Skip to main content

The Role of Housing: A Comparison of Front-Line Provider Views in Housing First and Traditional Programs

Administration and Policy in Mental Health and Mental Health Services Research volume 38, pages 77–85 (2011)Cite this article

Abstract

Purpose

Within the mental health system, there are two distinct service models for adults who have severe mental illness and are homeless: one prioritizes treatment before accessing permanent housing (Treatment First) while the other provides permanent housing upfront followed by clinical support (Housing First). Investigating front-line providers working within these two models affords an opportunity to learn more about their implementation from an insider perspective, thus shedding light on whether actual practice is consistent with or contrary to these program models’ contrasting philosophical values.

Methods

Forty-one providers were recruited from four agencies as part of a NIMH funded qualitative study. Multiple, in-depth interviews lasting 30–45 min were conducted with providers that explored working within these agencies. Thematic analysis was utilized to compare the views of 20 providers working in Housing First versus the 21 providers working in Treatment First programs.

Results

Providers viewed housing as a priority but differences emerged between Treatment First and Housing First providers along three major themes: the centrality of housing, engaging consumers through housing, and (limits to...) a right to housing.

Conclusion

Ironically, this study revealed that providers working within Treatment First programs were consumed with the pursuit of housing, whereas Housing First providers focused more on clinical concerns since consumers already had housing. Clearly, how programs position permanent housing has very different implications for how providers understand their work, the pressures they encounter, and how they prioritize client goals.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  • Allen, M. (2003). Waking Rip van Winkle: Why developments in the last 20 years should teach the mental health system not to use housing as a tool of coercion. Behav Sci Law, 21(4), 503–521.

    PubMed  Article  Google Scholar 

  • Bond, G., Drake, R. E., Mueser, K., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Review article. Disease Management and Health Outcomes, 9, 141–159.

    Article  Google Scholar 

  • Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. Thousand Oaks: SAGE.

    Google Scholar 

  • Dearing, J. W. (2008). Evolution of diffusion and dissemination theory. Journal of Public Health Management and Practice, 14(2), 99–108.

    PubMed  Google Scholar 

  • Dordick, G. A. (2002). Recovering from homelessness: Determining the “quality of sobriety” in a transitional housing program. Qualitative Sociology, 25(1), 7–33.

    Article  Google Scholar 

  • Drake, R. E., Osher, F. C., & Wallach, M. A. (1991). Homelessness and dual diagnosis. American Psychologist, 36, 1149–1158.

    Article  Google Scholar 

  • Hopper, K., & Barrow, S. M. (2003). Two genealogies of supported housing and their implications for outcome assessment. Psychiatric Services, 54(1), 50–54.

    PubMed  Article  Google Scholar 

  • Hopper, K., Jost, J., Hay, H., Welber, S., & Haugland, G. (1997). Homelessness, severe mental illness, and the institutional circuit. Psychiatric Services, 48, 659–665.

    PubMed  CAS  Google Scholar 

  • Kertesz, S. G., Crouch, K., Milby, J., Cusimano, R. A., & Schumacher, J. (2009). Housing First for homeless persons with active addiction: Are we overreaching? The Milbank Quarterly, 87(2), 1–52.

    Article  Google Scholar 

  • Leff, H. S., Chow, C. M., Pepin, R., Conley, J., Allen, I. E., & Seaman, C. A. (2009). Does one size fit all? What we can and can’t learn from a meta-analysis of housing models for persons with mental illness. Psychiatric Services, 60(4), 473–482.

    PubMed  Article  Google Scholar 

  • Locke, G., Khadduri, J., O’Hara, A. (2007). Housing models. In D. Dennis, G. Locke, J. Khadduri (Eds.). National Symposium on Homelessness Research. Retrieved July 20, 2008, from http://aspe.hhs.gov/hsp/homelessness/symposium07/locke/index.htm.

  • Matejkowski, J., & Draine, J. (2009). Investigating the impact of housing first on ACT fidelity. Community Mental Health Journal, 45(1), 6–11.

    PubMed  Article  Google Scholar 

  • New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA-03-3832.

  • Newman, S. J. (2001). Housing attributes and serious mental illness: Implications for research and practice. Psychiatric Services, 52(10), 1309–1317.

