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Background Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one’s potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their effectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity. Methods We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n = 245) or treatment as usual (n = 320). Results Exploratory and confirmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure’s concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities. Conclusions Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed.

The development and dissemination of Housing First programmes have been slow and without national info:eu-repo/semantics/publishedVersion

Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed. info:eu-repo/semantics/publishedVersion

Contains fulltext : 200223.pdf (Publisher’s version ) (Open Access) Background: Most European countries report rising numbers of people experiencing homelessness. For those with mental disorders, interventions are centered on achieving mental health and drug rehabilitation alongside housing readiness, often to the detriment of access to housing. Notwithstanding, more European countries are investing in a new model, Housing First (HF), which postulates immediate access to permanent housing with no initial requirements for treatment. While results of the European HF programs are published on individual-level data, little is known about the opinions of the general population about homelessness and the societal value of the HF model, which can represent barriers to the model's dissemination. Therefore, we present the protocol of a study designed for the following objectives: 1) to explore the knowledge, attitudes, and practices (KAP) about homelessness within the general population of 8 European countries, 2) to assess the valuation of the HF model by European citizens, and 3) to estimate the lifetime prevalence of homelessness in the targeted countries. Methods: A telephone survey was conducted from March to December 2017 among adults selected from opt-in panels from France, Ireland, Italy, the Netherlands, Portugal, Spain, Poland, and Sweden. A total sample of 5600 interviews was expected, with 700 per country. The interviews included three sections: first, the KAP about homelessness; second, the valuation of the HF model by measuring a respondent's willingness-to-pay (WTP) through the contingent valuation method; and third, an assessment of the lifetime prevalence of homelessness among the general population. Descriptive analyses and comparisons between countries will be conducted. KAP indicators will be created and their psychometric properties assessed. Determinants of WTP will be assessed through regression models. Discussion: This survey will highlight Europeans' views of homelessness, especially their level of tolerance towards homelessness, potential misconceptions and the most important barriers for the implementation of the HF model. Additionally, the results on the valuation of the HF model by citizens could be instrumental for key stakeholders in understanding the level of support from the general population. Ethics approval has been obtained from the Aix-Marseille University Ethics Committee (n degrees 2016-01-02-01) for this study, which is part of HOME_EU: Reversing Homelessness in Europe H2O20-SC6-REVINEQUAL-2016/GA726997.

Introduction: Homelessness is as large political question globally as it is in Sweden with a growing number of homeless. “Housing First” is a municipality based program aiming to offer stable and enduring housing to homeless people immediately. This model was imported to Sweden and was tried in Stockholm and Helsingborg, a provincial town in the southwest of Sweden. This prevailing study is to test the feasibility of making longitudinal studies on homeless individuals. Method: A longitudinal study using repeated measures of selfreports on questionnaires. Result: This study report results from baseline and a 24 month follow-up of the program compared to a treatment-as-usual control group. It was shown that although the former homeless in the Housing First group perceived an increased housing normality and empowerment there were no significant differences between groups across time. Conclusion: Although individuals living in a Housing First apartment tended to have a more normal way to live they seem to not improve psychologically. However some problems that is connected to longitudinal research on the homeless was detected. Since Housing First is a program consisting of housing and support the effect is dependent on both. The null result in this study was discussed as a consequence of foremost insufficient support in housing.

