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Evidence assessment and narrative synthesis of the key characteristics of older people living in service-integrated housing facilities, and their ‘accommodation journey’
- Authors:
- THOMPSON Juliana, et al
- Journal article citation:
- Housing Care and Support, 25(1), 2022, pp.31-45.
- Publisher:
- Emerald
Purpose: This paper aims to provide an evidence assessment and narrative synthesis of literature regarding the key characteristics of older people living in service-integrated housing (SIH) facilities and their “accommodation journey”. Design/methodology/approach: A rapid evidence assessment was conducted: 22 research publications met the inclusion criteria and were analysed using narrative synthesis. Findings: The quality of studies in this area is low, but consistency across components of the results of studies included in the review is apparent. Results suggest key characteristics of older people that drive moves into SIH are a decline in health, increased dependency, increased health service use and carer burden. Suggested key characteristics of SIH residents are high levels of health problems, dependency and health service use, but high self-reported health and well-being. Results indicate that the key driver for older people leaving SIH is a lack of workforce competency to manage further declines in health and dependency status. Research limitations/implications: Current policy may not realise or account for the complex health and care needs of SIH residents. Investment into integrated care, robust community health services and workforce development to facilitate a comprehensive assessment approach may be required to support residents to remain in SIH and live well. Further longitudinal studies are required to map the progression of SIH residents’ health status in detail over time to provide an understanding of preventative and enablement support, development of care pathways and workforce planning and development requirements. Originality/value: This evidence assessment is the first to consider the accommodation journey of older people residing in SIH. (Edited publisher abstract)
The extent to which non-conditional housing programs improve housing and well-being outcomes: a systematic review
- Authors:
- O’DONNELL Renee, et al
- Journal article citation:
- Housing Care and Support, 25(1), 2022, pp.46-60.
- Publisher:
- Emerald
Purpose: To reduce rates of homelessness, recent efforts have been directed toward developing non-conditional supported housing programs that prioritize the delivery of housing support and individual services, without tenancy conditions (i.e. maintaining sobriety and adhering to mental health treatment). As promising as these programs are, findings generally show that while housing stability is improved, other individual outcomes remain largely unchanged. No review to date has synthesized the collective evidence base of non-conditional housing programs, rather the focus has been on specific programs of delivery (e.g. Housing First) or on specific population groups (e.g. those with mental illness). The purpose of this paper is to evaluate the extent to which non-conditional housing interventions improve housing and well-being outcomes for all persons. Design/methodology/approach: A systematic search of the literature was conducted for randomized controlled studies that evaluated the effectiveness of a non-conditional housing intervention in improving housing and health outcomes among any participant group. Findings: A total of 31 studies were included in this review. Non-conditional supported housing programs were found to be most effective in improving housing stability as compared to health and well-being outcomes. Policymakers should consider this when developing non-conditional supported housing programs and ensure that housing and other health-related outcomes are also mutually supported. Originality/value: This is the first review, to the authors’ knowledge, to synthesize the collective impact of all non-conditional supported housing programs. The current findings may inform the (re)design and implementation of supported housing models to prioritize the health and well-being of residents. (Edited publisher abstract)
The role of occupational meaningfulness and citizenship as mediators between occupational status and recovery: a cross-sectional study among residents with co-occurring problems
- Authors:
- NESSE Linda, et al
- Journal article citation:
- Advances in Dual Diagnosis, 14(3), 2021, pp.99-118.
