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O'Shaughnessy BR, Mayock P, Kakar A. The recovery experiences of homeless service users with substance use disorder: A systematic review and qualitative meta-synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104528. [PMID: 39053034 DOI: 10.1016/j.drugpo.2024.104528] [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: 04/25/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The relationship between homelessness and substance use disorder (SUD) is layered and complex. Adults pursuing recovery while dealing with homelessness and SUD face many challenges. Little research has inspected qualitative first-person accounts of recovery in the context of homelessness and SUD, and few studies have employed conceptualisations of recovery beyond abstinence. In this systematic review study, we examine the qualitative literature on the recovery experiences of adult homeless service users with SUD. METHODS 2,042 records were identified via database and secondary searching strategy. After title and abstract and full text screening, 15 eligible studies remained. Critical Appraisal Skills Programme quality appraisal criteria was used to assess potential bias in the studies. Meta-ethnography was employed to synthesise extracted data. RESULTS Four themes were generated from the extracted data: Two sides of the Service Coin; Navigating Relationships; Recovery Practices and Personal Attributes; and Housing as Foundational for Recovery. CONCLUSION Unconditional housing, a broad array of supports, opportunities to contribute to society, and family reunification supports all facilitate the development of recovery for adults with SUD experiencing homelessness. Implications for policy are discussed.
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Affiliation(s)
- Branagh R O'Shaughnessy
- School of Social Work and Social Policy, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, College Green, Dublin 2, Ireland
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Miler JA, Foster R, Hnizdilova K, Murdoch H, Parkes T. ‘It maybe doesn’t seem much, but to me it’s my kingdom’: staff and client experiences of Housing First in Scotland. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2021.1926429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Joanna Astrid Miler
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Kristina Hnizdilova
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Helen Murdoch
- Homelessness Services, The Salvation Army, Glasgow, UK
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
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Parpouchi M, Moniruzzaman A, Somers JM. The association between experiencing homelessness in childhood or youth and adult housing stability in Housing First. BMC Psychiatry 2021; 21:138. [PMID: 33685434 PMCID: PMC7938606 DOI: 10.1186/s12888-021-03142-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Researchers have pointed out the paucity of research investigating long-term consequences of experiencing homelessness in childhood or youth. Limited research has indicated that the experience of homelessness in childhood or youth is associated with adverse adjustment-related consequences in adulthood. Housing First (HF) has acknowledged effectiveness in improving housing outcomes among adults experiencing homelessness and living with serious mental illness, although some HF clients struggle with maintaining housing. The current study was conducted to examine whether the experience of homelessness in childhood or youth increases the odds of poorer housing stability following entry into high-fidelity HF among adults experiencing serious mental illness and who were formerly homeless. METHODS Data were drawn from the active intervention arms of a HF randomized controlled trial in Metro Vancouver, Canada. Participants (n = 297) were referred to the study from service agencies serving adults experiencing homelessness and mental illness between October 2009 and June 2011. The Residential Time-Line Follow-Back Inventory was used to measure housing stability. Least absolute shrinkage and selection operator was used to estimate the association between first experiencing homelessness in childhood or youth and later housing stability as an adult in HF. RESULTS Analyses indicated that homelessness in childhood or youth was negatively associated with experiencing housing stability as an adult in HF (aOR = 0.53; 95% CI = 0.31-0.90). CONCLUSIONS Further supports are needed within HF to increase housing stability among adult clients who have experienced homelessness in childhood or youth. Asking clients about the age they first experienced homelessness may be of clinical utility upon enrollment in HF and may help identify support needs related to developmental experiences. Results further emphasize the importance of intervening earlier in life in childhood and youth before experiencing homelessness or before it becomes chronic. Findings also contribute to a limited knowledge base regarding the adverse long-term consequences of childhood and youth homelessness. TRIAL REGISTRATION Current Controlled Trials: ISRCTN57595077 and ISRCTN66721740 . Registered on October 9, 2012.
