What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA)

McPherson, Peter; Krotofil, Joanna; Killaspy, Helen

doi:10.3390/ijerph15020190

Cited by 67 publications

(60 citation statements)

References 115 publications

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“…The research material which resulted from the interviews was analyzed and categorized into main themes and subthemes in accordance with the principles of thematic analysis and the six steps proposed by Braun and Clarke (37,38), namely, familiarization with the data, initial coding, initial emergence of themes, refinement of themes, definition and naming of themes, and reporting of findings.…”

Section: Discussionmentioning

confidence: 99%

“…There is a variation between them regarding the number of residents, number of staff, if there is staff on-site, and criteria for receiving accommodation support. Out of these 25 units, 12 (protected accommodation apartments) have four residential places, there is no staff on-site, they offer low/moderate support, and there is limited emphasis on moveon and support individual accommodation [type 4 according STAX-SA, (36)]. Eight have 15 places, staff on-site, high support, limited emphasis on moving on a congregate setting (type 1).…”

Section: Methodsmentioning

confidence: 99%

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Experiences of Recovery in EPAPSY’s Community Residential Facilities and the Five CHIME Concepts: A Qualitative Inquiry

et al. 2020

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In the context of the reform of psychiatric services in Greece, the debate about the concept of recovery is still growing. Recovery is defined as a path through which individuals facing mental health challenges are enabled to regain and further develop significant relationships with family, friends, the community, and themselves and at the same time to cope with the detrimental effects of stigma through empowerment. The present qualitative study aims to explore the experiences of people living in EPAPSY's (Association for Regional Development and Mental Health) community residential facilities focusing mainly upon the key concepts of the CHIME (connectivity, hope, identity, meaning, and empowerment) conceptual framework of recovery. To this end, semistructured interviews were conducted with seven participants living and receiving mental health care in a residential facility of EPAPSY. The participants' accounts were analyzed using thematic analysis in a deductive and inductive manner. The research findings highlighted, among others, the challenges the participants faced during their early years in family and school, the experience of the revolving door effect, and the perceived turn their life took when they were transferred to a community residential facility, thus opening a new chapter in their lives. Of the five CHIME concepts, all are present in the participants' accounts, with emphasis given to a meaningful present, a need to feel "normal" again, and a positive outlook for the future, both for themselves and their relationships, despite the persistence of certain difficulties.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Experiences of Recovery in EPAPSY’s Community Residential Facilities and the Five CHIME Concepts: A Qualitative Inquiry

et al. 2020

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“…Finally, although there is a growing international evidence base pertaining to supported accommodation, interpretation of the literature 53 is hampered by a lack of comparable description of different supported accommodation services. This could be addressed by encouraging researchers and journals to adopt a consistent taxonomy, such as the one that one of our research team members (PM) developed alongside the QuEST programme, 54 so that results can be compared and collated.…”

Section: Summary Of Quest Study Findingsmentioning

confidence: 99%

Supported accommodation for people with mental health problems: the QuEST research programme with feasibility RCT

