Housing first, connection second: the impact of professional helping relationships on the trajectories of housing stability for people facing severe and multiple disadvantage

Abstract

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.

A Qualitative Study of the Working Alliance in the Strengths Model of Case Management with People with Severe Mental Illness

“…While the working alliance in psychotherapy (usually referred to as the “therapeutic alliance”) has been thoroughly researched with consistent positive results (Fluckiger et al, 2012 , 2018 ; Horvath, 2018 ; Wampold, 2015 ), the evidence base of the working alliance in mental health case management interventions is small with more variable research methods than psychotherapy research (De Leeuw et al, 2012 ; Kidd et al, 2017 ; McCabe & Priebe, 2004 ). Overall, mental health case management studies show a relationship between the working alliance and client outcomes, such as better functioning, lower depression, overall life satisfaction, and improved quality of life (Ashford et al, 2010 ; De Leeuw et al, 2012 ; Howgego et al, 2003 ; Kidd et al, 2017 ; Kondrat, 2012 ; Kondrat & Early, 2010 ; Latimer & Rabouin, 2011 ; McCabe & Priebe, 2004 ; Sandu et al, 2021 ; Tsai et al, 2013 ). Some proposed underlying mechanisms of change within the working alliance include having clear goals, having small caseloads, affirming a person, mutual respect, adopting structured interventions, and being a responsive case manager (Baldwin et al, 2007 ; De Leeuw et al, 2012 ; Farrelly & Lester, 2014 ; Fluckiger et al, 2018 ; Kidd et al, 2017 ; Wampold, 2015 ).…”

Homeless people's recovery in Housing First and Traditional Services: The role of working alliance in Italian housing services

“…At the same time, this relationship represents a key element in reinforcing users' desire for housing, increasing the commitment to transformation, avoiding drop‐outs, and finally, reaching program goals, especially concerning house maintenance (Sandu et al, 2021; Chen & Ogden, 2012).…”

“…Consistently, in the work of Stergiopoulos et al (2014), HF participants reporting higher levels of the working alliance were more likely to improve their quality of life and community integration (both physical and psychological). In addition, the professional helping relationship in HF programs seems to facilitate the transition into housing and promote housing stability in users, even if the variability within the sample does not allow to draw generalizable conclusions (Sandu et al, 2021). However, no differences were found in psychiatric symptoms and substance abuse based on the strength of the working alliance (Tsai et al, 2013).…”

Team Around Me: a case coordination model for clients experiencing multiple disadvantage

“…Additionally, with reference to the client case study, the way that a TAM directly involves clients effectively strengthens the bonds that clients have with services. Positive working relationships with clients improves outcomes such as housing stability (Sandu et al , 2021) due to clients feeling that services are more trustworthy and accessible.…”