Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen” Discus...

Onderzoekscentrum maatschappelijke zorg“gedreven door kennis, bewogen door mensen”

Discus Amsterdam: Housing

FirstEvaluation

© UMC St Radboud

Maart 2012

Judith Wolf, Marjolein Maas,

Sara Al Shamma, Dorieke Wewerinke


Onderzoekscentrum maatschappelijke zorg

Contents

•Discus Amsterdam: Housing First

•Research objectives & study components

•Discus clients: selection criteria

•Profile of clients

•Main outcomes:

Health, social contacts, Quality of life, residential stability, rates of nuisance, perceived benefits (satisfaction with Discus and QoL improvements), fulfilment of expectations

•Policy implications

•Future implementation



Discus Amsterdam: Housing First (Pathways to Housing, Tsemberis, 1992)

•Target group: roofless people

•Independent accommodation (dependent rent contracts)

•Housing accommodation dispersed throughout city

•Rehabilitation approach: focus on individual strengths



Selection criteria for Discus Amsterdam: Housing First1.Be motivated

2.Cause no nuisance

3.Pay the rent

4.Accept at least one home visit per week by the housing support worker

5.Agree to income management

6.Comply with the Discus behavioural rules



Evaluation: objectives and study components (Commissioned bij HVO Querido, City of Adam, Agis Health Insurance Company)

Gain insight into:Profile of participantsHealthSocial contactsQuality of life and QoL improvementsResidential stabilityRates of nuisancePerceived benefits from Discus:

- QoL improvements

- Satisfaction with Discus

Study period: 010 2010 – 010 2011 One semi-structured, face-to-face interview with clients (use of standardized instruments)

Completion of interview questionnaires by support workers

Group interview with support workers

Analysis of nuisance data recorded by housing associations and Discus

Study period: 010 2010 – 010 2011 One semi-structured, face-to-face interview with clients (use of standardized instruments)

Completion of interview questionnaires by support workers

Group interview with support workers

Analysis of nuisance data recorded by housing associations and Discus

No conclusions can be drawn as to whether Discus is better than other types of housing provision.



Profile of Discus customers84 customers registered with Discus between Dec 2010 - Feb 2011; 64 participants in study, response rate 80%

78% male, average age 45 (range: 24 to 62)55% of ethnic minority background, 74% non-Western 41% primary or no education80% unmarried88% single48% had children, 65% had 1 or 2 children

94% lived partly or wholly from social benefit, 72% from social assistance41% were in paid employment or voluntary workAverage monthly disposable income: €20870% in debt → €13,000 on average (range: €100 to €120,000)



HealthSelf-appraisal of physical and mental health: reasonable to excellent: 67% (physical), 80%

(mental)

52% had physical health problems, 45% had long-term health problems, 45% were currently

in treatment

Higher rates of mental health problems (anxiety, depression, psychosomatic symptoms,

hostility) in comparison to Dutch general population

≥ 50% reported past-month use of ≥ 5 daily units of alcohol, cannabis, crack or powder

cocaine, or methadone / LAAM / buprenorphine

Indication of vulnerability: lifetime use of mental health services52% outpatient addiction treatment52% inpatient addiction treatment64% outpatient psychiatric treatment42% inpatient psychiatric treatment



Social contacts

Visits within personal network:Family: 40% at least once a month, 29% neverFriends and acquaintances: 52% at least once a month, 24% never

Loneliness Discus-customers

Dutch population

Not lonely 25% 68%

Average loneliness 47% 28%

Rather lonely 23% 3%

Extremely lonely 5% 1%



Quality of Life (scale 1-7: ‘terrible’ to ‘delighted’)

General quality of life reported high: average score 5.0

Highest satisfaction rates:

Household maintenance and self-care: 5.7

Sense of safety: 5.7

Accommodation: 5.4

Emotional health: 5.4

Social functioning: 5.4

Resilience: 5.4

Relatively lower satisfaction:

Finances: 4.4

Relations with family: 4.6

Relations with offspring: 4.0



Residential stability Customers registered with Discus between inception in 2006 and 6 April 2011: n = 123

Still housed with Discus Support:

77% (n = 95)

No longer participating:

23% (n = 28)

- 7 had independent rent contracts

- 10 transferred to different type of housing provision

- 3 departed due to severe nuisance

- 8 departed for other reasons: 3 died, 1 withdrew voluntarily, 1 returned to family abroad, 3 entered prison



Rates of nuisance (2006-2011)

Complaints to housing associations:

26 nuisance complaints for 100 flats

Most complaints were by neighbourhood residents, most were about noise.

Complaints to Discus:

41 complaints, 75% involving mild to moderate nuisance

Discus takes up the complaints, but precise outcomes are not always clear. Needs improvement.



Perceived benefits from Discus: QoL improvements



Perceived benefits from Discus: Satisfaction

Satisfaction: Average score: 8.2 (1-to-10 scale)

69%: expectations fulfilled, satisfaction with outcome

– ‘Things are going great.... I’m satisfied with my flat. Discus recognises my problems and

accepts me the way I am.’

– ‘I’ve improved 99 per cent. I hadn’t expected that.’

19%: expectations partly fulfilled

– ‘I’m much more independent. It’s succeeded halfway. I’m still in debt, unemployed and

not financially stable.’

12%: expectations not fulfilled, outcome below expectations

– ‘I’m disappointed. I’ve got no job. I believed that if I got a flat, I’d soon get a job, but

things were different in practice. My social life is also not as good as I had hoped.’



Conclusions

Discus reaches a severely deprived group: people with weak socioeconomic status, multiple problems and high use of social and health services (past and present).

High satisfaction rate with Discus: a score of 8.2

High quality of life and high rates of perceived improvements in many life domains

Relatively low rates of nuisance complaints

After 5 1/2 years of Discus, the majority of clients (77%) were still housed with Discus

support and the real dropout rate was low (2.4%).

Discus Amsterdam is successful!



Policy implications

Parties concerned (HVO Querido, municipality of Amsterdam, and a health insurance company) want to continue policy of extramuralisation

Invest in Housing First: health insurance company already agreed on budget for 240 extra care packages for Housing First (commitment is 300 or more)

In collaboration with housing associations 240 houses have to be made available for Housing First (and possibly more).



Future implementation

Further development of strength based aproach, own direction and rehabilitation

Continued investment in (new) workers;

Focus on consensus within and between teams to assure internal quality

Practice based learning: reflecting on practice, developing procedures and annually assessing necessary adjustments



Thanks are due to

Customers of Discus

Discus housing support workers

Members of the advisory committee:

Wessel de Vries, Noor Bertens, Paul van Dijk and Nienke Boesveldt

Research team:

Sara Al Shamma, Marjolein Maas, Nicoline Jansen, Astrid Altena and Judith Wolf

Interviewers



Thank you for your attention.

Any questions?

Discus: Wessel de Vries: [email protected] St Radboud: Judith Wolf: [email protected]

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