The Paradigm Shift in Residential Services: From the Linear Continuum to Supported Housing Approaches

Psychosocial Rehabilitation Journal 03/1990; 13(4):11-31. DOI: 10.1037/h0099479


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.
    Full-text · Article · Jul 2015 · Journal of Social Distress and the Homeless
    • "More troubling questions concern the actual treatment availability for the HUD-VASH clients in this case series. The Housing First approach requires consumer-centered recovery services to engage clients and reduce substance use–related harms (Gilmer et al., 2013; Ridgway and Zipple, 1990). Although addiction treatment is not compulsory, regular and intensive engagement with clients to promote recovery is required . "
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    ABSTRACT: Over the last 5 years, community policies in response to homelessness have shifted toward offering permanent housing accompanied by treatment supports, without requiring treatment success as a precondition. The US Department of Veterans Affairs (VA) has embraced this "Housing First" approach. A 2013 report sounds a contrarian note. In a 16-person quasi-experimental study, 8 veterans who entered VA's permanent supportive housing did poorly, whereas 8 veterans who remained in more traditional treatment did well. In this commentary, we suggest that the report was problematic in the conceptualization of the matters it sought to address and in its science. Nonetheless, it highlights challenges that must not be ignored. From this report and other research, we now know that even more attention is required to support clinical recovery for Housing First clients. Successful implementation of Housing First requires guidance from agency leaders, and their support for clinical staff when individual clients fare poorly.
    No preview · Article · Jul 2015 · The Journal of nervous and mental disease
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    • "These settings integrated treatment and housing in a single, group or congregate setting, and were often organized in terms of a residential continuum. In theory, the residential continuum consisted of a range of settings varying in terms of the intensity of rehabilitation services provided and the amount of autonomy afforded (Ridgway & Zipple, 1990). As residents' functioning improved, they were expected to move to a less restrictive setting (e.g., from a halfway house to a quarterway house). "

    Preview · Article · Dec 2014 · Canadian journal of community mental health = Revue canadienne de santé mentale communautaire
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