Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming
1.1. Social Integration and Mental Health of Individuals Experiencing Homelessness
1.2. Social Integration among Housing First Residents
2. Materials and Methods
2.1. Setting and Participants
2.3. Quantitative Measures and Analysis
2.4. Qualitative Interview Focus and Analysis
3.1. Quantitative Results
3.2. Qualitative Findings
3.2.1. Types and Sources of Participants’ Social Support
She [HF staff member] makes sure appointments are scheduled. She makes sure that I make my appointments. I got bus passes if I need it…She’s hooked me up with different groups and things going on, different pantries when I didn’t have my food stamps…She’s a life saver!(Male, age 50, 6-month interview)
When my back’s out, I just stay in the apartment. They [HF staff] express their concern, and then, when they do see me they [say], “Man, I hope you’re alright. I see you’re feeling better, you’re up and about,” and stuff like that. There’s the concern, and it’s a truthful kind of thing. It’s not like they’re just doing it because it’s their job; they really care.(Male, age 48, 12-month interview)
Because they [family] come over, we laugh and kick it and, you know, they go on about their way. It’s good. It’s pretty good. Feels good. They’re real happy for me, real happy for me.(Female, age 48, 12-month interview)
I really didn’t have no friends because I had an abusive girlfriend, and I wasn’t allowed [by her] to have friends. She thought I was having sex with everybody I came in contact with.”(Female, Age 29, 6-month interview)
3.2.2. Changes in Participants’ Relationships
New [friendships], yea. Before like I really kept people at a great distance for a long time…I probably got like two people that I feel really close to [since being housed].(Female, age 51, 6-month interview)
Now [since moving] I have relationships with people…it’s hard to get to know somebody at a shelter. I mean, here [in the building], there are more people to pick from…More people I’d be likely to be friends with.(Female, age 58, 12-month interview)
You know, I think there's people [other residents] that are kind of a burden and things...I've kind of gotten out of the circle of the people that are drinking constantly and everything. I still associate with them, but I’m not like hanging out with them, getting drunk with them and stuff. [She associates]…with more positive people, and, you know, people I could trust more. You know, for a while I was letting about anybody in my apartment: they were stealing from me and stuff, and I kind of cut off people that I don't trust anymore…(Female, age 48, 6-month interview)
- Those relationships, have they changed for the positive, or the negative?
- Two of them for the negative.
- Okay. Why is that?
- Because one of them came in here and stole something from me. The other one…He thinks I’m supposed to believe everything he says…(Male, age 63, 12-month interview)
…I would get away from my girlfriend…It's like when she did something, I would do it. Because if I didn't do it, I would get beat up…It's over. She's even banned from [the building]…I have support here, and I'm clean, so...If I was still hanging out with her, I probably wouldn't be in this interview today.(Female, Age 29, 6-month interview)
Yeah, we’re [the participant and his wife] in contact more with them [family] now. I’ve had my brother here visiting. He stayed the night once, and we’re able to do that now. So, yeah, it’s gotten better…There was really no relationship before here. When we were homeless, they [family] didn’t try to help. They just separated themselves from us. It was like, “out of sight, out of mind” kinda thing. And now that we’re here, it’s changed.(Male, Age 48, 12-month interview)
- …in terms of your life changing since last January, how have your relationships changed?
- They’re better.
- How would you say they are better?
- My family trust me now…[now that] my lifestyle has changed.
- Okay, could you describe that?