Frequent attenders in substance misuse care

Inom ramen för regeringens hemlöshetsstrategi har Socialstyrelsen haft iuppdrag att, i samråd med Boverket, ta fram en kunskapsöversikt om olikaboendelösningar för att lösa hemlöshet.Grunden för kunskapsöversikten är en systematisk kartläggning avgenomförda effektutvärderingar av olika boendeprogram. Den systematiskakartläggningen bygger på internationellt publicerad forskning. De flesta avstudierna kommer från USA och avser till största delen grupper med svårsocial problematik.Kunskapsöversikten ska ses som ett steg i utvecklingen mot en evidensbaseradpraktik på hemlöshetsområdet. Innehållet i rapporten är komplextoch ger snarare en bild av forskningens kvalitet och inriktning än en direktvägledning i det praktiska arbetet. Materialet utgör dock en förutsättning föratt kunna gå vidare mot en konkretisering av insatserna. Nästa steg blir attSocialstyrelsen kommer att utarbeta ett konkret, vägledande material riktattill relevanta aktörer. Arbetet ska ske i samverkan med forskares kommuneroch brukarorganisationer.Ett antal slutsatser av övergripande principiell karaktär kan dras utifrånrapporten.En övergripande slutsats är att en så permanent boendelösning som möjligt– kompletterad med individuellt, behovsanpassat stöd – är ett krav.Hemlösa personer har samma behov som andra av ett tryggt och långsiktigtboende, oavsett eventuella övriga problem. Ett resultat tyder på att ett tryggtboende ibland också är en förutsättning för att stöd och vård i olika formerska ha effekt. Vägen till ett självständigt boende sker i många fall stegvis,med successivt minskat behov av vård och stöd. Den minskningen kanmycket väl ske i en och samma bostad.Ett könsperspektiv behövs i valet av boendelösningar. Ett resultat tyder påatt om insatser ska ha god effekt för kvinnor bör de vara direkt riktade tilldem.Två huvudtyper av boendeprogram har kunnat urskiljas – ”Bostad först”(parallellt boende) och vårdkedjemodellen (integrerat boende). Det bör poängterasatt inget av de program som beskrivs är renodlade, utan snararehybrider där man tillämpar inslag från olika program. Kopplade till de olikaboendeprogrammen finns ofta ett antal specifika metoder för vård och stöd.Dessa kan kombineras på olika sätt.I den internationellt publicerade forskningen saknas effektutvärderingarav boendetrappor, som är den vanligaste modellen i Sverige. Det är dockmöjligt att peka på likheter i bakomliggande tankesätt mellan boendetrapporoch de program som internationellt beskrivs i termer av vårdkedjemodeller.Detta, plus det faktum att ”Bostad först” börjat praktiseras i svenska kommunergör att de resultat som framkommit vid genomgången av studierna ärrelevanta för svenska förhållanden. En slutsats från genomgången av de två huvudtyperna av boendeprogramtalar för att ”Bostad först” är en lovande strategi. Det finns goda skäl att iSverige bygga vidare på de erfarenheter man gjort i arbetet med dessa program.Kunskapsöversikten ger dock inte underlag för att avfärda vårdkedjemodellensom ett verkningslöst program. För svenskt vidkommande betyderdet att boendetrappor kan vara verksamma program om det finns behovsanpassadevård- och stödinsatser kopplade till dessa.I en evidensbaserad praktik vägs tre kunskapskällor samman i dialog: bästavetenskapliga kunskap, de professionellas erfarenhet och brukarnas erfarenhetoch önskemål. Det sätt på vilket informationen från dessa källor vägssamman beror på det nationella och lokala sammanhanget, till exempel lagstiftning,riktlinjer och de resurser som finns tillgängliga.För att kunna jämföra de insatser som görs i Sverige med dem som kunskapsöversiktenavser är det nödvändigt att utförligt beskriva de svenskainsatserna vad gäller innehåll och metod. Att insatserna dokumenteras ochföljs upp är ett grundläggande krav. Detta är en viktig del i utvecklingenmot en evidensbaserad praktik.Efter den systematiska kartläggningen finns nu förutsättningar att gå vidaremed en systematisk översikt där analysen kan fördjupas. Institutet förutveckling av Metoder i Socialt arbete (IMS) planerar att under 2009–2010,inom ramen för det internationella samarbete som koordineras av CampbellCollaboration, genomföra en sådan systematisk översikt.Det som framförallt diskuteras i denna rapport är insatsernas utformning iSverige inom ramen för det handlingsutrymme som den kommunala socialtjänstenhar. En annan aspekt är hur kommunerna ska få tillgång till bostäderatt fördela till hemlösa personer och därigenom få ett reellt handlingsutrymmei valet av olika typer av insatser. För att komma tillrätta med hemlöshetsproblemetkrävs en samlad politisk vilja och insatser på flera nivåer.

The overarching aim of this dissertation is to explore and describe Swedish local authorities’ measures to prevent and manage homelessness; how these measures diverge between different municipal categories; what factors predict homelessness, provisions of accommodation and cov-erage rates between the number of accommodations and the respective municipalities’ housing interventions. Measures studied are policies and housing interventions. The housing interventions re-ferred to here are those provided by or through the social welfare authorities to persons living with unstable housing or who are homeless. The interventions can be divided into two main categories: 1) preventive interventions in the form of daily-life support, usually in the form of personnel support in the individual’s own apartment, designed to help persons at risk of becom-ing homeless to remain housed and prevent eviction; 2) accommodation support for persons who are already homeless and in need of housing. Such accommodations may be more or less temporary, more or less integrated and include a greater or lesser amount of care. Two sets of data were collected for the study: 1) a case study of two category-housing programmes using both qualitative and quantitative data; 2) a survey of 147 randomly chosen municipalities (about half of the municipalities in Sweden) to explore the prevalence and charac-teristics of policies and housing interventions. Findings from the case study show that special-category housing has positive direct effects on the housing stability of the residents and their feelings regarding their quality of life, but does not have a direct effect on their substance misuse. Moreover, the increased housing stability seems to be more a direct effect of the person having stayed on the programme, rather than a long-term effect. Furthermore, although their quality of life improves, the residents still experi-ence a lack of belonging and feel that their lives lack meaningful content. On the national level, the findings show that an array of housing interventions divided into 12 sub-categories is offered to counteract homelessness. These categories vary along two central dimensions: care and normality. The two most frequent types of housing interventions in all types of municipalities are daily-life support and social contracts. Other housing interventions are marginal compared with these two. There is greater fluctuation between municipalities in the level of care provided than in the level of normality. Furthermore, the more densely populated municipalities are more highly engaged in developing housing policies and the administrative means to handle them. Such policies, however, seem to decrease the level of normality without promoting levels of care. When exploring factors that predict homelessness, the findings show that urbanisation is central to understanding variations in homelessness, not only in the largest cities but also in less densely populated areas. In addition, higher rent levels and more of aggregated psychiatric prob-lems in the municipality seem to increase homelessness. The apartment rate and the proportion of public housing within the stock of apartments are both important for the possibility to pro-vide accommodations. Moreover, the proportion of single-parent households seems to enhance the need to provide such accommodations. Political majority and the functional organisation of the social services both seem to have an impact on the coverage rates. Thus, the findings indicate that the municipalities have various options for managing factors that impact on the homeless-ness rate. Keywords: housing interventions, level of care, level of normality, policies, municipality, predicting homelessness