Judith R. L. M. Wolf

Toward Needs Profiles of Shelter-Based Abused Women: A Latent Class Approach

Shelter-based abused women report a variety of needs across different domains (e.g., housing, finances, relationships, health, safety, and empowerment). This diversity of needs underscores the necessity for different types of services. In the current study, the authors constructed profiles of Dutch shelter-based abused women (N = 218) based on their reported needs. Further, the authors compared their needs profiles with respect to sociodemographic and social–economic characteristics, abuse type, symptoms of depression and posttraumatic stress disorder (PTSD), general life satisfaction, social support, self-efficacy, self-esteem, and the attuning of the shelter services to the needs reported. Latent class analysis (LCA) identified four needs profiles: a High Needs class, a Practical Needs class, an Empowerment Needs class, and a Low Needs class. The classes differed with respect to migration, mental health, well-being variables, and the attuning of care needs. The results of this study underline the necessity for specifically tailored interventions for these four subgroups in women’s shelters.

Intellectual Disability among Dutch Homeless People: Prevalence and Related Psychosocial Problems

Background There is a higher prevalence of intellectual disability (ID) among homeless people than in the general population. However, little is known about the additional psychosocial problems faced by homeless people with ID. We describe the prevalence of ID in a cohort of homeless people in the Netherlands, and report relationships between ID and psychosocial problems in terms of psychological distress, substance (mis)use and dependence, as well as demographic characteristics in this cohort. Methods This cross-sectional study is part of a cohort study among homeless people in the four major cities of the Netherlands. Data were derived from 387 homeless people who were interviewed and screened for ID six months after the baseline measurement. Multivariate logistic regression analyses and χ2 tests were performed to analyze relationships between ID, psychosocial problems and demographic characteristics. Findings Of all cohort members, 29.5% had a suspected ID. Participants with a suspected ID had a higher mean age, were more likely to be male and to fall in the lowest category of education than participants without a suspected ID. Having a suspected ID was related to general psychological distress (OR  = 1.56, p<0.05), somatization (OR  = 1.84, p<0.01), depression (OR  = 1.58, p<0.05) and substance dependence (OR  = 1.88, p<0.05). No relationships were found between a suspected ID and anxiety, regular substance use, substance misuse and primary substance of use. Conclusion The prevalence of ID among Dutch homeless people is higher than in the general population, and is related to more psychosocial problems than among homeless people without ID. Homeless people with a suspected ID appear to be a vulnerable subgroup within the homeless population. This endorses the importance of the extra attention required for this subgroup.

Appropriate Care for Shelter-Based Abused Women: Concept Mapping With Dutch Clients and Professionals

We conducted a concept mapping exercise to gain insight into the perspectives held by abused women and professionals with regard to appropriate care in Dutch women’s shelters. Three brainstorming sessions generated 92 statements that were then rated by 56 clients and 51 professionals. A total of 11 clusters were identified. The three most important clusters were “help with finding a safe house if necessary,” “safety and suitable care for the children,” and “a personalized, respectful approach.” The most important statement was “take women seriously and treat them with respect.” The mapping exercise identified key practice-based elements of intervention that should better accommodate the needs of shelter-based abused women. We have used these elements in developing a new intervention for shelter-based abused women in the Netherlands.

A Cluster Randomized Controlled Trial Testing the Effectiveness of Houvast: A Strengths-Based Intervention for Homeless Young Adults

Objective: To test the effectiveness of Houvast: a strengths-based intervention for homeless young adults. Method: A cluster randomized controlled trial was conducted with 10 Dutch shelter facilities randomly allocated to an intervention and a control group. Homeless young adults were interviewed when entering the facility and when care ended. Repeated-measures analyses and logistic regression analyses were conducted by the principle of intention-to-treat framework (N = 251). Results: Improvements were demonstrated on quality of life; satisfaction with family relations, finances, and health; employed or in school; depression; care needs; autonomy; competence, and resilience in both conditions. A higher proportion of homeless young adults who received care according to Houvast were still receiving care at follow-up and successfully completed the trajectory compared to those who received care as usual. Conclusion: Homeless young adults seem to benefit from service provision in general. Further research on the effectiveness of Houvast is needed after sufficient model fidelity has been achieved.

Self-determination in relation to quality of life in homeless young adults: Direct and indirect effects through psychological distress and social support

Abstract The self-determination theory emphasizes the importance of satisfaction with autonomy, competence, and relatedness for a person’s psychological growth and well-being. This study examines associations between autonomy, competence, and relatedness with quality of life in homeless young adults; and whether possible associations are mediated by psychological distress and perceived social support. By means of face-to-face interviews, 255 homeless young adults who receive care from 10 Dutch shelter facilities for homeless young adults have been interviewed (M age = 20, 77% male, 51% Dutch Nationality) shortly after entering the facility. Autonomy, competence, and relatedness are all associated with quality of life, with competence as the highest correlate. Psychological distress mediates both competence and autonomy, and social support mediates competence as well as relatedness. These findings emphasize the importance of intervention programs for homeless young adults, focusing on the enhancement of self-determination, especially competence, to improve their quality of life.

