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Kerman N, Kidd SA, Mutschler C, Sylvestre J, Henwood BF, Oudshoorn A, Marshall CA, Aubry T, Stergiopoulos V. Managing high-risk behaviours and challenges to prevent housing loss in permanent supportive housing: a rapid review. Harm Reduct J 2023; 20:140. [PMID: 37775776 PMCID: PMC10542260 DOI: 10.1186/s12954-023-00873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023] Open
Abstract
Permanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the relationship between high-risk issues and housing stability in permanent supportive housing has not been previously synthesized. This rapid review aimed to identify the housing-related outcomes of high-risk behaviours and challenges in permanent supportive housing settings, as well as the approaches used by agencies and residents to address them. A range of high-risk behaviours and challenges were examined, including risks to self (overdose, suicide/suicide attempts, non-suicidal self-injury, falls/fall-related injuries), and risks to multiple parties and/or building (fire-setting/arson, hoarding, apartment takeovers, physical/sexual violence, property damage, drug selling, sex trafficking). The search strategy included four components to identify relevant academic and grey literature: (1) searches of MEDLINE, APA PsycINFO, and CINAHL Plus; (2) hand searches of three journals with aims specific to housing and homelessness; (3) website browsing/searching of seven homelessness, supportive housing, and mental health agencies and networks; and (4) Advanced Google searches. A total of 32 articles were eligible and included in the review. Six studies examined the impacts of high-risk behaviours and challenges on housing tenancies, with overdose being identified as a notable cause of death. Twenty-six studies examined approaches and barriers to managing high-risk behaviours and challenges in PSH programs. These were categorized into eight types of approaches: (1) clinical, (2) relational/educational, (3) surveillant, (4) restrictive, (5) strategic, (6) design-based, (7) legal, and (8) self-defence. Consistent across all approaches was a lack of rigorous examination of their effectiveness. Further, some approaches that are legal, restrictive, surveillant, or strategic in nature may be used to promote safety, but may conflict with other program objectives, including housing stability, or resident empowerment and choice. Research priorities were identified to address the key evidence gaps and move toward best practices for preventing and managing high-risk behaviours and challenges in permanent supportive housing.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - John Sylvestre
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | | | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Forchuk C, Gyamfi S, Hassan H, Lucyk B, Booth R. Homeowner perspectives on the implementation of the Community Homes for Opportunity (CHO) program: an ethnographic group homes study in Southwestern Ontario Canada. BMC Public Health 2023; 23:585. [PMID: 36991379 PMCID: PMC10053089 DOI: 10.1186/s12889-023-15512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The global extant literature acknowledge that housing serves as a key social determinant of health. Housing interventions that involve group homes have been found to support the recovery of persons with mental illness and those with addiction issues. The current study explored the views of homeowners in relation to a supportive housing program called Community Homes for Opportunity (CHO) that modernised a provincial group home program (Homes for Special Care [HSC]) and provided recommendations for improving the program implementation in other geographical areas of Ontario. METHODS We applied ethnographic qualitative techniques to purposefully recruit 36 homeowner participants from 28 group homes in Southwest Ontario, Ontario Canada. Focus group discussions were conducted at two time points, during CHO program implementation (Fall 2018, and post implementation phases (Winter 2019) respectively. RESULTS Data analysis yielded 5 major themes. These include: (1) general impressions about the modernization process, (2) perceived social, economic and health outcomes, (3) enablers of the modernization program, (4) challenges to implementation of the modernization program, and (5) suggestions for implementation of the CHO in future. CONCLUSIONS A more effective and expanded CHO program will need the effective collaboration of all stakeholders including homeowners for successful implementation.
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Affiliation(s)
- Cheryl Forchuk
- Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery, Lawson Health Research Institute, Arthur Labatt School of Nursing, Western University London, Parkwood Institute Mental Health Care Building, 550 Wellington Road, Suite B3-110, P.O. Box 5777, London, STN B, N6A 4V2, Canada.