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Affiliation(s)
- Milad Parpouchi
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Julian M Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
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The roles of housing, financial, and food insecurities in understanding the relationship between childhood neglect and violence in adulthood. PLoS One 2021; 16:e0246682. [PMID: 33657121 PMCID: PMC7928485 DOI: 10.1371/journal.pone.0246682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/23/2021] [Indexed: 11/19/2022] Open
Abstract
The aim of this study is to determine whether basic housing, financial, and food insecurities in part explain the relationship between childhood neglect and violence as documented in the “cycle of violence” literature. Using a prospective cohort design, neglected children (under the age of 12) with court substantiated histories (1967–1971) in one metropolitan Midwest area and demographically matched non-neglected children were followed into adulthood. Housing, financial, and food insecurities were assessed in 2003–2005 interviews at mean age 41. Official arrest data were used to measure violence ever and from 2003 through 2013. Mediation was tested using probit structural equation modeling. Controlling for age, sex, and race, childhood neglect predicted violent arrests and housing, financial, and food insecurities in middle adulthood. Housing and financial securities predicted violent arrests ever and after 2003, whereas food insecurity only predicted any violent arrest ever. Housing and financial insecurities partially mediated the relationship between childhood neglect and violent criminal behavior. Greater attention and efforts need to focus on providing basic housing, financial, and food support for neglected children to reduce their risk for violent criminal behavior.
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Lenzi M, Santinello M, Gaboardi M, Disperati F, Vieno A, Calcagnì A, Greenwood RM, Rogowska AM, Wolf JR, Loubière S, Beijer U, Bernad R, Vargas-Moniz MJ, Ornelas J, Spinnewijn F, Shinn M. Factors Associated with Providers' Work Engagement and Burnout in Homeless Services: A Cross-national Study. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:220-236. [PMID: 33137234 DOI: 10.1002/ajcp.12470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The complexity of homeless service users' characteristics and the contextual challenges faced by services can make the experience of working with people in homelessness stressful and can put providers' well-being at risk. In the current study, we investigated the association between service characteristics (i.e., the availability of training and supervision and the capability-fostering approach) and social service providers' work engagement and burnout. The study involved 497 social service providers working in homeless services in eight different European countries (62% women; mean age = 40.73, SD = 10.45) and was part of the Horizon 2020 European study "Homelessness as Unfairness (HOME_EU)." Using hierarchical linear modeling (HLM), findings showed that the availability of training and supervision were positively associated with providers' work engagement and negatively associated with burnout. However, results varied based on the perceived usefulness of the training and supervision provided within the service and the specific outcome considered. The most consistent finding was the association between the degree to which a service promotes users' capabilities and all the aspects of providers' well-being analyzed. Results are discussed in relation to their implications for how configuration of homeless services can promote social service providers' well-being and high-quality care.
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Affiliation(s)
- Michela Lenzi
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Massimo Santinello
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Marta Gaboardi
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Francesca Disperati
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Alessio Vieno
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Antonio Calcagnì
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | | | | | - Judith R Wolf
- Impuls-Netherlands Center for Social Care Research, Radboud Institute for Health Sciences, Radboud, The Netherlands
- University Medical Center, Nijmegen, The Netherlands
| | - Sandrine Loubière
- School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Aix-Marseille University, Marseille, France
- Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Ulla Beijer
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Maria J Vargas-Moniz
- APPsyCI-Applied Psychology Research Center Capabilities and Inclusion, ISPA-Instituto Universitário, Lisboa, Portugal
| | - José Ornelas
- APPsyCI-Applied Psychology Research Center Capabilities and Inclusion, ISPA-Instituto Universitário, Lisboa, Portugal
| | - Freek Spinnewijn
- FEANTSA, European Federation of National Organisations Working with the Homeless, Bruxelles, Belgique
| | - Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
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O'Shaughnessy BR, Greenwood RM. Autonomy and authority: Homeless service users' empowering experiences in housing first and staircase services. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Greenwood RM, Manning RM, O'Shaughnessy BR, Vargas-Moniz MJ, Loubière S, Spinnewijn F, Lenzi M, Wolf JR, Bokszczanin A, Bernad R, Källmén H, Ornelas J. Homeless Adults' Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 65:353-368. [PMID: 31793001 DOI: 10.1002/ajcp.12404] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed.
