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![Page 1: Exploring the role of ‘choice’ in achieving increased wellbeing for clients of Housing First: A Case Study Chris Parker Northumbria University.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfd11a28abf838cab1dd/html5/thumbnails/1.jpg)
Exploring the role of ‘choice’ in achieving increased wellbeing for
clients of Housing First: A Case Study
Chris ParkerNorthumbria University
![Page 2: Exploring the role of ‘choice’ in achieving increased wellbeing for clients of Housing First: A Case Study Chris Parker Northumbria University.](https://reader035.fdocuments.us/reader035/viewer/2022062409/5697bfd11a28abf838cab1dd/html5/thumbnails/2.jpg)
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
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Consumerism and ‘choice’ in UK welfare provision
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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
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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).
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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
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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
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‘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
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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
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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.
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‘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
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‘Antagonisms’ of choice and Housing First
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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
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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
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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
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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
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Exploring the role of consumer choice in achieving increased
wellbeing for clients of Housing First: A Case Study
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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
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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
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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
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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