- What my lifestyle used to be? Well, I was a hustler, boosting [stealing], doing drugs, selling drugs, that type of stuff.(Male, age 53, 12-month interview)
Yeah, I get along really well with staff…[S]ome of them knew me before I came here, so they seen the change [in the participant’s behavior]. You know, being more social and more trusting…We work together well.(Male, age 48, 6-month interview)
My relationships [with staff] have grown. I don't really know how to explain it. They're really working with me, try[ing] to get my mental health stable and keep me clean and sober so I can get visitation with my son. Not actually get custody with my son back but get visitation.(Female, Age 29, 6-month interview)
Conflicts of Interest
- Alverson, Hoyt S., Marianne Alverson, and Robert E. Drake. 2000. An ethnographic study of the longitudinal course of substance abuse among people with severe mental illness. Community Mental Health Journal 36: 557–69. [Google Scholar] [CrossRef] [PubMed]
- Anthony, William. 1993. Recovery from mental illness: The guiding vision of mental health services in the 1990s. Psychosocial Rehabilitation Journal 16: 11–23. [Google Scholar] [CrossRef]
- Anderson, Isobel, Peter Kemp, and Deborah Quilgars. 1993. Single Homeless People. London: HMS. [Google Scholar]
- Borgatti, Stephen. 2006. E-Network Software for Ego-Network Analysis. Lexington: Analytic Technologies. [Google Scholar]
- Buck, Page Walker, and Leslie B. Alexander. 2006. Neglected voices: Consumers with serious mental illness speak about intensive case management. Administration and Policy in Mental Health and Mental Health Services Research 33: 470–81. [Google Scholar] [CrossRef] [PubMed]
- Charmaz, Kathy. 2014. Constructing Grounded Theory. Los Angeles: Sage, ISBN 978-0-85702-9133. [Google Scholar]
- Coltman, Linda, Susan Gapka, Dawnmarie Harriott, Michael Koo, Jenna Reid, and Alex Zsager. 2015. Understanding community integration in a Housing-First approach: Toronto at Home/Chez Soi community-based research. Intersectionalities: A Global Journal of Social Work Analysis, Research, Polity, and Practice 4: 39–50. [Google Scholar]
- Creswell, John W., and Vicky Plano Clark. 2011. Designing and Conducting Mixed Methods Research, 2nd ed. Los Angeles: Sage, ISBN 10 1412975174. [Google Scholar]
- Daiski, Isolde, Nancy Viva, Davis Halifax, Gail J. Mitchell, and Andre Lyn. 2012. Homelessness in the suburbs: Engulfment in the grotto of poverty. Studies in Social Justice 6: 103–23. [Google Scholar] [CrossRef]
- Davidson, Larry, David Stayner, Connie Nickou, Thomas Styron, Michael Rowe, and Matthew Chinman. 2001. “Simply to be let in”: Inclusion as a basis for recovery. Psychiatric Rehabilitation journal 24: 375. [Google Scholar] [CrossRef] [PubMed]
- Drake, Robert E., Michael A. Wallach, Hoyt S. Alverson, and Kim T. Mueser. 2002. Psychosocial aspects of substance abuse by clients with severe mental illness. The Journal of Nervous and Mental Disease 190: 100–6. [Google Scholar] [CrossRef] [PubMed]
- Duchesne, Annie, and David W. Rothwell. 2015. What leads to homeless shelter re-entry? An exploration of the psychosocial, health, contextual and demographic factors. Canadian Journal of Public Health 107: 94–99. [Google Scholar] [CrossRef] [PubMed]
- Fitzpatrick, Suzanne, Peter Kemp, and Susanne Klinker. 2000. Single Homelessness: An Overview of Research in Britain. Bristol: The Policy Press, ISBN 1-86134-2136. [Google Scholar]
- Goering, Paula, Scott Veldhuizen, Aimee Watson, Carol Adair, Brianna Kopp, Eric Latimer, Geoff Nelson, Eric MacNaughton, David Streiner, and Tim Aubry. 2014. National at Home Chez Soi Final Report. Calgary: Mental Health Commission of Canada, Available online: https://www.mentalhealthcommission.ca/sites/default/files/mhcc_at_home_report_national_cross-site_eng_2_0.pdf (accessed on 20 July 2017).
- Gravlee, Clarence C. 2002. Mobile computer-assisted personal interviewing with handheld computers: The Entryware System 3.0. Field Methods 14: 322–36. [Google Scholar] [CrossRef]
- Halgin, Daniel S., and Stephen P. Borgatti. 2012. An introduction to personal network analysis and tie churn statistics using E-NET. Connections 32: 37–48. [Google Scholar]
- Harris, Paul A., Robert Taylor, Robert Thielke, Jonathon Payne, Nathaniel Gonzalez, and Jose G. Conde. 2009. Research Electronic Data Capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics 42: 377–81. [Google Scholar] [CrossRef] [PubMed]
- Hawkins, Robert L., and Courtney Abrams. 2007. Disappearing acts: The social networks of formerly homeless individuals with, co-occurring disorders. Social Science and Medicine 65: 2031–42. [Google Scholar] [CrossRef] [PubMed]
- Henry, Meghan, Rian Watt, Lily Rosenthal, and Axim Shivji. 2016. The 2016 annual homeless assessment report (AHAR) to Congress. Washington D.C.: The U.S. Department of Housing and Urban Development, Office of Community Planning and Development, Available online: https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf (accessed on 30 June 2017).