Substance use among Dutch homeless people, a follow-up study: prevalence, pattern and housing status

BACKGROUND Previous studies have shown that substance use among homeless people is a prevalent problem that is associated with longer durations of homelessness. Most studies of substance use among the homeless were carried out outside Europe and have limited generalizability to European countries. This study therefore aimed to address the prevalence of substance use among homeless people in the Netherlands, the pattern of their use and the relationship with housing status at follow-up. METHODS This study included 344 participants (67.1% of the initial cohort) who were followed from baseline to 18 months after the baseline interview. Multinomial logistic regression analyses examined the relationship between substance use and housing status. RESULTS The most reported substances which were used among these homeless people were cannabis (43.9%) and alcohol (≥5 units on one occasion) (30.7%). Other substances were used by around 5% or less of the participants. Twenty-seven percent were classified as substance misuser and 20.9% as substance dependent. The odds to be marginally housed (4.14) or institutionalized (2.12) at follow-up compared to being housed of participants who were substance users were significantly higher than those of participants who did not use substances. The odds to be homeless were more than twice as high (2.80) for participants who were substance dependent compared with those who were not. CONCLUSION Homeless people who use substances have a more disadvantageous housing situation at follow-up than homeless people who do not use substances. Attention is needed to prevent and reduce long-term homelessness among substance-using homeless people.

Critical Time Intervention for Homeless People Making the Transition to Community Living: A Randomized Controlled Trial

Highlights This study contributes to a European evidence base for effective interventions for homeless people. It is the first RCT conducted in Dutch shelter services; this is uncommon outside the United States. In this sample, recurrent homelessness was rare 9 months after moving from a shelter to housing. Beneficial effects of CTI on mental health seem to be independent of health care system or context.

Interventions to prevent tenant evictions: a systematic review

Tenant evictions are a significant cause of homelessness. As evictions are a traumatic experience for those being evicted and involve high costs, preventing evictions is vital and should be part of local and national policy. In order to develop and implement preventive practices and policies, it is essential to know which interventions are effective in preventing evictions. However, little is known about these interventions. Therefore, a systematic search of the international literature, providing an overview of interventions to prevent evictions published in scientific journals and reporting on their (cost-)effectiveness, was conducted. Nine electronic databases and Google Scholar were searched for peer-reviewed and non-reviewed publications describing research into interventions to prevent tenant evictions published in English between January 1985 and May 2012. Two researchers reviewed titles, abstracts and full-text articles and eventually seven publications describing eight interventions to prevent tenant evictions were analysed. The eight interventions vary widely in terms of their target population, focus, type of support and duration, which makes comparison of results difficult. Only three effect studies on preventive interventions regarding tenant evictions were found; two researchers assessed their quality. One of these studies was of insufficient quality to assess the effectiveness of the intervention described. Legal assistance and debt advice are promising interventions that seem to be effective in decreasing the risk of eviction. The effectiveness of the other five interventions cannot be determined. More methodologically sound research into the prevention of tenant evictions is needed and future research will have to clarify what works for whom, in which context.

Psychometric properties of the consumer quality index to assess shelter and community care services

BACKGROUND Our aim was to design a valid and reliable consumer quality index (CQI) specifically suited to assess the experiences that homeless people, homeless youth, and abused women have with shelter and community care services. METHODS A pilot CQI questionnaire was constructed on the basis of literature study, focus group discussions with clients, concept mapping by clients and shelter workers, and a pre-pilot study. The pilot questionnaire was completed by 762 clients using shelter facilities for homeless people, homeless youth or abused women. Psychometric and multilevel analyses were performed to optimize the instrument and determine its validity, reliability and discriminative power. RESULTS The preparatory research had revealed seven primary focus topics, all of which were incorporated into the pilot questionnaire. Psychometric analyses resulted in four reliable scales, one of which applied only to clients in residential, day or night shelter programs. The final instrument consisted of 42 items for community care clients and 52 for clients using residential facilities, and day and night shelters; 32 and 42 such items pertained to client experiences. CONCLUSION The consumer quality index for shelter and community care services (CQI-SCCS) is a valid, reliable instrument for assessing the quality of these services. It provides guidance to facilities in quality maintenance and improvement, and it is useful in determining quality differences in facilities for homeless people and homeless youth.

Het hostelprogramma in Utrecht

SamenvattingTussen 2000 en 2010 ontwikkelde GG&GD Utrecht, in opdracht van de Utrechtse gemeenteraad, stadsbreed twee tijdelijke en acht permanente hostels voor 183 (verslaafde) daklozen. Met dit hostelprogramma wilde de gemeente Utrecht het mensonwaardige leven op straat van verslaafde daklozen beëindigen en bijdragen aan de vermindering van de overlast door verslaafden in en om het centrum van de stad. In verschillende studies zijn onderzocht: de effecten van het hostelprogramma op de bewoners en op de veiligheid en leefbaarheid voor omwonenden, de financiering, het omgevingsbeheer rond de hostels, de kritische succesfactoren voor het hostelprogramma en de toekomstige opgaven. Het hostelprogramma is een succes: het gaat beter met de verslaafden. Vanwege de complexiteit en weerbarstigheid van hun problematiek blijven velen mogelijk langdurig aangewezen op zorg. Verder blijkt huisvesting voor verslaafde daklozen in woonwijken mogelijk, zonder dat dit afbreuk doet aan de leefbaarheid in de wijken en de veiligheid van omwonenden.