A Comprehensive Assessment to Enable Recovery of the Homeless: The HOP-TR Study

Abstract

Background: Homelessness is an increasing problem in Western European countries. In the Netherlands, policy reforms and austerity measures induced an urgent need for management information on local homeless citizens. Municipal authorities initiated cross-sectional reviews of Homeless Service (HS) users. The resulting Homeless People Treatment and Recovery (HOP-TR) study developed a health and needs assessment strategy over different domains to comprehensively assess individuals and care networks with the perspective on recovery.Methods: Dutch HS users were selected using a naturalistic meta-snowball sampling. Semi-structured interviews provided the primary data source. The interview content was partly derived from the InterRAI Community Mental Health questionnaire and the “Homelessness Supplement.” Using the raw interview data, algorithmic summary scores were computed and integrating clinical parameters assessed. The data describe health and needs in a rights-based, recovery-oriented frame of reference. The mental health approach is transdiagnostic. The positive health framework is used for structuring health and needs aspects in relation to the symptomatic (physical and mental health), social (daily living, social participation), and personal (quality of life, meaning) dimensions of recovery.Results: Recruitment (between 2015 and 2017) resulted in a saturated sample of 436 HS users in 16 facilities and seven cities. Most participants were long-term or intermittently homeless. The sample characteristics reveal the multi domain character of needs and the relevance of a broad, comprehensive approach. Local authorities used the reports to reflect and discuss needs, care provision, access, and network cooperation. These dialogs incited to improve the quality of care at various ecosystem levels.Discussion: This paper describes new recruitment strategies and data collections of comprehensive data domains, to improve our knowledge in the field of homelessness. Traditional epidemiological literature on homelessness is often domain specific and relies on administrative sources. The HOP-TR study uses an analytical epidemiological approach. It shifts the assessment focus from problem-centered marginalization processes toward a comprehensive, three-dimensional recovery-oriented vision of health. Different perspectives are integrated to explore the interaction of homeless people with care networks.

Perceived Social Support Attenuates the Association between Stress and Health-Related Quality of Life among Adults Experiencing Homelessness

“…Thus, despite the fact that this population is known to experience a disproportionate amount of stressors relative to the domiciled population [45] and exhibit high rates of mental and physical health conditions [3][4][5][6][7][8][9], interventions designed to foster social support for individuals experiencing homelessness may benefit their overall experience of physical and/or mental health. Consistent with a recovery-oriented approach to the care of individuals experiencing homelessness, results suggest the potential importance of assessing the capability of the multi-level ecological networks surrounding these adults to assist in their weathering of stressors so that any gaps can be addressed in holistic resiliency building [46]. Thus, interventions to bolster social support for this marginalized group can and should be considered across multiple levels, including those directed at individuals, agencies, and systems that are frequently encountered by this group.…”

Rapid Review on the Concept of Positive Health and Its Implementation in Practice

“…Furthermore, eight articles reported that the dimensions of PH were part of their qualitative research methods, either during data collection [ 34 , 37 , 52 , 59 , 71 ] or as a framework during data analysis to organise themes based on the various dimensions [ 43 , 52 , 67 , 69 , 71 ].…”

Vital Needs of Dutch Homeless Service Users: Responsiveness of Local Services in the Light of Health Equity

“…An analysis of variance was conducted, based on the subsample means of health problems, and MHRCN. The methods paper proves that subsample addition was continued until topic saturation was reached [42].…”

“…Instead, substantial improvements require a radical commitment to all ingredients of the ecosystem of care. HSU urgently need comprehensive, integrating, socio-ecological ecosystem strategies that better serve the needs of marginalized populations with interdependent needs [27,42]. A crucial concept, defined in the quintuple aim care outcome model, is health equity.…”

“…A separate paper has documented the methods used in the HOP-TR study [42]. In seven Dutch cities, local health reviews were conducted in various types of homeless facilities.…”