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Agha A, Hwang SW, Palepu A, Aubry T. The role of housing stability in predicting social capital: Exploring social support and psychological integration as mediators for individuals with histories of homelessness and vulnerable housing. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38713847 DOI: 10.1002/ajcp.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/29/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
Social capital is a collective asset important for individual and population well-being. Individuals who experience homelessness may face barriers in accessing social capital due to health challenges, small social networks, and social exclusion. Data from a 4-year longitudinal study was used to determine if housing stability predicted greater social capital and if this relationship was mediated by social support and psychological integration for a sample of 855 homeless and vulnerably housed participants living in three Canadian cities. Findings showed that housing stability was not associated with trust and linking social capital. However, higher levels of social support and psychological integration had a mediating effect on the association between housing stability and trust and linking social capital. These findings highlight the importance of social support and psychological integration as means of promoting social capital for people who experience homelessness and vulnerable housing. Social interventions for housed individuals with histories of homelessness may be an avenue to foster greater social capital by building relationships with neighbors and connections to community resources and activities.
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Affiliation(s)
- Ayda Agha
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim Aubry
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario, Canada
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2
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Photo elicitation to explore health and social exclusion with rooming house residents in Ottawa, Canada. Health Place 2022; 77:102866. [PMID: 35932596 DOI: 10.1016/j.healthplace.2022.102866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
Little is known about how rooming house residents perceive how housing influences their health, despite higher morbidity and premature death compared to other Canadians. The social exclusion framework of the Social Knowledge Exchange Network (SEKN) conceptualized by Popay et al. (2008) was used to investigate how rooming houses are linked to health among ten rooming house residents from six rooming houses in Ottawa, Ontario, Canada. Study activities included taking photos to show how living in a rooming house affects health, a community walk-about with the principal investigator, a focus group, and individual interviews. Thematic analysis revealed two broad themes: Housing is Health Care, and Just Managing Today. Findings suggest that structural inequalities and siloed care contribute to the health of rooming house residents, including the balance between poverty and desire to maintain housing, and how residents cope with this stress. If health care providers want to help alleviate the disparities in rooming house residents' health, they need to broaden the lens through which health is conceptualized.
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3
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Flike K, Foust JB, Hayman LL, Aronowitz T. Homelessness and Vulnerably-Housed Defined: A Synthesis of the Literature. Nurs Sci Q 2022; 35:350-367. [PMID: 35762065 DOI: 10.1177/08943184221092445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is no single accepted definition used in policy or research for the concepts of homelessness and vulnerably housed. Neuman's systems model (NSM) was the framework for this mixed-studies review, with the client system defined as these social issues and categorized as environmental stressors. Eighteen unique definitions of the concepts were identified in 30 studies. Extrapersonal stressors included housing history, interpersonal stressors included dependence on others for housing, and intrapersonal stressors included self-identification. Each level of stressor should be considered when defining these populations for inclusion in future research. Proposed definitions were formulated from the analysis of the results.
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Affiliation(s)
- Kimberlee Flike
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Janice B Foust
- Robert and Donna Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Laura L Hayman
- Robert and Donna Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Teri Aronowitz
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA
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4
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Kaltsidis G, Grenier G, Cao Z, Bertrand K, Fleury MJ. Predictors of change in housing status over 12 months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:631-643. [PMID: 32985755 DOI: 10.1111/hsc.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/16/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
Homelessness is an ongoing societal and public health problem in Canada and other countries. Housing services help homeless individuals along the transition towards stable housing, yet few studies have assessed factors that predict change in individual housing trajectories. This study identified predictors of change in housing status over 12 months for a sample of 270 currently or formerly homeless individuals using emergency shelters, temporary housing (TH) or permanent housing (PH) resources in Quebec. Participants recruited from 27 community or public organisations were interviewed between January and September 2017, and again 12 months later. Sociodemographic variables, housing history, health conditions, service use and client satisfaction were measured. Directors and programme coordinators from the selected organisations also completed a baseline questionnaire measuring strictness in residential codes of living/conduct, interorganisational collaboration and overall budget. Independent variables were organised into predisposing, enabling and needs factors, based on the Gelberg-Andersen Behavioral Model. Multilevel logistic regressions were used to test associations with the dependent variable: change in housing status over 12 months, whether positive (e.g. shelter to TH) or negative (e.g. PH to shelter). Predictors of positive change in housing status were as follows: residing in PH, being female, having children (predisposing factors); having consulted a psychologist, higher frequency in use of public ambulatory services (enabling factors); and not having physical illnesses (needs factor). The findings support strategies for helping this clientele obtain and maintain stable housing. They include deploying case managers to promote access to public ambulatory services, mainly among men or individuals without children who are less likely to seek help; greater use of primary care mental health teams; the establishment of more suitable housing for accommodating physical health problems; and reinforcing access to subsidised PH programmes.
