligibility; such exclusion is scheduled to expire on March 17, 2024. Irremediability, capacity, quality of life, autonomy, family involvement, and healthcare system constraints have been debated intensively. Recent studies have not explored the views of family me…
Case managers’ reflections of a brief case management intervention in Canada
The ideal population for this intervention are adults with mental health issues in need of system navigation, and those motivated to address their goals. Further research is needed to establish fidelity criteria
Victimization, safety, and overdose in homeless shelters: A systematic review and narrative synthesis
Examining Risk Factors and Protective Resources as Predictors of Recovery Among Youth With Mental Illness and Lived Experience of Homelessness
High level of mental health problems are a critical concern among youth experiencing or at-risk of homelessness. Using data from a randomized controlled trial on Housing First in Canada, this study examined the risk factors and protective resources associated with mental health recovery among 215 homeless youth with mental illness at baseline and at a 24-month follow-up. At study entry, higher levels of recovery were associated with a lower numbe…
Searching for relief from suffering: A patient-oriented qualitative study on medical assistance in dying for mental illness as the sole underlying medical condition
Medical assistance in dying (MAiD) was introduced into Canadian legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is excluded from eligibility; this is expected to change in 2024. Incurability, intolerable suffering, capacity to make healthcare decisions, and suicidality have been publicly debated in connection with mental illness. Few studies have explored the views of persons with mental illness on the intro…
“Systems trauma”: A qualitative study of work-related distress among service providers to people experiencing homelessness in Canada
Service provision to people experiencing homelessness is challenging and stressful work. Yet, there is a dearth of evidence on how the work experiences of service providers contribute to mental health distress and wellness. This qualitative study examined the contributing factors to workplace mental health among service providers to people experiencing homelessness in Canada, with the aim of establishing a causal theory for how work-related chall…
Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives
INTRODUCTION: Homelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but studies investigating key stakeholder perspectives are lacking. This study aimed to elicit, using qualitative methods, nuanced service user and provider experiences by using financial incentives to…
Implementing Housing First Across Sites and Over Time: Later Fidelity and Implementation Evaluation of a Pan‐Canadian Multi‐site Housing First Program for Homeless People with Mental Illness
This article examines later fidelity and implementation of a five‐site pan‐Canadian Housing First research demonstration project. The average fidelity score across five Housing First domains and 10 programs was high in the first year of operation (3.47/4) and higher in the third year of operation (3.62/4). Qualitative interviews (36 key informant interviews and 17 focus groups) revealed that staff expertise, partnerships with other services, and …
Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers, Training/Technical Assistance, and Points of Leverage
We present interim findings of a cross‐site case study of an initiative to expand Housing First ( HF ) in Canada through training and technical assistance ( TTA ). HF is an evidence‐based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early impleme…
More than being against it: Anti-racism and anti-oppression in mental health services
Anti-racism and anti-oppression frameworks of practice are being increasingly advocated for in efforts to address racism and oppression embedded in mental health and social services, and to help reduce their impact on mental health and clinical outcomes. This literature review summarizes how these two philosophies of practice are conceptualized and the strategies used within these frameworks as they are applied to service provision toward raciali…
Implementing a trauma‐informed intervention for homeless female survivors of gender‐based violence: Lessons learned in a large Canadian urban centre
Gender-based violence is associated with an elevated risk of physical and psychological harm for girls and women. This study examines service user and provider experiences of a trauma-informed, peer-facilitated group psychosocial intervention (Peer Education and Connection through Empowerment [PEACE]) targeting female-identified youth experiencing homelessness and gender-based violence. Participants were recruited among service users and provider…
What Happens After the Demonstration Phase? The Sustainability of Canada's At Home/Chez Soi Housing First Programs for Homeless Persons with Mental Illness
