Julia Woodhall-Melnik

A systematic review of outcomes associated with participation in Housing First programs

Abstract Housing First (HF) models have gained popularity among many politicians, policy-makers, and social service providers. Proponents of this model argue for its strength by drawing on research evidence. In other words, the use of HF is deemed an ‘evidence-based practice.’ Despite this, a strong synthesis of the evidence used to champion these models is lacking. This article seeks to address this gap, with a review focused on outcomes associated with participation in HF programs. Specifically, we investigate the details of program design coupled with specific outcomes, so as to better inform future action and research. We conclude that the research forming the evidence base for HF is methodologically strong. However, additional research is needed to determine the benefits of HF for diverse populations. Additional research is also required to conclusively determine the impact of HF on substance use and psychiatric treatment. We recommend that policy-makers consider the needs of local populations when developing and implementing HF programing.

Enriching qualitative research by engaging peer interviewers: a case study

Engaging peer-interviewers in qualitative inquiry is becoming more popular. Yet, there are differing opinions as to whether this practice improves the research process or is prohibitively challenging. Benefits noted in the literature are improved awareness/acceptance of disenfranchised groups, improved quality of research, and increased comfort of participants in the research process. Challenges include larger investment in time and money to hire, train, and support peer-interviewers, and the potential to disrupt peer recovery. We illustrate, through case study, how to engage peer-interviewers, meet potential challenges, and the benefits of such engagement. We draw upon our experience from a qualitative study designed to understand men’s experiences of problem gambling and housing instability. We hired three peers to conduct semi-structured qualitative interviews with 30 men from a community-based organization. We contend, that with appropriate and adequate resources (time, financial investment), peer-interviewing produces a positive, capacity building experience for peer-interviewers, participants and researchers.

Strategizing Safety: Theoretical Frameworks to Understand Women’s Decision Making in the Face of Partner Violence and Social Inequities:

Women in physically and psychologically abusive relationships face numerous decisions related to their safety: decisions that historically have been viewed by researchers and human service practitioners as related to individual or interpersonal factors, such as how they feel about their partner, what they (or those they are close to) think is best for their children, or whether they have a safe place to go to. Social and structural factors, such as poverty, sexism, and barriers related to disability, are either left out or viewed at their individual-level consequence, such as a woman’s employment status. Using interview data and case studies from a larger study on housing instability, partner violence, and health, the authors apply ecological and macro-level theoretical models that go beyond the individual level to the stories of women who struggled with partner violence, arguing that it is critical to examine the large social and structural forces that impact women’s lives if we are to understand the decisions women make when facing a violent partner.

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

The Impact of a 24 Month Housing First Intervention on Participants’ Body Mass Index and Waist Circumference: Results from the At Home / Chez Soi Toronto Site Randomized Controlled Trial

Research suggests that individuals experiencing homelessness have high rates of overweight and obesity. Unhealthy weights and homelessness are both associated with increased risk of poor health and mortality. Using longitudinal data from 575 participants at the Toronto site of the At Home/Chez Soi randomized controlled trial, we investigate the impact of receiving a Housing First intervention on the Body Mass Index (BMI) and waist circumference of participants with moderate and high needs for mental health support services. The ANCOVA results indicate that the intervention resulted in no significant change in BMI or waist circumference from baseline to 24 months. The findings suggest a need for a better understanding of factors contributing to overweight, obesity, and high waist circumference in populations who have histories of housing precarity and experience low-income in tandem with other concerns such as mental illness and addictions. Trial Registration International Standard Randomized Control Trial Number Register ISRCTN42520374

Establishing stability: exploring the meaning of 'home' for women who have experienced intimate partner violence

There is evidence that involuntary housing instability may undermine health and well-being. For women who have experienced intimate partner violence (IPV), achieving stability is likely as important for other groups, but can be challenging. Through our analysis of 41 interviews with women who have experienced low income and IPV, we argue that definitions of housing stability are multifaceted and for many centred on a shared understanding of the importance of creating an environment of “home”. We found that obtaining housing that satisfied material needs was important to women. However, in asking women to define what housing stability meant to them, we found that other factors related to ontological security and the home, such as safety, community, and comfort, contributed to women’s experiences of stability. Through our discussion of the importance these women placed on establishing stable homes, we argue that future research on women’s experiences with housing stability and IPV should include definitions of stability that capture both material security and women’s experiences with building emotionally stable homes.

