The paradigm shift in residential services: From the linear continuum to supported housing approaches.

Psychosocial Rehabilitation Journal 03/1990; DOI: 10.1037/h0099479

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)

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    • "Models for Assisting Homeless Individuals with Substance Abuse Two prominent models have emerged in response to the need for housing for persons with cooccurring substance abuse and unstable housing: linear and Housing First. The linear approach (Kertesz, et al., 2009; Ridgway & Zipple, 1990) emphasizes abstinence from substances as an explicit goal. "
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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
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    • "Thus, the system can contribute to chronic homelessness for many individuals who then join the " institutional circuit " and rotate through repeated stays in costly acute care services, such as emergency rooms, hospitals, shelters, and jails (Hopper, Jost, Hay, Welber, & Haugland, 1997). Traditional programs have been criticized for undermining choice and autonomy , putting strict limits on tenancy rights, such as requiring treatment and sobriety as a condition for continued tenure, and for sustaining social segregation of individuals with psychiatric disabilities by placing them in residences solely dedicated to housing this population (Allen, 1996; Carling, 1993; Ridgway & Zipple, 1990; Shinn & Tsemberis, 1998). From these critiques, the PHF model was born. "
    Journal of Social Issues 01/2013; · 1.96 Impact Factor
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    • "This graduated model essentially tied housing to services, as the type of housing was dependent upon sobriety and engagement in treatment, and the rejection of or failure to adhere to these requirements was often what drove people back onto the streets. However, in the 1990s the supported housing model emerged, articulated by consumer advocates , which instead called for housing that fostered community integration, honored consumer choice, and gave people immediate access to permanent independent scatter-site housing (Ridgeway & Zipple, 1990). "
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    ABSTRACT: Evidence Based Policy has been articulated and practiced in Europe, particularly under the 'New Labour' policies of the former Labour government in the United Kingdom. In the United States, the impact of research on policy has been inconsistent due to differing relationships between researchers and policy makers. This paper gives an overview of evidence based policy and presents critiques based on its reliance on positivist methods and technical approach to policy making. Using these critiques as a framework, the paper discusses the case of Housing First, a policy adopted by the Bush Administration in order to address the problem of chronic homelessness. The case is an example of research driven policy making but also resulted in a progressive policy being promoted by a conservative administration. In discussing the case, the paper elaborates on the relationship between evidence and policy, arguing that evidence based policy fails to integrate evidence and values into policy deliberations. The paper concludes with alternative models of policy decision making and their implications for research.
    International Journal of Law and Psychiatry 07/2011; 34(4):275-82. DOI:10.1016/j.ijlp.2011.07.006 · 1.19 Impact Factor
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