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Contains fulltext : 306069.pdf (Publisher’s version ) (Open Access)

14 februari 2023, Item does not contain fulltext, This study assesses the extent to which reciprocal relations exist between financial hardship, sense of societal belonging and mental health for social assistance recipients. This provides crucial information on how a desired change in these outcomes may be realized, and which factors to target to improve recipients' disadvantaged situation most. In order to answer our research question, we drew on three-wave panel data (N = 348) from a social experiment in the municipality of Nijmegen, the Netherlands, which ran from December 2017 to January 2020. The data were analyzed using cross-lagged panel models. Our findings show that financial hardship and sense of societal belonging did not predict change in recipients' mental health. A better mental health at baseline, in contrast, predicted an increase in sense of societal belonging one and two years later. In addition, both a better mental health and a stronger sense of societal belonging at baseline predicted a decrease in financial hardship one year later, but this relation was not found between other waves. These findings emphasize that improving recipients’ mental health may be a promising policy strategy to improve their situation.

Item does not contain fulltext, According to recent legislation, support provided by local authorities in the Netherlands ought to be strengths-based and empower inhabitants to gain control over their lives. This study examined the outcomes, critical elements and working mechanisms of Pathways to Empowerment (PTE), a person-centered, strengths-based intervention, in local social support services provided by a medium size Dutch local authority, from the perspective of citizens needing support. A year after implementation of PTE, semi-structured face-to-face interviews were held with 17 citizens onto their experiences with the provided support with PTE, inquiring their experiences with certain principles of PTE and the changes the support has brought into their lives. The outcomes of support with PTE were: resilience, self-consciousness, positive connections and access to resources and services. According to citizens, 'being there', an empowering approach, listening and taking them seriously, focusing on strengths and qualities, working on naturally occurring resources and made-to-measure support is what makes support with PTE work. Working mechanisms connecting the critical elements with the reported outcomes were: building trust and rapport in the client-professional relationship, stimulating trust in and empowerment of self, stimulating social trust and awareness of naturally occurring resources, as well as support, guidance and mediation. The results of this study can help local authorities to better substantiate their choice for applying strengths-based interventions, like PTE, in local social support services.

Contains fulltext : 251458.pdf (Publisher’s version ) (Open Access), Homeless people are increasingly supported by peer workers in one-on-one mentorship relations called intentional unidirectional peer support (IUPS). Insight is therefore needed into the application and outcome of IUPS for this vulnerable population. This study examined the outcomes, critical elements, and working mechanisms of IUPS within homeless services from the perspective of both clients receiving IUPS and peer workers providing IUPS. Semi-structured face-to-face interviews were held with ten homeless clients and ten peer workers. According to participants, IUPS enhances clients' self-image, advances their personal growth, and results in better engagement with needed services. Rapport and empathy, a trustworthy and empowering relationship, as well as support, guidance, and mediation are what makes IUPS work according to the participants. The inclusion of both perspectives has led to a deeper understanding of what makes IUPS work for homeless people. Implications for practice are discussed.

Contains fulltext : 251417.pdf (Publisher’s version ) (Open Access), BACKGROUND: 'What matters to me' is a five-category preference elicitation tool to assist clients and professionals in choosing long-term care. This study aimed to evaluate the use of and experiences with this tool. METHODS: A mixed-method process evaluation was applied. Participants were 71 clients or relatives, and 12 professionals. They were all involved in decision-making on long-term care. Data collection comprised online user activity logs (N = 71), questionnaires (N = 38) and interviews (N = 20). Descriptive statistics was used for quantitative data, and a thematic analysis for qualitative data. RESULTS: Sixty-nine per cent of participants completed one or more categories in an average time of 6.9 (±0.03) minutes. The tool was rated 6.63 (±0.88) of 7 in the Post-Study System Usability Questionnaire (PSSUQ). Ninety-five per cent experienced the tool as useful in practice. Suggestions for improvement included a separate version for relatives and a non-digital version. Although professionals thought the potentially extended consultation time could be problematic, all participants would recommend the tool to others. CONCLUSION: 'What matters to me' seems useful to assist clients and professionals with preference elicitation in long-term care. Evaluation of the impact on consultations between clients and professionals by using 'What matters to me' is needed.

