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There is still much to learn about how aspects of the ecology of homelessness shape homeless adults' recovery experiences. In the present mixed-methods study, the relationship of service providers' work-related values to their service users' recovery experiences in the microsystem of homelessness were examined. Service providers completed semi-structured qualitative interviews about their service users, daily work activities, and work-related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration. Service providers' interview transcripts were coded for three indicators of values: assumptions, actions, and end-states. Summative Content Analysis was used to transform qualitative codes into numeric data so they could be used to predict service users' recovery. In a series of growth curve models, the extent to which service providers' end-state values, as an indicator of consumer-led values, was shown to indirectly predict service users' recovery experiences, through their perceived choice and mastery. Findings confirm that providers' values are an important influence on service users' recovery. Results are discussed in terms of their implications for recovery-oriented theory and practice.

OBJECTIVE: Recovery is the process through which one learns to overcome, manage, or live with the negative consequences of physical illness, mental illness, alcohol or drug misuse, or trauma. Homeless individuals endure many, or all, of these experiences. Previous research has shown that characteristics of homeless services, particularly the amount of choice they afford to service users, can influence recovery experiences, potentially by increasing a sense of mastery. The purpose of this study was to test the hypothesis that choice in housing and services would predict recovery in a number of domains, and that these relationships would be mediated by mastery. METHOD: Using survey data collected from a sample of homeless services users (n = 160) in Ireland, we conducted a series of cross-sectional mediation analyses to predict recovery in domains of physical health, psychiatric symptoms, alcohol and drug use, and community integration. RESULTS: We observed the hypothesized mediational relationship for each recovery domain except alcohol use. That is, personal mastery mediated the relationship of perceived choice to self-appraised physical health, psychiatric symptoms, drug use, and physical and psychological aspects of community integration, but not alcohol use. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings add further support to the growing body of evidence that suggests choice is centrally important to recovery experiences among individuals in homelessness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evidence-based management (EBM) encourages managers to draw upon evidence in decision-making. It is increasingly clear, however, that doing so often involves multiple actors, mobilizing multiple ev...

BackgroundInnovation driven by authoritative evidence is critical to the survival of England’s NHS. Clinical Commissioning Groups (CCGs) are central in NHS efforts to do more with less. Although decisions should be based on the ‘best available evidence’, this is often problematic, with frequent mismatches between the evidence ‘pushed’ by producers and that used in management work. Our concern, then, is to understand practices and conditions (which we term ‘capabilities’) that enable evidence use in commissioning work. We consider how research gets into CCGs (‘push’), how CCGs use evidence (‘pull’) and how this can be supported (toolkit development). We aim to contribute to evidence-based NHS innovation, and, more generally, to improved health-care service provision.MethodSupported by the National Institute for Health Research (NIHR), we conducted semistructured ethnographic interviews in eight CCGs. We also conducted observations of redesign meetings in two of the CCGs. We used inductive and deductive coding to identify evidence used and capabilities for use from the qualitative data. We then compared across cases to understand variations in outcomes as a function of capabilities. To help improvements in commissioning, we collated our findings into a toolkit for use by stakeholders. We also conducted a small-scale case study of the production of evidence-based guidance to understand evidence ‘push’.ResultsFieldwork indicated that different evidences inform CCG decision-making, which we categorise as ‘universal’, ‘local’, ‘expertise-based’ and ‘trans-local’. Fieldwork also indicated that certain practices and conditions (‘capabilities’) enable evidence use, including ‘sourcing and evaluating evidence’, ‘engaging experts’, ‘effective framing’, ‘managing roles and expectations’ and ‘managing expert collaboration’. Importantly, cases in which fewer capabilities were recorded tended to report more problems, relative to cases in which needed capabilities were applied. These latter cases were more likely to effectively use evidence, achieve objectives and maintain stakeholder satisfaction. We also found that various understandings of end-users are inscribed into products by evidence producers, which seems to reflect the evolving landscape of the production of authoritative evidence.ConclusionsThis was exploratory research on evidence use capabilities in commissioning decisions. The findings suggest that commissioning stakeholders need support to identify, understand and apply evidence. Support to develop capabilities for evidence may be one means of ensuring effective, evidence-based innovations in commissioning. Our work with evidence producers also shows variation in their perceptions of end users, which may inform the ‘push’/’pull’ gap between research and practice. There were also some limitations to our project, including a smaller than expected sample size and a time frame that did not allow us to capture full redesign projects in all CCGs.Future workWith these findings in mind, future work may look more closely at how information comes to be treated as evidence and at the relationships of capabilities to project outcomes. Going forward, knowledge, especially that related to generalisability, may be built by means of a longer time and the study of redesign projects in different settings.FundingThe NIHR Health Services and Delivery Research programme.

Clinical decision-making has seen significant attempts to shift the process from being primarily clinician-led to the inclusion of patients. This is reflected in recent UK and US legislature on cli...

Previous research demonstrated the importance of consumer choice and mastery to residential stability and psychiatric functioning for adults with histories of homelessness. In the present study, we investigated whether these relationships hold, even in the context of problem-related substance misuse. Questionnaire data were collected in Ireland from 101 residents of long-term homeless accommodation in 2010. Hayes' PROCESS macro for mediation and moderation analysis in SPSS was employed to test our hypotheses. Findings demonstrated that the indirect effect of choice through mastery on psychiatric functioning was stronger for individuals with more recent problem-related substance use than for those with no or distant histories of problem-related substance use. Our findings confirm that consumer choice in housing and services is important to homeless services users' recovery experiences. Because of its relationship with mastery, consumer choice in housing and services protects homeless services users' psychiatric functioning, especially when substance use-related choices have had negative consequences. Our findings suggest that if homeless services take away consumer choice when substance use causes problems, they may actually undermine, rather than foster, service users' psychiatric functioning.