Distal supports, capabilities, and growth-focused recovery: A comparison of Housing First and the staircase continuum of care.

Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth-related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth-focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth-related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.

Psychometric properties of the measure of achieved capabilities in homeless services.

BACKGROUND: Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one's potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their effectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity. METHODS: We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n = 245) or treatment as usual (n = 320). RESULTS: Exploratory and confirmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure's concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities. CONCLUSIONS: Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed.

Homeless Adults' Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries.

Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed.

Understanding Innovation in Homeless Service Provision: A Study of Frontline Providers' Values-Readiness for Change.

Service innovation for adults experiencing mental illness and homelessness typically involves shifting from treatment-led, staircase models toward recovery-oriented, Housing-First models. Aligning frontline service providers' values to those embedded within newer models is an important, but under-investigated, influence on the innovation process. To assess values alignment in this context, we conducted semi-structured qualitative interviews with frontline providers in staircase services in Ireland (n = 50). Data showed that, while their values mostly aligned to the treatment-led model, there was meaningful evidence of more recovery-oriented values, too. Strategies to enhance innovation through values-alignment are discussed.

Microsystems of Recovery in Homeless Services: The Influence of Service Provider Values on Service Users' Recovery Experiences.

There is still much to learn about how aspects of the ecology of homelessness shape homeless adults' recovery experiences. In the present mixed-methods study, the relationship of service providers' work-related values to their service users' recovery experiences in the microsystem of homelessness were examined. Service providers completed semi-structured qualitative interviews about their service users, daily work activities, and work-related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration. Service providers' interview transcripts were coded for three indicators of values: assumptions, actions, and end-states. Summative Content Analysis was used to transform qualitative codes into numeric data so they could be used to predict service users' recovery. In a series of growth curve models, the extent to which service providers' end-state values, as an indicator of consumer-led values, was shown to indirectly predict service users' recovery experiences, through their perceived choice and mastery. Findings confirm that providers' values are an important influence on service users' recovery. Results are discussed in terms of their implications for recovery-oriented theory and practice.

A dominance analysis on the relationship between schizotypy and loneliness type.

BACKGROUND: This study investigated how individual differences in schizotypy differentially predicted types of loneliness - direct, social, emotional, and existential loneliness (in relationships and meaninglessness in life). METHODS: We presented participants with the brief version of the Oxford-Liverpool Inventory of Feelings and Experiences and the de Jong Giervald loneliness scale and used dominance analysis to evaluate the dominant predictors of schizotypy on loneliness. We also evaluated the impact of depression on each model. RESULTS: In our preregistered analysis we found evidence to suggest that cognitive disorganization and introvertive anhedonia are consistently the most dominant of the schizotypy predictors. Introvertive anhedonia was the most dominant predictor for social loneliness and existential loneliness in relationships, and cognitive disorganization was the most dominant predictor of direct, emotional and existential meaninglessness in life loneliness. Depression became the most dominant predictor of all types of loneliness when added to the models. LIMITATIONS: This research is limited by the cross-sectional nature of the data which is unable to account for changes in loneliness over time, and we acknowledge that the relationship between predictors and outcome is likely bi-directional. CONCLUSIONS: Our findings highlight the diverse relationship between schizotypy and loneliness type and suggest that schizotypy domains linked to social anxiety and withdrawal are key predictors of loneliness. These findings are important for the development of focused interventions and the prevention of clinical disorder development.

Examining the impact of a Volunteer-Delivered counselling service for people experiencing sight loss: a mixed methods evaluation.

PURPOSE: This article describes a mixed methods evaluation of a volunteer-delivered counselling service for people experiencing sight loss, to identify the outcomes, benefits, and challenges of this model of service provision within rehabilitation services. MATERIALS AND METHOD: A mixed methods approach was used, with both outcome and process evaluation components. Outcomes for 817 service users were assessed pre-and-post service use, using standardised (CORE10) measures. Semi-structured interviews and surveys with 22 volunteer counsellors and 4 senior counsellors were conducted, to understand their experiences of the format, content, and delivery of the service. RESULTS: Clients presenting for counselling experienced significant levels of self-reported depression, anxiety, and feelings of bereavement. Analysis showed a significant positive change in clinical outcomes for service users who received volunteer-delivered counselling services. Volunteer counsellors saw the unique and specialist nature of the service as critical for its impact on clients, and reported benefits of volunteering for this service, including developing their skills with this client group. CONCLUSIONS: Volunteer-delivered counselling can be effective for people affected by sight loss, providing accessible and much-needed psychological support, which is relevant given current pressures on health and social care services. There are key lessons for future models of this type.Implications for RehabilitationVision loss can have a profound negative impact on people's emotional and mental well-being, with many advocating for counselling and emotional support (CESS) to be included in low vision rehabilitative services.Despite this, access to psychological support is often overlooked in low vision rehabilitation, and access to CESS services is often poor.This study evaluated a volunteer-delivered CESS service, demonstrating that this model of service delivery is effective for this group.There are clear advantages to a volunteer-delivered model for those with sight loss, in terms of widening access, supporting integrated rehabilitative care, and reducing health inequalities.