Contains fulltext : 245452.pdf (Publisher’s version ) (Closed access)

Item does not contain fulltext, The complexity of homeless service users' characteristics and the contextual challenges faced by services can make the experience of working with people in homelessness stressful and can put providers' well-being at risk. In the current study, we investigated the association between service characteristics (i.e., the availability of training and supervision and the capability-fostering approach) and social service providers' work engagement and burnout. The study involved 497 social service providers working in homeless services in eight different European countries (62% women; mean age = 40.73, SD = 10.45) and was part of the Horizon 2020 European study "Homelessness as Unfairness (HOME_EU)." Using hierarchical linear modeling (HLM), findings showed that the availability of training and supervision were positively associated with providers' work engagement and negatively associated with burnout. However, results varied based on the perceived usefulness of the training and supervision provided within the service and the specific outcome considered. The most consistent finding was the association between the degree to which a service promotes users' capabilities and all the aspects of providers' well-being analyzed. Results are discussed in relation to their implications for how configuration of homeless services can promote social service providers' well-being and high-quality care.

Contains fulltext : 236027.pdf (Publisher’s version ) (Open Access), In order to prevent evictions, it is important to gain more insight into factors predicting whether or not tenants receive an eviction order. In this study, ten potential risk factors for evictions were tested. Tenants who were at risk of eviction due to rent arrears in five Dutch cities were interviewed using a structured questionnaire, and six months later their housing associations were asked to provide information about the tenants' current situation. Multiple logistic regression analyses with data on 344 tenants revealed that the amount of rent arrears was a strong predictor for receiving an eviction order. Furthermore, single tenants and tenants who had already been summoned to appear in court were more likely to receive an eviction order. These results can contribute to identifying households at risk of eviction at an early stage, and to develop targeted interventions to prevent evictions.

Contains fulltext : 236968.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext, Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed.

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Contains fulltext : 219904.pdf (Publisher’s version ) (Closed access), This study identifies subgroups of tenants in a sample of 495 tenants at risk of eviction, due to rent arrears, by 16 housing associations in five Dutch municipalities, and examines the attuning of services to the needs of the tenants in these subgroups. Latent class analysis with eight known risk factors for eviction identified five subgroups of tenants, which can be characterised as young immigrants, native Dutch tenants with little support, highly educated native Dutch tenants with much support, depressed tenants with little support and highly educated mentally stable older single tenants. The young immigrants reported the highest number of unmet care needs; the highly educated native Dutch tenants with much support, on the other hand, mentioned the least unmet care needs. This study demonstrates the diversity of a population of tenants at risk of eviction. Together with the differences in care needs, this indicates the necessity to develop targeted and personalised interventions to prevent evictions.

Radboud University, 11 september 2020, Promotores : Wolf, J.R.L.M., Mheen, H. van de Co-promotores : Boersma, S.N., Rodenburg, G., Contains fulltext : 220351.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 217668.pdf (publisher's version ) (Open Access)

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Radboud University, 30 januari 2020, Promotores : Wolf, J.R.L.M., Hemert, A.M. van, Herman, D.B. Co-promotor : Beijersbergen, M.D., Contains fulltext : 213934.pdf (publisher's version ) (Open Access)

Background: To reduce homelessness, it is important to gain a better understanding of the differences between homeless people who remain in institutions and those who gain and can sustain independent housing. This longitudinal study explores differences in housing transitions and differences in changes in health and selfdetermination between formerly homeless people still living in institutions 2.5 years later and those now living in independent housing in the Netherlands. Methods: This study mapped the housing transitions of 263 participants from when they entered the social relief system (SRS) to 2.5 years later when they were in independent housing or institutions. These individuals were compared at the 2.5-year mark in terms of gender, age and retrospectively in terms of duration of homelessness. They were also compared with regard to changes in psychological distress, perceived health, substance use and self-determination. Results: Two and a half years after entering the SRS, 81% of participants were independently housed and 19% still lived in institutions. People in institutions had a longer lifetime duration of homelessness, were more often men, and their number of days of alcohol use had decreased significantly more, whereas independently housed people had shown a significant increase in their sense of autonomy and relatedness. Conclusion: Formerly homeless people living in independent housing and in institutions show few health-related differences 2.5 years after entering the SRS, but changes in autonomy and relatedness are distinctly more prevalent, after the same period of time, in those who are independently housed. ....................

