The paradigm shift in residential services: From the linear continuum to supported housing approaches.
ABSTRACT Describes a paradigm shift, beginning in the 1950s and reaching its zenith in the 1970s, toward supported housing models and deinstitutionalization of the mentally ill. The linear residential continuum model formed the basis for residential treatment and the provision of specialized environments that prepared patients/clients for life in the community. A supported housing paradigm shifts the primary role of the service recipient from patient to community and shifts the locus of control from staff to client. Other elements of the shift include an emphasis on (1) social integration rather than homogeneous grouping by disability and (2) the most facilitative environment and best functioning rather than the least restrictive environment and independence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
- SourceAvailable from: Tim Aubry
Dataset: Senate.brief.Mental Health
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ABSTRACT: Within the mental health system, there are two distinct service models for adults who have severe mental illness and are homeless: one prioritizes treatment before accessing permanent housing (Treatment First) while the other provides permanent housing upfront followed by clinical support (Housing First). Investigating front-line providers working within these two models affords an opportunity to learn more about their implementation from an insider perspective, thus shedding light on whether actual practice is consistent with or contrary to these program models' contrasting philosophical values. Forty-one providers were recruited from four agencies as part of a NIMH funded qualitative study. Multiple, in-depth interviews lasting 30-45 min were conducted with providers that explored working within these agencies. Thematic analysis was utilized to compare the views of 20 providers working in Housing First versus the 21 providers working in Treatment First programs. Providers viewed housing as a priority but differences emerged between Treatment First and Housing First providers along three major themes: the centrality of housing, engaging consumers through housing, and (limits to...) a right to housing. Ironically, this study revealed that providers working within Treatment First programs were consumed with the pursuit of housing, whereas Housing First providers focused more on clinical concerns since consumers already had housing. Clearly, how programs position permanent housing has very different implications for how providers understand their work, the pressures they encounter, and how they prioritize client goals.Administration and Policy in Mental Health 03/2011; 38(2):77-85. · 2.09 Impact Factor
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ABSTRACT: Supportive housing, defined as subsidized housing in conjunction with site-based social services, may help improve the health and residential stability of highly disadvantaged individuals. This study examined changes in health status, quality of life, substance use, health care utilization, and residential stability among 112 homeless and vulnerably housed individuals who applied to a supportive housing program in Toronto, Canada, from December 2005 to June 2007. Follow-up interviews were conducted every 6 months for 18 months. Comparisons were made between individuals who were accepted into the program (intervention) and those who were wait-listed (usual care) using repeated-measures analyses. Individuals who were accepted into the housing program experienced significantly greater improvements in satisfaction with living situation compared with individuals in the usual care group (time, F(3,3,261) = 47.68, p < 0.01; group × time, F(3,3,261) = 14.60, p < 0.01). There were no significant differences in other quality of life measures, health status, health care utilization, or substance use between the two groups over time. Significant improvement in residential stability occurred over time, independent of assigned housing group (time, F(3,3,261) = 9.96, p < 0.01; group × time, F(3,3,261) = 1.74, p = 0.17). The ability to examine the effects of supportive housing on homeless individuals was limited by the small number of participants who were literally homeless at baseline and by the large number of participants who gained stable housing during the study period regardless of their assigned housing status. Nonetheless, this study shows that highly disadvantaged individuals with a high prevalence of poor physical and mental health and substance use can achieve stable housing.Journal of Urban Health 06/2011; 88(6):1076-90. · 1.89 Impact Factor