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Affiliation(s)
| | - Rachel M Manning
- Department of Psychology, University of Limerick, Limerick, Ireland
| | | | - Maria J Vargas-Moniz
- APPsyCI - Applied Psychology Research Center Capabilities and Inclusion, ISPA-Instituto Universitário, Lisboa, Portugal
| | - Sandrine Loubière
- Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Freek Spinnewijn
- FEANTSA, European Federation of National Organisations Working with the Homeless, Bruxelles, Belgique
| | - Michela Lenzi
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Judith R Wolf
- Impuls - Netherlands Center for Social Care Research, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | | | - Håkan Källmén
- STAD, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - José Ornelas
- APPsyCI - Applied Psychology Research Center Capabilities and Inclusion, ISPA-Instituto Universitário, Lisboa, Portugal
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Greenwood RM, Manning RM, O'Shaughnessy BR, Cross O, Vargas-Moniz MJ, Auquier P, Santinello M, Wolf JR, Bokszczanin A, Bernad R, Källmén H, Spinnewijn F, Ornelas J. Comparison of Housing First and Traditional Homeless Service Users in Eight European Countries: Protocol for a Mixed Methods, Multi-Site Study. JMIR Res Protoc 2020; 9:e14584. [PMID: 32022696 PMCID: PMC7055843 DOI: 10.2196/14584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Homeless services expend considerable resources to provide for service users' most basic needs, such as food and shelter, but their track record for ending homelessness is disappointing. An alternative model, Housing First, reversed the order of services so that homeless individuals are offered immediate access to independent housing, with wraparound supports but no treatment or abstinence requirements. Although the evidence base for Housing First's effectiveness in ending homelessness is robust, less is known about its effectiveness in promoting recovery. OBJECTIVE The objective of this research is to compare rehabilitation- and recovery-related outcomes of homeless services users who are engaged in either Housing First or traditional staircase services in eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden. METHODS A mixed methods, multi-site investigation of Housing First and traditional services will compare quantitative outcomes at two time points. Key rehabilitation outcomes include stable housing and psychiatric symptoms. Key growth outcomes include community integration and acquired capabilities. Semistructured interviews will be used to examine service users' experiences of environmental constraints and affordances on acquired capabilities to identify features of homeless services that enhance service users' capabilities sets. Multi-level modelling will be used to test for group differences-Housing First versus traditional services-on key outcome variables. Thematic analysis will be used to understand the ways in which service users make sense of internal and external affordances and constraints on capabilities. RESULTS The study is registered with the European Commission (registration number: H2020-SC6-REVINEQUAL-2016/ GA726997). Two press releases, a research report to the funding body, two peer-reviewed articles, and an e-book chapter are planned for dissemination of the final results. The project was funded from September 2016 through September 2019. Expected results will be disseminated in 2019 and 2020. CONCLUSIONS We will use the findings from this research to formulate recommendations for European social policy on the configuration of homeless services and the scaling up and scaling out of Housing First programs. From our findings, we will draw conclusions about the setting features that promote individuals' exits from homelessness, rehabilitation, and recovery. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/14584.
