'Recovery Work' in Housing First Practices: Contents and Conditions

Onderzoekscentrum maatschappelijke zorg

“gedreven door kennis, bewogen door mensen”

Housing First: what’s second?

Reflections on recovery oriented support

20th September 2013

Judith Wolf




“So I thought, this is not the life that I want, this is not the life that I had in mind

or had expected. And that made me wiser. I had lost my focus and my goals.

I wasn’t in control anymore. That was wrong.”




Housing First: What’s second?

Compelling evidence:

Most homeless people can

sustain ordinary housing if

given right support

Focus on Long-term sustainability in

relation to recovery based support

•Need for understanding ‘why’ & ‘how’ it works

in addition to ‘whether’ (Goering, Nelson, Stefancic, Tsemberis, 2013)

•Use of multiple sources: theoretical concepts,

empirical data on process, output and outcome

& knowledge and experience of service users

and professionals

•Identify & elaborate on critical ingredients and

adapt to specific context




Clients’ perspective: What is essential for long-term stability?

“That I will have a regular structure, a regular day-night rhythm. Not being

awake all night.”

“Through rest in my body and peace and quiet around me. I am not looking for

trouble.”

“I continue to work. That’s how I can avoid losing balance.”

housing

rest & routine daily

activities

a supportive social

environment

being mentally stable

sufficient

income

medication limited use of

alcohol/drugs

recall what has

happend in the past companionship

Professional help

Access to public

services




What gives my life meaning & strength? service users (n=81) & staff (n=20)

Clusters

1. Living conditions (4.1)

2. Self control & goal achievement (3.9)

3. Personal acceptance & growth (3.8)

4. Meaningful relationships with others (3.8)

5 Basic necessities & self care (3.6)

6. Independence & resources (3.6)

7. Forgiveness (3.3)

8. Meaningful experiences (3.2)

9. Motivational drivers (3.0)

10. Relaxation & fun (2.9)

11. Belief & spirituality (2.7)

12. Not stealing anymore (2.5)

13. Alcohol & drug use (2.1)

10

8

5

1

2

3

4

6

9

7

12

11

13




Involvement

Express empathy

Explore clients’ concerns

Demonstrate

understanding of clients’

position

Avoid judgment or blame

Be reliable & trustworthy

Genuinely invest in

relationship

Foster self-determination | satisfying basic psychological needs

Competence

Help develop clear and

realistic expectations

about behaviour change

and outcomes

Help clients develop

appropriate goals

Provide positive

feedback

Support self-efficacy

(Markland et al., 2005)

Autonomy

Avoid coercion

Help develop personally

meaningful rationale for

engaging in behaviour

Help minimize external

controls

Provide opportunities for

participation & choice

Acknowledge negative

feelings associated with

engaging in difficult tasks




Recovery work (Wolf, 2012, based on Rapp & Goscha, 2010))

Support service users in finding

meaning, hope & perspective, and in:

• securing socio-economic living

conditions & supporting service users

in taking their life into their own hands

• connecting to other people

• gaining access to community resources, care & legal rights

• building a positive identity and self-esteem | a coherent sense of self

“I had a negative self image. In the

long run you start to believe

everything they say. Now it is

different…

I have discovered that I can hold

my ground and that I am a very

social person. I now know that I

can make choices myself and can

reach goals.

I ask questions about what I want

for my future and how I can make

things happen.” (service user)




Sustainable care | systemic & embedded

Social isolation & boredom:

• Overcoming feelings of guilt & shame

• Social integration and taking on new roles

Recognition of role of social environment:

• Prevent exhaustion | use resources

Recognition of exclusion mechanisms:

• Cut back unnecessary rules and regulations, fight stigma,

increase responsiveness

Connections in light of prevention & recovery:

• Access to community resources & strengthen alliances

with job market, education, health promotion, welfare,

sports, culture etc.




Thank you! Judith.Wolf@ radboudumc.nl ; 00 31 6 1587 2045

'Recovery Work' in Housing First Practices: Contents and Conditions

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