- Henwood, Benjamin F., Harmony Rhoades, Hsun-Ta Hsu, Julie Couture, Eric Rice, and Suzanne L. Wenzel. 2017. Changes in social networks and HIV risk behaviors among homeless adults transitioning into permanent supportive housing: A mixed methods pilot study. Journal of Mixed Methods Research 11: 124–37. [Google Scholar] [CrossRef]
- Henwood, Benjamin F., Ana Stefancic, Robin Petering, Sarah Schreiber, Courtney Abrams, and Deborah K. Padgett. 2015. Social relationships of dually diagnosed homeless adults following enrollment in Housing First or traditional treatment services. Journal of the Society for Social Work and Research 6: 385–406. [Google Scholar] [CrossRef] [PubMed]
- Kawachi, Ichiro, and Lisa F. Berkman. 2001. Social ties and mental health. Journal of Urban Health 78: 458–67. [Google Scholar] [CrossRef] [PubMed]
- Kessler, Ronald C., and Jane D. McLeod. 1985. Social Support and Mental Health in Community Samples. Edited by Sheldon Cohen and Syme Leonard. New York: Academic Press. [Google Scholar]
- Kuckartz, Udo. 2014. Qualitative Text Analysis: A Guide to Methods, Practice and Using Software. Los Angeles: Sage, ISBN 1446297756. [Google Scholar]
- Laudet, Alexandre B., and Keith Humphreys. 2013. Promoting recovery in an evolving policy context: What do we know and what do we need to know about recovery support services? Journal of Substance Abuse Treatment 45: 126–33. [Google Scholar] [CrossRef] [PubMed]
- Laudet, Alexandre B., and William L. White. 2008. Recovery capital as prospective predictor of sustained recovery, life satisfaction and stress among former poly-substance users. Substance use and Misuse 43: 27–54. [Google Scholar] [CrossRef] [PubMed]
- Lincoln, Karen D. 2000. Social support, negative social interactions, and psychological well-being. Social Service Review 74: 231–52. [Google Scholar] [CrossRef] [PubMed]
- Lee, Hyo Jung, and Maximiliane E. Szinovacz. 2016. Positive, negative, and ambivalent interactions with family and friends: Associations with well-being. Journal of Marriage and Family 78: 660–79. [Google Scholar] [CrossRef]
- Mitchell, Carey Usher, and Mark LaGory. 2002. Social capital and mental distress in an impoverished community. City and Community 1: 199–222. [Google Scholar] [CrossRef]
- Morgan, Craid, Tom Burns, Ray Fitzpatrick, Vanessa Pinfold, and Stefan Priebe. 2007. Social exclusion and mental health. The British Journal of Psychiatry 191: 477–83. [Google Scholar] [CrossRef] [PubMed]
- Nooe, Roger M., and David A. Patterson. 2010. The ecology of homelessness. Journal of Human Behavior in the Social Environment 20: 105–52. [Google Scholar] [CrossRef]
- Padgett, Deborah K., Leyla Gulcur, and Sam Tsemberis. 2006. Housing First services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice 16: 74–83. [Google Scholar] [CrossRef]
- Padgett, Deborah K., and Robert E. Drake. 2008. Social relationships among persons who have experienced serious mental illness, substance abuse, and homelessness: Implications for recovery. American Journal of Orthopsychiatry 3: 333–39. [Google Scholar] [CrossRef] [PubMed]
- Padgett, Deborah K., Victoria Stanhope, Ben F. Henwood, and Ana Stefancic. 2010. Substance use outcomes among homeless clients with serious mental illness: Comparing housing first with treatment first programs. Community Mental Health Journal 47: 227–32. [Google Scholar] [CrossRef] [PubMed]
- Padgett, Deborah K., Ben Henwood, Courtney Abrams, and Robert E. Drake. 2008. Social relationships among persons who have experienced serious mental illness, substance abuse, and homelessness: Implications for recovery. American Journal of Orthopsychiatry 78: 333–39. [Google Scholar] [CrossRef] [PubMed]
- Patterson, Michelle L., Akm Moniruzzaman, and Julian M. Somers. 2014. Community participation and belonging among formerly homeless adults with mental illness after 12 months of Housing First in Vancouver, British Columbia: A randomized Controlled Trial. Community Mental Health Journal 50: 604–11. [Google Scholar] [CrossRef] [PubMed]
- PhenX Toolkit. 2015. Version 8.2. Available online: https://www.phenxtoolkit.org/index.php (accessed on 5 June 2015).