Radboud University, 08 september 2020, Promotor : Wolf, J.R.L.M. Co-promotor : Beijersbergen, M.D., Contains fulltext : 220332.pdf (Publisher’s version ) (Closed access)

Radboud University, 21 juni 2019, Promotor : Wolf, J.R.L.M. Co-promotor : Beijersbergen, M.D., Contains fulltext : 203564.pdf (publisher's version ) (Open Access)

Contains fulltext : 204219.pdf (publisher's version ) (Open Access)

Contains fulltext : 207218.pdf (publisher's version ) (Open Access), The number of older homeless people with a limited life expectancy is increasing. European studies on their health-related characteristics are lacking. This study compared self-reported health, healthcare service use and health-related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross-sectional data from 378 participants who completed 2.5-year follow-up, we analysed differences in self-reported health, healthcare service use, and health-related needs between homeless adults aged >/=50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health-related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non-acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter-based or commu

Contains fulltext : 207095.pdf (publisher's version ) (Open Access), BACKGROUND: Social exclusion (SE), or the inability to participate fully in society, is considered one of the driving forces of health inequalities. Systematic evidence on this subject is pertinent but scarce. This review aims to systematically summarise peer reviewed studies examining the association between the multidimensional concepts of SE and social inclusion (SI) and health among adults in EU and OECD countries. METHODS: The protocol was registered on Prospero (CRD42017052718). Three major medical databases were searched to identify studies published before January 2018, supplemented by reference and citation tracking. Articles were included if they investigated SE or SI as a multidimensional concept with at least two out of the four dimensions of SE/SI, i.e. economic, social, political and cultural. A qualitative synthesis was conducted. RESULTS: Twenty-two observational studies were included. In the general population, high SE/low SI was associated with adverse mental and general health. For physical health, the evidence was inconclusive. In groups at high risk of SE, support was found for the association between high SE/low SI and adverse mental health but no conclusions could be drawn for physical and general health. CONCLUSIONS: This review found evidence for the association between high SE/low SI and adverse health outcomes, particularly mental health outcomes. The evidence is mainly based on cross-sectional studies using simple and often ad hoc indicators of SE/SI. The development and use of validated measures of SE/SI and more longitudinal research is needed to further substantiate the evidence base and gain better understanding of the causal pathways.

Contains fulltext : 207157.pdf (publisher's version ) (Open Access), The implementation and adaptation of the Housing First (HF) model represented profound changes the structure and delivery, goals, and principles of homeless services. These features of homeless services directly influence providers, their work performance and the clients' outcomes. The present research, conducted in eight European countries, investigated how social providers working in HF or TS (Traditional Staircase) describe and conceptualize the goals and the principles of their services. Data were collected through 29 focus group discussions involving 121 providers. The results showed that HF and TS had similar and different goals for their clients in the following areas: support, social integration, satisfaction of needs, housing, and well-being. HF providers emphasized clients' autonomy and ability to determine their personal goals, with housing being considered a start on the path of recovery, while TS were more focused on individual clients' basic needs with respect to food, health and finding temporary accommodations. HF providers privileged the person-centered approach and housing as a right, while TS providers were more focused on helping everyone. Implications of the results are discussed as suggestions both for practice and for research.

Contains fulltext : 201265.pdf (publisher's version ) (Open Access)

Contains fulltext : 215791.pdf (publisher's version ) (Open Access), BACKGROUND: The recently developed Social Exclusion Index for Health Surveys (SEI-HS) revealed particularly strong social exclusion in non-Western immigrant groups compared to the native Dutch population. To qualify such results, cross-cultural validation of the SEI-HS in non-Western immigrant groups is called for. METHODS: A sequential explanatory mixed methods design was used, employing quantitative data from the Netherlands Public Health Monitor along with qualitative interviews. Data from 1,803 adults aged 19 years or older of Surinamese, 1,009 of Moroccan and 1,164 of Turkish background and 19,318 native Dutch living in the four largest cities in the Netherlands were used to test the factorial structure of the SEI-HS and differential item functioning across immigrant groups. Additionally, 52 respondents with a high score on the SEI-HS and from different background were interviewed on the item content of the SEI-HS and subjective feelings of exclusion. For each SEI-HS item the semantic, conceptual and contextual connotations were coded and compared between the immigrant groups and native Dutch. RESULTS: High levels of social exclusion were found in 20.0% of the urban population of Surinamese origin, 20.9% of Moroccan, 28.7% of Turkish and 4.2% of native Dutch origin. The 4-factor structure of the SEI-HS was confirmed in all three immigrant groups. None of the items demonstrated substantial differential item functioning in relation to immigration background. The interviews uncovered some methodological shortcomings, but these did not substantially impact the observed excess of social exclusion in immigrant groups. CONCLUSIONS: The present study provides evidence in support of the validity of the SEI-HS in adults of Surinamese, Moroccan and Turkish background and confirms the major social exclusion of these immigrant groups in the main cities in the Netherlands. Policy measures to enhance social inclusion and reduce exclusion are urgently needed.

