Structure and agency in capabilities‐enhancing homeless services: Housing first, housing quality and consumer choice

In a context of neoliberalism, decisions made for a “public” good are often articulated as what makes the most financial sense, and citizenship is exercised as a matter of consumer choice. Neoliberal theory positions choice as an unmitigated good, and as universally available when markets are deregulated and goods and services are privatized. Examining rhetorics of choice, however, illuminates the often-invisible power relations that shape choice, and makes visible the ways in which choice is conditioned by inequality. This essay attends to the cost–benefit analysis used to promote the spread of Housing First, an approach to addressing chronic homelessness in the United States. It argues that a neoliberal discourse of choice reconfigures possibilities for rhetorical citizenship by constructing “good” and “bad” consumer citizen subjectivities, constraining agency for “expensive” people while concentrating responsibility for public decision-making among “taxpayers.” These discourses thus limit membership to neoliberal publics to people with access to private resources.

Download Full-text

Comparison of Housing First and Traditional Homeless Service Users in Eight European Countries: Protocol for a Mixed Methods, Multi-Site Study (Preprint)

10.2196/preprints.14584 ◽

2019 ◽

Author(s):

Ronni Michelle Greenwood ◽

Rachel M Manning ◽

Branagh R O'Shaughnessy ◽

Oisin Cross ◽

Maria J Vargas-Moniz ◽

...

Keyword(s):

Mixed Methods ◽

Psychiatric Symptoms ◽

Community Integration ◽

Site Investigation ◽

Evidence Base ◽

European Countries ◽

Housing First ◽

Research Report ◽

Service Users ◽

Homeless Services

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 RR1-10.2196/14584

Download Full-text

Comparison of Housing First and Traditional Homeless Service Users in Eight European Countries: Protocol for a Mixed Methods, Multi-Site Study

JMIR Research Protocols ◽

10.2196/14584 ◽

2020 ◽

Vol 9 (2) ◽

pp. e14584 ◽

Cited By ~ 2

Author(s):

Ronni Michelle Greenwood ◽

Rachel M Manning ◽

Branagh R O'Shaughnessy ◽

Oisin Cross ◽

Maria J Vargas-Moniz ◽

...

Keyword(s):

Mixed Methods ◽

Psychiatric Symptoms ◽

Community Integration ◽

Site Investigation ◽

Evidence Base ◽

European Countries ◽

Housing First ◽

Research Report ◽

Service Users ◽

Homeless Services

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

Download Full-text

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 ◽

10.3390/ijerph16091590 ◽

2019 ◽

Vol 16 (9) ◽

pp. 1590 ◽

Cited By ~ 6

Author(s):

Marta Gaboardi ◽

Michela Lenzi ◽

Francesca Disperati ◽

Massimo Santinello ◽

Alessio Vieno ◽

...

Keyword(s):

Work Performance ◽

Well Being ◽

European Countries ◽

Housing First ◽

Personal Goals ◽

Focus Group Discussions ◽

Group Discussions ◽

Homeless Services ◽

Person Centered Approach ◽

Satisfaction Of Needs

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.

Download Full-text

Reconciling Alternative to Incarceration and Treatment Mandates with a Consumer Choice Housing First Model: A Qualitative Study of Individuals with Psychiatric Disabilities

Journal of Forensic Psychology Practice ◽

10.1080/15228932.2012.697424 ◽

2012 ◽

Vol 12 (4) ◽

pp. 382-408 ◽

Cited By ~ 5

Author(s):

Ana Stefancic ◽

Larissa Hul ◽

Colleen Gillespie ◽

John Jost ◽

Sam Tsemberis ◽

...

Keyword(s):

Qualitative Study ◽

Consumer Choice ◽

Psychiatric Disabilities ◽

Housing First ◽

Alternative To Incarceration

Download Full-text

Housing and mental health

Oxford Textbook of Public Mental Health ◽

10.1093/med/9780198792994.003.0017 ◽

2018 ◽

pp. 151-158

Author(s):

Tom K. J. Craig ◽

Jed Boardman

Keyword(s):

Mental Health ◽

Independent Living ◽

Group Home ◽

Poor Quality ◽

Housing Quality ◽

Housing First ◽

High Rise ◽

Permanent Housing ◽

Rehabilitation Model ◽

Stressful Environments

There are strong links between housing quality and ill health, in particular infections, chronic diseases, and injuries. Poor-quality housing is associated with mental illness, although the links are complex given the fact that decrepit housing is often also high rise, multiple occupancy, and located in neighbourhoods characterized by vandalism, graffiti, and crime. People suffering from severe conditions such as schizophrenia are particularly sensitive to these stressful environments and many struggle to manage day to day, running into difficulties maintaining their home and keeping up with rent or mortgage payments. Therefore, early approaches emphasized a step-wise approach through progressively more independent settings, from hospital to group home, despite the fact that the majority of people would prefer independent living. Today, such stepped resettlement is being challenged by ‘housing first’ approaches that bypass the traditional rehabilitation model placing people directly into permanent housing with the flexible support they need to maintain it.

Download Full-text