Exploring the role of ‘choice’ in achieving increased wellbeing for clients of Housing First: A Case Study Chris Parker Northumbria University.

Exploring the role of ‘choice’ in achieving increased wellbeing for

clients of Housing First: A Case Study

Chris ParkerNorthumbria University

Structure

• The rise of consumerism and the concept of ‘choice’ in welfare provision

• The benefits and ‘antagonisms’ of ‘choice’ in welfare provision

• Choice and control in single homeless literature

• ‘Antagonisms’ of choice and Housing First• This study

Consumerism and ‘choice’ in UK welfare provision

The rise of consumerism in Welfare Provision

• Winter of Discontent

• Campaigns from Disabled service user groups for ‘full citizenship’ and greater independence

• Shift in global dynamics of capitalist restructuring in globalising, post-Fordist or neo-liberal forms

• Election of the Thatcher Government in 1979

How consumerism became ‘choice’

‘Choice puts the levers in the hands of the parents and patients so that they as citizens and consumers can be a driving force for improvement in their public services’

(Tony Blair, Guardian, June 2004 c. Greve 2011).

Who choosing what (and why)?• Choice of provider, of professional, of service, of

appointment time and of access channel. (Le Grand 2005)

• Having choice over services empowers individuals and motivates them to take control of their lives

• Enhancing perception of choice enables greater subjective wellbeing

• Services are made more fair and responsive

What’s the problem with ‘choice’- Clarke, Newman et al. (2008) summarise the wide

literature critiquing choice in public service into 3 main ‘antagonisms’:

EquityPower relationsPublic

provision

‘Responsibilisation’, conditionality and Multiple Exclusion Homelessness

• Traditional services have been widely critiqued for their ‘responsibilisation’ agenda (Whiteford, 2010)

• Those who don’t meet conditions can be excluded from support and often end up rough sleeping

• They are termed as living chaotic lifestyles and can be seen as ‘responsible’ for maintaining homelessness

Housing First

• Shifted from a model to principles to a philosophy as more implementations have spread

• The principles which are retained are:- Immediate, ‘private’ housing - Harm reduction approach- Separation of housing and treatment (‘right to

refuse’)- Commitment to open ended but intensive support- A ‘client led’ approach emphasising choice and

control for the client

Housing First

• Focused primarily on individuals who other services haven’t worked for – MEH/ ‘stock’ rough sleeper population

• Spread to a wide range of contexts largely due to the rigorous evaluation framework which surrounds the original.

‘Success’ in Housing First

• Housing retention is a success in itself

• North American studies have shown decreases in psychiatric outcomes, substance misuse and improved quality of life

• Long term outcomes elsewhere less established

‘Antagonisms’ of choice and Housing First

Equity

• Housing First generally works with MEH individuals so there are less chances of inequity occurring

• Housing First widens the offer to encompass those who traditional services don’t work for

• Key differences in characteristics may allow some to interact with choice more positively than others

• Those homeless individuals who may be more ‘housing ready’ aren’t given this option

Public Service Provision• Housing provides ontological

security and greater subjective wellbeing

• A lack of conditions enables engagement and saves public money on emergency support

• The ACT support model enables a wide range of support and specialists to inform choices

• ‘Selling’ MEH individuals to landlords is difficult and affordable stock is likely to be in low income areas.

• Welfare reform measures may retain conditionality on clients

• Service provision in the UK is less joined up and funding usually restricts services to single caseworkers

Power relations• Conditions of entering

Housing First are less imposing (no specific conditions)

• The ‘right to refuse’ shifts power to client

• Client’s have a ‘safety net’ for bad choices in terms of tenancy liaison and support.

• Conditions may not be so favourable (tenancy conditions, isolation)

• Clients need to be informed and motivated to exercise the ‘right to refuse’

• UK commissioning arrangements conflict with ‘client led’ and ‘open ended’ support

Summary• Housing First offers more choice than traditional ‘treatment

first ‘ services

• The extent and importance of choice has not been examined

• Less evidence to suggest that control and autonomy are achievable under Housing First philosophy

• Long term outcomes of greater sense of wellbeing and citizenship may be limited

Exploring the role of consumer choice in achieving increased

wellbeing for clients of Housing First: A Case Study

Objectives• To establish and measure service outcome priorities for

commissioners, providers and clients, and explore any differences in these outcome priorities.

• To identify and measure the level of choice and autonomy achieved by clients and explore the role of these in meeting outcomes related to wellbeing and social integration

• To establish the social, political and economic factors which influence how clients of Housing First in Newcastle achieve outcomes and interact with choice

Overview

- The study will focus on a Housing First service in Newcastle – upon – Tyne.

- Longitudinal study with mixed method interviews over 3 stages (0, 6, 12 months)

- Participants include all individuals entering the HF service from the ‘stock’ group of rough sleepers between Feb 2015 – May 2015

Measures of ‘success’• Council’s indicators will be transferred into validated scales

and measures

• Client’s own priorities identified in pilot and translated into valid and reliable measures

• Choice will be measured using ‘perceived choice’ question and Pearlin and Schooler Mastery Scale

• Qualitative elements will allow greater depth on the service, sense of choice and control and outcomes

Interview stage 1 (0 – 3 months in service)

-Explores client’s past experiences of homelessness

-Measures outcomes according to service outcome indicators

-Explores and measures choice in early stages of

service

-Defines client’s personal priorities for success

Stage 2 (6 – 9 months in service)

-Measures outcomes through service outcome

indicators and client’s priorities

-Explores and measures choice in this stage of

service

-Observation of the ‘communication of choice’

Stage 3 (12 – 15 months in service

-Measures outcomes through council indicators

and client’s priorities

-Explores and measures choice in this stage of

service

-Explore priorities for the future and how these match

with former priorities and service outcome indicators