Article

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

Tilburg University, Tilburg, North Brabant, Netherlands
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

ABSTRACT

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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    • "The Pathways Housing First model represents a shift in the traditional service philosophy for homeless individuals with severe and persistent mental illness (Tsemberis, 1999; Tsemberis and Eisenberg, 2000; Tsemberis et al., 2004; Greenwood et al., 2005). Homeless individuals are rapidly placed in the housing of their choice, provided with a rental subsidy, and offered support through an Assertive Community Treatment (ACT) team (Tsemberis, 1999; Tsemberis and Eisenberg, 2000). "

    Full-text · Dataset · Dec 2015
    • "The HF programs delivered in the At Home/Chez-Soi project were based on the model developed by Pathways to Housing (Greenwood et al., 2005; Tsemberis, 2010; Tsemberis & Eisenberg, 2000; Tsemberis et al., 2004). Participants received a rent supplement and paid 30% of their income towards their rent. "
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    ABSTRACT: Background: At Home/Chez-Soi was a 24 month randomized controlled trial of Housing First (HF) conducted in five Canadian cities. Aims: This article attempts to identify the characteristics of participants who experienced housing instability one year after entering HF. Methods: Those defined as experiencing housing instability were housed < 50% of the last 9 months of the first year, excluding time in institutions, unless they were housed 100% of the past 3 months. Results: Only 13.5% of HF participants (157/1162) met criteria for housing instability. Several variables were significant predictors of instability in between-group comparisons and multiple regression analyses: residence in Winnipeg, cumulative lifetime homelessness, percent of previous 3 months spent in jail, and community psychological integration; while residence in Moncton and a diagnosis of PTSD or panic disorder predicted stability. The predictive models were weak, identifying correctly only 3.8% of individuals that failed to achieve housing stability. Conclusions: It is not possible to predict confidently at baseline who will experience early housing instability in HF. There are certain individual characteristics that might be considered risk factors. Providing HF to all individuals who qualify for a HF program remains the most valid way to administer admission to housing.
    No preview · Article · Dec 2015 · Journal of Mental Health
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    • "The Pathways Housing First model represents a shift in the traditional service philosophy for homeless individuals with severe and persistent mental illness (Tsemberis, 1999; Tsemberis and Eisenberg, 2000; Tsemberis et al., 2004; Greenwood et al., 2005). Homeless individuals are rapidly placed in the housing of their choice, provided with a rental subsidy, and offered support through an Assertive Community Treatment (ACT) team (Tsemberis, 1999; Tsemberis and Eisenberg, 2000). "
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    ABSTRACT: This paper presents the findings of a second fidelity assessment of a Housing First programme in a small Canadian city. The evaluation included two components: a) a fidelity assessment by an external team of experts; and b) key informant interviews and focus groups with programme staff to identify contributors to programme areas of high fidelity and low fidelity. Findings from the second fidelity assessment indicated that the programme in Moncton had effectively addressed a number of issues raised in the first fidelity assessment. However, the second fidelity assessment also identified the presence of a number of challenges that continued to be faced by the programme. Notable programme areas requiring further development included the integration of substance abuse treatment into services delivered by the Assertive Community Treatment (ACT) team, the use of individualized service planning focusing on recovery goals, and the addition of a peer specialist to the ACT team. The findings from the fidelity assessment are interpreted in the context of information collected from key informants and programme staff. Recommendations coming out of the assessment for addressing programme areas of low fidelity are discussed.
    Full-text · Article · Dec 2015
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