Exploring Transitions Within a Project-based Housing First Setting: Qualitative Evaluation and Practice Implications

Abstract

The Housing First (HF) approach is a model of housing that entails the provision of immediate, permanent, low-barrier, supportive housing to chronically homeless individuals either in separate apartments within a larger community (known as scattered-site HF) or in a single building (known as project-based HF). One recent innovation is the application of project-based HF with chronically homeless individuals with alcohol problems. Although initial studies have shown its effectiveness, there is currently no research on residents’ and staff's experiences living and working in a project-based HF program. The purpose of this article was to document these experiences and highlight strengths and challenges of project-based HF programs. Using data collected from naturalistic observations, agency documentation, one-on-one resident interviews, and a staff focus group, we delineated transitional periods, including moving into project-based HF, community-building, managing day-to-day, and transitions from project-based HF. Findings are interpreted to help health care policymakers and providers envision the role of project-based HF in comprehensive public health efforts and to integrate lessons learned into their own clinical practice.

Voices of Homeless Alcoholics Who Frequent Bellevue Hospital: A Qualitative Study

“…Many of the existing qualitative analyses were designed to evaluate and inform aspects of interventions, such as low-barrier housing. 21,26,27,42,43 Participants in these studies may differ from ours because all agreed to participate in interventions, were receiving specialized services or housing, and were identified primarily through community rather than hospital referral. Yet these and other studies provide important insight into how structured, supportive environments and various means of approaching these individuals and caring for them helps to empower them by addressing factors that have contributed to their loss of self-identity and selfdetermination.…”

“…Yet these and other studies provide important insight into how structured, supportive environments and various means of approaching these individuals and caring for them helps to empower them by addressing factors that have contributed to their loss of self-identity and selfdetermination. 21,[23][24][25][26][27]44 Other researchers have explored the perspectives of medical professionals and others who encounter this population rather than directly studying the individuals of interest. 45,46 Incorporating a wide range of different perspectives through purposive sampling and exploring negative cases that may contradict prevailing theories strengthened our study.…”

“…Harm reduction approaches with more achievable goals that provide structure and alleviate the demands of street survival are likely to be more acceptable to these individuals who have diminished self-efficacy and motivation for treatment. [24][25][26][27]44 This underscores the need for the ED to participate in the development and evaluation of multidisciplinary, transinstitutional interventions that incorporate components of efficacious interventions such as care management, housing facilitation, and pharmacological and behavioral therapy. Implementation strategies, such as expanding the role of observation units and partnering with agencies in the community that are invested in finding treatments to address high users of publicly funded services, should be explored to enhance the feasibility and efficiency of delivering integrated care.…”

“…[7][8][9][10][11]19,20 However, there are few data from the perspective of the individual describing the evolution, environment, and psychosocial context of the disease, and many of these qualitative studies have aimed to evaluate and inform components of interventions. [21][22][23][24][25][26][27][28][29] The purpose of this phenomenological study was to explore the evolution, environment, and psychosocial context of alcoholism from the perspective of chronically homeless, alcoholdependent persons who frequent Bellevue Hospital Center in Editor's Capsule Summary…”

Efficacité de l’approche « logement d’abord » : une revue systématique

“…Notre remise en question prend sa source dans deux constats. D'un côté, les participants qui ont eu accès au logement mentionnent, dans les études qualitatives, qu'ils se sentent plus en sécurité, qu'ils se sentent mieux (Padgett, 2007) et qu'ils ont diminué leur consommation substances (Collins et al, 2012) depuis qu'ils ont accès à un logement. D'un autre côté, l'approche « logement d'abord » s'appuie sur une logique de réduction des méfaits, laquelle vise la réduction des conséquences négatives associées à certains comportements (ministère de la Santé et des Services sociaux, 1999).…”