Contains fulltext : 207879.pdf (publisher's version ) (Open Access)

Contains fulltext : 202030.pdf (publisher's version ) (Open Access)

The number of older homeless people with a limited life expectancy is increasing. European studies on their health‐related characteristics are lacking. This study compared self‐reported health, healthcare service use and health‐related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross‐sectional data from 378 participants who completed 2.5‐year follow‐up, we analysed differences in self‐reported health, healthcare service use, and health‐related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health‐related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non‐acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter‐based or comm

Contains fulltext : 200223.pdf (Publisher’s version ) (Open Access), Background: Most European countries report rising numbers of people experiencing homelessness. For those with mental disorders, interventions are centered on achieving mental health and drug rehabilitation alongside housing readiness, often to the detriment of access to housing. Notwithstanding, more European countries are investing in a new model, Housing First (HF), which postulates immediate access to permanent housing with no initial requirements for treatment. While results of the European HF programs are published on individual-level data, little is known about the opinions of the general population about homelessness and the societal value of the HF model, which can represent barriers to the model's dissemination. Therefore, we present the protocol of a study designed for the following objectives: 1) to explore the knowledge, attitudes, and practices (KAP) about homelessness within the general population of 8 European countries, 2) to assess the valuation of the HF model by European citizens, and 3) to estimate the lifetime prevalence of homelessness in the targeted countries. Methods: A telephone survey was conducted from March to December 2017 among adults selected from opt-in panels from France, Ireland, Italy, the Netherlands, Portugal, Spain, Poland, and Sweden. A total sample of 5600 interviews was expected, with 700 per country. The interviews included three sections: first, the KAP about homelessness; second, the valuation of the HF model by measuring a respondent's willingness-to-pay (WTP) through the contingent valuation method; and third, an assessment of the lifetime prevalence of homelessness among the general population. Descriptive analyses and comparisons between countries will be conducted. KAP indicators will be created and their psychometric properties assessed. Determinants of WTP will be assessed through regression models. Discussion: This survey will highlight Europeans' views of homelessness, especially their level of tolerance towards

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Although homelessness is inherently associated with social exclusion, homeless individuals are rarely included in conventional studies on social exclusion. Use of longitudinal survey data from a cohort study on homeless people in four major Dutch cities (n = 378) allowed to examine: changes in indicators of social exclusion among homeless people over a 2.5-year period after reporting to the social relief system, and associations between changes in indicators of social exclusion and changes in psychological distress. Multinomial logistic regression analysis was applied to investigate the associations between changes in indicators of social exclusion and changes in psychological distress. Improvements were found in various indicators of social exclusion, whereas financial debts showed no significant improvement. Changes in unmet care needs, health insurance, social support from family and relatedness to others were related to changes in psychological distress. This study demonstrated improvements in various indicators of social exclusion among homeless people over a period of 2.5 years, and sheds light on the concept of social exclusion in relation to homelessness.

Objectives We explored whether changes in the perceived health of homeless people after entering the social relief system (SRS) in The Netherlands were predicted by housing, income, hours of work, social support, unmet care needs, arrests, physical and mental health, substance use, and experiences of autonomy, competence and relatedness, in addition to perceived health at baseline, demographics, suspected intellectual disability, the duration of homelessness and the company of children in the shelter facility. Methods A hierarchical regression analysis was used to explore the significant predictors of the perceived health of 344 homeless persons 18 months after entering the social relief system. Results A decrease in psychological distress and an increase in hours of (paid/voluntary) work as well as competence predicted a better perceived health. Conclusions Perceived health is not only influenced by objective circumstances related to work and mental health, but also self-determination, as shown by the influence of competence. Services should aim to reduce psychological distress of homeless people, support them in increasing their working hours and focus on strengthening their competence.

