Advertisement

Understanding Innovation in Homeless Service Provision: A Study of Frontline Providers’ Values-Readiness for Change

  • Rachel M. ManningEmail author
  • Ronni Michelle Greenwood
Original Article

Abstract

Service innovation for adults experiencing mental illness and homelessness typically involves shifting from treatment-led, staircase models toward recovery-oriented, Housing-First models. Aligning frontline service providers’ values to those embedded within newer models is an important, but under-investigated, influence on the innovation process. To assess values alignment in this context, we conducted semi-structured qualitative interviews with frontline providers in staircase services in Ireland (n = 50). Data showed that, while their values mostly aligned to the treatment-led model, there was meaningful evidence of more recovery-oriented values, too. Strategies to enhance innovation through values-alignment are discussed.

Keywords

Homelessness Treatment-led values Recovery-oriented values 

Notes

Funding

This research was completed with support from The Irish Research Council’s Postgraduate Scholarship, awarded to the first author.

Compliance with Ethical Standards

Conflict of interest

Authors have no conflicts to declare.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Anthony, W., Rogers, E. S., & Farkas, M. (2003). Research on evidence-based practices: Future directions in an era of recovery. Community Mental Health Journal, 39(2), 101–114.CrossRefGoogle Scholar
  2. Aubert, B. A., & Hamel, G. (2001). Adoption of smart cards in the medical sector: the Canadian experience. Social Science & Medicine, 53(7), 879–894.CrossRefGoogle Scholar
  3. Aubry, T., Nelson, G., & Tsemberis, S. (2015). Housing first for people with severe mental illness who are homeless: A review of the research and findings from the at home—chez soi demonstration project. The Canadian Journal of Psychiatry, 60(11), 467–474.  https://doi.org/10.1177/070674371506001102.CrossRefGoogle Scholar
  4. Aubry, T., Bernad, R., & Greenwood, R. (2018). A multi-country study of program fidelity to housing first. European Journal of Homelessness, 12(3), 15–31.Google Scholar
  5. Bell, M. D., Lysaker, P. H., & Milstein, R. M. (1996). Clinical benefits of paid work activity in schizophrenia. Schizophrenia Bulletin, 22, 51–67.  https://doi.org/10.1093/schbul/22.1.51.CrossRefGoogle Scholar
  6. Blackwell, B., Eilers, K., & Robinson, D. (2000). The consumer’s role in assessing quality. In G. Stricker, W. G. Troy, & S. A. Shueman (Eds.), Handbook of quality management in behavioral health (pp. 375–386). Berlin: Springer.CrossRefGoogle Scholar
  7. Braun, V., & Clarke, V. (2014). What can “thematic analysis” offer health and wellbeing researchers? International Journal of Qualitative Studies on Health and Well-being.  https://doi.org/10.3402/qhw.v9.26152.Google Scholar
  8. Brown, T. T., Mahoney, C. B., Adams, N., Felton, M., & Pareja, C. (2010). What predicts recovery orientation in county departments of mental health? A pilot study. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 388–398.CrossRefGoogle Scholar
  9. Busch-Geertsema V (2014) Housing first Europe–results of a European social experimentation project. European Journal of Homelessness 8(1). Retrieved from: https://www.feantsaresearch.org/download/article-01_8-13977658399374625612.pdf
  10. Busch-Geertsema, V., Culhane, D., & Fitzpatrick, S. (2016). Developing a global framework for conceptualizing and measuring homelessness. Habitat International, 55, 124–132.CrossRefGoogle Scholar
  11. Chen, S. P., Krupa, T., Lysaght, R., McCay, E., & Piat, M. (2013). The development of recovery competencies for in-patient mental health providers working with people with serious mental illness. Administration and Policy in Mental Health and Mental Health Services Research, 40(2), 96–116.  https://doi.org/10.1007/s10488-011-0380-x.CrossRefGoogle Scholar
  12. Clark, P. G. (1997). Values in health care professional socialization: Implications for geriatric education in interdisciplinary teamwork. The Gerontologist, 37, 441–451.  https://doi.org/10.1093/geront/37.4.441.CrossRefGoogle Scholar
  13. Cunningham, C. E., Barwick, M., Rimas, H., Mielko, S., & Barac, R. (2018). Modeling the decision of mental health providers to implement evidence-based children’s mental health services: A discrete choice conjoint experiment. Administration and Policy in Mental Health and Mental Health Services Research, 45(2), 302–317.  https://doi.org/10.1007/s10488-017-0824-z.CrossRefGoogle Scholar
