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- Homeless adults’ recovery experiences in housing first and traditional services programs in seven european countriesPublication . Greenwood, Ronni Michelle; Manning, M; O' Shaughnessy, Branagh; Moniz, Maria João Vargas; Loubiere, Sandrine; Spinnewijn, Freek; Lenzi, Michela; Wolf, Walter; Bokszczanin, Anna; Bernad, Roberto; Källmen, Håkan; Ornelas, José; Monteiro, Maria Fátima Jorge; Almas, Inês; Duarte, Teresa; Disperati, Francesca; Gaboardi, Marta; Santinello, Massimo; Vieno, Alessio; Marques, Rita P.; Carmona, Maria; Nave, Américo; Rivero, Borja; Julián, Martin; Zmaczynska–Witek, Barbara; Katarzyna, Skałacka; Rogowska, Aleksandra; Schel, Sandra; Peters, Yvonne; Van Loenen, Tessa; Raben, Liselotte; Beijer, Ulla; Blid, Mats; Bispo, Teresa; Cruz, Tiago; Pereira, Carla; Auquier, Pascal; Petit, Leon; Tinland, AurelieAcross 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.
- Structure and agency in capabilities‐enhancing homeless services: Housing first, housing quality and consumer choicePublication . Greenwood, Ronni; Manning, Rachel; O'Shaughnessy, Branagh R.; Vargas‐Moniz, Maria; Auquier, Pascal; Lenzi, Michela; Wolf, Judith; Bokszczanin, Anna; Bernad, Roberto; Källmen, Håkan; Spinnewijn, Freek; Ornelas, JoséThe capabilities approach, a framework for understanding and measuring inequality, stipulates that equality is best understood as the freedom to do and be within a particular context. Homelessness has been referred to as a situation of ‘capabilities deprivation’, and the extent to which homeless services restore or enhance capabilities is of increasing interest. As part of a large, eight-country study of homelessness in Europe, we examined the extent to which adults with histories of perceived the services they receive as capabilities-enhancing. We collected data at two time points: baseline (nt1 = 565) and follow-up (nt2 = 399). Measures included perceived capabilities, choice and housing quality. Participants engaged with Housing First (HF) programmes perceived services as more capabilities-enhancing than participants engaged with treatment as usual (TAU); this relationship was mediated by consumer choice and perceived housing quality. Implications for social policy, practice and training are discussed.
- Psychometric properties of the measure of achieved capabilities in homeless servicesPublication . Greenwood, Ronni; O'Shaughnessy, Branagh R.; Manning, Rachel; Vargas-Moniz, Maria; Sacchetto, Beatrice; Ornelas, José; Jorge-Monteiro, Maria F.; Almas, Inês; Duarte, Teresa; Disperati, Francesca; Gaboardi, Marta; Lenzi, Michela; Santinello, Massimo; Vieno, Alessio; Marques, Rita P.; Carmona, Maria; Nave, Américo; Bernad, Roberto; Rivero, Borja; Julien, Martin; Bokszczanin, Anna; Kalinowska-Witek, Barbara; Katarzyna, Skałacka; Rogowska, Aleksandra; Schel, Sandra; Peters, Yvonne; vanLoenen, Tessa; Raben, Liselotte; Wolf, Judith R.; Beijer, Ulla; Blid, Mats; Källmen, Håkan; Bispo, Maria Teresa; Cruz, Tiago; Pereira, Carla; Auquier, Pascal; Petit, Pascal; Loubière, Sandrine; Tinland, AurélieBackground Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one’s potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their efectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity. Methods We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n=245) or treatment as usual (n=320). Results Exploratory and confrmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure’s concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities. Conclusions Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed.
- European public perceptions of homelessness: A knowledge, attitudes and practices surveyPublication . Petit, Junie; Loubiere, Sandrine; Tinland, Aurlie; João Vargas Moniz, Maria; Spinnewijn, Freek; Manning, Rachel; Santinello, Massimo; Wolf, Judith; Bokszczanin, Anna; Bernad, Roberto; Källmen, Håkan; Ornelas, José; Auquier, PascalAddressing Citizen's perspectives on homelessness is crucial for the design of effective and durable policy responses, and available research in Europe is not yet substantive. We aim to explore citizens' opinions about homelessness and to explain the differences in attitudes within the general population of eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden.
- Europeans’ willingness to pay for ending homelessness: A contingent valuation studyPublication . Loubiere, Sandrine; Taylor, Owen; Tinland, Aurelie; Moniz, Maria João Vargas; O'Shaughnessy, Branagh R; Bokszczanin, Anna; Källmen, Håkan; Bernad, Roberto; Wolf, Judith R.; Santinello, Massimo; Loundou, Anderson; Ornelas, José.; Auquier, PascalThe purpose of this study is to assess the utility value European citizens put on an innovative social program aimed at reducing homelessness. The Housing First (HF) model involves access to regular, scattered, independent and integrated housing in the community with the support of a multidisciplinary team. Currently, HF is not implemented by most European countries or funded by healthcare or social plans, but randomised controlled trials have stressed significant results for improved housing stability, recovery and healthcare services use. The broader implementation of HF across Europe would benefit from a better understanding of citizens' preferences and "willingness to pay" (WTP) for medico-social interventions like HF. We conducted a representative telephone survey between March and December 2017 in eight European countries (France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden). Respondent's WTP for HF (N = 5631) was assessed through a contingent valuation method with a bidding algorithm. 42.3% of respondents were willing to pay more taxes to reduce homelessness through the HF model, and significant differences were found between countries (p < 0.001); 30.4% of respondents who did not value the HF model were protest zeros (either contested the payment vehicle-taxes- or the survey instrument). Respondents were willing to pay €28.2 (±11) through annual taxation for the HF model. Respondents with higher educational attainment, who paid national taxes, reported positive attitudes about homelessness, or reported practices to reduce homelessness (donations, volunteering) were more likely to value the HF model, with some countries' differences also related to factors at the environmental level. These findings inform key stakeholders that European citizens are aware of the issue of homelessness in their countries and that scaling up the HF model across Europe is both feasible and likely to have public support.