- Publisher:
- Emerald
Purpose: Engagement in meaningful occupations and being included as full citizens of the community, is essential in everyday life, and may be of considerable relevance for recovery and quality of life. However, persons with co-occurring substance use and mental health problems experience extensive obstacles to engagement in occupations and citizenship. The relationship between objective measures of occupational status and subjective experiences of occupational meaningfulness, citizenship and recovery, is scarcely researched in the context of co-occurring problems. As such, the purpose of this study is to examine associations between occupational status, occupational meaningfulness, citizenship and recovery and quality of life and to examine the roles of occupational meaningfulness and citizenship as possible mediators between occupational status and recovery and quality of life. Design/methodology/approach: The study used a cross-sectional design with a sample of 104 residents at supported housing sites across six Norwegian cities. Findings: Linear regression analyzes indicated that occupational status was significantly associated with the citizenship domains caring for others and community participation and with the quality of life measure positive affect. Occupational meaningfulness and citizenship were significantly associated with different domains of recovery and quality of life. Furthermore, mediation analyzes showed that the relationship between occupational status and recovery and quality of life was mediated by caring for others and community participation. Originality/value: The results suggest that emphasizing opportunities for occupational meaningfulness and citizenship in practice may have positive implications for recovery among persons with co-occurring problems. (Edited publisher abstract)
“Come together”: a thematic analysis of experiences with belonging
- Authors:
- OGUNDIPE Esther, et al
- Journal article citation:
- Advances in Dual Diagnosis, 13(3), 2020, pp.123-134.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore, describe and interpret two research questions: How do persons with co-occurring mental health and substance abuse problems, living in supportive housing, experience belonging? How do residential support staff experience promoting a sense of belonging for persons with co-occurring mental health and substance abuse problems, living in a supportive housing? Design/methodology/approach: Individual semi-structured interviews were conducted with five persons with co-occurring mental health and substance abuse problems living in supportive housing in a Norwegian district. In addition, one semi-structured focus group was conducted with nine residential support staff. All interviews were transcribed verbatim and analyzed using thematic analysis. Findings: Analysis resulted in three main themes: “I do not go to sleep in my pajamas”, “Do I have a choice?” and “Be kind to each other”. Research limitations/implications: More research on how inclusive practices that are commonly described in guidelines actually affect the experience of residents and residential support staff is needed. Practical implications: Practices that incorporate a communal and contextual understanding when assigning supportive housing are warranted. Originality/value: By paying attention to the components of social recovery, this paper provides a nuanced understanding of how persons with co-occurring mental health and substance abuse problems, living in supportive housing, experience belonging. In addition, residential support staffs’ experiences with promoting a sense of belonging for this group are explored. (Edited publisher abstract)
Residualisation in supported housing: an organisational case study
- Authors:
- HOBSON Jonathan, LYNCH Kenneth, LODGE Alex
- Journal article citation:
- Housing Care and Support, 23(1), 2020, pp.1-13.
- Publisher:
- Emerald
The purpose of this paper is to examine how residualisation is experienced across a supported housing provider in an English county. The analysis is in three parts: firstly, it focuses on organisational provision, including impacts of change on decisions on market entry and exit; secondly, it reviews evidence on service provision and the adaptations services are making to reflect the changing pressures of the sector; finally, it considers the impacts on service delivery and the experiences of those that rely on the provision. Design/methodology/approach: The analysis uses interview data across the organisation, together with material from the UK Government department consultation (2017) and a UK Parliamentary Select Committee inquiry (2017) to examine the impacts across the different tiers of service, including the day-to-day experience of residualised services for those that deliver and receive that support. Findings:The paper concludes that residualisation is a direct outcome of the neoliberalisation of welfare states, introducing limits to state involvement and funding, a greater emphasis on quasi-market involvement in the sector and a shifting of responsibility from government to individuals. Research limitations/implications: It not only demonstrates the impacts of reducing state support on the supported housing sector but also emphasises the importance of residualisation as a conceptual framework applicable to the wider : This paper demonstrates the way that the burden of responsibility is being shifted away from the public provision of support and onto the individuals. This can be problematic for the individuals who are vulnerable as a result of their economic medical or social circumstances. Social implications: The retreat of the state from supported housing is both a political change and an austerity-led change. This article provides insight from a single-supported housing provider. In so doing, it illustrates the pressure such an organisation is under. Originality/value:This paper provides a unique insight from the perspective of all levels of a supported housing service provider, combined with the analysis of government consultation and parliamentary inquiry. (Edited publisher abstract)
Improving continuity of forensic mental health care
- Authors:
- DE VOGEL Vivienne, SCHAFTENAAR Petra, CLERCX Maartje
- Journal article citation:
- Journal of Forensic Practice, 21(3), 2019, pp.180-189.