This research examined the sustainability of Canada's At Home/Chez Soi Housing First ( HF ) programs for homeless persons with mental illness 2 years after the end of the demonstration phase of a large (more than 2000 participants enrolled), five‐site, randomized controlled trial. Qualitative interviews were conducted with 142 participants (key informants, HF staff, and persons with lived experience) to understand sustainability outcomes and fact…
Longitudinal interrelationships of mental health discrimination and stigma with housing and well-being outcomes in adults with mental illness and recent experience of homelessness
Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness
Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24-month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the…
Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions
Promoting timely and continuous care for people experiencing homelessness has been a challenge in many jurisdictions, plagued by access barriers and service fragmentation. As part of a larger programme evaluation, this study used qualitative methods to examine the role of a brief interdisciplinary intervention in supporting continuity of care for this population in a large Canadian urban centre. The intervention provides time-limited case managem…
Patterns and effects of social integration on housing stability, mental health and substance use outcomes among participants in a randomized controlled Housing First trial
Systems change in the context of an initiative to scale up Housing First in Canada
In this study, we examine changes in the homeless‐serving system in the context of a training and technical assistance initiative to scale up Housing First (HF) in 6 Canadian communities. Based on qualitative data from focus groups and individual interviews with key stakeholders (k = 7, n = 35) and field notes gathered over a 3‐year period (n = 146), we found 2 main system changes: (a) changes in the capacity of the service delivery system at mul…
Dynamic Sustainability: Practitioners’ Perspectives on Housing First Implementation Challenges and Model Fidelity Over Time
Objectives: Although Housing First (HF) is a popular evidence-based intervention for persons experiencing homelessness and mental illness, research exploring its sustainability over time is scant. This mixed methods study captures practitioners' perspectives on key shifts in implementation of Housing First in a large urban center, and factors affecting fidelity to the model over time. Methods: This study uses fidelity assessments, at baseline and…
The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial
We assessed the effects of the Toronto Site Housing First (HF) intervention on hospitalizations and emergency department (ED) visits among homeless adults with mental illness over 7 years of follow-up. The Toronto Site is part of an unblinded multi-site randomized pragmatic trial of HF for homeless adults with mental illness in Canada, which followed participants up to 7 years. Five hundred seventy-five participants were recruited and classified …
Housing First and Severe Mental Disorders: The Challenge of Exiting Homelessness
We examine the long-term housing trajectories of 543 program participants at the Toronto site of the At Home/Chez-Soi project, a randomized controlled trial of a Housing First (HF) intervention for adults with mental disorders. The average follow-up period for our study was 5.5 years. We find that the HF approach, which includes housing subsidies and support services, was strongly associated with rapid transitions to sustained housing (70.4 perce…
Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada
Highlights Housing First can be implemented beyond demonstration sites without new resources. Using an intentional implementation strategy communities implemented high‐fidelity programs. One key implementation challenge was accessing affordable housing and housing subsidies. By helping develop housing specialists and reflective practice, the TTA facilitated effective implementation
Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless
Towards the Quadruple Aim in permanent supportive housing: A mixed methods study of workplace mental health among service providers
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 p…
Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs
Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry
Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among…
Shelter Bans Among People Experiencing Homelessness: An Exploratory Study of Predictors in Two Large Canadian Datasets
Differential impacts of Covid ‐19 and associated responses on the health, social well‐being and food security of users of supportive social and health programs during the Covid ‐19 pandemic: A qualita…
The effects of the coronavirus disease-2019 (COVID-19) pandemic on the lives of underserved populations are underexplored. This study aimed to identify the impacts of the COVID-19 pandemic and associated public health responses on the health and social well-being, and food security of users of Housing First (HF) services in Toronto (Canada) during the first wave of the COVID-19 pandemic. This qualitative descriptive study was conducted from July …
Promoting Wellness and Recovery of Young Women Experiencing Gender-Based Violence and Homelessness: The Role of Trauma-Informed Health Promotion Interventions