- Knowledge, attitudes, and practices about homelessness and willingness-to-pay for housing-first across 8 European countries: a survey protocolPublication . Petit, J. M.; Loubiere, Sandrine; Moniz, Maria João Vargas; Tinland, A.; Spinnewijn, Feek; Greenwood, Ronni Michelle; Santinello, Massimo; Wolf, Judith R.; Bokszczanin, Anna; Bernad, Roberto; Kallmen, H.; Ornelas, José; Auquier, PascalBackground: 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 newmodel, 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.
- Comparison of housing first and traditional homeless service users in eight european countries: Protocol for a mixed methods, Multi-site studyPublication . Greenwood, Ronni Michelle; Manning, Rachel; O'Shaughnessy, Branagh R.; Cross, Oisin; Moniz, Maria João Vargas; Auquier, Pascal; Santinello, Massimo; Wolf, Judith R; Bokszczanin, Anna; Bernad, Roberto; Källmen, Håkan; Spinnewijn, Frederik; Ornelas, JoséHomeless 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.
- Lifetime, 5-year and past-year prevalence of homelessness in Europe: a cross-national survey in eight European nationsPublication . Taylor, Owen; Loubiere, Sandrine; Tinland, Aurelie; Moniz, Maria João Vargas; Spinnewijn, Freek; Manning, Rachel; Gaboardi, Marta; Wolf, Judith R L M; Bokszczanin, Ana; Bernad, Roberto; Källmen, Håkan; Toro, Paul; Ornelas, José H.; Auquier, PascalObjectives To examine the lifetime, 5-year and past-year prevalence of homelessness among European citizens in eight European nations. Design A nationally representative telephone survey using trained bilingual interviewers and computer-assisted telephone interview software. Setting The study was conducted in France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain and Sweden. Participants European adult citizens, selected from opt-in panels from March to December 2017. Total desired sample size was 5600, with 700 per country. Expected response rates of approximately 30% led to initial sample sizes of 2500 per country. Main outcome measures History of homelessness was assessed for lifetime, past 5 years and past year. Sociodemographic data were collected to assess correlates of homelessness prevalence using generalised linear models for clustered and weighted samples. Results Response rates ranged from 30.4% to 33.5% (n=5631). Homelessness prevalence was 4.96% for lifetime (95% CI 4.39% to 5.59%), 1.92% in the past 5 years (95% CI 1.57% to 2.33%) and 0.71% for the past year (95% CI 0.51% to 0.98%) and varied significantly between countries (pairwise comparison difference test, p<0.0001). Time spent homeless ranged between less than a week (21%) and more than a year (18%), with high contrasts between countries (p<0.0001). Male gender, age 45–54, lower secondary education, single status, unemployment and an urban environment were all independently strongly associated with lifetime homelessness (all OR >1.5). Conclusions The prevalence of homelessness among the surveyed nations is significantly higher than might be expected from point-in- time and homeless service use statistics. There was substantial variation in estimated prevalence across the eight nations. Coupled with the well-established health impacts of homelessness, medical professionals need to be aware of the increased health risks of those with experience of homelessness. These findings support policies aiming to improve health services for people exposed to homelessness.
- Psychometric properties of the measure of achieved capabilities in homeless servicesPublication . Greenwood, Ronni Michelle; O'Shaughnessy, Branagh R.; Manning, Rachel M.; Vargas-Moniz, Maria; Sacchetto, Beatrice; Ornelas, José; Jorge-Monteiro, Maria Fátima; Almas, Inês; Duarte, Teresa; Disperati, Francesca; Gaboardi, Marta; Lenzi, Michela; Santinello, Massimo; Vieno, Alessio; Marques, Rita P.; Carmona, Maria; Nave, Américo; Bernad, Roberto; Rivero Jiménez, Borja; Julien, Martin; Bokszczanin, Anna; Zmaczynska-Witek, Barbara; Katarzyna, Skałacka; Rogowska, Aleksandra; Schel, Sandra; Peters, Yvonne; vanLoenen, Tessa; Raben, Liselotte; Wolf, Judith; Beijer, Ulla; Blid, Mats; Källmen, Håkan; Bispo, Maria Teresa; Cruz, Tiago; Pereira, Carla; Auquier, Pascal; Petit, Junie M.; Loubière, Sandrine; Tinland, AurélieBackground Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one’s potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their efectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity. Methods We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n=245) or treatment as usual (n=320). Results Exploratory and confrmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure’s concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities. Conclusions Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed.