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- Distal supports, capabilities, and growth‐focused recovery: A comparison of Housing First and the staircase continuum of carePublication . Greenwood, Ronni Michelle; O'Shaughnessy, Branagh R.; Manning, Rachel; Hogan, Niamh; Vargas‐Moniz, Maria J.; Ornelas, JoséAdults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of “distal support” that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth‐related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth‐focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth‐related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.
- 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.
- Working with people experiencing homelessness in EuropePublication . Gaboardi, Marta; Santinello, Massimo; Disperati, Francesca; Lenzi, Michela; Vieno, Alessio; loubiere, sandrine; João Vargas Moniz, Maria; Spinnewijn, Freek; Greenwood, Ronni Michelle; Wolf, Judith R.; Bokszczanin, Anna; Bernad, Roberto; Blid, Mats; Ornelas, José; Shinn, MarybethIn Europe, the widespread transition from the Traditional Staircase (TS) model to the Housing First (HF) model is transforming the way social service providers work with people experiencing homelessness. This study examined social service providers’ perspectives in both models regarding factors that facilitate or hinder their work. Data were collected through 17 photovoice projects involving 81 social service providers from eight European countries. The results show factors affecting social service providers’ work at three levels: systemic, organizational, and individual. Professionals in TS and HF identified similar topics; however, TS providers discussed more obstacles to work. Implications for practice 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.
- Distal supports, capabilities, and growth‐focused recovery: A comparison of housing first and the staircase continuum of carePublication . Greenwood, Ronni Michelle; O'Shaughnessy, Branagh R.; Manning, Rachel M.; Hogan, Niamh; Vargas‐Moniz, Maria J.; Ornelas, JoséAdults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of “distal support” that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth‐related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth‐focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth‐related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.
- Distal supports, capabilities, and growth‐focused recovery: A comparison of Housing First and the staircase continuum of carePublication . Greenwood, Ronni Michelle; O'Shaughnessy, Branagh R.; Manning, Rachel; Hogan, Niamh; Vargas-Moniz, Maria; Ornelas, JoséAdults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of “distal support” that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth‐related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth‐focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth‐related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.
- 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.
- Goals and principles of providers working with people experiencing homelessness: A comparison between housing first and traditional staircase services in eight european countriesPublication . Gaboardi, Marta; Lenzi, Michela; Disperati, Francesca; Santinello, Massimo; Vieno, Alessio; Tinland, Aurélie; Moniz, Maria João Vargas; Spinnewijn, Freek; O' Shaughnessy, Branagh; Wolf, Judith R; Bokszczanin, Anna; Bernad, Roberto; Beijer, Ulla; Ornelas, José; Shinn, MarybethThe 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.
- Distal supports, capabilities, and growth‐focused recovery: A comparison of Housing First and the staircase continuum of carePublication . Greenwood, Ronni Michelle; O'Shaughnessy, Branagh R.; Manning, Rachel; Hogan, Niamh; Vargas‐Moniz, Maria João; Ornelas, JoséAdults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of “distal support” that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth‐related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth‐focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth‐related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.
- The role of perceived housing quality and perceived choice to recovery: An ecological perspective on a housing first program in LisbonPublication . Martins, Paulo Daniel Fernandes; Ornelas, José; Silva, Ana CristinaThis study explores, from an ecological perspective, the relationship between perceived housing quality and the perception of choice, and between perceived choice and recovery of 45 Housing First Lisbon participants. For this purpose, we used a quantitative method and applied three instruments that report perceived housing quality, perceived choice and severe mental illness recovery. The findings reveal a significant and positive association between perceived housing quality and perceived choice, and between perceived choice and recovery, with choice being predicted by housing quality and recovery predicted by choice. These results reinforce the scientific evidence regarding the success of housing first models as a consumer choice-driven intervention, addressing pertinent environmental factors that contribute to housing stability. The study demonstrates that recovery processes can be maximized through services that empower their consumers by allowing them to choose and control the priority and order of the support services received.