Article

Project-based Housing First for chronically homeless individuals with alcohol problems: Within-subjects analyses of 2-year alcohol trajectories

Addictive Behaviors Research Center, University of Washington, Seattle, WA 98104, USA.
American Journal of Public Health (Impact Factor: 4.23). 03/2012; 102(3):511-9. DOI: 10.2105/AJPH.2011.300403
Source: PubMed

ABSTRACT Two-year alcohol use trajectories were documented among residents in a project-based Housing First program. Project-based Housing First provides immediate, low-barrier, nonabstinence-based, permanent supportive housing to chronically homeless individuals within a single housing project. The study aim was to address concerns that nonabstinence-based housing may enable alcohol use.
A 2-year, within-subjects analysis was conducted among 95 chronically homeless individuals with alcohol problems who were allocated to project-based Housing First. Alcohol variables were assessed through self-report. Data on intervention exposure were extracted from agency records.
Multilevel growth models indicated significant within-subjects decreases across alcohol use outcomes over the study period. Intervention exposure, represented by months spent in housing, consistently predicted additional decreases in alcohol use outcomes.
Findings did not support the enabling hypothesis. Although the project-based Housing First program did not require abstinence or treatment attendance, participants decreased their alcohol use and alcohol-related problems as a function of time and intervention exposure.

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    • "A different type of problem is the use of a single group design of participants who entered Housing First with high rates of alcohol problems. Here, the improvements noted over time could be due to regression to the mean or ceiling effects (e.g., Collins, et al., 2012). Finally, Kertesz et al. (2009) questioned the appropriateness of some of the " usual care " comparison conditions, many of which were unspecified aggregate conditions, limited by underfunding, and lacking evidence based interventions. "
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    ABSTRACT: Communities throughout the U.S. are struggling to find solutions for serious and persistent homelessness. Alcohol and drug problems can be causes and consequences of homelessness, as well as co-occurring problems that complicate efforts to succeed in finding stable housing. Two prominent service models exist, one known as “Housing First” takes a harm reduction approach and the other known as the “linear” model typically supports a goal of abstinence from alcohol and drugs. Despite their popularity, the research supporting these models suffers from methodological problems and inconsistent findings. One purpose of this paper is to describe systematic reviews of the homelessness services literature, which illustrate weaknesses in research designs and inconsistent conclusions about the effectiveness of current models. Problems among some of the seminal studies on homelessness include poorly defined inclusion and exclusion criteria, inadequate measures of alcohol and drug use, unspecified or poorly implemented comparison conditions, and lack of procedures documenting adherence to service models. Several recent papers have suggested broader based approaches for homeless services that integrate alternatives and respond better to consumer needs. Practical considerations for implementing a broader system of services are described and peer managed recovery homes are presented as examples of services that address some of the gaps in current approaches. Three issues are identified that need more attention from researchers: 1) improving upon the methodological limitations in current studies, 2) assessing the impact of broader based, integrated services on outcome, and 3) assessing approaches to the service needs of homeless persons involved in the criminal justice system.
    Journal of Social Distress and the Homeless 07/2015; DOI:10.1179/1573658X15Y.0000000004
    • "Provision of housing plus support services has been found to be a cost-effective solution for a vulnerable subset of people who are homeless and have been diagnosed with serious mental illness and co-occurring substance use (Culhane et al. 2002). Among supportive housing programs , a distinct difference in programmatic philosophy has resulted in differential service user experiences and outcomes (Padgett 2007; Collins et al. 2012; Tsai et al. 2010; Pearson et al. 2009). The traditional approach (called treatment first (TF) here) has followed a ''staircase'' or continuum model with service users moving from emergency shelter to transitional to permanent housing, earning higher levels of independence with demonstrated treatment compliance and sobriety (Kertesz et al. 2009; Wong and Stanhope 2009). "
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    ABSTRACT: Behavioral health organizations use clinical supervision to ensure professional development and practice quality. This qualitative study examined 35 service coordinators' perspectives on supervision in two distinct supportive housing program types (permanent and transitional). Thematic analysis of in-depth interviews yielded three contrast themes: support versus scrutiny, planned versus impromptu time, and housing first versus treatment first. Supervisory content and format resulted in differential perceptions of supervision, thereby influencing opportunities for learning. These findings suggest that unpacking discrete elements of supervision enactment in usual care settings can inform implementation of recovery-oriented practice.
    Administration and Policy in Mental Health and Mental Health Services Research 06/2015; DOI:10.1007/s10488-015-0665-6 · 3.44 Impact Factor
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    • "Another study assessing differences in substance use outcomes between HF and Treatment First (i.e., temporary congregate housing with prerequisite of detoxification/sobriety and 'housing readiness') participants using qualitative data, found that participants who received treatment first were more likely to use drugs and/or abuse alcohol 12 months after program entry than HF participants (Padgett et al., 2011). Studies based on an HF program in Seattle serving chronically homeless persons with severe alcohol problems found steady decreases in daily alcohol use, reductions in median number of drinks and number of days intoxicated among the intervention group (Collins et al., 2012; Larimer et al., 2009). "
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    ABSTRACT: There is strong evidence that Housing First interventions are effective in improving housing stability and quality of life among homeless people with mental illness and addictions. However, there is very little evidence on the effectiveness of Housing First in improving substance use-related outcomes in this population. This study uses a randomized control design to examine the effects of scatter-site Housing First on substance use outcomes in a large urban centre. Substance use outcomes were compared between a Housing First intervention and treatment as usual group in a sample of 575 individuals experiencing homelessness and mental illness, with or without a co-occurring substance use problem, in the At Home/Chez Soi trial in Toronto, Canada. Generalized linear models were used to compare study arms with respect to change in substance use outcomes over time (baseline, 6, 12, 18 and 24 month). At 24 months, participants in the Housing First intervention had significantly greater reductions in number of days experiencing alcohol problems and amount of money spent on alcohol than participants in the Treatment as Usual group. No differences between the study arms in illicit drug outcomes were found at 24 months. These findings show that a Housing First intervention can contribute to reductions in alcohol problems over time. However, the lack of effect of the intervention on illicit drug problems suggests that individuals experiencing homelessness, mental illness and drug problems may need additional supports to reduce use. Trial Registration: Current controlled trials ISRCTN42520374. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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