| | - Sebastian Gyamfi
- Lawson Health Research Institute, Arthur Labatt School of Nursing, Parkwood Research Institute, Western University, London, Canada
| | - Heba Hassan
- Lawson Health Research Institute, Parkwood Research Institute, London, ON, Canada
| | - Bryanna Lucyk
- Lawson Health Research Institute, Parkwood Research Institute, London, ON, Canada
| | - Richard Booth
- Lawson Health Research Institute, Arthur Labatt School of Nursing, Western University, London, Canada
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Kerman N, Polillo A, Bardwell G, Gran-Ruaz S, Savage C, Felteau C, Tsemberis S. Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review. Drug Alcohol Depend 2021; 228:109052. [PMID: 34601279 DOI: 10.1016/j.drugalcdep.2021.109052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Harm reduction is a central tenet of Housing First. As the intervention has been shown to stably house people experiencing chronic homelessness across the lifespan with complex behavioural health needs, it is critical to understand the harm reduction outcomes and practices in Housing First. METHODS A systematic review following PRISMA guidelines was conducted of five databases: PsycINFO, MEDLINE, Embase, CINAHL, and Google Scholar. Harm reduction outcomes and practices in Housing First were examined in four domains: substance-related harms, viral health, sexual health, and harm reduction service use. RESULTS A total of 35 articles were included in the review, 23 of which examined harm reduction outcomes and 12 of which investigated harm reduction practices in Housing First. Harm reduction outcome studies focused mostly on nonspecific substance use problems, with Housing First being found to have minimal effects in this domain. More severe harms, such as delirium tremens and substance use-related deaths, have been minimally explored, though preliminary evidence is promising. Viral health, sexual health, and harm reduction service use outcomes were the focus of few studies. Research on harm reduction practices highlighted that Housing First providers experience both flexibility and ambiguity in their work using a harm reduction approach, and the importance of empathetic working relationships for engagement in harm reduction work. CONCLUSIONS Harm reduction outcomes in Housing First remain underexamined and any conclusions of the intervention's impacts in this domain would be premature. Effective harm reduction practices in Housing First require strong working relationships between staff and tenants.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada; University of British Columbia, Department of Medicine, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Sophia Gran-Ruaz
- University of Ottawa, School of Psychology, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada
| | - Cathi Savage
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Charlie Felteau
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Sam Tsemberis
- Pathways Housing First Institute, 1328 2nd Street, Santa Monica, CA, 90403, United States
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Tiderington E, Bosk E, Mendez A. Negotiating child protection mandates in Housing First for families. CHILD ABUSE & NEGLECT 2021; 115:105014. [PMID: 33662884 DOI: 10.1016/j.chiabu.2021.105014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Housing First (HF) is an evidence-based service model that combines permanent housing and supportive case management premised on harm reduction and consumer self-determination to end homelessness for high-need individuals. Originally developed for use with single adults, this model is now being employed with families. Yet there is little empirical work on how HF is implemented with this particular population. OBJECTIVE The aim of this study is to examine how frontline providers adapt and apply HF to formerly homeless or at-risk, families involved in child welfare. PARTICIPANTS AND SETTING Frontline providers working in family HF programs (N = 59) were recruited from two states, across 11 organizations, and 16 program sites. The theoretical sample (n = 26) includes 13 participants working in programs that encouraged direct collaboration with Child Protective Services (CPS) in the program model and 13 participants from three non-CPS-aligned sites in a second state. METHODS A grounded theory approach was used to analyze semi-structured, qualitative interviews. RESULTS Frontline providers exercised street-level bureaucratic discretion when interpreting child protection reporting mandates and they found ways to adapt the HF model to this population. In doing so, they worked to juggle both their mandates to child protection and to principles of HF to create a "child safety-modified" form of HF. CONCLUSIONS While our study shows that providers are modifying HF to address the needs of families involved in child welfare, it also raises questions as to the degree to which HF can be done with high fidelity when used with this population.
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Affiliation(s)
- Emmy Tiderington
- School of Social Work, Rutgers University, The State University of New Jersey, New Brunswick, NJ, USA.