Gambling in the Landscape of Adversity in Youth: Reflections from Men Who Live with Poverty and Homelessness

Most of the research on gambling behaviour among youth has been quantitative and focused on measuring prevalence. As a result, little is known about the contextual experiences of youth gambling, particularly among those most vulnerable. In this paper, we explore the previous experiences of youth gambling in a sample of adult men experiencing housing instability and problem gambling. We present findings from a qualitative study on problem gambling and housing instability conducted in Toronto, Canada. Thirty men with histories of problem or pathological gambling and housing instability or homelessness were interviewed. Two thirds of these men reported that they began gambling in youth. Five representative cases were selected and the main themes discussed. We found that gambling began in early life while the men, as youth, were also experiencing adversity (e.g., physical, emotional and/or sexual abuse, neglect, housing instability, homelessness, substance addiction and poverty). Men reported they had access to gambling activity through their family and wider networks of school, community and the streets. Gambling provided a way to gain acceptance, escape from emotional pain, and/or earn money. For these men problematic gambling behaviour that began in youth, continued into adulthood.

“Talk with me”: perspectives on services for men with problem gambling and housing instability

BackgroundProblem gambling and homelessness are recognized as important public health concerns that significantly impact individuals, their friends and families, communities and broader society. We aimed to explore the experiences with health and social services of men who had histories of problem gambling and housing instability in Toronto, Ontario.MethodsWe used a community-based participatory approach with a multi-service agency serving low-income individuals. We conducted qualitative interviews with men (n = 30) who had experienced problem gambling and housing instability. Our interviews employed open-ended questions to elicit men’s perceptions of services related to housing instability, problem gambling and other comorbid conditions (e.g., mental illness, substance use). We reviewed relevant themes related to experiences with services (e.g., Use of and feedback on: health and social services, housing services, justice/legal aid services, substance use services, gambling services; stigma; goals; triggers; physical health; coping strategies; finances; relationships; barriers to services and recommendations for services).ResultsThe concept of person-centred engagement was identified as a main overarching theme, and seemed to be lacking in most of the men’s experiences of services. Person-centred engagement for these men entailed empowerment and autonomy; empathy, compassion and sincerity; respectful communication; and tailored and holistic life plans. While there was a strong emphasis placed on independence, the men identified the importance of positive therapeutic relationships as being critical aspects of the recovery process. Based on our analyses, several recommendations were identified: 1) Increasing general awareness of services for problem gambling; 2) Delivering integrated services in a one-stop-shop; 3) Addressing mental health with psychotherapy and pharmacotherapy; 4) Providing timely access to prevention and recovery services; and 5) Enhancing life skills with peer support.ConclusionsOur study highlighted that most of the men we interviewed were not having their health and social needs met. Services need to address the intersection of problem gambling, housing instability, and other comorbidities. Ensuring services are grounded in person-centred engagement appears to be critical for optimal service delivery.

More than convenience: the role of habitus in understanding the food choices of fast food workers

This article explores the consumption practices of fast food workers through the lens of Bourdieu, specifically his notion of habitus. The authors address a gap in knowledge in the field of fast food work and explore the ways that the family environment and social relationships outside the family shape adult food choices using qualitative interviews with 40 fast food workers. Most fast food workers eat fast food when they are at work but their consumption patterns and choices reflect familial, cultural and class-based eating patterns and learning in adult social relationships (e.g., eating practices with friends). Some engage in a deliberate (conscious) process in their eating habits. The findings suggest that structure, disposition and conscious thought may influence food consumption.

Men’s experiences of early life trauma and pathways into long-term homelessness

Previous studies that have explored the association between childhood trauma and homelessness indicate that traumatic events can lead to survivor distrust of interpersonal relationships and institutions, prolonged homelessness and poor health and social outcomes. The majority of this literature relies on quantitative data and fails to investigate the personal experiences of childhood trauma that are found to impact housing status later in life. Semi-structured, qualitative interviews were conducted with 25 men living in an urban area in Ontario who had spent more than 30 consecutive nights in an emergency shelter over the course of their housing histories. During data analysis, it was observed that all of the men had experienced some form of trauma or neglect in childhood which contributed to their entries into homelessness. Using a case study approach, three entry pathways into long term homelessness are described: 1) youth; 2) emerging or early adulthood; and 3) middle adulthood. Participants are classified into the pathways by the developmental period at which they first entered homelessness. These findings have implications for policy makers and service providers, as key intervention points are identified. Establishing effective interventions that address crises experienced at these points could assist with homelessness prevention across the life course.