American Journal of Community Psychology

, Volume 36, Issue 3–4, pp 223–238 | Cite as

Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with Histories of Homelessness

  • Ronni Michelle GreenwoodEmail author
  • Nicole J. Schaefer-McDaniel
  • Gary Winkel
  • Sam J. Tsemberis
Regular Articles


Despite the increase in consumer-driven interventions for homeless and mentally ill individuals, there is little evidence that these programs enhance psychological outcomes. This study followed 197 homeless and mentally ill adults who were randomized into one of two conditions: a consumer-driven “Housing First” program or “treatment as usual” requiring psychiatric treatment and sobriety before housing. Proportion of time homeless, perceived choice, mastery, and psychiatric symptoms were measured at six time points. Results indicate a direct relationship between Housing First and decreased homelessness and increased perceived choice; the effect of choice on psychiatric symptoms was partially mediated by mastery. The strong and inverse relationship between perceived choice and psychiatric symptoms supports expansion of programs that increase consumer choice, thereby enhancing mastery and decreasing psychiatric symptoms.


homelessness treatment services choice psychiatric disabilities 


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Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Ronni Michelle Greenwood
    • 1
    • 2
    • 4
    Email author
  • Nicole J. Schaefer-McDaniel
    • 1
  • Gary Winkel
    • 1
  • Sam J. Tsemberis
    • 3
  1. 1.The City University of New York Graduate CenterNew York
  2. 2.Social and Behavioural ScienceTilburg UniversityTilburgThe Netherlands
  3. 3.Pathways to HousingNew York
  4. 4.School of PsychologyCardiff UniversityCardiffUnited Kingdom

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