Housing First: what s second?

Transcriptie

1 Housing First: what s second? Reflections on recovery oriented support 20th September 2013 Judith Wolf

2 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.

3 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 Onderzoekscentrum multiple sources: maatschappelijke theoretical concepts, zorg empirical gedreven data door on kennis, process, bewogen output door and mensen outcome & knowledge and experience of service users and professionals Identify & elaborate on critical ingredients and adapt to specific context

4 Clients perspective: What is essential for long-term stability? housing daily activities limited use of alcohol/drugs rest & routine being mentally stable Access to public services companionship a supportive social environment recall what has happend in the past Professional help medication That I will have a regular structure, a regular day-night rhythm. Not being awake all night. sufficient income 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.

5 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) Personal acceptance & growth (3.8) 4. Meaningful relationships with others (3.8) 5 Basic necessities & self care (3.6) Independence & resources (3.6) Forgiveness (3.3) 4 8. Meaningful experiences (3.2) 7 9. Motivational drivers (3.0) 10. Relaxation & fun (2.9) Belief & spirituality (2.7) 12. Not stealing anymore (2.5) 13. Alcohol & drug use (2.1)

6 Foster self-determination satisfying basic psychological needs Competence Autonomy Involvement Help develop clear and realistic expectations about behaviour change and outcomes Help clients develop appropriate goals Provide positive feedback Support self-efficacy Avoid coercion Help develop personally meaningful rationale for engaging in behaviour Help minimize external controls Express empathy Explore clients concerns Demonstrate understanding of clients position Provide opportunities for participation & choice Acknowledge negative feelings associated with engaging in difficult tasks Avoid judgment or blame Be reliable & trustworthy Genuinely invest in relationship

7 Recovery work (Wolf, 2012, based on Rapp & Goscha, 2010)) Support service users in finding meaning, hope & perspective, and in: I had a negative self image. In the long run you start to believe everything they say. Now it is different 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 selfesteem a coherent sense of self 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)

8 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 gedreven unnecessary door kennis, rules and bewogen regulations, door fight mensen 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.

9 Thank you! radboudumc.nl ;