BACKGROUND AND OBJECTIVES:
"Housing First" has been shown to improve housing stability in homeless individuals with mental illness, but had not been empirically tested in homeless youth. We aimed to evaluate the effect of "Housing First" on housing stability in homeless youth aged 18 to 24 years participating in At Home/Chez Soi, a 24-month randomized trial of "Housing First" in 5 Canadian cities.
METHODS:
Homeless individuals with mental illness were randomized to receive "Housing First" (combined with assertive community treatment or intensive case management depending on their level of need) or treatment as usual. We defined our primary outcome, housing stability, as the percent of days stably housed as a proportion of days for which residence data were available.
RESULTS:
Of 2148 participants who completed baseline interviews and were randomized, 7% (n = 156) were youth aged 18 to 24 years; 87 received "Housing First" and 69 received treatment as usual. In an adjusted analysis, youth in "Housing First" were stably housed a mean of 437 of 645 (65%) days for which data were available compared with youth in treatment as usual, who were stably housed a mean of 189 of 582 (31%) days for which data were available, resulting in an adjusted mean difference of 34% (95% confidence interval, 24%–45%; P < .001).
CONCLUSIONS:
"Housing First" was associated with improved housing stability in homeless youth with mental illness. Future research should explore whether adaptations of the model for youth yield additional improvements in housing stability and other outcomes.
Background
Despite the accumulating evidence on the role of professional helping relationships for highly disadvantaged populations, methodological shortcomings have made it difficult to establish a robust relationships-outcomes link. This study sought to establish the impact of professional helping relationships on the trajectories over 24 months of housing stability for 2141 people facing severe and multiple disadvantage using data from the Housing First controlled trial in Canada.
Method
The study used a mixed method design. Latent growth curve and growth mixture models assessed the impact of working alliance across the sample as a whole and within subgroups with different patterns of housing stability. Thematic analysis explored the factors that may affect the quality of working alliances within different subgroups.
Results
Three distinct trajectories of housing stability emerged (i.e., Class 1: “sharp rise, sustained, and decline housing”; Class 2: “hardly any time housed”; Class 3: “high rise, sustained, and decline housing”) with professional helping relationships having different effects in each. The analysis revealed structural and individual circumstances that may explain differences among the classes.
Conclusions
The findings underscore the role of professional helping relationships, as distinct from services, in major interventions for highly disadvantaged populations, and draws new attention to the temporal patterns of responses to both the quality of relationship and targeted interventions.
The aim of this study was to explore the way young people facing severe and multiple disadvantage and their support workers perceive the circumstances of the young person. The leaders of 11 U.K. and five U.S. support-providing organisations identified 30 young people aged 16 to 25 who were in great need and 35 workers for this study. Thematic analysis of the semistructured interviews found that shame was a primary emotional reaction to severe and multiple disadvantage.A history of poor relationships led them to develop an acute assessment of others and a tendency to back away from help. Over time, they perceived themselves to be unworthy and unable. Findings underscored the young people's role in shaping their trajectories and shone light on the role of emotions in explaining disconnection from support.
Family‐like professional helping relationships have the potential to alter the trajectories of young people facing significant disadvantage. This study seeks to identify the worker attributes that allow the formation of deep bonds with young people in these circumstances. Access to young people in difficult circumstances was secured via organisations that provided support to this population. Interviews about positive‐helping relationships were conducted with young people (n = 30) and support workers (n = 35) from 11 UK and 5 US not‐for‐profit organisations. Thematic analysis was used to analyse the data. Three sets of worker qualities were identified and linked to how relationships change young people's trajectories in the context of adversity. This study has implications for the selection, training, and support of workers who provide support to young people facing difficult challenges underscoring the qualities needed to provide support and change young people's outcomes.
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