Comparison of Housing First and Traditional Homeless Service Users in Eight European Countries: Protocol for a Mixed Methods, Multi-Site Study

Abstract

Background Homeless services expend considerable resources to provide for service users’ most basic needs, such as food and shelter, but their track record for ending homelessness is disappointing. An alternative model, Housing First, reversed the order of services so that homeless individuals are offered immediate access to independent housing, with wraparound supports but no treatment or abstinence requirements. Although the evidence base for Housing First’s effectiveness in ending homelessness is robust, less is known about its effectiveness in promoting recovery. Objective The objective of this research is to compare rehabilitation- and recovery-related outcomes of homeless services users who are engaged in either Housing First or traditional staircase services in eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden. Methods A mixed methods, multi-site investigation of Housing First and traditional services will compare quantitative outcomes at two time points. Key rehabilitation outcomes include stable housing and psychiatric symptoms. Key growth outcomes include community integration and acquired capabilities. Semistructured interviews will be used to examine service users’ experiences of environmental constraints and affordances on acquired capabilities to identify features of homeless services that enhance service users’ capabilities sets. Multi-level modelling will be used to test for group differences—Housing First versus traditional services—on key outcome variables. Thematic analysis will be used to understand the ways in which service users make sense of internal and external affordances and constraints on capabilities. Results The study is registered with the European Commission (registration number: H2020-SC6-REVINEQUAL-2016/ GA726997). Two press releases, a research report to the funding body, two peer-reviewed articles, and an e-book chapter are planned for dissemination of the final results. The project was funded from September 2016 through September 2019. Expected results will be disseminated in 2019 and 2020. Conclusions We will use the findings from this research to formulate recommendations for European social policy on the configuration of homeless services and the scaling up and scaling out of Housing First programs. From our findings, we will draw conclusions about the setting features that promote individuals’ exits from homelessness, rehabilitation, and recovery. International Registered Report Identifier (IRRID) RR1-10.2196/14584

Home as a Base for a Well-Lived Life: Comparing the Capabilities of Homeless Service Users in Housing First and the Staircase of Transition in Europe

“…The leaders of the service users' study, who were based in Ireland, developed a protocol that was followed by participating research teams. The protocol, described elsewhere (Greenwood, Manning, O'Shaughnessy, Cross, et al 2020) included guidance for participant recruitment, consent, interview schedule administration, and analysis. We used this protocol together with biannual meetings, and regular communication with study consortium partners to help standardise study activities across the eight countries and reduce inconsistencies in procedural implementation.…”

“…Research teams in each country identified HF programmes according to study protocol (Greenwood, Manning, O'Shaughnessy, Cross, et al 2020), which stipulated that eligible programmes followed the principles of the Pathways Housing First model (Tsemberis, Gulcur, and Nakae 2004). Participants in SS were recruited from temporary shelter accommodation, women's refuges, drop-in psychiatric services, and night shelters, for example.…”

Psychometric properties of the measure of achieved capabilities in homeless services

“…As part of larger investigation of experiences of homelessness in Europe [ 81 ], data were collected at two-time points [Time 1 (T1) and Time 2 (T2)] from adults engaged either with a Housing First programme or a service at any step in the staircase of transition (i.e., outreach, emergency services, short-term, or long-term accommodation), hereafter referred to as staircase services (SS). At T1, participants were age 18 or older and sufficiently fluent in the language of their country of residence to understand the questionnaire and consenting materials.…”

“…In this larger project, we took a social justice approach to understand the phenomenon of chronic homelessness in Europe from multiple perspectives: service users, service providers, stakeholders, and the public. As part of this larger project, we invited adults engaged in either any step of the staircase of transition or with a Housing First programme to complete a larger questionnaire comprised of a range of measures that assessed aspects of their experiences of homelessness, homeless services, and well-being at two time points [ 81 ]. Here, we used data obtained from participants on the new Measure of Achieved Capabilities in Homeless Services (MACHS) to assess its factor structure, construct validity, and concurrent validity.…”

Structure and agency in capabilities‐enhancing homeless services: Housing first, housing quality and consumer choice

“…Researchers entered participants' responses into a standardized data file that was sent to the second author, who cleaned, merged and managed all 16 (eight countries, two time points) data sets. See (Greenwood et al, 2020a) for more details on recruitment, data collection and data management procedures.…”