Examining provider perspectives within housing first and traditional programs
Open accessAbstract
Pathways' Housing First represents a radical departure from traditional programs that serve individuals experiencing homelessness and co-occurring psychiatric and substance use disorders. This paper considered two federally funded comparison studies of Pathways' Housing First and traditional programs to examine whether differences were reflected in the perspectives of frontline providers. Both quantitative analysis of responses to structured questions with close-ended responses and qualitative analysis of open-ended responses to semistructured questions showed that Pathways providers had greater endorsement of consumer values, lesser endorsement of systems values, and greater tolerance for abnormal behavior that did not result in harm to others than their counterparts in traditional programs. Comparing provider perspectives also revealed an "implementation paradox"; traditional providers were inhibited from engaging consumers in treatment and services without housing, whereas HF providers could focus on issues other than securing housing. As programs increasingly adopt a Housing First approach, implementation challenges remain due to an existing workforce habituated to traditional services.
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Four studies found that Housing First's harm reduction philosophy fostered improved working relationships, as service users were not fearful of losing their housing if they disclosed substance use, allowing them to discuss the topic more freely with case managers.
“Four studies found that Housing First's harm reduction philosophy fostered improved working relationships, as service users were not fearful of losing their housing if they disclosed substance use, allowing them to discuss the topic more freely with case managers (Andvig et al., 2018; Henwood et al., 2013; Watson et al., 2012; Tiderington et al., 2013).”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Henwood et al., 2013
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Experimental — accuracy not yet measuredThe flexibility also posed challenges for service providers, such as determining when to intervene and producing ambiguity about whether or not they were 'doing enough' to support tenants.
“Yet, the flexibility also posed challenges for service providers, such as determining when to intervene and producing ambiguity about whether or not they were 'doing enough' to support tenants (Henwood et al., 2013, 2014; Tiderington et al., 2013).”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Henwood et al., 2013
The Results (Acceptance versus Conformity; page not available) report that some Housing First providers felt inner tension about accepting consumer choice when consumers were not doing well. That supports the general claim that flexibility could be challenging, but our copy does not say providers struggled to decide when to intervene or questioned whether they were “doing enough.” (LLM, conf=0.83)
Experimental — accuracy not yet measuredFactors that affected working relationships and alliances included service providers' interpersonal style and level of patience, development and sustainment of appropriate boundaries, and unconditional positive regard and acceptance of tenants.
“Factors that affected working relationships and alliances included service providers' interpersonal style and level of patience (Collins et al., 2012a; Tiderington et al., 2013), development and sustainment of appropriate boundaries (Collins et al., 2012a), and unconditional positive regard and acceptance of tenants (Collins et al., 2012a; Henwood et al., 2013).”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Henwood et al., 2013
TF service providers were less accepting of deviant behaviours, wanting tenants to conform to housing program expectations.
“TF service providers were less accepting of deviant behaviours, wanting tenants to conform to housing program expectations”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Henwood et al. (2013)
Adoption of a harm reduction model enables HF tenants to be accepted as they are, which is instrumental to building strong working relationships.
“Adoption of a harm reduction model enables HF tenants to be accepted as they are, which is instrumental to building strong working relationships”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Henwood et al. (2013)
HF service providers can experience 'inner tension' with the tenet of individual choice when tenants are unwell.
“HF service providers can experience 'inner tension' with the tenet of individual choice when tenants are unwell”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Henwood et al. (2013)
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Self-citation
- Authors
- Henwood, B. F., Shinn, M., Tsemberis, S., & Padgett, D. K.
- Affiliations
- University of Southern California (US)
- Vanderbilt University (US)
- Pathways to Housing (US)
- New York University (US)
- Venue
- American Journal of Psychiatric Rehabilitation
- Publisher
- University of Nebraska Press
- Published
- 2013-10
- Volume
- 16
- Issue
- 4
- Pages
- 262-274
- ISSN
- 1548-7768 (ISSN-L)
- 1548-7776
- PMC
- PMC3956654
- OpenAlex
- W2101651727
- Cited by
- 41
- References
- 18
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 1 · 2021: 8 · 2020: 4 · 2019: 2 · 2018: 8 · 2017: 5 · 2016: 4 · 2015: 7
- FWCI
- 6.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatric Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH069865, F31MH083372)
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- Housing First, homelessness, provider perspectives, consumer values
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