- Publisher:
- Emerald
Purpose: Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising continuity can be complicated due to restrictions from finances or legislation and difficulties in collaboration between settings. In the Netherlands, several programs have been developed to improve continuity of forensic care. It is unknown whether professionals and clients are sufficiently aware of these programs. The paper aims to discuss this issue. Design/methodology/approach: The experienced difficulties and needs of professionals and patients regarding continuity of forensic care were explored by means of an online survey and focus groups. The survey was completed by 318 professionals. Two focus groups with professionals (15 participants), one focus group and one interview with patients (six participants) were conducted. Findings: The overall majority (85.6 percent) reported to experience problems in continuity on a frequent basis. The three main problems are: first, limited capacity for discharge from inpatient to outpatient or sheltered living; second, collaboration between forensic and regular mental health care; and, third, limited capacity for long-term inpatient care. Only a quarter of the participants knew the existing programs. Actual implementation of these programs was even lower (3.9 percent). The top three of professionals’ needs are: better collaboration; higher capacity; more knowledge about rules and regulation. Participants of the focus groups emphasised the importance of transparent communication, timely discharge planning and education. Practical implications: Gathering best practices about regional collaboration networks and developing a blueprint based on the best practices could be helpful in improving collaboration between setting in the forensic field. In addition, more use of systematic discharge planning is needed to improve continuity in forensic mental health care. It is important to communicate in an honest, transparent way to clients about their forensic mental health trajectories, even if there are setbacks or delays. More emphasis needs to be placed on communicating and implementing policy programs in daily practice and more education about legislation is needed Structured evaluations of programs aiming to improve continuity of forensic mental health care are highly needed. (Edited publisher abstract)
Building connection against the odds: project workers relationships with people experiencing homelessness
- Authors:
- WATSON Clare, NOLTE Lizette, BROWN Rachel
- Journal article citation:
- Housing Care and Support, 22(2), 2019, pp.129-140.
- Publisher:
- Emerald
Purpose: Trusting and empathic relationships between project workers and people experiencing homelessness (PEH) form the cornerstone for their needs to be met. However, under the UK austerity agenda project workers practice in a context of increasing pressure and limited resources; with relationships often characterised by conditionality and disconnection. The purpose of this paper is to report on a study investigating project workers’ experiences of building relationships with PEH living in supported housing projects. Design/methodology/approach: A qualitative design was employed in which focus groups were carried out in six projects, using an opportunity sample of 22 project workers. Data were analysed using thematic analysis, within a social constructionist epistemology. Findings: Three main themes were identified: “Working hard to build connection”, “Supporting each other within an unsupportive context” and “Draining but sustaining”. Project workers acted out of strong value systems in building relationships with residents against a backdrop of systemic disconnection. Originality/value: Clear clinical implications are put forward with in a Psychologically Informed Environment framework. Services supporting PEH need to be psychologically informed and organisations need to embed reflection within their policies and every day practice. In developing services for PEH interdependence not in/dependence needs to be the aim. Finally, the responsibility for improving the lives of PEH should be placed back on society to provide a context in which PEH can thrive. (Edited publisher abstract)
Conducting evaluations with older populations in supported housing
- Authors:
- YAP Jade, et al
- Journal article citation:
- Working with Older People, 23(1), 2019, pp.1-6.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to reflect on the challenges and learnings of evaluating a public mental health programme with older people: Standing Together, which delivered weekly facilitated self-help groups for older people in extra care housing. Following evaluation, a list of practical recommendations was developed to inform future evaluations of similar programmes. Design/methodology/approach: This paper resulted from our reflections as evaluators or practitioners on Standing Together. The evaluation followed a mixed-methods design. It reflects on findings from the Standing Together evaluation, which employed quantitative and qualitative research methods to determine the project’s impact on key outcome areas. Quantitative questionnaires were completed by tenants at baseline and towards the end of the project. Focus groups