    PubMed  Article  CAS  Google Scholar 

  • O’Hara, A. (2007). Housing for people with mental illness: Update of a report to the President’s New Freedom Commission. Psychiatric Services, 58, 907–913.

    PubMed  Article  Google Scholar 

  • Onken, S. J., Craig, C. M., Ridgway, P., Ralph, R. O., & Cook, J. A. (2007). An analysis of the definitions and elements of recovery: A review of the literature. Psychiatr Rehabil J, 31(1), 9–22.

    PubMed  Article  Google Scholar 

  • Padgett, D. K. (2008). Qualitative methods in social work research (2nd ed.). Los Angeles: SAGE.

    Google Scholar 

  • Padgett, D. K., Gulcur, L., & Tsemberis, S. (2006). Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74–83.

    Article  Google Scholar 

  • Piat, M., Lesage, A., Boyer, R., Dorvil, H., Couture, A., Grenier, G., et al. (2008). Housing for persons with serious mental illness: Consumer and provider preferences. Psychiatric Services, 59(9), 1011–1017.

    PubMed  Article  Google Scholar 

  • Ridgway, P., & Zipple, A. M. (1990). The paradigm shift in residential services: From the linear continuum to supported housing approaches. Psychosocial Rehabilitation Journal, 13(4), 11–31.

    Google Scholar 

  • Robbins, P. C., Petrila, J., Le Melle, S., & Monahan, J. (2006). The use of housing as leverage to increase adherence to psychiatric treatment in the community. Administration and Policy in Mental Health and Mental Health Services Research, 33(2), 226–236.

    PubMed  Article  Google Scholar 

  • Rog, D. J. (2004). The evidence on supported housing. Psychiatr Rehabil J, 27(4), 334–344.

    PubMed  Article  Google Scholar 

  • Salyers, M. P., & Tsemberis, S. (2007). ACT and recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams. Community Mental Health Journal, 43(6), 619–641.

    PubMed  Article  Google Scholar 

  • SAMHSA, (2006). National Consensus Statement on Mental Health Recovery [Brochure]. Retrieved May 2, 2010 from http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/.

  • Stanhope, V., Henwood, B. F., & Padgett, D. K. (2009). Understanding service disengagement from the perspective of case managers. Psychiatric Services, 60(4), 459–464.

    PubMed  Article  Google Scholar 

  • Substance Abuse and Mental Health Services Administration (SAMHSA). (2003). Blueprint for change: Ending Chronic Homelessness for persons with serious mental illnesses and co- occurring substance use disorders. DHHS Pub. No. SMA-04-3870, Rockville, MD.

  • Sylvestre, J., Nelson, G., Sabloff, A., & Peddle, S. (2007). Housing for people with serious mental illness: A comparison of values and research. American Journal of Community Psychology, 40(1–2), 125–137.

    PubMed  Article  Google Scholar 

  • Trattner, W. I. (1998). From poor law to welfare state: A history of social welfare in America (6th ed.). New York: Free Press.

    Google Scholar 

  • Tsemberis, S. J., Moran, L., Shinn, M., Asmussen, S. M., & Shern, D. L. (2003). Consumer preference programs for individuals who are homeless and have psychiatric disabilities: A drop-in center and a supported housing program. American Journal of Community Psychology, 32(3–4), 305–317.

    PubMed  Article  Google Scholar 

  • Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651–656.

    PubMed  Article  Google Scholar 

  • Wong, Y. L. I., & Stanhope, V. (2009). Conceptualizing community: A comparison of neighborhood characteristics of supportive housing for persons with psychiatric and developmental disabilities. Social Science and Medicine, 68(8), 1376–1387.

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by grants 5F31MH083372 and R01 69865 from the National Institute of Mental Health. The authors report no competing interests.

Author information

Affiliations

  1. School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA

    Benjamin F. Henwood, Victoria Stanhope & Deborah K. Padgett

Authors
  1. Benjamin F. Henwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victoria Stanhope
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah K. Padgett
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin F. Henwood.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Henwood, B.F., Stanhope, V. & Padgett, D.K. The Role of Housing: A Comparison of Front-Line Provider Views in Housing First and Traditional Programs. Adm Policy Ment Health 38, 77–85 (2011). https://doi.org/10.1007/s10488-010-0303-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-010-0303-2

Keywords

  • Front-line providers
  • Homelessness
  • Qualitative research