Housing First and Social Integration

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Presentation by Deborah Quilgars, University of York, UK, at the 2013 FEANTSA Research Conference, Alice Salomon Hochschule Berlin, 20th September 2013

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Housing First and Social Integration

  1. 1. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Housing First & Health and Social Integration: A Review Deborah Quilgars & Nicholas Pleace, Centre for Housing Policy, University of York Insert your logo here
  2. 2. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Background to the Review  Housing First proven as a highly effective response to ending chronic homelessness for service users  USA – 88% of people using Pathways Housing First stably housed after 5 years (Tsemberis, 2010)  Similar rates of tenancy sustainment in Canada, Netherlands, Denmark, UK and Portugal (over shorter periods) (Goering et al, 2012; Busch-Geertsema, 2013)
  3. 3. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Background to the Review  Some criticisms of Housing First:  HF goals narrower than for staircase services? – do not need to be housing ready with health/ drug issues addressed  People with highest needs not always reached by HF?  Emerging evidence/ commentary that HF delivers more limited/ variable effects on the health status and social integration of formerly homeless people?
  4. 4. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Review Aims and Methods  Three main aims:  What types of supports are provided by HF to promote health? How effective are these supports? Could they be enhanced?  What types of supports are provided by HF to promote social integration? How effective are these supports? Could they be enhanced?  Are there lessons from other areas of policy and practice for HF in these areas?
  5. 5. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Review Methods  Rapid Evidence Assessment  International in scope; evidence from 1990  Searches carried out by Information Scientist (1,258 references retrieved)  Quality assessment broader than traditional systematic reviews  Limitations:  Focused primarily on English language papers  Key evaluations still in progress (Canada; France)  Much evidence is USA – applicability to EU context
  6. 6. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Social Integration: Definitions  Social integration poorly defined  Influential paper by Wong and Solomon (2002) – three main elements:  Physical; social/ community; psychological  Dispersed networks/ social media discussions usually absent  What levels of integration are enjoyed/ expected of other community members?  Focus on ‘integration’; communities of interest may also be important?
  7. 7. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Social Integration: Evidence  Limited literature/ studies describing/ evaluating social integration  Most studies do not utilise a control or comparison group  Rarely longitudinal in nature  Researcher–led measures of social integration; service users’ perspective largely absent
  8. 8. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Social Integration: Aims of HF  Primarily to promote social integration via the key components of HF – normal housing in normal community settings, opportunities and choice  General support from mobile workers  Specific services to promote social integration are rare; though some examples in new projects – including Canada and France
  9. 9. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Types of Social Integration  Four main areas examined in Review:  ‘Passing’/ community acceptance  ‘Joining’/ community participation  Working/ economic participation  Voting/ political participation
  10. 10. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Community Acceptance  Studies suggest that nuisance / disruptive behaviour not a major problem in HF projects (eg. 3 of HF Europe projects)  Where problems exist, HF appears to function as an effective intermediary and/or people can move properties (egs: Glasgow/ Amsterdam HF)  Positive effect on criminality (US studies)  Convictions often ‘misdeameanors’ (Clifasefi et al, 2012)  However association may be with housing and support more generally (Culhane et al, 2002)
  11. 11. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Community Participation  US studies  Small but significant increases for some activities (effect disappeared after controlling for clinical symptoms) (Tsai et al, 2012)  More effective on some measures than Treatment as Usual (Gulcur et al, 2007)  Varying levels of community participation within any one project (see Busch-Geertsema, 2013)  Lack of comparisons with other community members
  12. 12. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Economic participation  Limited/ no impact on economic participation  no change in employment after 12 months (Tsai et al, 2012)  Some impacts in areas of ‘preparation for work’ – training , education and meaningful activity (see Busch-Geertsema, 2013; Polvere et al, 2013)  Shift from survival to ‘envisioning’ a future  Considerable barriers to employment
  13. 13. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Political participation  Not been explored by studies in the main  One study found an increase from 21% to 31% of services users intending to vote over 12 months (Tsai et al, 2012)  Major gap in research
  14. 14. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Health impacts: Key findings  Mental health - stabilisation or modest improvement over longer term (no deterioration); feelings of ontological security  Alcohol and drug issues - mainly stabilisation, no deterioration; success for communal services for specific groups  Physical health - very limited evidence; possibly improved engagement with services
  15. 15. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Conclusion  Evidence on social integration is weak  Need for conceptual development – to include social change and service user definitions  However, limited evidence suggests limited impacts on social integration  Potential strength of HF is in delivering ‘ontological security’ and providing a base from which people can begin to engage in community
  16. 16. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Conclusion  Relative effectiveness of communal versus dispersed models not known  Expecting too much of people and HF? (Hopper, 2012; Busch-Geertsema, 2013)  Setting targets within philosophy of choice/ self-determination inappropriate?; risk of service failure? (Hansen Löfstrand & Juhila, 2012)  Specific services to maximise social and economic opportunities could be promoted further in new HF developments?
  17. 17. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Some Key References  Busch-Geertseema, V. (2013) Housing First Europe Final Report, Brussels: European Commission.  Culhane, D. Metraux, S., Hadley, T., (2002) ‘Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing’, Housing Policy Debate, 13, 1, pp.107-163.  Clifasefi, S.L.; Malone, D.K. and Collins, S. E. (2012) ‘Exposure to project- based Housing First is associated with reduced jail time and bookings’, International Journal of Drug Policy (online).  Goering, P.; Veldhuizen, S.; Watson, A.; Adair, C.; Kopp, B.; Latimer, E. and Ly, A. (2012) At Home/Chez Soi Interim Report Mental Health Commission of Canada  Gulcur, L., Tsemberis, S., Stefancic, A. and Greenwood, R.M. (2007). "Community integration of adults with psychiatric disabilities and histories of homelessness." Community Mental Health Journal 43(3): 211-228.  Hansen Löfstrand, C. and Juhila, K. (2012) ‘The Discourse of Consumer Choice in the Pathways Housing First Model’ European Journal of Homelessness 6, 2, pp. 47-68
  18. 18. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Some Key References 2  Hopper, K. (2012) ‘The Counter Reformation that Failed? A Commentary on the Mixed Legacy of Supported Housing’ Psychiatric Services 63, 5, pp. 461-463.  Polvere, L.; Macnaughton, E. and Piat, M. (2013) ‘Participant Perspectives on Housing First and Recovery: Early Findings From the At Home/Chez Soi Project’ Psychiatric Rehabilitation Journal 36, 2, pp.110-112.  Tsai, J., Mares, A.S. and Rosenheck, R.A. (2012). "Does housing chronically homeless adults lead to social integration?" Psychiatric Services, 63(5): 427-434  Tsemberis, S. (2010) ‘Housing First: Ending Homelessness, Promoting Recovery and Reducing Costs’ in I. Gould Ellen and B. O’Flaherty (Editors) How to House the Homeless Russell Sage Foundation: New York  Wong, Y. L. I. and Solomon, P.L. (2002) ‘Community integration of persons with psychiatric disabilities in supportive independent housing: A conceptual model and methodological considerations’ Mental Health Services Research 4(1): 13-28.
  19. 19. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Thank you for listening  Deborah Quilgars & Nicholas Pleace  Centre for Housing Policy, University of York, England  deborah.quilgars@york.ac.uk / nicholas.pleace@york.ac.uk  www.york.ac.uk/chp  With thanks to DIHAL/ FEANTSA for funding the Review

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