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Open AccessArticle

Bread and Shoulders: Reversing the Downward Spiral, a Qualitative Analyses of the Effects of a Housing First-Type Program in France

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Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France
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Research Laboratory, Maison Blanche Hospital, 75018 Paris, France
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Observatory Regional of Health, Midi Pyrenees, 31000 Toulouse, France
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French Housing First Study Group, 13000 Marseille, France
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Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Public Hospital of Marseille (AP-HM), 13005 Marseille, France
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Community Mental Health Outreach Team, MARS (Movement and Action for Social Recovery), Public Hospital of Marseille (AP-HM), 13005 Marseille, France
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Regional Health Agency PACA (ARS), 13002 Marseille, France
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Author to whom correspondence should be addressed.
French Housing First Study Group: T. Apostolidis, E. Beetlestone, P. Birmes, T. Bossetti, R. Bouloudnine, B. Combes, J. Debieve, B. Falissard, C. Lancon, P. Le Cardinal, J. Naudin and B. Videau.
Int. J. Environ. Res. Public Health 2018, 15(3), 520; https://doi.org/10.3390/ijerph15030520
Received: 19 December 2017 / Revised: 11 February 2018 / Accepted: 23 February 2018 / Published: 14 March 2018
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)
This paper is a qualitative analysis of the effects of accompagnement, a support framework, on recovery trajectories of people with long-term homelessness and severe psychiatric disorders during 24 months in a Housing First-type program in France. A comprehensive methodology based on grounded theory was used to construct an interview guide, conduct multiple interviews with 35 Housing First participants sampled for heterogeneity, and produce memos on their trajectories before and after entering the program based on interview information. Thematic analysis of a representative subsample (n = 13) of memos identified 12 objective factors and 6 subjective factors key to the recovery process. An in-depth re-analysis of the memos generated four recovery themes: (1) the need for secure space favorable to self-reflexivity; (2) a “honeymoon” effect; (3) the importance of even weak social ties; (4) support from and hope among peers. Three challenges to recovery were identified: (1) finding a balance between protection and risk; (2) breaking downward spirals; (3) bifurcating the trajectory. This study provides new insight into the recovery process, understood as a non-linear transformation of an experience—the relationship between objective life conditions and subjective perception of those conditions—which reinforces protective support over risk elements. View Full-Text
Keywords: qualitative research; intervention research; Housing First; recovery; homelessness; trajectories qualitative research; intervention research; Housing First; recovery; homelessness; trajectories
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Rhenter, P.; Moreau, D.; Laval, C.; Mantovani, J.; Albisson, A.; Suderie, G.; French Housing First Study Group; Boucekine, M.; Tinland, A.; Loubière, S.; Greacen, T.; Auquier, P.; Girard, V. Bread and Shoulders: Reversing the Downward Spiral, a Qualitative Analyses of the Effects of a Housing First-Type Program in France. Int. J. Environ. Res. Public Health 2018, 15, 520.

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