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Provider Perspectives on the Relationship Between Housing and Mental Health Needs

Victoria Stanhope, Benjamin Henwood and Deborah Padgett Silver School of Social Work New York University. Provider Perspectives on the Relationship Between Housing and Mental Health Needs . Qualitative Research on Mental Health Conference August 27, 2010 Funded by NIMH:

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Provider Perspectives on the Relationship Between Housing and Mental Health Needs

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  1. Victoria Stanhope, Benjamin Henwood and Deborah Padgett Silver School of Social Work New York University Provider Perspectives on the Relationship Between Housing and Mental Health Needs Qualitative Research on Mental Health Conference August 27, 2010 Funded by NIMH: R01 69865 & F31 MH083372

  2. Background Problem framed as chronic homelessness Interrelated agendas of housing and mental health Continuum of Care Housing: Housing as output Supported Housing: Housing as input Provider negotiation between housing and mental health services Lipsky’s “street level bureaucrat” Schoen’s “reflective practitioner”

  3. Traditional system Permanent housing Transitional housing Level of independence Shelter placement Homeless Treatment compliance + psychiatric stability + abstinence

  4. Housing First Permanent housing Transitional housing Level of independence Shelter placement Homeless Treatment compliance + psychiatric stability + abstinence

  5. Comparison Treatment First Providers • Individual case management • Help enforce rules necessary for shared living • Assist in moving through the continuum • Abstinence model Permanent housing Transitional housing Shelter placement Homeless Housing First Providers • ACT team model • Help clients maintain independent living • Harm reduction HomelessPermanent housing

  6. Study Questions What do providers see as the role of housing in the delivery of services? How does the process of accessing housing affect providers’ relationships with clients? How do front-line providers articulate and translate their program’s values and philosophy?

  7. New York Services Study 41 providers were recruited from four agencies as part of a NIMH funded qualitative study 129 in–depth interviews lasting 30-45 minutes were conducted with providers Analysis was utilized to compare views of 20 Housing First providers and 21Treatment First providers

  8. Providers

  9. Methods 2-phase analysis of provider transcripts • Phase 2 • 70 transcripts • reviewed and themes revised Phase 1 59 transcripts co-coded and initial themes developed Boyatzis (1998) 1 Generate and apply codes across transcripts 2 Revise codes and develop themes that fit the data 3 Determine validity or ‘trustworthiness’ by seeking confirming and non-confirming data ATLAS.ti software used to separate and sort coded material

  10. Theme 1 Centrality of Housing Treatment First Housing First • Mostly focused on housing • Housing trumps treatment • ‘Commodify’ consumers • Necessary but not sufficient • Hierarchy of needs • Platform for recovery

  11. Theme 2 Engagement through Housing Treatment First Housing First • Gatekeeping role • Leverage part of system • Discretionary power common • Trusting relational foundation • Reduced hierarchy and promotes trust • Perception is still an issue

  12. Theme 3 (Limits to…) A right to housing Treatment First Housing First • Housing must be earned • ‘Housing ready’ criteria • Negative case: • Revolving door • Top-down philosophy • Converted providers • Negative case: • Extreme addiction

  13. Conclusions Revealed discrepancies between models and practice (irony of HF vs. TF) Discretionary power more prevalent in TF as providers negotiated system constraints Providers views and practice largely reflected the philosophy and structure of their programs Reflective of tensions within social welfare system – language of rights versus language of worthiness

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