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Evaluation of a Two-Year Housing First Project in Sweden
 

Evaluation of a Two-Year Housing First Project in Sweden

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    Evaluation of a Two-Year Housing First Project in Sweden Evaluation of a Two-Year Housing First Project in Sweden Presentation Transcript

    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Evaluation of Housing First in Sweden. A comparison with the staircase model Håkan Källmen, Karolinska institutet and Mats Blid, MidSweden University
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Background  Homelessness can be considered as due to structural problems on an aggregated level (low housing construction) or as an individual problem with substance abuse/psychiatric problems.  The usual housing support to the homeless in Sweden is called the “Staircase model”. According to that model the homeless have to learn and prove step by step the ability to live in an own apartment and adapt to a proper life.  .
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Background  Although large resources has been allocated to solve the homelessness problem. The prevalence rate increase.  To solve the problem a new paradigm ”Housing First” was suggested. This is a concept combining housing before optional support to solve individual problems.
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Evaluation  This evaluation compares the usual staircase model to ”Housing First” regarding perceived normal housing, psychological factors and misuse of alcohol and drugs over a three year follow-up period.  In the evaluation a comparison regarding criminality, incomes and health care consumption is made although not presented here.
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 First aim  To evaluate if Housing First leads to perception of a more normal and stable housing over time than the staircase model.
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Second aim  Another aim is to compare the development of misuse of alcohol and drugs and also the changes in psychological factors over time.
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Third aim  The third aim is to compare the consumption of health care, incomes and criminality over time
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 A longitudinal non-equivalent control group design Baseline assessment Housing first group Controlgroup Assessments every sixth month during three years
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Participants  Participants in this study are 36 homeless persons assessed both at baseline and follow-up. They have a long period without a stable housing and are considered as inable to get a housing within the stair case model.  They will have a wish to live in an own apartment and also wish to cooperate with the social sevice
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Data collection After informed consent, data from the housing first group were collected by the city mission in Stockholm and the social service in Helsingborg. Data from the control group were collected at ordinary appointments at the social service in Stockholm. Each respondent received a voucher of 8 Euro worth and each datacollector received a ticket to cinema at 9 Euro worth.
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Results at baseline Intervention group M SD Control group M SD P Normality in housing 4,08 1,44 4,28 1,64 0,74 Stability in housing 3,62 0,50 3,60 1,19 0,21 Locus of control 28,50 4,60 27,95 6,70 0,80 KASAM 53,77 13,63 51,45 13,78 0,64 Comprehensibilit y 20,69 5,59 20,95 6,21 0,90 Manageability 16,00 5,00 15,60 5,65 0,84 Meninfulness 17,08 4,86 14,90 4,83 0,22 AUD IT 12,18 11,20 11,68 10,33 0,95 DUDIT 9,85 10,41 14,06 11,54 0,84 Table 1. Means and standarddeviation for groups on the assessed variables at baseline and p-values for differences between groups (T-test).
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Results at six month follow-up. Intervention group M SD Control group M SD p Normality in housing 7,85 1,95 4,65 1,88 <0,001 Stability in housing 4,00 0,85 3,78 1,06 0,292 Locus of control 28,46 6,05 29,13 5,30 0,568 KASAM 59,23 13,73 56,74 14,24 0,926 Comprehensibilit y 22,23 6,57 21,91 5,98 0,664 Manageability 17,38 4,73 16,56 4,67 0,814 Meningfullness 19,61 4,44 18,26 3,85 0,269 AUD IT 10,50 12,44 10,39 11,80 0,693 DUDIT 9,54 10,96 6,70 7,85 0,603 Table 2. Means and standarddeviation on study variables at six month follow-up P-values for differences between groups with T-test.
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Results over time Variable Effect F df p Housing normality Time 18,40 1,29 0,001 Time x Group 10,79 1,29 0,003 Housing Stability Time 1,93 1,30 0,175 Time x Group 0,43 1,30 0,518 Locus of Control Time 0,43 1,30 0,516 Time x Group 0,19 1,30 0,664 KASAM (total) Time 4,60 1,31 0,040 Time x Group 0,00 1,31 0,994 Comprensibiity Time 0,94 1,31 0,341 Time x Group 0,052 1,31 0,821 Manageability Time 1,55 1,31 0,222 Time x Group 0,07 1,31 0,793 Meningfullness Time 11,61 1,31 0,002 Time x Group 0,38 1,31 0,545 Alcohol habits Time 2,66 1,28 0,114 Time x Group 0,730 1,28 0,400 Drug habits Time 4,63 1,31 0,027 Time x Group 4,34 1,28 0,039 Table 3. Testof main effekt of time and interaction time x group
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Results cont.  The normality of housing, KASAM and Meningfullness improved and drug habits mitigated on average among all homeless during 6 months.  However, housing normality improved even as a consequence of ”Housing First” but drug use did not mitigate as much as in the control grup
    • European Research Conference Access to Housing for Homeless People in Europe York, 21st September 2012 Discussion  The fact that all homeless individuals improved their housing conditions and their structure/meaningfullness in life over time maybe is a consequence of supervision and social support. The harm reduction philosofy of ”Housing First” can be responsible of a less decrease in drug use among those who received an apartment from the project.