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

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). 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 outcomes of homeless services uses 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 multi-method, 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. Semi-structured interviews will examine service users’ experiences of environmental constraints and affordances on acquired capabilities to identify features of homeless services that enhance service users’ capabilities sets. Results: Multi-level modelling (MLM) 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. Conclusions: will use findings from this research to formulate recommendations about the configuration of homeless services and the scaling up and scaling out of HF programs. From our findings we will draw conclusions about the setting features that promote individuals’ exits from homelessness, rehabilitation, and recovery. Clinical Trial: H2020-SC6-REVINEQUAL-2016/ GA726997