Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with Histories of Homelessness

The City University of New York Graduate Center, New York, NY, USA.
American Journal of Community Psychology (Impact Factor: 1.74). 01/2006; 36(3-4):223-38. DOI: 10.1007/s10464-005-8617-z
Source: PubMed


Despite the increase in consumer-driven interventions for homeless and mentally ill individuals, there is little evidence that these programs enhance psychological outcomes. This study followed 197 homeless and mentally ill adults who were randomized into one of two conditions: a consumer-driven "Housing First" program or "treatment as usual" requiring psychiatric treatment and sobriety before housing. Proportion of time homeless, perceived choice, mastery, and psychiatric symptoms were measured at six time points. Results indicate a direct relationship between Housing First and decreased homelessness and increased perceived choice; the effect of choice on psychiatric symptoms was partially mediated by mastery. The strong and inverse relationship between perceived choice and psychiatric symptoms supports expansion of programs that increase consumer choice, thereby enhancing mastery and decreasing psychiatric symptoms.

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    • "It has been shown to be a good indicator of the effectiveness of these services in attaining their established objectives (Chan et al., 1997; Ford et al., 1997; Perez de los Cobos et al., 2002, 2004, 2005). Carr et al. (1998) found that examining client satisfaction allows researchers to identify the extent and nature of unmet needs and expectations, and satisfaction with services and constructive relationships with service providers have been consistently associated with improved follow-up and treatment adherence (Brochu, 2007; Carlin et al., 2005; Greenwood et al., 2005; Hser et al., 2004; Melnick et al., 2004; Rickmans et al., 2007; Schulte et al., 2007, 2011; Slote- Morris & McKeganey, 2007). Prométhéus residents are current and former opioid users without permanent housing, who are highly disorganized, come from precarious conditions, often have physical or mental health problems, and experience difficulty living within a set structure and respecting schedules and responsibilities . "
    Journal of Substance Use 10/2015; DOI:10.3109/14659891.2015.1029022 · 0.48 Impact Factor
    • "For this reason, supported housing is being increasingly referred to as HF (in contrast to ''Treatment First''). HF programs have become a preferred strategy for addressing chronic homelessness of individuals with severe and persistent mental illness because the majority of HF tenants achieve housing stability (Greenwood et al. 2005; Stefancic and Tsemberis 2007; Tsemberis and Eisenberg 2000; Tsemberis et al. 2004). A critical ingredient of HF is the fact that tenants hold a lease in regular, private market housing of their choice facilitating their integration into the community (Rog 2004; Tabol et al. 2010; Wong et al. 2007). "
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    ABSTRACT: The rental of housing units by landlords to participants in Housing First (HF) programs is critical to the success of these programs. Therefore, it is important to understand the experiences of landlords with having these individuals as tenants. The paper presents findings of qualitative interviews with 23 landlords who rented to tenants from a HF program located in a small city and adjoining rural area in eastern Canada and in which approximately 75 % of tenants had been housed for at least six consecutive months at 2 years in the program. Findings showed that landlords are motivated to rent to HF tenants for financial and pro-social reasons. They reported holding a range of positive, neutral, and negative perceptions of these tenants. They identified problems encountered with some HF tenants that included disruptive visitors, conflict with other tenants, constant presence in their apartments, and poor upkeep of units. On the other hand, landlords perceived HF tenants as being mostly good tenants who are similar to their other tenants. Implications for practice in the context of HF programs are discussed.
    American Journal of Community Psychology 04/2015; 55(3-4). DOI:10.1007/s10464-015-9714-2 · 1.74 Impact Factor
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    • "Several Canadian studies report that individuals who are homeless and/or have a mental illness prefer to be housed in independent housing rather than congregate settings [55,66,67]. Immediate access to independent housing of their choice and case management support, grounded in a program philosophy of participant empowerment and choice, form the foundation of the HF approach [10], leading to positive housing and health outcomes in a growing number of studies [12,18,25,34,62,63]. Nonetheless, studies have not consistently found that this community placement leads to community integration among program participants [68]. "
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    ABSTRACT: Housing first has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants' early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrolment in a Canadian field trial of Housing First. The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis. The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrolment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support. Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs.Trial registration: Current Controlled Trials ISRCTN42520374.
    BMC Health Services Research 04/2014; 14(1):167. DOI:10.1186/1472-6963-14-167 · 1.71 Impact Factor
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