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Affiliation(s)
- Gesthika Kaltsidis
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Karine Bertrand
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Longueuil, QC, Canada
- Institut Universitaire sur les Dépendances, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
- Institut Universitaire sur les Dépendances, Montréal, QC, Canada
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Phipps M, Dalton L, Maxwell H, Cleary M. A qualitative exploration of women's resilience in the face of homelessness. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1212-1227. [PMID: 33855717 DOI: 10.1002/jcop.22574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study was to examine the experiential perspectives of women becoming and experiencing homelessness. Situated in the qualitative interpretative tradition, data were collected using auto-driven photo-elicitation and in-depth face-to-face interviews. Eleven Australian women used photographs that represented their experiences of being homeless to guide their interview discussion. The findings revealed that homelessness for women is a period often preceded by a series of adverse incidents in their lives, characterised by progressive resilience building in the face of trauma, finding hope and building strength to work towards exiting homelessness. After becoming homeless, five stages of resilience transition emerged: The trauma of homelessness, Finding hope and surviving, Finding help, Finding connection and Taking control. Women experiencing homelessness are resilient and capable of enacting competence and autonomy in seeking help to exit homelessness. Changes to service delivery are recommended to improve trauma-informed, person-centred housing and social services that are integrated and easy to navigate.
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Affiliation(s)
- Monique Phipps
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Lisa Dalton
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Hazel Maxwell
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Michelle Cleary
- School of Nursing, University of Tasmania, Sydney, New South Wales, Australia
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Gaboardi M, Santinello M, Shinn M. Beyond behaviour: rethinking integration for people experiencing homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:846-855. [PMID: 33560560 DOI: 10.1111/hsc.13314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
Integration is one of the main goals of homeless services. Despite the growing research on integration and homelessness, few studies start with the perspective of people experiencing homelessness. Integration is often measured as participation in a list of standard behaviours. This process assesses behaviour in accordance with social norms but ignores people's own feelings and understanding of integration. The main aim of this study is to explore the meaning of integration from the perspective of people experiencing homelessness. Data were collected through semi-structured interviews involving 26 people in homeless service programmes. Five main themes regarding the meanings of integration were generated: work, housing, respectful relationships, family and personal dignity. Moreover, two themes of obstacles and facilitators affecting integration were identified. A new conceptualisation of integration is generated that captures the participants' sense of personal dignity, respect and recognition from others and a sense of utility within their living environments (work, house and family). Implications of the results are discussed with respect to homeless services and research on homelessness.
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Affiliation(s)
- Marta Gaboardi
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Massimo Santinello
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
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Patterns and effects of social integration on housing stability, mental health and substance use outcomes among participants in a randomized controlled Housing First trial. Soc Sci Med 2020; 265:113481. [PMID: 33218893 DOI: 10.1016/j.socscimed.2020.113481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Recent research has shown that social integration, involving community integration and social support, can be protective resources for the health of homeless individuals. However, it is not clear how social integration affects health in the transition from homelessness into housing, and subsequent housing retention. This paper examines, through mixed quantitative and qualitative methods, how social integration changes over time, and how these changes relate to housing stability, substance use and mental health outcomes among a sample of homeless individuals experiencing mental illness participating in the At Home/Chez Soi Housing First randomized controlled trial in Canada. METHODS Longitudinal quantitative data (baseline, 6, 12, 24 month) and qualitative data ( 18 month) from the five trial sites (Moncton, Montreal, Toronto, Winnipeg and Vancouver) were examined using mixed models, mediation analyses, and thematic analysis. RESULTS Social integration (i.e., social network size, social interest, psychological integration) increased over time among study participants, with social network size increasing significantly more among Housing First participants than Treatment as Usual participants. Social network size mediated the effect of the intervention on the percentage of days in stable housing, indicating that the Housing First intervention may have increased participants' social network size, which in turn increased the percentage of days stably housed. No significant mediation of social integration on the effects of the intervention on mental health and substance use outcomes was found. Findings from the qualitative interviews support and expand upon these quantitative findings.