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Affiliation(s)
| | - Rachel M Manning
- Psychology Department, University of Limerick, Limerick, Ireland
| | | | - Oisin Cross
- Psychology Department, University of Limerick, Limerick, Ireland
| | - Maria J Vargas-Moniz
- Applied Psychology Research Center Capabilities and Inclusion, Instituto Superior de Psicologia Aplicada, Instituto Universitário, Lisbon, Portugal
| | - Pascal Auquier
- Centre d'Études et de Recherche sur les Services de Santé et la Qualité de Vie, La Timone Medical Campus, School of Medicine, Aix-Marseille University, Marseille, France
| | - Massimo Santinello
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Judith R Wolf
- Impuls - Netherlands Center for Social Care Research, Radboud Institute for Health Science, Nijmegen, Netherlands
| | | | - Roberto Bernad
- Red de Apoyo a la Integración Sociolaboral Fundacion, Madrid, Spain
| | - Håkan Källmén
- Stockholm Prevents Alcohol and Drug Problems, Stockholm Center for Psychiatry Research and Education, Karolinska Institute, Stockholm, Sweden
| | - Frederik Spinnewijn
- European Federation of National Organisations Working with the Homeless, Brussels, Belgium
| | - José Ornelas
- Applied Psychology Research Center Capabilities and Inclusion, Instituto Superior de Psicologia Aplicada, Instituto Universitário, Lisbon, Portugal
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- see Authors' Contributions,
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9
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Manning RM, Greenwood RM. Understanding Innovation in Homeless Service Provision: A Study of Frontline Providers' Values-Readiness for Change. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:649-659. [PMID: 31190168 DOI: 10.1007/s10488-019-00943-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Service innovation for adults experiencing mental illness and homelessness typically involves shifting from treatment-led, staircase models toward recovery-oriented, Housing-First models. Aligning frontline service providers' values to those embedded within newer models is an important, but under-investigated, influence on the innovation process. To assess values alignment in this context, we conducted semi-structured qualitative interviews with frontline providers in staircase services in Ireland (n = 50). Data showed that, while their values mostly aligned to the treatment-led model, there was meaningful evidence of more recovery-oriented values, too. Strategies to enhance innovation through values-alignment are discussed.
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Affiliation(s)
- Rachel M Manning
- Department of Psychology, University of Limerick, Room E1-017d, Castletroy, Co Limerick, Ireland.
| | - Ronni Michelle Greenwood
- Department of Psychology, University of Limerick, Room E1-017d, Castletroy, Co Limerick, Ireland
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Gaboardi M, Lenzi M, Disperati F, Santinello M, Vieno A, Tinland A, Vargas-Moniz MJ, Spinnewijn F, O'Shaughnessy BR, Wolf JR, Bokszczanin A, Bernad R, Beijer U, Ornelas J, Shinn M, Consortium Study Group HE. Goals and Principles of Providers Working with People Experiencing Homelessness: A Comparison Between Housing First and Traditional Staircase Services in Eight European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091590. [PMID: 31067661 PMCID: PMC6539657 DOI: 10.3390/ijerph16091590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/25/2022]
Abstract
The implementation and adaptation of the Housing First (HF) model represented profound changes the structure and delivery, goals, and principles of homeless services. These features of homeless services directly influence providers, their work performance and the clients’ outcomes. The present research, conducted in eight European countries, investigated how social providers working in HF or TS (Traditional Staircase) describe and conceptualize the goals and the principles of their services. Data were collected through 29 focus group discussions involving 121 providers. The results showed that HF and TS had similar and different goals for their clients in the following areas: support, social integration, satisfaction of needs, housing, and well-being. HF providers emphasized clients’ autonomy and ability to determine their personal goals, with housing being considered a start on the path of recovery, while TS were more focused on individual clients’ basic needs with respect to food, health and finding temporary accommodations. HF providers privileged the person-centered approach and housing as a right, while TS providers were more focused on helping everyone. Implications of the results are discussed as suggestions both for practice and for research.