- Pescosolido, Bernice A., and Eric R. Wright. 2004. The view from two worlds: The convergence of social network reports between mental health clients and their ties. Social Science and Medicine 58: 1795–806. [Google Scholar] [CrossRef]
- Sadowski, Laura S., Romina A. Kee, Tyler J. VanderWeele, and David Buchanan. 2009. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. Journal of the American Medical Association 301: 1771–78. [Google Scholar] [CrossRef] [PubMed]
- Sankari, Ashley, and Laura Littlepage. 2016. Ten-Year Trend Shows Slight Decrease in the Number of People Experiencing Homelessness. Indianapolis: Public Policy Institute. [Google Scholar]
- Stergiopoulos, Vicky, Agnes Gozdzik, Patricia O’Campo, Alixandra R. Holtby, Jeyagobi Jeyaratnam, and Sam Tsemberis. 2014. Housing First: Exploring participants’ early support needs. BMC Health Services Research 14: 167. [Google Scholar] [CrossRef] [PubMed]
- Thomas, David R. 2006. A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation 27: 237–46. [Google Scholar] [CrossRef]
- Trumbetta, Susan L., Kim T. Mueser, Ernest Quimby, Richard Bebout, and Gregory B. Teague. 1999. Social networks and clinical outcomes of dually diagnosed homeless persons. Behavior Therapy 30: 407–30. [Google Scholar] [CrossRef]
- Tsemberis, Sam. 2010. Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction Manual. Center City: Hazelden Press. [Google Scholar]
- Tsemberis, Sam, and Sara Asmussen. 1999. From streets to homes: The pathways to housing consumer preference supported housing model. Alcoholism Treatment Quarterly 17: 113–31. [Google Scholar] [CrossRef]
- Tsemberis, Sam, and Ronda F. Eisenberg. 2000. Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services 51: 487–93. [Google Scholar] [CrossRef] [PubMed]
- Turner, R. Jay, and Robyn Lewis Brown. 2010. Social support and mental health. In A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems, 2nd ed. Edited by Allan V. Horwitz and Teresa L. Scheid. Cambridge: Cambridge University Press, pp. 200–12. ISBN 0521561337. [Google Scholar]
- Center for Substance Abuse Treatment. 1994. Simple Screening Instruments for Outreach for Alcohols and Other Drug Abuse and Infectious Diseases; Rockville: Center for Substance Abuse Treatment.
- U.S. Department of Housing and Urban Development. 2013. Homeless emergency assistance and rapid transition to housing: Defining “chronically homeless.”. Available online: https://www.hudexchange.info/resources/documents/Defining-Chronically-Homeless-Final-Rule.pdf (accessed 20 June 2017).