Constructing the places of young people in public space: Conflict, belonging and identity.

Building on the growing discursive approach to people-place relations, we examine how young people negotiate people-place tensions and relations, and how they establish their everyday sense of place in contemporary public spaces. Facilitated by the use of Collaborative Spatial Mapping, analysis of focus group data from 51 young people focuses on three aspects of participants' talk about the places that make up their everyday lives: appropriation of micro-geographical spaces, the construction of autobiographical insideness and the mobilization of shared socio-spatial histories. Our analysis illustrates young people's responses to a broader problematic of being 'troublesome' in public spaces, demonstrating how they construct a deep-rooted attachment to, and sense of themselves as located members within, such spaces. We argue that place appropriation and autobiographical insideness are important concepts for understanding the practice of citizenship by young people, and how such practice is embedded in wider political processes of spatial conflict and exclusion.

Comparison of Housing First and Traditional Homeless Service Users in Eight European Countries: Protocol for a Mixed Methods, Multi-Site Study.

BACKGROUND: Homeless services expend considerable resources to provide for service users' most basic needs, such as food and shelter, but their track record for ending homelessness is disappointing. An alternative model, Housing First, reversed the order of services so that homeless individuals are offered immediate access to independent housing, with wraparound supports but no treatment or abstinence requirements. Although the evidence base for Housing First's effectiveness in ending homelessness is robust, less is known about its effectiveness in promoting recovery. OBJECTIVE: The objective of this research is to compare rehabilitation- and recovery-related outcomes of homeless services users who are engaged in either Housing First or traditional staircase services in eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden. METHODS: A mixed methods, multi-site investigation of Housing First and traditional services will compare quantitative outcomes at two time points. Key rehabilitation outcomes include stable housing and psychiatric symptoms. Key growth outcomes include community integration and acquired capabilities. Semistructured interviews will be used to examine service users' experiences of environmental constraints and affordances on acquired capabilities to identify features of homeless services that enhance service users' capabilities sets. Multi-level modelling will be used to test for group differences-Housing First versus traditional services-on key outcome variables. Thematic analysis will be used to understand the ways in which service users make sense of internal and external affordances and constraints on capabilities. RESULTS: The study is registered with the European Commission (registration number: H2020-SC6-REVINEQUAL-2016/ GA726997). Two press releases, a research report to the funding body, two peer-reviewed articles, and an e-book chapter are planned for dissemination of the final results. The project was funded from September 2016 through September 2019. Expected results will be disseminated in 2019 and 2020. CONCLUSIONS: We will use the findings from this research to formulate recommendations for European social policy on the configuration of homeless services and the scaling up and scaling out of Housing First programs. From our findings, we will draw conclusions about the setting features that promote individuals' exits from homelessness, rehabilitation, and recovery. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/14584.

Recovery in homelessness: The influence of choice and mastery on physical health, psychiatric symptoms, alcohol and drug use, and community integration.

OBJECTIVE: Recovery is the process through which one learns to overcome, manage, or live with the negative consequences of physical illness, mental illness, alcohol or drug misuse, or trauma. Homeless individuals endure many, or all, of these experiences. Previous research has shown that characteristics of homeless services, particularly the amount of choice they afford to service users, can influence recovery experiences, potentially by increasing a sense of mastery. The purpose of this study was to test the hypothesis that choice in housing and services would predict recovery in a number of domains, and that these relationships would be mediated by mastery. METHOD: Using survey data collected from a sample of homeless services users (n = 160) in Ireland, we conducted a series of cross-sectional mediation analyses to predict recovery in domains of physical health, psychiatric symptoms, alcohol and drug use, and community integration. RESULTS: We observed the hypothesized mediational relationship for each recovery domain except alcohol use. That is, personal mastery mediated the relationship of perceived choice to self-appraised physical health, psychiatric symptoms, drug use, and physical and psychological aspects of community integration, but not alcohol use. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings add further support to the growing body of evidence that suggests choice is centrally important to recovery experiences among individuals in homelessness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Assessing the Impact of Music Therapy on Sensory Gating and Attention in Children With Autism: A Pilot and Feasibility Study.