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Affiliation(s)
- Marta Gaboardi
- Department of Developmental and Social Psychology, University of Padova, 35131 Padua, Italy.
| | - Michela Lenzi
- Department of Developmental and Social Psychology, University of Padova, 35131 Padua, Italy.
| | - Francesca Disperati
- Department of Developmental and Social Psychology, University of Padova, 35131 Padua, Italy.
| | - Massimo Santinello
- Department of Developmental and Social Psychology, University of Padova, 35131 Padua, Italy.
| | - Alessio Vieno
- Department of Developmental and Social Psychology, University of Padova, 35131 Padua, Italy.
| | - Aurélie Tinland
- Department of Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique⁻Hôpitaux de Marseille, 13385 Marseille, France.
| | - Maria J Vargas-Moniz
- APPsyCI-Applied Psychology Research Center Capabilities and Inclusion, ISPA-Instituto Universitário, Lisboa 1149-041, Portugal.
| | - Freek Spinnewijn
- FEANTSA, European Federation of National Organisations Working with the Homeless, Bruxelles 1210, Belgique.
| | | | - Judith R Wolf
- Impuls-Netherlands Center for Social Care Research, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen 6525 EZ, The Netherlands.
| | - Anna Bokszczanin
- Institute of Psychology, Opole University, Opole 45-052, Poland.
| | | | - Ulla Beijer
- STAD, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm 113 64, Sweden.
| | - José Ornelas
- APPsyCI-Applied Psychology Research Center Capabilities and Inclusion, ISPA-Instituto Universitário, Lisboa 1149-041, Portugal.
| | - Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN 37203, USA.
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Petit JM, Loubiere S, Vargas-Moniz MJ, Tinland A, Spinnewijn F, Greenwood RM, Santinello M, Wolf JR, Bokszczanin A, Bernad R, Kallmen H, Ornelas J, Auquier P. Knowledge, attitudes, and practices about homelessness and willingness-to-pay for housing-first across 8 European countries: a survey protocol. ACTA ACUST UNITED AC 2018; 76:71. [PMID: 30505443 PMCID: PMC6260705 DOI: 10.1186/s13690-018-0317-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022]
Abstract
Background Most European countries report rising numbers of people experiencing homelessness. For those with mental disorders, interventions are centered on achieving mental health and drug rehabilitation alongside housing readiness, often to the detriment of access to housing. Notwithstanding, more European countries are investing in a new model, Housing First (HF), which postulates immediate access to permanent housing with no initial requirements for treatment. While results of the European HF programs are published on individual-level data, little is known about the opinions of the general population about homelessness and the societal value of the HF model, which can represent barriers to the model's dissemination. Therefore, we present the protocol of a study designed for the following objectives: 1) to explore the knowledge, attitudes, and practices (KAP) about homelessness within the general population of 8 European countries, 2) to assess the valuation of the HF model by European citizens, and 3) to estimate the lifetime prevalence of homelessness in the targeted countries. Methods A telephone survey was conducted from March to December 2017 among adults selected from opt-in panels from France, Ireland, Italy, the Netherlands, Portugal, Spain, Poland, and Sweden. A total sample of 5600 interviews was expected, with 700 per country. The interviews included three sections: first, the KAP about homelessness; second, the valuation of the HF model by measuring a respondent's willingness-to-pay (WTP) through the contingent valuation method; and third, an assessment of the lifetime prevalence of homelessness among the general population. Descriptive analyses and comparisons between countries will be conducted. KAP indicators will be created and their psychometric properties assessed. Determinants of WTP will be assessed through regression models. Discussion This survey will highlight Europeans' views of homelessness, especially their level of tolerance towards homelessness, potential misconceptions and the most important barriers for the implementation of the HF model. Additionally, the results on the valuation of the HF model by citizens could be instrumental for key stakeholders in understanding the level of support from the general population. Ethics approval has been obtained from the Aix-Marseille University Ethics Committee (n° 2016-01-02-01) for this study, which is part of HOME_EU: Reversing Homelessness in Europe H2O20-SC6-REVINEQUAL-2016/GA726997.