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Bassi A, Sylvestre J, Kerman N. Finding home: Community integration experiences of formerly homeless women with problematic substance use in Housing First. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:2375-2390. [PMID: 32779795 DOI: 10.1002/jcop.22423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
AIMS This study explored community integration among women participating in a Housing First program. Physical, social, and psychological dimensions of community integration were examined. METHODS This study used neighborhood walk-along and photo-elicitation interviews to explore 16 formerly homeless women's experiences of community integration. RESULTS Participants described limited community integration. Health, poverty, service inaccessibility, and safety concerns shaped how they took part in activities in their neighborhoods. Participants primarily socialized with people in their buildings, though some preferred to keep to themselves. There was minimal sense of neighborhood belonging, with participants not interested in belonging to a community and being judged by others. CONCLUSION Housing First promoted housing stability but did not contribute to community integration. Participants did not express a strong desire to integrate in their communities. Future research should consider the extent to which community integration remains a priority for marginalized populations, such as formerly homeless women.
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Affiliation(s)
- Amandeep Bassi
- Department of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nick Kerman
- University of Ottawa, Ottawa, Ontario, Canada
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9
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La Motte-Kerr W, Rhoades H, Henwood B, Rice E, Wenzel S. Exploring the Association of Community Integration in Mental Health among Formerly Homeless Individuals Living in Permanent Supportive Housing. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:3-13. [PMID: 32853418 DOI: 10.1002/ajcp.12459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Supportive housing has been widely used among persons experiencing chronic homelessness and/or mental health conditions. While it has been demonstrated to be effective in addressing homelessness among populations with complex needs, community integration remains a challenge. Community integration is the extent to which individuals live, participate, and socialize in their community and consists of three aspects: physical, social, and psychological. The study utilized data from the Transitions to Housing project that followed formerly homeless individuals (N = 383) throughout their first year of residence in permanent supportive housing (PSH). The study set out to examine which aspects of community integration are associated with mental health symptoms in this population. Five nested multivariate linear regression models were conducted and then compared. The model that accounted for demographics, substance use, neighborhood quality, and all three aspects of community integration simultaneously was the best fit and explained the most variance in mental health symptoms (24%). The complete model suggested higher levels of psychological integration were significantly associated with decreased mental health symptoms in this sample. This finding suggests fostering a sense of belonging among PSH residents could improve mental health outcomes. Implications for practice and future research are discussed.
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Affiliation(s)
- Wichada La Motte-Kerr
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Harris T, Rhoades H, Duan L, Wenzel SL. Mental health change in the transition to permanent supportive housing: The role of housing and social networks. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1834-1849. [PMID: 31421655 DOI: 10.1002/jcop.22230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Abstract
AIMS Permanent Supportive Housing (PSH) may improve homeless adults' mental health via housing stabilization and/or improved relational factors, however, the role of housing and social networks on PSH residents' mental health change is minimally understood. METHODS Interviews were conducted with a baseline sample of adults experiencing homelessness ( N = 421), across their initial year in PSH (3-months, 6-months, and 12-months). Generalized linear mixed models assessed changes in positive past-month psychiatric disability screenings (Modified-Colorado Symptom Index [MCSI]) and probable posttraumatic stress disorder (PC-PTSD) in controlled models, and between and within-subject effects of time-varying social network correlates on mental health changes. RESULTS Compared with baseline, positive MCSI screens continuously decreased over time (56%, 54%, and 50%) while PC-PTSD screens declined initially (40%) with marginal decreases at remaining follow-ups (39% and 38%). These differences remained significant in controlled models. Gaining a romantic partner was associated with a longitudinal increase in a positive MCSI screening. Between subjects, emotional health counselors and conflicting network members were associated with an increased likelihood in positive screenings, while doctors and case managers were protective. CONCLUSION Housing may facilitate positive changes in PSH residents' mental health, yet positive screenings remain high. Social network interventions that increase residents' positive interpersonal exchanges and prosocial relationships are warranted.
