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Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth‐related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth‐focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth‐related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods. Highlights: Participants in Housing First (HF) reported more distal supports (DS) than those in staircase services.More distal supports predicted stronger sense of community integration (CI).The link from Housiing First to well‐being indicators is indirect, through DS and CI.More research on the indirect effects of HF on important well‐being outcomes is needed.Future research should identify the specific mechanisms through whch HF programs promote DS. [ABSTRACT FROM AUTHOR]

The capabilities approach, a framework for understanding and measuring inequality, stipulates that equality is best understood as the freedom to do and be within a particular context. Homelessness has been referred to as a situation of 'capabilities deprivation', and the extent to which homeless services restore or enhance capabilities is of increasing interest. As part of a large, eight‐country study of homelessness in Europe, we examined the extent to which adults with histories of homelessness perceived the services they receive as capabilities‐enhancing. We collected data at two time points: baseline (nt1 = 565) and follow‐up (nt2 = 399). Measures included perceived capabilities, choice and housing quality. Participants engaged with Housing First (HF) programmes perceived services as more capabilities‐enhancing than participants engaged with treatment as usual (TAU); this relationship was mediated by consumer choice and perceived housing quality. Implications for social policy, practice and training are discussed. [ABSTRACT FROM AUTHOR]

Nussbaum's Central Capabilities refer to the elements of a well-lived life, and many adults who experience homelessness are deprived of these capabilities. The study aim was to investigate whether service users experience different homeless services as affording or constraining capabilities. We conducted semi-structured interviews with homeless service users (n = 77) in Housing First (HF) and staircase services (SS) in eight European countries. We used thematic analysis to identify three themes: autonomy and dependency, the relational impact of living arrangements, and community interaction and stigma. While SS participants were able to address their bodily integrity and health, their higher-order capabilities were constrained by their homeless situations. HF participants described home as a base from which they could enact a wide range of capabilities indicative of a well-lived life. We conclude that housing-led service models with appropriate supports are key to affording service users' capabilities. Practical and policy implications are discussed. [ABSTRACT FROM AUTHOR]

Highlights: Housing First reports more service user recovery but little is known about how this is achieved.Certain features of homeless services are likely to promote service users' recovery.Housing First service users reported more choice, better housing quality, and more satisfaction.Service features predicted independent housing, psychiatric symptoms, and community integration.Across socio‐political and economic contexts, Housing First predicts greater recovery than traditional services. 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. [ABSTRACT FROM AUTHOR]

Objective: Recovery is the process through which one learns to overcome, manage, or live with the negative consequences of physical illness, mental illness, alcohol or drug misuse, or trauma. Homeless individuals endure many, or all, of these experiences. Previous research has shown that characteristics of homeless services, particularly the amount of choice they afford to service users, can influence recovery experiences, potentially by increasing a sense of mastery. The purpose of this study was to test the hypothesis that choice in housing and services would predict recovery in a number of domains, and that these relationships would be mediated by mastery. Method: Using survey data collected from a sample of homeless services users (n = 160) in Ireland, we conducted a series of cross-sectional mediation analyses to predict recovery in domains of physical health, psychiatric symptoms, alcohol and drug use, and community integration. Results: We observed the hypothesized mediational relationship for each recovery domain except alcohol use. That is, personal mastery mediated the relationship of perceived choice to self-appraised physical health, psychiatric symptoms, drug use, and physical and psychological aspects of community integration, but not alcohol use. Conclusions and Implications for Practice: Findings add further support to the growing body of evidence that suggests choice is centrally important to recovery experiences among individuals in homelessness. [ABSTRACT FROM AUTHOR]

Abstract: There is still much to learn about how aspects of the ecology of homelessness shape homeless adults’ recovery experiences. In the present mixed‐methods study, the relationship of service providers’ work‐related values to their service users’ recovery experiences in the microsystem of homelessness were examined. Service providers completed semi‐structured qualitative interviews about their service users, daily work activities, and work‐related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration. Service providers’ interview transcripts were coded for three indicators of values: assumptions, actions, and end‐states. Summative Content Analysis was used to transform qualitative codes into numeric data so they could be used to predict service users’ recovery. In a series of growth curve models, the extent to which service providers’ end‐state values, as an indicator of consumer‐led values, was shown to indirectly predict service users’ recovery experiences, through their perceived choice and mastery. Findings confirm that providers’ values are an important influence on service users’ recovery. Results are discussed in terms of their implications for recovery‐oriented theory and practice. [ABSTRACT FROM AUTHOR]

Previous research demonstrated the importance of consumer choice and mastery to residential stability and psychiatric functioning for adults with histories of homelessness. In the present study, we investigated whether these relationships hold, even in the context of problem-related substance misuse. Questionnaire data were collected in Ireland from 101 residents of long-term homeless accommodation in 2010. Hayes' PROCESS macro for mediation and moderation analysis in SPSS was employed to test our hypotheses. Findings demonstrated that the indirect effect of choice through mastery on psychiatric functioning was stronger for individuals with more recent problem-related substance use than for those with no or distant histories of problem-related substance use. Our findings confirm that consumer choice in housing and services is important to homeless services users' recovery experiences. Because of its relationship with mastery, consumer choice in housing and services protects homeless services users' psychiatric functioning, especially when substance use-related choices have had negative consequences. Our findings suggest that if homeless services take away consumer choice when substance use causes problems, they may actually undermine, rather than foster, service users' psychiatric functioning. [ABSTRACT FROM AUTHOR]