Item does not contain fulltext, Housing stability is an important focus in research on homeless people. Although definitions of stable housing differ across studies, the perspective of homeless people themselves is generally not included. Therefore, this study explored the inclusion of satisfaction with the participant's current housing status as part of the definition of housing stability and also examined predictors of housing stability with and without the inclusion of homeless person's perspective. Of the initial cohort consisting of 513 homeless participants who were included at baseline in 2011, 324 (63.2%) were also interviewed at 2.5-year follow-up. To determine independent predictors of housing stability, we fitted multivariate logistic regression models using stepwise backward regression. At 2.5-year follow-up, 222 participants (68.5%) were stably housed and 163 participants (51.1%) were stably housed and satisfied with their housing status. Having been arrested (OR = 0.36, 95% CI: 0.20-0.63), a high level of somatisation (physical manifestations of psychological distress) (OR = 0.52, 95% CI: 0.30-0.91) and having unmet care needs (OR = 0.77, 95% CI: 0.60-0.99) were negative predictors of housing stability. Having been arrested (OR = 0.43, 95% CI: 0.25-0.75), high debts (OR = 0.45, 95% CI: 0.24-0.84) and a high level of somatisation (OR = 0.49, 95% CI: 0.28-0.84) were negative predictors of stable housing when satisfaction with the housing status was included. Because inclusion of a subjective component revealed a subgroup of stably housed but not satisfied participants and changed the significant predictors, this seems a relevant addition to the customary definition of housing stability. Participants with characteristics negatively associated with housing stability should receive more extensive and individually tailored support services to facilitate achievement of housing stability.

Contains fulltext : 175723.pdf (publisher's version ) (Open Access), International dissemination of evidence-based interventions calls for rigorous evaluation. As part of an evaluation of critical time intervention (CTI) for homeless people and abused women leaving Dutch shelters, this study assessed fidelity in two service delivery systems and explored factors influencing model adherence. Data collection entailed chart review (n = 70) and two focus groups with CTI workers (n = 11). The intervention obtained an overall score of three out of five (fairly implemented) for compliance fidelity and chart quality combined. Fidelity did not differ significantly between service systems, supporting its suitability for a range of populations. The eight themes that emerged from the focus groups as affecting model adherence provide guidance for future implementation efforts.

Item does not contain fulltext, Cognitive impairment is a prevalent problem among the homeless and seems related to more psychosocial problems. However, little is known about the care needs of the subgroup of homeless people with an intellectual disability compared to those without an intellectual disability and how their care needs develop over time. This study explores self-reported care needs within a broad range of life domains among Dutch homeless people with and without a suspected intellectual disability to gain insight into the transition of self-reported care needs from baseline to follow-up in both subgroups. This longitudinal study is part of a cohort study among homeless people who had been accepted for an individual programme plan in four major Dutch cities. The initial cohort consisted of 513 participants who were interviewed in 2011. At 1.5-year follow-up, 336 participants (65.5%) were also interviewed and screened for intellectual disability. Of these participants, 31% (95% CI 26.2-36.1) had a suspected intellectual disability. For both groups, between baseline and follow-up, the number of 'unmet care needs' decreased significantly and the number of 'no care needs' increased significantly, while at follow-up, participants with a suspected intellectual disability reported 'no care needs' on significantly fewer life domains than those without a suspected intellectual disability (mean numbers 16.4 vs. 17.5). Between baseline and follow-up, 'met care needs' decreased significantly on housing for both groups, and increased on finances and dental care for participants with a suspected intellectual disability. At follow-up, participants with a suspected intellectual disability more often preferred housing support available by appointment than those without a suspected intellectual disability. These findings suggest that homeless people who had been accepted for an individual programme plan with a suspected intellectual disability have care needs for a longer period of time than those with

Contains fulltext : 189798.pdf (publisher's version ) (Closed access)

Contains fulltext : 177297.pdf (publisher's version ) (Open Access), INTRODUCTION: The USA lags behind other high-income countries in many health indicators. Outcome differences are associated with differences in the relative spending between healthcare and social services at the national level. The impact of the ratio and delivery of social and healthcare services on the individual patient's health is however unknown. 'Reframing Healthcare Services through the Lens of Co-Production' (RheLaunCh) will be a cross-Atlantic comparative study of the mechanisms by which healthcare and social service delivery may impact patient health with chronic conditions. Insight into these mechanisms is needed to better and cost-effectively organise healthcare and social services. METHODS: We designed a mixed methods study to compare the socioeconomic background, needs of and service delivery to patients with congestive heart failure and chronic obstructive pulmonary disease in the USA and the Netherlands. We will conduct: (1) a literature scan to compare national and regional healthcare and social service systems; (2) a retrospective database study to compare patient's socioeconomic and clinical characteristics and the service use and spending at the national, regional and hospital level; (3) a survey to compare patient perceived quality of life, receipt and experience of service delivery and ability of these services to meet patient needs; and (4) multiple case studies to understand what patients need to better govern their quality of life and how needs are met by services. ETHICS AND DISSEMINATION: Ethics approval was granted by the ethics committee of the Radboud University Medical Center (2016-2423) in the Netherlands and by the Human Subjects Research Committee of the Hennepin Health Care System, Inc. (HSR #16-4230) in the USA. Multiple approaches will be used for dissemination of results, including (inter)national research presentations and peer-reviewed publications. A website will be established to support the development of a community of pra