were held with tenants and interviews were undertaken with multiple stakeholders. Findings: There were challenges in evaluating Standing Together that were unique to the older population group. Recommendations cover the full spectrum of the role of practitioners, evaluators, setting and methodology. Co-production was found to be an overarching theme linking together the recommendations, and most of the challenges encountered can, in principle, be alleviated with greater focus on co-production during the evaluation design stage. Originality/value: The recommendations in the paper have practical relevance to those involved in evaluations of public health programmes or interventions. Incorporating these recommendations when conducting similar evaluations with older populations in housing settings will ensure more accurate reporting of outcomes. (Edited publisher abstract)
Mapping the "housing with care" concept with stakeholders: insights from a UK case study
- Authors:
- WILD Annie, et al
- Journal article citation:
- Journal of Integrated Care, 26(4), 2018, pp.257-266.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to present the findings of an early stage, exploratory case study of a proposed housing with care initiative (the Crichton Care Campus (CCC)). This sought the perspectives of a range of key stakeholders on the proposed model and how it might be best realised. The analyses of these findings show their relevance to debates on integrated housing with care, and reflect on the methodology used and its potential relevance to similar projects. Design/methodology/approach: The study used a transactive planning approach, where grounded views are sought from a variety of stakeholders. A purposive sample identified informants from relevant health, social care and housing organisations and nine semi-structured interviews were conducted. These were transcribed and data analysis was undertaken on an “interactive” basis, relating care theory to empirical expressions. Findings: The authors identify two contrasting orientations – inclusive “community-oriented” and professional “service-oriented”. This distinction provides the basis for a rudimentary conceptual map which can continue to be used in the planning process. Two significant variables within the conceptual map were the extent to which CCC should be intergenerational and as such, the degree to which care should come from formalised and self-care/informal sources. The potential to achieve an integrated approach was high with stakeholders across all sectors fully supporting the CCC concept and agreeing on the need for it to have a mixed tenure basis and include a range of non-care amenities. Originality/value: This paper offers originality in two respects. Methodologically, it describes an attempt to undertake early stage care planning using a needs led transactive methodology. In more practical terms, it also offers an innovative environment for considering any approach to care planning that actively seeks integration – based on an acknowledgement of complexity, a variety of perspectives and possible conflicts. The authors propose that the concepts of “community-orientation” and “service-orientation” are used as a helpful basis for planning negotiations, making implicit divergences explicit and thus better delineated. (Publisher abstract)
Understanding everyday life and mental health recovery through CHIME
- Authors:
- PIAT Myra, SEIDA Kimberly, SABETTI Judith
- Journal article citation:
- Mental Health and Social Inclusion, 21(5), 2017, pp.271-279.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to understand how daily life reflects the recovery journeys of individuals with serious mental illness (SMI) living independently in the community. Design/methodology/approach: The go-along technique, which blends participant observation and interviewing, was used to gather data from 19 individuals with SMI living in supported housing. Data were analysed through the CHIME framework of personal recovery, which includes social connectedness, hope and optimism, identity, meaning in life, and empowerment. Findings: Applying the CHIME framework to qualitative data reveals the multiple ways in which everyday experiences, within and beyond formal mental healthcare environments, shapes personal recovery processes. Research limitations/implications: Combining novel methods and conceptual frameworks to lived experiences sharpens extant knowledge of the active and non-linear aspects to personal recovery. The role of the researcher must be critically considered when using go-along methods. Practical implications: Practitioners working with this population should account for the role of socially supportive and financially accessible spaces and activities that support the daily work of recovery beyond the context of formal care and services. Originality/value: This study utilises an innovative method to illustrate the crucial role of daily and seemingly banal experiences in fostering or hindering personal recovery processes. It is also the one of the first studies to comprehensively apply the CHIME framework to qualitative data in order to understand the recovery journeys of individuals with SMI living in supported housing. (Publisher abstract)