Housing First and Social Integration

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

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)

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?

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?

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

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?

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

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

Types of Social Integration
 Four main areas examined in Review:
 ‘Passing’/ community acceptance
 ‘Joining’/ community participation
 Working/ economic participation
 Voting/ political participation

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)

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

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

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

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

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

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?

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

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.

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

Housing First and Social Integration

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (18)

En vedette

En vedette (15)

Similaire à Housing First and Social Integration

Similaire à Housing First and Social Integration (20)

Plus de FEANTSA

Plus de FEANTSA (20)

Dernier

Dernier (20)

Housing First and Social Integration