Contains fulltext : 164942.pdf (publisher's version ) (Closed access), The development of a strong working alliance between homeless young adults and their social workers is seen as a critical component in the recovery process. The purpose of this study was to examine the composition of the working alliance between homeless young adults and their social workers, and its association with self-determination, resilience and quality of life. A sample of 102 homeless young adults and 32 social workers from ten Dutch shelter facilities participated. Homeless young adults were interviewed twice: when entering the facility (baseline) and sixth months after baseline or when care ended earlier. Social workers were questioned about the working alliance at follow-up. Data were analyzed by using a one-with-many design. Results showed that homeless young adults who generally reported strong alliances with their social worker, do not have a social worker who generally reported strong alliances (generalized reciprocity). In addition, if a young adult reported to have an especially strong alliance with his worker, this worker did not necessarily reported to have a strong alliance in return (dyadic reciprocity). Homeless young adults who perceived a stronger working alliance with their social worker than other young adults, who were supported by the same social worker, improved more on self-determination than young adults who reported to have a weaker alliance. Our results indicate that the working alliance is important in achieving outcomes. A dialogical approach should be encouraged in which young adults feel valued and safe enough to express their expectations and to build a strong working alliance.

Contains fulltext : 177684.pdf (publisher's version ) (Open Access), To help create an evidence base in Europe for effective interventions that improve the well-being of homeless people, we tested whether critical time intervention (CTI), a time-limited intervention developed to support vulnerable people during times of transition, is effective outside the United States. For this multicenter, parallel-group randomized controlled trial, 183 adults who were moving from shelters in the Netherlands to supported or independent housing were allocated to CTI or care-as-usual. The primary outcome was number of days rehoused, which was assessed by interviewing participants four times during a 9-month follow-up. Outcomes were analyzed with three-level mixed-effects models. The primary outcome did not differ between groups. CTI had a significant effect on family support and, for people experiencing less social support, psychological distress. Groups did not differ significantly on social support, fulfillment of care needs, quality of life, self-esteem, excessive alcohol use, or cannabis use. Because few participants were homeless at 9 months, more research is needed to establish whether CTI can prevent long-term recurrent homelessness. Given recent emphasis on informal support in public services and positive effects of CTI on family support and psychological distress, CTI is a fitting intervention for Dutch shelter services.

Contains fulltext : 176401.pdf (publisher's version ) (Closed access), 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.

Objectives: We explored whether changes in the perceived health of homeless people after entering the social relief system (SRS) in The Netherlands were predicted by housing, income, hours of work, social support, unmet care needs, arrests, physical and mental health, substance use, and experiences of autonomy, competence and relatedness, in addition to perceived health at baseline, demographics, suspected intellectual disability, the duration of homelessness and the company of children in the shelter facility. Methods: A hierarchical regression analysis was used to explore the significant predictors of the perceived health of 344 homeless persons 18 months after entering the social relief system. Results: A decrease in psychological distress and an increase in hours of (paid/voluntary) work as well as competence predicted a better perceived health. Conclusions: Perceived health is not only influenced by objective circumstances related to work and mental health, but also self-determination, as shown by the influence of competence. Services should aim to reduce psychological distress of homeless people, support them in increasing their working hours and focus on strengthening their competence.

Radboud University, 25 november 2016, Promotor : Wolf, J.R.L.M. Co-promotor : Sijbrandij, E.M., Contains fulltext : 160843.pdf (publisher's version ) (Open Access)

Radboud University, 11 november 2016, Promotores : Wolf, J.R.L.M., Vollebergh, W.A.M. Co-promotor : Boersma, S.N., Contains fulltext : 161613.pdf (publisher's version ) (Open Access)

Contains fulltext : 161562.pdf (publisher's version ) (Open Access), 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.

Item does not contain fulltext, 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.