Killaspy

Priebe

King

et al. 2019

Programme Grants Appl Res

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Background Across England, around 60,000 people live in mental health supported accommodation: residential care, supported housing and floating outreach. Residential care and supported housing provide on-site support (residential care provides the highest level), whereas floating outreach staff visit people living in their own tenancies. Despite their abundance, little is known about the quality and outcomes of these services. Objectives The aim was to assess the quality, costs and effectiveness of mental health supported accommodation services in England. The objectives were (1) to adapt the Quality Indicator for Rehabilitative Care (QuIRC) and the Client Assessment of Treatment scale for use in mental health supported accommodation services; (2) to assess the quality and costs of these services in England and the proportion of people who ‘move on’ to less supported accommodation without placement breakdown (e.g. to move from residential care to supported housing or supported housing to floating outreach, or, for those receiving floating outreach, to manage with fewer hours of support); (3) to identify service and service user factors (including costs) associated with greater quality of life, autonomy and successful move-on; and (4) to carry out a feasibility trial to assess the required sample size and appropriate outcomes for a randomised evaluation of two existing models of supported accommodation. Design Objective 1 – focus groups with staff (n = 12) and service users (n = 16); psychometric testing in 52 services, repeated in 87 services (adapted QuIRC) and with 618 service users (adapted Client Assessment of Treatment scale). Objectives 2 and 3 – national survey and prospective cohort study involving 87 services (residential care, n = 22; supported housing, n = 35; floating outreach, n = 30) and 619 service users followed over 30 months; qualitative interviews with 30 staff and 30 service users. Objective 4 – individually randomised, parallel-group feasibility trial in three centres. Setting English mental health supported accommodation services. Participants Staff and users of mental health supported accomodation services. Interventions Feasibility trial involved two existing models of supported accommodation: supported housing and floating outreach. Main outcome measures Cohort study – proportion of participants who successfully moved to less supported accommodation at 30 months’ follow-up without placement breakdown. Feasibility trial – participant recruitment and withdrawal rates. Results The adapted QuIRC [QuIRC: Supported Accomodation (QuIRC-SA)] had excellent inter-rater reliability, and exploratory factor analysis confirmed its structural validity (all items loaded onto the relevant domain at the > ± 0.3 level). The adapted Client Assessment of Treatment for Supported Accommodation had good internal consistency (Cronbach’s alpha 0.89) and convergent validity (r s = 0.369; p < 0.001). Supported housing services scored higher than residential care and floating outreach on six out of seven QuIRC-SA quality domains. Service users had a high prevalence of severe self-neglect (57%) and vulnerability to exploitation (37%). Those in supported housing (25%) and floating outreach (20%) experienced more crime than those in residential care (4%) but had greater autonomy. Residential care was the most expensive service (mean cost per resident per week was £581 for residential care, £261 for supported housing and £66 for floating outreach) but supported users with the greatest needs. After adjusting for clinical differences, quality of life was similar for users of supported housing and residential care (mean difference –0.138, 95% confidence interval –0.402 to 0.126; p = 0.306), whereas autonomy was greater for supported housing users (mean difference 0.145, 95% confidence interval 0.010 to 0.279; p = 0.035). Qualitative interviews showed that staff and service users shared an understanding of service goals and what constituted effective support. After adjusting for clinical differences, those in floating outreach were more likely to move on successfully at 30 months’ follow-up than those in residential care [odds ratio (OR) 7.96; p < 0.001] and supported housing (OR 2.74; p < 0.001), and this was more likely for users of supported housing than residential care (OR 2.90; p = 0.04). Successful move-on was positively associated with scores on two QuIRC-SA domains: the degree to which the service promoted ‘human rights’ (e.g. facilitating access to advocacy) and ‘recovery-based practice’ (e.g. holding therapeutic optimism and providing collaborative, individualised care planning). Service use costs for those who moved on were significantly lower than for those who did not. Recruitment in the feasibility trial was difficult: 1432 people were screened but only eight were randomised. Barriers included concerns about accommodation being decided at random and a perceived lack of equipoise among clinicians who felt that individuals needed to ‘step down’ from supported housing to floating outreach services. Conclusions We did not find clear evidence on the most effective model(s) of mental health supported accommodation. Indeed, our feasibility study suggests that trials comparing effectiveness cannot be conducted in this country. A range of options are required to provide appropriate support to individuals with differing needs. Future work Future research in this field requires alternatives to trials. Service planners should be guided by the mental health needs of the local population and the pros and cons of the different services that our study identified, rather than purely financial drivers. Trial registration Current Controlled Trials ISRCTN19689576. Funding This programme was funded by the National Institute for Heath Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 7. See the NIHR Journals Library website for further project information. The fundholders are Camden and Islington NHS Foundation Trust and the research is a collaboration between University College London, Queen Mary University of London, King’s College London, the University of Ulster and Durham University.

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“…The context of this study is supported housing services based on type 1 in the Simple Taxonomy for Supported Accommodation (STAX-SA) [4]: a) staff on-site, b) high support, c) limited emphasis on moving on, and d) a congregate setting. As this bears some resemblance to inpatient settings, community supported housing has been claimed to carry the risk of adopting 'institution-like' qualities [5], despite the initial intention to promote 'normality' and social inclusion of tenants.…”

Section: Introductionmentioning

confidence: 99%

Exploring staff conceptions of prevention and management practices in encounters with staff-directed aggression in supported housing following education and training

Maagerø-Bangstad

Sælør

Lillevik

et al. 2020

Preprint

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Background: Staff-directed aggression is a concern for service providers in mental healthcare, frequently affecting both the quality of services and staff wellbeing. This also applies to supported housing services for people with mental health problems. Staff themselves consider training to be an important route to improve the prevention and management of staff-directed aggression. The aims of this study are to explore how staff in community supported housing conceptualize practice in prevention and management of aggression and how these conceptions develop following a local education and training endeavor in disempowerment-sensitive, de-escalating and knowledge-based risk assessment and management. Method: Phenomenography, a qualitative research approach, was adopted to pursue the study aims. The data consisted of two interviews with 13 participants from five different municipal housing facilities in Oslo, Norway. Results: The analysis led to the development of six qualitatively different, yet logically interrelated, categories of description regarding practice in encounters with staff-directed aggression: 1) Observation, alertness and awareness , 2) Established understanding and knowledge of service users , 3) Team-based risk management and deliberation , 4) Adaption of own dispositions and behaviors , 5) Reflexivity, sensitivity and care and 6) Involvement and dialogue . These conceptions were found to vary in meaning and focus; they ranged from implementing safeguarding and protective measures, to drawing on what was portrayed in terms of staff’s expert knowledge, to increasingly allowing for, and committing to, tenant perspectives in designing practice. The results indicate a moderate, yet beneficial, effect of the course on conceptual change in the participants. Conclusion: This study shows that practice in encounters with staff-directed aggression is conceptualized as complex and multifaceted by staff in community mental health services and that the various conceptions will have different consequences for the way staff-directed aggression is mitigated individually and collectively. Our findings also suggest that it is beneficial to take conceptual variation regarding practice into consideration when devising education and training to enhance staff knowledge, skills and practices.

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What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA)

Cited by 67 publications

References 115 publications

Experiences of Recovery in EPAPSY’s Community Residential Facilities and the Five CHIME Concepts: A Qualitative Inquiry

Experiences of Recovery in EPAPSY’s Community Residential Facilities and the Five CHIME Concepts: A Qualitative Inquiry

Supported accommodation for people with mental health problems: the QuEST research programme with feasibility RCT

Exploring staff conceptions of prevention and management practices in encounters with staff-directed aggression in supported housing following education and training

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