| | - Emily Bosk
- School of Social Work, Rutgers University, The State University of New Jersey, New Brunswick, NJ, USA
| | - Alicia Mendez
- School of Social Work, Rutgers University, The State University of New Jersey, New Brunswick, NJ, USA
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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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Choy-Brown M, Tiderington E, Tran Smith B, Padgett DK, Stefancic A. Strategies for Sustaining Fidelity: A Multi-state Qualitative Analysis in Housing First Programs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:36-45. [PMID: 32323216 DOI: 10.1007/s10488-020-01041-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Little is known about long-term fidelity of evidence-based interventions (EBIs) under changing conditions. This study examines how staff at 'mature' (eight or more years in operation) Housing First (HF) programs strategize to sustain EBI fit in different geographic areas in the Mid-Atlantic/Northeastern United States. Six focus groups (FGs) at three purposively selected HF programs were conducted with separate FGs for case managers and supervisors at each site. FG discussions elicited participants' service approaches and strategies in addressing fidelity amidst ongoing changes affecting each program. Thematic content analysis of FG transcripts was conducted using the five HF fidelity domains (housing choice/structure, separation of housing and services, service philosophy, service array, and program structure) as a priori themes with inductive content analyses conducted on data in each theme. Strategies for rigor were employed. Case managers (N = 17) and supervisors (N = 16) were predominantly white (76%) and female (60%). Across the themes, challenges included lack of affordable housing and choice, funders' restrictions and practice 'drift.' Strategies included community engagement and hiring, strong leadership and 'bending the rules.' There were no differences across sites. Later-stage implementation challenges show the need for continued vigilance in fidelity to EBIs. Among the strategies used to address fidelity in this study, the pursuit of pro-active community engagement to attract knowledgeable staff as well as increase local buy-in was considered pivotal at all three sites. These findings underscore the need to attend to the external setting as well as to internal program operations.
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Affiliation(s)
- Mimi Choy-Brown
- University of Minnesota, 1404 Gortner Avenue, St. Paul, MN, 55108, USA.
| | - Emmy Tiderington
- Rutgers University, 360 Martin Luther King Jr. Boulevard, Newark, NJ, 07102, USA
| | - Bikki Tran Smith
- University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA
| | - Deborah K Padgett
- New York University, 1 Washington Square North, New York, NY, 10011, USA
| | - Ana Stefancic
- Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
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Tiderington E. "I achieved being an adult": A Qualitative Exploration of Voluntary Transitions from Permanent Supportive Housing. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:9-22. [PMID: 32232704 DOI: 10.1007/s10488-020-01036-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined how individuals voluntarily leaving permanent supportive housing (PSH) through a Moving On initiative experienced the transition from PSH services to mainstream housing. Participants (N = 25) were purposively sampled from five supportive housing agencies in a Moving On initiative. A modified grounded theory approach was used to analyze semi-structured, post-move interviews. Participants described the transition from PSH as a process that involved gaining freedom from negative aspects of the PSH environment and a stagnation in services, adjusting to a new environment and the loss of familiar supports, taking on new responsibilities of self-advocacy and managing new financial burdens, and feeling empowered to move on to next steps, which ultimately, led to achievement of independence. Various contextual conditions, including PSH- and postmove housing type, influenced participants' experience of this process. Findings can inform future Moving On initiatives, implementation of PSH programs, as well as the design of the larger homeless service system.
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Affiliation(s)
- Emmy Tiderington
- Rutgers School of Social Work, The State University of New Jersey, 360 Dr. Martin Luther King Blvd., Hill Hall, Suite 401C, Newark, NJ, 07102-1801, USA.
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Harm reduction in a Norwegian housing first project: a qualitative study of the treatment providers’ practice. ADVANCES IN DUAL DIAGNOSIS 2018. [DOI: 10.1108/add-08-2017-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Little is known about how harm reduction is practiced in Norwegian housing first (HF) projects. The purpose of this paper is to explore, describe, and interpret how providers apply a harm reduction approach within a housing project focused on individuals who are homeless with co-morbid substance use and mental health problems.
Design/methodology/approach
This qualitative study was part of a larger evaluation study of a three-year HF project in a Norwegian municipality. Data were collected using four multi-stage focus groups with five providers working in the HF project. Focus group interviews were transcribed verbatim and analyzed using thematic analysis.
Findings
Analysis resulted in three main themes: “Letting the service user sit in the driver’s seat,” “We don’t follow service provision contracts, we do everything,” and “Collaborating with the local community.”
Research limitations/implications
There is a need to develop increased knowledge about service users’ experiences within the harm reduction approach.
Practical implications
To practice effective harm reduction, treatment providers must have open authorizations and the opportunity to exercise professional judgment. Harm reduction practice must also focus on social, political, and economic factors influencing users’ everyday lives.
Originality/value
The paper contributes to the knowledge base on harm reduction within HF practice that differs from a traditional model wherein clients are expected to abstain from substance use. It highlights important preconditions for challenges practitioners might encounter at both individual and service system levels.
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