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Affiliation(s)
- J M Petit
- 1Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - S Loubiere
- 2Department of Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - M J Vargas-Moniz
- 3Applied Psychology Research Center: Capabilities and Inclusion (APPsyCI), ISPA-Instituto Universitário, Rua Jardim do Tabaco, 34, 1149-041 Lisbon, Portugal
| | - A Tinland
- 2Department of Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - F Spinnewijn
- FEANTSA, European Federation of National Organisations Working with the Homeless, 194, Chaussée de Louvain, 1210 Brussels, Belgium
| | - R M Greenwood
- 5Department of Psychology, University of Limerick, Limerick, V94 T9PX Ireland
| | - M Santinello
- 6Department of Developmental and Social Psychology, University of Padova, Via Venezia, 8 - 35131, Padova, Italy
| | - J R Wolf
- 7Impuls - Netherlands Center for Social Care Research, Radboud Institute for Health Sciences, Geert Grooteplein 27, 6525 EZ Nijmegen, The Netherlands
| | - A Bokszczanin
- 8Institute of Psychology, Opole University, Pl. Staszica 1, 45-052 Opole, Poland
| | - R Bernad
- Rais Fundación, C/ Ardemans 42, 28028 Madrid, Spain
| | - H Kallmen
- 10STAD, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Norra Stationsgatan 69, 113 64 Stockholm, Sweden
| | - J Ornelas
- 3Applied Psychology Research Center: Capabilities and Inclusion (APPsyCI), ISPA-Instituto Universitário, Rua Jardim do Tabaco, 34, 1149-041 Lisbon, Portugal
| | - P Auquier
- 1Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13385 Marseille, France
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Macnaughton E, Nelson G, Worton SK, Tsemberis S, Stergiopoulos V, Aubry T, Hasford J, Distasio J, Goering P. Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 62:135-149. [PMID: 30106486 DOI: 10.1002/ajcp.12268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi-component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team-based practice, and facilitating case-based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system-practitioners, teams, and communities-while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.
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Affiliation(s)
- Eric Macnaughton
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Geoffrey Nelson
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - S Kathleen Worton
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sam Tsemberis
- Pathways Housing First Training Institute, Montclair, NJ, USA
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Julian Hasford
- School of Child and Youth Care, Ryerson University, Toronto, ON, Canada
| | - Jino Distasio
- Institute of Urban Studies, University of Winnipeg, Winnipeg, MB, Canada
| | - Paula Goering
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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Watson DP, Adams EL, Shue S, Coates H, McGuire A, Chesher J, Jackson J, Omenka OI. Defining the external implementation context: an integrative systematic literature review. BMC Health Serv Res 2018; 18:209. [PMID: 29580251 PMCID: PMC5870506 DOI: 10.1186/s12913-018-3046-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/20/2018] [Indexed: 11/27/2022] Open
Abstract
Background Proper implementation of evidence-based interventions is necessary for their full impact to be realized. However, the majority of research to date has overlooked facilitators and barriers existing outside the boundaries of the implementing organization(s). Better understanding and measurement of the external implementation context would be particularly beneficial in light of complex health interventions that extend into and interact with the larger environment they are embedded within. We conducted a integrative systematic literature review to identify external context constructs likely to impact implementation of complex evidence-based interventions. Methods The review process was iterative due to our goal to inductively develop the identified constructs. Data collection occurred in four primary stages: (1) an initial set of key literature across disciplines was identified and used to inform (2) journal and (3) author searches that, in turn, informed the design of the final (4) database search. Additionally, (5) we conducted citation searches of relevant literature reviews identified in each stage. We carried out an inductive thematic content analysis with the goal of developing homogenous, well-defined, and mutually exclusive categories. Results We identified eight external context constructs: (1) professional influences, (2) political support, (3) social climate, (4) local infrastructure, (5) policy and legal climate, (6) relational climate, (7) target population, and (8) funding and economic climate. Conclusions This is the first study to our knowledge to use a systematic review process to identify empirically observed external context factors documented to impact implementation. Comparison with four widely-utilized implementation frameworks supports the exhaustiveness of our review process. Future work should focus on the development of more stringent operationalization and measurement of these external constructs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3046-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dennis P Watson
- Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
| | - Erin L Adams
- Department of Psychology, Indiana University Purdue University-Indianapolis, 420 N Blackford St, Indianapolis, IN, 46202, USA
| | - Sarah Shue
- Indiana University-Purdue University Indianapolis, School of Health and Rehabilitation Sciences, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Heather Coates