Little is known regarding the types of interventions most effective in supporting wellness and recovery of victims of gender-based violence, particularly those simultaneously experiencing homelessness. This qualitative study explored the experiences of 18 young women experiencing gender-based violence and homelessness who participated in a community-based, trauma-informed group intervention in Toronto, Canada. Participants completed audio-recorde…
Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital
Ending homelessness among people with mental illness: The At Home/Chez Soi randomized trial of a Housing First intervention in Toronto
Recruitment at the Toronto site of AH/CS project produced a sample of participants that reflects the diverse demographics of the target population. This study will provide much needed data on how to best address the issue of homelessness and mental illness in Canada
More than being against it: Anti-racism and anti-oppression in mental health services
Anti-racism and anti-oppression frameworks of practice are being increasingly advocated for in efforts to address racism and oppression embedded in mental health and social services, and to help reduce their impact on mental health and clinical outcomes. This literature review summarizes how these two philosophies of practice are conceptualized and the strategies used within these frameworks as they are applied to service provision toward raciali…
The role and meaning of interim housing in housing first programs for people experiencing homelessness and mental illness
The housing first (HF) model for individuals experiencing homelessness and mental illness differs by design from traditional models that require consumers to achieve "housing readiness" by meeting program or treatment prerequisites in transitional housing settings prior to permanent housing placement. Given a growing body of evidence for its favorable outcomes and cost effectiveness, HF is increasingly seen as an alternative to and argument again…
Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness: A Randomized Trial
Importance Scattered-site housing with Intensive Case Management (ICM) may be an appropriate and less-costly option for homeless adults with mental illness who do not require the treatment intensity of Assertive Community Treatment. Objective To examine the effect of scattered-site housing with ICM services on housing stability and generic quality of life among homeless adults with mental illness and moderate support needs for mental health servi…
Cardiovascular risk factors and 30-year cardiovascular risk in homeless adults with mental illness
Current Controlled Trials ISRCTN42520374
Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless
Dynamic Sustainability: Practitioners’ Perspectives on Housing First Implementation Challenges and Model Fidelity Over Time
Objectives: Although Housing First (HF) is a popular evidence-based intervention for persons experiencing homelessness and mental illness, research exploring its sustainability over time is scant. This mixed methods study captures practitioners' perspectives on key shifts in implementation of Housing First in a large urban center, and factors affecting fidelity to the model over time. Methods: This study uses fidelity assessments, at baseline and…
Implementing Housing First Across Sites and Over Time: Later Fidelity and Implementation Evaluation of a Pan‐Canadian Multi‐site Housing First Program for Homeless People with Mental Illness
This article examines later fidelity and implementation of a five‐site pan‐Canadian Housing First research demonstration project. The average fidelity score across five Housing First domains and 10 programs was high in the first year of operation (3.47/4) and higher in the third year of operation (3.62/4). Qualitative interviews (36 key informant interviews and 17 focus groups) revealed that staff expertise, partnerships with other services, and …
A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness
OBJECTIVE: Housing First with assertive community treatment (ACT) is a promising approach to assist people with serious mental illness to exit homelessness. The article presents two-year findings from a multisite trial on the effectiveness of Housing First with ACT. METHODS: The study design was a randomized controlled trial conducted in five Canadian cities. A sample of 950 participants with serious mental illness who were absolutely homeless or…
Provider and Consumer Perceptions of Trauma Informed Practices and Services for Substance Use and Mental Health Problems
Introducing a Recovery Education Centre for Adults Experiencing Mental Health Challenges and Housing Instability in a Large Urban Setting
The effectiveness of a Housing First adaptation for ethnic minority groups: Findings of a pragmatic randomized controlled trial
International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374 , assigned August 18, 2009
Integrating Hospital and Community Care for Homeless People with Unmet Mental Health Needs: Program Rationale, Study Protocol and Sample Description of a Brief Multidisciplinary Case Management Interv…
Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions
Promoting timely and continuous care for people experiencing homelessness has been a challenge in many jurisdictions, plagued by access barriers and service fragmentation. As part of a larger programme evaluation, this study used qualitative methods to examine the role of a brief interdisciplinary intervention in supporting continuity of care for this population in a large Canadian urban centre. The intervention provides time-limited case managem…
What Happens After the Demonstration Phase? The Sustainability of Canada's At Home/Chez Soi Housing First Programs for Homeless Persons with Mental Illness
This research examined the sustainability of Canada's At Home/Chez Soi Housing First ( HF ) programs for homeless persons with mental illness 2 years after the end of the demonstration phase of a large (more than 2000 participants enrolled), five‐site, randomized controlled trial. Qualitative interviews were conducted with 142 participants (key informants, HF staff, and persons with lived experience) to understand sustainability outcomes and fact…
Coping and resilience among ethnoracial individuals experiencing homelessness and mental illness
BACKGROUND: The multiple challenges that ethnoracial homeless individuals experiencing mental illness face are well documented. However, little is known about how this homeless subpopulation copes with the compounding stressors of racial discrimination, homelessness and mental illness. AIMS: This study is an in-depth investigation of the personal perceived strengths, attitudes and coping behaviors of homeless adults of diverse ethnoracial backgro…
Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers, Training/Technical Assistance, and Points of Leverage
We present interim findings of a cross‐site case study of an initiative to expand Housing First ( HF ) in Canada through training and technical assistance ( TTA ). HF is an evidence‐based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early impleme…
Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada
Highlights Housing First can be implemented beyond demonstration sites without new resources. Using an intentional implementation strategy communities implemented high‐fidelity programs. One key implementation challenge was accessing affordable housing and housing subsidies. By helping develop housing specialists and reflective practice, the TTA facilitated effective implementation
Recovery education for people experiencing housing instability: An evaluation protocol
Background: Recovery education centers (RECs) offer recovery supports through education rather than traditional health services. The Supporting Transitions and Recovery Learning Centre (STAR) in Toronto, Canada, is among the few that are internationally focused on individuals with histories of homelessness. Although research suggests that RECs positively impact participants, there is a paucity of rigorous studies and none address the engagement a…
Housing Stability and Neurocognitive Functioning in Homeless Adults With Mental Illness: A Subgroup Analysis of the At Home/Chez Soi Study
Objective: This study examined the association of housing stability with neurocognitive outcomes of a well-characterized sample of homeless adults with mental illness over 18 months and sought to identify demographic and clinical variables associated with changes in neurocognitive functioning. Method: A total of 902 participants in the At Home/Chez Soi study completed neuropsychological measures 6 and 24 months after study enrollment to assess ne…
Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness
Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24-month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the…
Implementing a trauma‐informed intervention for homeless female survivors of gender‐based violence: Lessons learned in a large Canadian urban centre
Gender-based violence is associated with an elevated risk of physical and psychological harm for girls and women. This study examines service user and provider experiences of a trauma-informed, peer-facilitated group psychosocial intervention (Peer Education and Connection through Empowerment [PEACE]) targeting female-identified youth experiencing homelessness and gender-based violence. Participants were recruited among service users and provider…
Systems change in the context of an initiative to scale up Housing First in Canada
In this study, we examine changes in the homeless‐serving system in the context of a training and technical assistance initiative to scale up Housing First (HF) in 6 Canadian communities. Based on qualitative data from focus groups and individual interviews with key stakeholders (k = 7, n = 35) and field notes gathered over a 3‐year period (n = 146), we found 2 main system changes: (a) changes in the capacity of the service delivery system at mul…
Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: A systematic review
Medicine (62 works) · Homelessness and Social Issues (53 works) · Mental health (53 works) · Psychology (50 works) · Psychiatry (48 works) · Nursing (37 works) · Mental illness (33 works) · Sociology (25 works) · Housing First (22 works) · Mental Health and Patient Involvement (22 works)