Children with autism spectrum disorder (ASD) frequently demonstrate atypical processing of sensory information and deficits in attentional abilities. These deficits may impact social and academic functioning. Although music therapy has been used to address sensory and attentional needs, there are no studies including physiologic indicators of sensory processing to determine the impact of music therapy. The objective of this study was to determine the feasibility of conducting study protocols, determine the adequacy of electroencephalography (EEG) and behavioral measures in identifying attentional differences in children with ASD compared with typically developing (TD) children, and to gather preliminary evidence of intervention effects on brain responses and attention outcomes. Seven children with high functioning ASD ages 5 -12 and seven age- and gender-matched TD completed procedures measuring brain responses (EEG) and behaviors (the Test of Everyday Attention for Children). Children with ASD then completed a 35-min individual music therapy attention protocol delivered by a board-certified music therapist ten times over 5 weeks. Children with ASD completed measures of brain responses and behavior post-intervention to determine pre- to post-test differences. Consent and completion rates were 100% for children who met the study criteria. Feasibility measures indicated that measures of brain responsivity could be used to determine attentional differences between children with ASD and typical children. Initial outcome data for brain responses and behavior indicated positive trends for the impact of music therapy on selective attention skills.

European public perceptions of homelessness: A knowledge, attitudes and practices survey.

BACKGROUND: Addressing Citizen's perspectives on homelessness is crucial for the design of effective and durable policy responses, and available research in Europe is not yet substantive. We aim to explore citizens' opinions about homelessness and to explain the differences in attitudes within the general population of eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden. METHODS: A nationally representative telephone survey of European citizens was conducted in 2017. Three domains were investigated: Knowledge, Attitudes, and Practices about homelessness. Based on a multiple correspondence analysis (MCA), a generalized linear model for clustered and weighted samples was used to probe the associations between groups with opposing attitudes. RESULTS: Response rates ranged from 30.4% to 33.5% (N = 5,295). Most respondents (57%) had poor knowledge about homelessness. Respondents who thought the government spent too much on homelessness, people who are homeless should be responsible for housing, people remain homeless by choice, or homelessness keeps capabilities/empowerment intact (regarding meals, family contact, and access to work) clustered together (negative attitudes, 30%). Respondents who were willing to pay taxes, welcomed a shelter, or acknowledged people who are homeless may lack some capabilities (i.e. agreed on discrimination in hiring) made another cluster (positive attitudes, 58%). Respondents living in semi-urban or urban areas (ORs 1.33 and 1.34) and those engaged in practices to support people who are homeless (ORs > 1.4; p<0.005) were more likely to report positive attitudes, whereas those from France and Poland (p<0.001) were less likely to report positive attitudes. CONCLUSION: The majority of European citizens hold positive attitudes towards people who are homeless, however there remain significant differences between and within countries. Although it is clear that there is strong support for increased government action and more effective solutions for Europe's growing homelessness crisis, there also remain public opinion barriers rooted in enduring negative perceptions.

Lifetime, 5-year and past-year prevalence of homelessness in Europe: a cross-national survey in eight European nations.

OBJECTIVES: To examine the lifetime, 5-year and past-year prevalence of homelessness among European citizens in eight European nations. DESIGN: A nationally representative telephone survey using trained bilingual interviewers and computer-assisted telephone interview software. SETTING: The study was conducted in France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain and Sweden. PARTICIPANTS: European adult citizens, selected from opt-in panels from March to December 2017. Total desired sample size was 5600, with 700 per country. Expected response rates of approximately 30% led to initial sample sizes of 2500 per country. MAIN OUTCOME MEASURES: History of homelessness was assessed for lifetime, past 5 years and past year. Sociodemographic data were collected to assess correlates of homelessness prevalence using generalised linear models for clustered and weighted samples. RESULTS: Response rates ranged from 30.4% to 33.5% (n=5631). Homelessness prevalence was 4.96% for lifetime (95% CI 4.39% to 5.59%), 1.92% in the past 5 years (95% CI 1.57% to 2.33%) and 0.71% for the past year (95% CI 0.51% to 0.98%) and varied significantly between countries (pairwise comparison difference test, p<0.0001). Time spent homeless ranged between less than a week (21%) and more than a year (18%), with high contrasts between countries (p<0.0001). Male gender, age 45-54, lower secondary education, single status, unemployment and an urban environment were all independently strongly associated with lifetime homelessness (all OR >1.5). CONCLUSIONS: The prevalence of homelessness among the surveyed nations is significantly higher than might be expected from point-in-time and homeless service use statistics. There was substantial variation in estimated prevalence across the eight nations. Coupled with the well-established health impacts of homelessness, medical professionals need to be aware of the increased health risks of those with experience of homelessness. These findings support policies aiming to improve health services for people exposed to homelessness.

