Onderzoekscentrum maatschappelijke zorg
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Discus Amsterdam: Housing First
Evaluation
Dorieke Wewerinke
© UMC St Radboud
Maart 2012
Judith Wolf, Marjolein Maas, Sara Al Shamma
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
Onderzoekscentrum maatschappelijke zorg
Contents
• Discus Amsterdam: Housing First
• Research objectives & study components
• Discus clients: selection criteria
• Profile of clients
• Main outcomes:
Health, social contacts, Quality of life, residential stability, rates of nuisance,
perceived benefits (satisfaction with Discus and QoL improvements), fulfilment
of expectations
• Policy implications
• Future implementation
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Discus Amsterdam: Housing First (Pathways to Housing, Tsemberis, 1992)
• Target group: roofless people
• Independent accommodation (dependent rent contracts)
• Housing accommodation dispersed throughout city
• Rehabilitation approach: focus on individual strengths
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
Onderzoekscentrum maatschappelijke zorg
Selection criteria for Discus Amsterdam: Housing First
1. Be motivated
2. Cause no nuisance
3. Pay the rent
4. Accept at least one home visit per week by the housing support worker
5. Agree to income management
6. Comply with the Discus behavioural rules
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Evaluation: objectives and study components (Commissioned bij HVO Querido, City of Adam, Agis Health Insurance Company)
Gain insight into:
Profile of participants
Health
Social contacts
Quality of life and QoL improvements
Residential stability
Rates of nuisance
Perceived benefits from Discus:
- QoL improvements
- Satisfaction with Discus
Study period: 010 2010 – 010 2011
One semi-structured, face-to-face
interview with clients (use of
standardized instruments)
Completion of interview
questionnaires by support workers
Group interview with support
workers
Analysis of nuisance data recorded
by housing associations and Discus
No conclusions can be drawn as to whether Discus is better than other types of housing provision.
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Profile of Discus customers 84 customers registered with Discus between Dec 2010 - Feb 2011;
64 participants in study, response rate 80%
78% male, average age 45 (range: 24 to 62)
55% of ethnic minority background, 74% non-Western
41% primary or no education
80% unmarried
88% single
48% had children, 65% had 1 or 2 children
94% lived partly or wholly from social benefit, 72% from social assistance
41% were in paid employment or voluntary work
Average monthly disposable income: €208
70% in debt → €13,000 on average (range: €100 to €120,000)
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Health
Self-appraisal of physical and mental health: reasonable to excellent: 67% (physical),
80% (mental)
52% had physical health problems, 45% had long-term health problems, 45% were
currently in treatment
Higher rates of mental health problems (anxiety, depression, psychosomatic symptoms,
hostility) in comparison to Dutch general population
≥ 50% reported past-month use of ≥ 5 daily units of alcohol, cannabis, crack or powder
cocaine, or methadone / LAAM / buprenorphine
Indication of vulnerability: lifetime use of mental health services
52% outpatient addiction treatment
52% inpatient addiction treatment
64% outpatient psychiatric treatment
42% inpatient psychiatric treatment
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Social contacts
Visits within personal network:
Family: 40% at least once a week, 29% never
Friends and acquaintances: 52% at least once a week, 24% never
Loneliness Discus-
customers
Dutch
population
Not lonely 25% 68%
Average loneliness 47% 28%
Rather lonely 23% 3%
Extremely lonely 5% 1%
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Quality of Life (scale 1-7: ‘terrible’ to ‘delighted’)
General quality of life reported high: average score 5.0
Highest satisfaction rates:
Household maintenance and self-care: 5.7
Sense of safety: 5.7
Accommodation: 5.4
Emotional health: 5.4
Social functioning: 5.4
Resilience: 5.4
Relatively lower satisfaction:
Finances: 4.4
Relations with family: 4.6
Relations with offspring: 4.0
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Residential stability Customers registered with Discus between inception in 2006 and 6 April 2011: n = 123
Still housed with Discus Support:
77% (n = 95)
No longer participating:
23% (n = 28)
- 7 had independent rent contracts
- 10 transferred to different type of housing provision
- 3 departed due to severe nuisance
- 8 departed for other reasons:
3 died, 1 withdrew voluntarily, 1 returned to family abroad, 3 entered prison
Onderzoekscentrum maatschappelijke zorg
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Rates of nuisance (2006-2011)
Complaints to housing associations:
26 nuisance complaints for 100 flats
Most complaints were by neighbourhood residents, most were about noise.
Complaints to Discus:
41 complaints, 75% involving mild to moderate nuisance
Discus takes up the complaints, but precise outcomes are not always clear.
Needs improvement.
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“gedreven door kennis, bewogen door mensen”
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Perceived benefits from Discus: QoL improvements
0% 20% 40% 60% 80% 100%
Personal resilience (N=63)
Relations with offspring (N=21)
Substance use (N=62)
Mental health (N=63)
Physical health (N=63)
Sense of safety (N=63)
Social contacts (N=63)
Relations with family (N=61)
Household maintenance and self-care (N=63)
Structured daily activities (N=63)
Finances (N=63)
Housing situation (N=63)
General quality of life (N=63)
Better Unchanged Worse
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Perceived benefits from Discus: Satisfaction
Satisfaction: Average score: 8.2 (1-to-10 scale)
69%: expectations fulfilled, satisfaction with outcome
– ‘Things are going great.... I’m satisfied with my flat. Discus recognises my
problems and accepts me like I am.’
– ‘I’ve improved 99 per cent. I hadn’t expected that.’
19%: expectations partly fulfilled
– ‘I’m much more independent. It’s succeeded halfway. I’m still in debt,
unemployed and not financially stable.’
12%: expectations not fulfilled, outcome below expectations
– ‘I’m disappointed. I’ve got no job. I believed that if I got a flat, I’d soon get a job,
but things were different in practice. My social life is also not as good as I had
hoped.’
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Conclusions
Discus reaches a severely deprived group: people with weak socioeconomic
status, multiple problems and high use of social and health services (past and
present).
High satisfaction rate with Discus: a score of 8.2
High quality of life and high rates of perceived improvements in many life
domains
Relatively low rates of nuisance complaints
After 5 1/2 years of Discus, the majority of clients (77%) were still housed with
Discus support and the real dropout rate was low (2.4%).
Discus Amsterdam is successful!
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Policy implications
Parties concerned (HVO Querido, municipality of Amsterdam, and a health
insurance company) want to continue policy of extramuralisation
Invest in Housing First: health insurance company already agreed on
budget for 240 extra care packages for Housing First (commitment is 300
or more)
In collaboration with housing associations 240 houses have to be made
available for Housing First (and possibly more).
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Future implementation
Further development of strength based aproach, own direction and
rehabilitation
Continued investment in (new) workers;
-recruiting and selecting workers with qualities needed to strengthen the team
-keeping up with new knowledge and training
Focus on consensus within and between teams to assure internal quality
Practice based learning: reflecting on practice, developing procedures and
annually assessing necessary adjustments
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
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Thanks are due to
Customers of Discus
Discus housing support workers
Members of the advisory committee:
Wessel de Vries, Noor Bertens, Paul van Dijk and Nienke Boesveldt
Research team:
Sara Al Shamma, Marjolein Maas, Nicoline Jansen, Astrid Altena and Judith Wolf
Interviewers
Onderzoekscentrum maatschappelijke zorg
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Thank you for your attention.
Any questions?
Discus: Wessel de Vries: [email protected]
UMC St Radboud: Judith Wolf: [email protected]
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