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Affiliation(s)
- Taylor Harris
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Lei Duan
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Suzanne L Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
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Wong YLI, Huangfu Y, Hadley T. Place and community inclusion: Locational patterns of supportive housing for people with intellectual disability and people with psychiatric disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 83:108-119. [PMID: 30193159 DOI: 10.1016/j.ridd.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/05/2018] [Accepted: 08/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE This study examines the locational patterns of publicly-funded supportive housing for people with intellectual disability (people with ID) and people with psychiatric disorders (people with PD). METHODS Administrative data provided housing locations of 4599 people with ID and people with PD in one urban county and one suburban county in the United States. Census tract data captured neighborhood characteristics. Descriptive statistics and spatial analysis were used to analyze the distribution of supportive housing sites. RESULTS People with ID were more dispersed across a larger number of census tracts with smaller number of residents per tract than people with PD. While spatial dispersion in favor of people with ID was consistent across both counties, difference in dispersion was more pronounced in the urban county. People with PD were concentrated in neighborhoods with more socio-economic disadvantage, more residential instability, and a higher level of race/ethnic diversity than people with ID. CONCLUSION This study suggests that spatial-analytic method can serve as a useful tool for assessing the extent to which integrated housing is achieved for people with ID and people with PD. Interpretation of findings should be given due consideration of the policy context and neighborhood characteristics of the study communities.
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Affiliation(s)
- Yin-Ling Irene Wong
- School of Social Policy & Practice, University of Pennsylvania 3701 Locust Walk, Philadelphia, PA 19104-6214, USA.
| | - Yiyue Huangfu
- Department of Sociology, University of Wisconsin-Madison 1180 Observatory Drive, Madison, WI 53706-1393, USA.
| | - Trevor Hadley
- Center for Mental Health Policy and Services Research, University of Pennsylvania 3535 Market Street, 3/F, Philadelphia, PA 19104, USA.
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Henwood BF, Lahey J, Harris T, Rhoades H, Wenzel SL. Understanding Risk Environments in Permanent Supportive Housing for Formerly Homeless Adults. QUALITATIVE HEALTH RESEARCH 2018; 28:2011-2019. [PMID: 29972082 PMCID: PMC6277023 DOI: 10.1177/1049732318785355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In this study, we used ethnographic methods and a risk environment framework to consider how contextual factors produce or reduce risk for substance use with a sample of 27 adults who recently moved into permanent supportive housing (PSH). Most apparent was how the social and physical environments interacted, because most participants focused on how having an apartment had dramatically changed their lives and how they interact with others. Specific themes that emerged that also involved economic and policy environments included the following: isolation versus social engagement; becoming one's own caseworker; and engaging in identity work. This study underscores the scarcity yet importance of research that examines the multiple types of environment in which PSH is situated, and suggests that a better understanding of how these environments interact to produce or reduce risk is needed to develop optimal interventions and support services.
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Affiliation(s)
| | - John Lahey
- 1 University of Southern California, Los Angeles, California, USA
| | - Taylor Harris
- 1 University of Southern California, Los Angeles, California, USA
| | - Harmony Rhoades
- 1 University of Southern California, Los Angeles, California, USA
| | - Suzanne L Wenzel
- 1 University of Southern California, Los Angeles, California, USA
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Wenzel S, Rhoades H, Moore H, Lahey J, Henwood B, La Motte-Kerr W, Bird M. Life Goals Over Time Among Homeless Adults in Permanent Supportive Housing. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:421-432. [PMID: 29537648 PMCID: PMC6217826 DOI: 10.1002/ajcp.12237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Permanent supportive housing (PSH) is a widely-accepted solution to the challenge of chronic homelessness. While housing support and retention, physical health, and healthcare continue to be important for formerly homeless persons in PSH, "higher-order" and humanistic needs such as thriving have received less attention and as a result are less well understood in this population. One important indicator of thriving is the ability to establish and articulate life goals. This study utilizes longitudinal data from 421 formerly homeless adults prior to their move into PSH, and at 3-, 6- and 12-months after move-in (369 respondents completed all four interviews), to examine what life goals are articulated by this population and how those goals change over time. Prior to housing, most respondents articulated housing attainment as their primary life goal, whereas at follow-up interviews health goals, housing relocation, and financial goals became more prevalent. Aspirational goals (e.g., independence, self-improvement, artistic pursuits) were also common, but demonstrated a decrease over time in housing. Relationship goals remained common and consistent over time. Findings indicate that housing is a necessary, but perhaps not sufficient, step for improving thriving among formerly homeless adults. Implications for practice and future research are discussed.