The Kitty Genovese murder and the social psychology of helping: the parable of the 38 witnesses.

This article argues that an iconic event in the history of helping research -- the story of the 38 witnesses who remained inactive during the murder of Kitty Genovese -- is not supported by the available evidence. Using archive material, the authors show that there is no evidence for the presence of 38 witnesses, or that witnesses observed the murder, or that witnesses remained inactive. Drawing a distinction between the robust bystander research tradition and the story of the 38 witnesses, the authors explore the consequences of the story for the discipline of psychology. They argue that the story itself plays a key role in psychology textbooks. They also suggest that the story marks a new way of conceptualizing the dangers of immersion in social groups. Finally, they suggest that the story itself has become a modern parable, the telling of which has served to limit the scope of inquiry into emergency helping.

Mastery matters: consumer choice, psychiatric symptoms and problematic substance use among adults with histories of homelessness.

Previous research demonstrated the importance of consumer choice and mastery to residential stability and psychiatric functioning for adults with histories of homelessness. In the present study, we investigated whether these relationships hold, even in the context of problem-related substance misuse. Questionnaire data were collected in Ireland from 101 residents of long-term homeless accommodation in 2010. Hayes' PROCESS macro for mediation and moderation analysis in SPSS was employed to test our hypotheses. Findings demonstrated that the indirect effect of choice through mastery on psychiatric functioning was stronger for individuals with more recent problem-related substance use than for those with no or distant histories of problem-related substance use. Our findings confirm that consumer choice in housing and services is important to homeless services users' recovery experiences. Because of its relationship with mastery, consumer choice in housing and services protects homeless services users' psychiatric functioning, especially when substance use-related choices have had negative consequences. Our findings suggest that if homeless services take away consumer choice when substance use causes problems, they may actually undermine, rather than foster, service users' psychiatric functioning.

Accelerators: Sparking Innovation and Transdisciplinary Team Science in Disparities Research.

Development and implementation of effective, sustainable, and scalable interventions that advance equity could be propelled by innovative and inclusive partnerships. Readied catalytic frameworks that foster communication, collaboration, a shared vision, and transformative translational research across scientific and non-scientific divides are needed to foster rapid generation of novel solutions to address and ultimately eliminate disparities. To achieve this, we transformed and expanded a community-academic board into a translational science board with members from public, academic and private sectors. Rooted in team science, diverse board experts formed topic-specific "accelerators", tasked with collaborating to rapidly generate new ideas, questions, approaches, and projects comprising patients, advocates, clinicians, researchers, funders, public health and industry leaders. We began with four accelerators-digital health, big data, genomics and environmental health-and were rapidly able to respond to funding opportunities, transform new ideas into clinical and community programs, generate new, accessible, actionable data, and more efficiently and effectively conduct research. This innovative model has the power to maximize research quality and efficiency, improve patient care and engagement, optimize data democratization and dissemination among target populations, contribute to policy, and lead to systems changes needed to address the root causes of disparities.

'Oh my god, we're not doing nothing': young people's experiences of spatial regulation.

Social psychologists have become increasingly concerned with examining the ways in which social practices are interrelated with their location. Critical perspectives have highlighted the traditional lack of attention given to both the collective aspects of spatial identities, together with the discursive practices that construct the relationships between people and places. In this article, we draw together the developing discursive work on place with work on children's geographies, in order to examine young people's accounts of spatial regulation. Adopting a discursive approach to the analysis of focus group discussion, we illustrate a variety of concerns managed in relation to spatial practices by 41 young people living in a large city in the South of England. Our findings suggest that everyday use of public space by young people is constructed at a nexus of competing concerns around childhood/adulthood, freedom, and citizenship, and illustrate the dynamic nature of place, and its regulation, as a resource for constructing identities.