  14. Davidson, L., Tondora, J., O’connell, M. J., Kirk, T., Jr., Rockholz, P., & Evans, A. C. (2007). Creating a recovery-oriented system of behavioral health care: Moving from concept to reality. Psychiatric Rehabilitation Journal, 31(1), 23.  https://doi.org/10.2975/31.1.2007.23.31.CrossRefGoogle Scholar
  15. Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19(3), 91.CrossRefGoogle Scholar
  16. Farkas, M., Gagne, C., Anthony, W., & Chamberlin, J. (2005). Implementing recovery-oriented evidence-based programs: Identifying the critical dimensions. Community Mental Health Journal, 41, 141–158.  https://doi.org/10.1007/s10597-005-2649-6.CrossRefGoogle Scholar
  17. Feantsa & Fondation Abbé Pierre (November 26, 2018). Third Overview of Housing Exclusion in Europe. Accessed from: https://www.feantsa.org/en/report/2018/03/21/the-second-overview-of-housing-exclusion-in-europe-2017.
  18. Foster-Fishman, P. G., Nowell, B., & Yang, H. (2007). Putting the system back into systems change: A framework for understanding and changing organizational and community systems. American Journal of Community Psychology, 39, 197–215.  https://doi.org/10.1007/s10464-007-9109-0.CrossRefGoogle Scholar
  19. Gehman, J., Trevino, L. K., & Garud, R. (2013). Values work: A process study of the emergence and performance of organizational values practices. Academy of Management Journal, 56, 84–112.  https://doi.org/10.5465/amj.2010.0628.CrossRefGoogle Scholar
  20. Greenwood, R. M., Stefancic, A., Tsemberis, S., & Busch-Geertsema, V. (2013). Implementations of housing first in Europe: Successes and challenges in maintaining model fidelity. American Journal of Psychiatric Rehabilitation, 16(4), 290–312.CrossRefGoogle Scholar
  21. Hacking, S., Secker, J., Spandler, H., Kent, L., & Shenton, J. (2008). Evaluating the impact of participatory art projects for people with mental health needs. Health and Social Care in the Community, 16, 638–648.  https://doi.org/10.1111/j.1365-2524.2008.00789.x.CrossRefGoogle Scholar
  22. Henwood, B. F., Stanhope, V., & Padgett, D. K. (2011). The role of housing: A comparison of front-line provider views in housing first and traditional programs. Administration and Policy in Mental Health and Mental Health Services Research, 38, 77–85.  https://doi.org/10.1007/s10488-010-0303-2.CrossRefGoogle Scholar
  23. Henwood, B. F., Derejko, K. S., Couture, J., & Padgett, D. K. (2015). Maslow and mental health recovery: A comparative study of homeless programs for adults with serious mental illness. Administration and Policy in Mental Health and Mental Health Services Research, 42(2), 220–228.  https://doi.org/10.1007/s10488-014-0542-8.CrossRefGoogle Scholar
  24. Kertesz, S. G., Crouch, K., Milby, J. B., Cusimano, R. E., & Schumacher, J. E. (2009). Housing first for homeless persons with active addiction: Are we over-reaching? The Milbank Quarterly, 87(2), 495–534.  https://doi.org/10.1111/j.1468-0009.2009.00565.x.CrossRefGoogle Scholar
  25. Krogh, K. S. (1998). A conceptual framework of community partnerships: Perspectives of people with disabilities on power, beliefs and values. Canadian Journal of Rehabilitation, 12, 123–134.Google Scholar
  26. Le Boutillier, C., Slade, M., Lawrence, V., Bird, V. J., Chandler, R., Farkas, M., et al. (2015). Competing priorities: Staff perspectives on supporting recovery. Administration and Policy in Mental Health and Mental Health Services Research, 42(4), 429–438.  https://doi.org/10.1008/s10488-014-0585-x.CrossRefGoogle Scholar
  27. Leathers, S. J., Spielfogel, J. E., Blakey, J., Christian, E., & Atkins, M. S. (2016). The effect of a change agent on use of evidence-based mental health practices. Administration and Policy in Mental Health and Mental Health Services Research, 43(5), 768–782.  https://doi.org/10.1007/s10488-015-0694-1.CrossRefGoogle Scholar
  28. Lucock, M., Gillard, S., Adams, K., Simons, L., White, R., & Edwards, C. (2011). Self-care in mental health services: A narrative review. Health and Social Care in the Community, 19, 602–616.  https://doi.org/10.1111/j.1365-2524.2011.01014.x.CrossRefGoogle Scholar
  29. Macnaughton, E., Nelson, G., Goering, P., & Piat, M. (2017). Moving evidence into policy: The story of the At Home/Chez Soi initiative’s impact on federal homelessness policy in Canada and its implications for the spread of housing first in Europe and internationally. European Journal of Homelessness., 11(1), 109–130.Google Scholar