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Affiliation(s)
- S.L. Wenzel
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - H. Rhoades
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - H. Moore
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - J. Lahey
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - B. Henwood
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - W. La Motte-Kerr
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - M. Bird
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
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14
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O'Connell M, Sint K, Rosenheck R. How do Housing Subsidies Improve Quality of Life Among Homeless Adults? A Mediation Analysis. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:433-444. [PMID: 29493811 DOI: 10.1002/ajcp.12229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Supported housing, combining rent subsidies with intensive case management, is associated with improvements in quality of life of homeless adults, but factors mediating their impact on quality of life have not been studied. Twelve-month outcome data from a randomized trial of the Housing and Urban Development- Veterans Affairs Supported Housing program (HUD-VASH) showed that access to a housing rent subsidy plus intensive case management (ICM) was associated with greater improvement in subjective quality of life than ICM alone. Multiple mediation analyses were applied to identify variables that significantly mediated the relationship between receipt of housing voucher and improvements in quality of life. Significant mediating covariates were those whose 95% bias-corrected confidence intervals, when added to the model predicting improvement in quality of life, did not overlap zero. Increases in the number of days housed, size of social network, and availability of emotional support appear to mediate improvement in quality of life and account for 71% of the benefit attributable to having a rent subsidy. Improvement in subjective quality of life though housing subsidies is mediated by gains in both material and psychosocial factors. Mediating factors deserve special attention in supported housing services.
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Affiliation(s)
- Maria O'Connell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kyaw Sint
- School of Public Health, Yale University, New Haven, CT, USA
- Department of Veterans Affairs, New England Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, CT, USA
| | - Robert Rosenheck
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- School of Public Health, Yale University, New Haven, CT, USA
- Department of Veterans Affairs, New England Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, CT, USA
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15
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Sylvestre J, Klodawsky F, Gogosis E, Ecker J, Polillo A, Czechowski K, Agha A, Shankar S, To M, Gadermann A, Palepu A, Hwang S. Perceptions of Housing and Shelter among People with Histories of Unstable Housing in three Cities in Canada: A Qualitative Study. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:445-458. [PMID: 29577343 DOI: 10.1002/ajcp.12243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Housing is a key social determinant of health that contributes to the well-documented relationship between socioeconomic status and health. This study explored how individuals with histories of unstable and precarious housing perceive their housing or shelter situations, and the impact of these settings on their health and well-being. Participants were recruited from the Health and Housing in Transition study (HHiT), a longitudinal, multi-city study that tracked the health and housing status of people with unstable housing histories over a 5-year period. For the current study, one-time semi-structured interviews were conducted with a subset of HHiT study participants (n = 64), living in three cities across Canada: Ottawa, Toronto, and Vancouver. The findings from an analysis of the interview transcripts suggested that for many individuals changes in housing status are not associated with significant changes in health due to the poor quality and precarious nature of the housing that was obtained. Whether housed or living in shelters, participants continued to face barriers of poverty, social marginalization, inadequate and unaffordable housing, violence, and lack of access to services to meet their personal needs.
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Affiliation(s)
- John Sylvestre
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Fran Klodawsky
- Department of Geography and Environmental Studies, Faculty of Arts and Social Sciences, Carleton University, Ottawa, ON, Canada
| | - Evie Gogosis
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - John Ecker
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- Canadian Observatory on Homelessness, York University, Toronto, ON, Canada
| | - Alexia Polillo
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Konrad Czechowski
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ayda Agha
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Sneha Shankar
- Department of Education and Counselling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | - Matthew To
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephen Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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16
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Brown M, Chodzen G, Mihelicova M, Collins K. Applying a Time-Patterned Typology of Homelessness Among Individuals with Mental Illness. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 59:306-315. [PMID: 28471489 DOI: 10.1002/ajcp.12140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Identification of subgroups of the homeless populations, or typologies, has been an important research priority to guide homelessness services and policies. This study builds on previous typological research conducted in the general homeless population by focusing on individuals with mental illness to further delineate typologies within a more homogenous subset of the homeless population. A time-patterned typology based on episodes of street and shelter homelessness over a four-year period was applied to a sample of 246 individuals identified through mental health administrative records. Four groups were created based upon patterns of homelessness: 26.8% experienced homelessness for 4 years, 13.4% had one episode of homelessness but were no longer homeless at the end of the follow-up, 48.4% had at least two episodes of homelessness, and 11.4% had a single episode of homelessness lasting 3 months or less. Findings from a multinomial logistic regression indicated that gender, presence of a psychotic disorder, substance abuse, and year of study enrollment significantly predicted group membership. Residential trajectories upon exit from homelessness and at the end of the four-year follow-up were examined. Implications for current policy and future research are discussed.
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Affiliation(s)
- Molly Brown
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Gia Chodzen
- Department of Psychology, DePaul University, Chicago, IL, USA
| | | | - Kelly Collins
- Department of Psychology, DePaul University, Chicago, IL, USA
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