- Indiana University-Purdue University Indianapolis, University Library, Center for Digital Scholarship, 755 W. Michigan St, Indianapolis, IN, 46202, USA
| | - Alan McGuire
- Richard L. Roudebush VA, 1481 W. 10th St, Indianapolis, IN, 46202, USA
| | - Jeremy Chesher
- Department of Environmental Health Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Joanna Jackson
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Ogbonnaya I Omenka
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
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Manning RM, Greenwood RM. Microsystems of Recovery in Homeless Services: The Influence of Service Provider Values on Service Users' Recovery Experiences. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:88-103. [PMID: 29323412 DOI: 10.1002/ajcp.12215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is still much to learn about how aspects of the ecology of homelessness shape homeless adults' recovery experiences. In the present mixed-methods study, the relationship of service providers' work-related values to their service users' recovery experiences in the microsystem of homelessness were examined. Service providers completed semi-structured qualitative interviews about their service users, daily work activities, and work-related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration. Service providers' interview transcripts were coded for three indicators of values: assumptions, actions, and end-states. Summative Content Analysis was used to transform qualitative codes into numeric data so they could be used to predict service users' recovery. In a series of growth curve models, the extent to which service providers' end-state values, as an indicator of consumer-led values, was shown to indirectly predict service users' recovery experiences, through their perceived choice and mastery. Findings confirm that providers' values are an important influence on service users' recovery. Results are discussed in terms of their implications for recovery-oriented theory and practice.
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Affiliation(s)
- Rachel M Manning
- Department of Psychology, University of Limerick, Limerick, Ireland
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15
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Shinn M. Methods for Influencing Social Policy: The Role of Social Experiments. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 58:239-244. [PMID: 27451017 DOI: 10.1002/ajcp.12072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research methods in community psychology have grown more diverse since the Swampscott conference, but rigorous social experiments maintain a place among the multiplicity of methods that can promote community psychology values. They are particularly influential in policy circles. Two examples of social experiments to end homelessness for different populations illustrate their role. Both studies show that offering extremely poor and disenfranchised people autonomy and the resources they seek works better than "helping" them to overcome deficits in ways designed by well-meaning service providers. Experiments are neither the first nor the last method community psychologists should employ, but are a critical part of the field's armamentarium for systems change.
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Affiliation(s)
- Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
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Aubry T, Nelson G, Tsemberis S. Housing First for People With Severe Mental Illness Who Are Homeless: A Review of the Research and Findings From the At Home-Chez soi Demonstration Project. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:467-74. [PMID: 26720504 PMCID: PMC4679127 DOI: 10.1177/070674371506001102] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)-Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing. METHOD The AH-CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care. RESULTS Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH-CS demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual. CONCLUSIONS Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH-CS project and to scale up the HF approach across Canada.
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Affiliation(s)
- Tim Aubry
- Professor, School of Psychology, University of Ottawa, Ottawa, Ontario
| | - Geoffrey Nelson
- Professor, Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario
| | - Sam Tsemberis
- Chief Executive Officer, Pathways to Housing National, New York, New York
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Macnaughton E, Stefancic A, Nelson G, Caplan R, Townley G, Aubry T, McCullough S, Patterson M, Stergiopoulos V, Vallée C, Tsemberis S, Fleury MJ, Piat M, Goering P. 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. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2015; 55:279-291. [PMID: 25772023 DOI: 10.1007/s10464-015-9709-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
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 leadership facilitated implementation, while staff turnover, rehousing participants, participant isolation, and limited vocational/educational supports impeded implementation. The findings shed light on important implementation "drivers" at the staff, program, and community levels.
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Stefancic A, Tsemberis S, Messeri P, Drake R, Goering P. The Pathways Housing First Fidelity Scale for Individuals With Psychiatric Disabilities. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2013. [DOI: 10.1080/15487768.2013.847741] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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