- Watson, Dennis P. 2012. From structural chaos to a model of consumer support: Understanding the roles of structure and agency in mental health recovery for the formerly homeless. Journal of Forensic Psychology Practice 12: 325–48. [Google Scholar] [CrossRef] [PubMed]
- Watson, Dennis P., Dana E. Wagner, and Michael Rivers. 2013. Understanding the critical ingredients for facilitating consumer change in Housing First programming: A case study approach. The Journal of Behavioral Health Services and Research 40: 169–79. [Google Scholar] [CrossRef] [PubMed]
- Watson, Dennis P., Jeani Young, Emily Ahonen, Huiping Xu, Macey Henderson, Valery Shuman, and Randi Tolliver. 2014. Development and testing of an implementation strategy for a complex housing intervention: Protocol for a mixed methods study. Implementation Science 14: 30. [Google Scholar] [CrossRef] [PubMed]
- Watson, Dennis P., Valery Shuman, James Kowalsky, Elizabeth Golembiewski, and Molly Brown. 2017. Housing First and harm reduction: A rapid review and document analysis of the US and Canadian open-access literature. Harm Reduction Journal 14: 30. [Google Scholar] [CrossRef] [PubMed]
- Wright, Eric R., and Bernice A. Pescosolido. 2002. “Sorry, I forgot”: The role of recall error in longitudinal personal network studies. In Social Networks and Health Advances in Medical Sociology. Edited by Judith A. Levy and Bernice A. Pescosolido. Bingley: Emerald Group Publishing Limited, vol. 8, pp. 113–29. [Google Scholar]
- Yanos, Philip T., Susan M. Barrow, and Sam Tsemberis. 2004. Community integration in the early phase of housing among homeless persons diagnosed with severe mental illness: Successes and challenges. Community Mental Health Journal 40: 133–50. [Google Scholar] [CrossRef] [PubMed]
- Yanos, Philip T., Barbara J. Felton, Sam Tsemberis, and Victoria A. Frye. 2007. Exploring the role of housing type, neighborhood characteristics, and lifestyle factors in the community integration of formerly homeless persons diagnosed with mental illness. Journal of Mental Health 16: 703–17. [Google Scholar] [CrossRef]
- Yanos, Philip T., Ana Stefancic, and Sam Tsemberis. 2012. Objective community integration of mental health consumers living in supported housing and of others in the community. Psychiatric Services 63: 438–44. [Google Scholar] [CrossRef] [PubMed]
|High school or less||21||65.6|
|Associates or technical degree||4||12.5|
|Divorced, separated, or widowed||10||31.3|
|Number of homeless episodes||3.1||3.9||1.0–20.0|
|Longest episode of homelessness [Years]||6.1||6.5||0.5–25.0|
|Self-reported psychiatric diagnosis||18||56.3|
|Moderate to high substance use disorder symptoms a||26||81.3|
|Variable||Baseline||12 months||Percent Change|
|Network density a||0.65||0.29||0.1–1.0||0.79||0.29||0.0–1.0||+21.5%|
|Proportion same race||0.93||0.21||0.3–1.0||0.98||0.58||0.8–1.0||+5.4%|
|Mean closeness b||2.74||0.32||2.0–3.0||2.74||0.34||2.0–3.0||0.0%|
|Mean contact c||2.48||0.49||1.7–3.0||2.80||0.24||2.3–3.0||+12.9% *|
|Emotional & interactional||10|
|Research Questions||Quantitative Results||Qualitative Findings||Conclusions|
|1. What changes in social network size and quality occurred over the course of the first year of services?||Networks decreased in size, while increasing in density and frequency of contact between ego and alters.||Loss of alters not seen as problematic or was due to shedding of negative relationships.||Decrease in network size was due largely to shedding of negative relationships.|
|2. How did residents perceive their social networks and social support to change?||Proportion of network alters who were family members and romantic partners increased, while providers and friends decreased. Family members were the most likely to be retained in networks, while the most likely to be lost were friends, providers, and other relationships.||While some new friendships and romantic relationships were added, participants largely discussed strengthening of relationships with family and staff and shedding of abusive relationships.||While changes in network composition led to some lost relationships, relationship quality with those who remained in the network improved.|
|3. How were changes in social networks and support related to housing attainment?||N/A||Participants discussed more opportunities to make friends, being able to visit with family more, family and staff developing trust in them, and discontinuing previous friendships and romantic relationships that were negative because they were able to recognize the abuse or no longer needed their support to survive.||Housing provided individuals with more opportunities to engage with family and friends, while also providing stability from which trusting relationships could grow. Housing also provided residents the stability they needed to discontinue abusive relationships.|
© 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Golembiewski, E.; Watson, D.P.; Robison, L.; Coberg II, J.W. Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming. Soc. Sci. 2017, 6, 96. https://doi.org/10.3390/socsci6030096
Golembiewski E, Watson DP, Robison L, Coberg II JW. Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming. Social Sciences. 2017; 6(3):96. https://doi.org/10.3390/socsci6030096Chicago/Turabian Style
Golembiewski, Elizabeth, Dennis P. Watson, Lisa Robison, and John W. Coberg II. 2017. "Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming" Social Sciences 6, no. 3: 96. https://doi.org/10.3390/socsci6030096