Frontline Practice within Housing First Programs

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Frontline Practice within Housing First Programs by Benjamin Henwood from the workshop 5.9 Research on the Efficacy of Housing First at the 2014 National Conference on Ending Homelessness.

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Frontline Practice within Housing First Programs

  1. 1. FRONTLINE PRACTICE WITHIN HOUSING FIRST PROGRAMS National Alliance to End Homelessness Annual Conference July 30, 2014 Presented by: Benjamin Henwood, PhD, MSW USC School of Social Work, Los Angeles
  2. 2. 1. Why would frontline practice in Housing First differ from other types of programs? 2. Do HF providers have a different approach services? 3. What does it mean to deliver recovery oriented services within HF? 4. How do HF providers implement a harm reduction framework?
  3. 3. 1. Why would frontline practice in Housing First differ from other types of programs?
  4. 4. Traditional system approach Homeless Shelter placement Transitional housing Permanent housing Level of independence Treatment compliance + psychiatric stability + abstinence
  5. 5. Housing First approach Homeless Shelter placement Transitional housing Permanent housing Ongoing, flexible support Harm Reduc+on
  6. 6. 2. Do HF providers have a different approach services?
  7. 7. Compared to non-HF, HF providers had: - Greater endorsement of consumer values, - Lesser endorsement of systems values, - Greater tolerance for abnormal behavior
  8. 8. Implementation paradox TF providers were consumed by the pursuit of housing. HF providers focused on clinical concerns. Front-Line Practice Housing First Model Treatment First Model Focus on Housing Focus on Treatment *Henwood, B.F., Shinn, M., Tsemberis, S., & Padgett, D.K. (2013). Examining provider perspectives within housing first and traditional programs. American Journal of Psychiatric Rehabilitation, 16(4), 262-274.
  9. 9. 3. What does it mean to deliver recovery oriented services within HF?
  10. 10. Provider creates meaningful choices Provider Reflexivity Model 1 Reflexivity ↓ Create choice↓ • Providers deny both client expertise and agency • Accept traditional power dynamics Model 3 Reflexivity ↓ Create choice↑ • Choice is an explicit value but there’s not much consideration of the values and expertise that clients bring. Model 2 Reflexivity ↑ Create choice↓ • Acceptance that client have a unique perspective but provider doesn’t allow for providers to make substantive decisions. Model 4 Reflexivity ↑ Create choice↑ • Recognition of complicated decision making processes AND the importance of clients being the drivers of their destiny is embraced. Low High High Emergent Framework for Promoting Self-Determination , * Katz, M., Henwood, B.F., Stefancic, A., & Gilmer, T. (in preparation). In what ways do front-line providers promote client choice? A comparative analysis based on fidelity to Housing First. ,
  11. 11. 4. How do HF providers implement a harm reduction framework?
  12. 12. Figure 1. Housing First harm reduc1on emergent conceptual model Strong consumer-­‐ provider rela1onship Poor consumer-­‐ provider rela1onship Open drug use discussion No/limited drug use discussion High self-­‐ determina1on & Health impact Low self-­‐ determina1on & Health impact Holding Environment Consumer Need *Tiderington, E., Stanhope, V., & Henwood, B. (2012). A Qualitative Analysis of Case Managers' Use of Harm Reduction in Practice. Journal of Substance Abuse Treatment, 44, 71-77.
  13. 13. Concluding Thoughts 1. Harm reduction: Need more than a conceptual framework; what are the actual practices? 2. Recovery orientation: But what if other providers don’t speak this language? 3. HF allows us to bypass an ineffective staircase; what other types of ‘bypasses’ should we embrace? 4. HF providers have a different approach as compared to traditional providers; how do HF providers serving youth approach things differently than those serving adults?

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