  30. Manning, R. M., & Greenwood, R. M. (2018). Microsystems of recovery in homeless services: The influence of frontline provider values on consumers’ recovery experiences. American Journal of Community Psychology, 61, 88–103.  https://doi.org/10.1002/ajcp.12215.CrossRefGoogle Scholar
  31. Manning, R. M., Greenwood, R. M., & Kirby, C. (2018). Building a way home: A study of fidelity to the housing first model in Dublin. Ireland. European Journal of Homelessness., 12(3), 33–54.Google Scholar
  32. Maton, K. I. (2008). Empowering community settings: Agents of individual development, community betterment, and positive social change. American Journal of Community Psychology, 41, 4–21.  https://doi.org/10.1007/s10464-007-9148-6.CrossRefGoogle Scholar
  33. Miller, J., & Timson, D. (2004). Exploring the experiences of partners who live with a chronic low back pain sufferer. Health and Social Care in the Community, 12, 34–42.  https://doi.org/10.1111/j.1365-2524.2004.00466.x.CrossRefGoogle Scholar
  34. Mondros, J. B., & Wilson, S. M. (1994). Organizing for power and empowerment. New York: Columbia University Press.Google Scholar
  35. Nelson, G., Walsh-Bowers, R., & Hall, G. B. (1998). Housing for psychiatric survivors: Values, policy, and research. Administration and Policy in Mental Health and Mental Health Services Research, 25(4), 455–462.  https://doi.org/10.1023/A:1022252826524.CrossRefGoogle Scholar
  36. Ogunlayi, F., & Britton, P. (2017). Achieving a ‘top-down’ change agenda by driving and supporting a collaborative ‘bottom-up’process: Case study of a large-scale enhanced recovery program. BMJ Open Qual, 6, e000008.  https://doi.org/10.1136/bmjoq-2017-000008.CrossRefGoogle Scholar
  37. Parsons, B. A. (2007). The state of methods and tools for social systems change. American Journal of Community Psychology, 39(3–4), 405–409.  https://doi.org/10.1007/s10464-007-9118-z.CrossRefGoogle Scholar
  38. Robey, K. L., Ramsland, S. E., & Castelbaum, K. (1991). Alignment of agency and personal missions: An evaluation. Administration and Policy in Mental Health and Mental Health Services Research, 19(1), 39–45.  https://doi.org/10.1007/BF00710517.CrossRefGoogle Scholar
  39. Rogers, E. (1995). Diffusion of innovations. New York: The Free Press.Google Scholar
  40. Rowe, M., Hoge, M. A., & Fisk, D. (1996). Critical issues in serving people who are homeless and mentally ill. Administration and Policy in Mental Health and Mental Health Services Research, 23(6), 555–565.  https://doi.org/10.1007/BF02108691.CrossRefGoogle Scholar
  41. Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., et al. (2014). Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems. World Psychiatry, 13, 12–20.  https://doi.org/10.1002/wps.20084.CrossRefGoogle Scholar
  42. Sowers, W. (2005). Transforming systems of care: The American association of community psychiatrists guidelines for recovery-oriented services. Community Mental Health Journal, 41, 757–774.  https://doi.org/10.1007/s10597-005-6433-4.CrossRefGoogle Scholar
  43. Tiderington, E. (2017). We always think you’re here permanently: The paradox of “permanent” housing and other barriers to recovery-oriented practice in supportive housing services. Administration and Policy in Mental Health and Mental Health Services Research, 44(1), 103–114.  https://doi.org/10.1007/s10488-015-0707-0.CrossRefGoogle Scholar
  44. Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health., 94(4), 651–656.CrossRefGoogle Scholar
  45. van Boekel, R. L., Steegers, M. A., Verbeek-van Noord, I., van der Sande, R., & Vissers, K. C. (2015). Acute pain services and postsurgical pain management in the Netherlands: A survey. Pain Practice, 15, 447–454.  https://doi.org/10.1111/papr.12192.CrossRefGoogle Scholar
  46. Vatne, S., & Fagermoen, M. S. (2007). To correct and to acknowledge: Two simultaneous and conflicting perspectives of limit-setting in mental health nursing. Journal of Psychiatric and Mental Health Nursing, 14, 41–48.  https://doi.org/10.1111/j.1365-2850.2007.01037.x.CrossRefGoogle Scholar
  47. White, W. L. (1998). Slaying the dragon: The history of addiction treatment and recovery in America. Bloomington: Chestnut Health Systems/Lighthouse Institute.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of LimerickCastletroyIreland

Personalised recommendations