OBJECTIVES: We explored whether changes in the perceived health of homeless people after entering the social relief system (SRS) in The Netherlands were predicted by housing, income, hours of work, social support, unmet care needs, arrests, physical and mental health, substance use, and experiences of autonomy, competence and relatedness, in addition to perceived health at baseline, demographics, suspected intellectual disability, the duration of homelessness and the company of children in the shelter facility.METHODS: A hierarchical regression analysis was used to explore the significant predictors of the perceived health of 344 homeless persons 18 months after entering the social relief system.RESULTS: A decrease in psychological distress and an increase in hours of (paid/voluntary) work as well as competence predicted a better perceived health.CONCLUSIONS: Perceived health is not only influenced by objective circumstances related to work and mental health, but also self-determination, as shown by the influence of competence. Services should aim to reduce psychological distress of homeless people, support them in increasing their working hours and focus on strengthening their competence.
Housing stability is an important focus in research on homeless people. Although definitions of stable housing differ across studies, the perspective of homeless people themselves is generally not included. Therefore, this study explored the inclusion of satisfaction with the participant's current housing status as part of the definition of housing stability and also examined predictors of housing stability with and without the inclusion of homeless person's perspective. Of the initial cohort consisting of 513 homeless participants who were included at baseline in 2011, 324 (63.2%) were also interviewed at 2.5-year follow-up. To determine independent predictors of housing stability, we fitted multivariate logistic regression models using stepwise backward regression. At 2.5-year follow-up, 222 participants (68.5%) were stably housed and 163 participants (51.1%) were stably housed and satisfied with their housing status. Having been arrested (OR = 0.36, 95% CI: 0.20-0.63), a high level of somatisation (physical manifestations of psychological distress) (OR = 0.52, 95% CI: 0.30-0.91) and having unmet care needs (OR = 0.77, 95% CI: 0.60-0.99) were negative predictors of housing stability. Having been arrested (OR = 0.43, 95% CI: 0.25-0.75), high debts (OR = 0.45, 95% CI: 0.24-0.84) and a high level of somatisation (OR = 0.49, 95% CI: 0.28-0.84) were negative predictors of stable housing when satisfaction with the housing status was included. Because inclusion of a subjective component revealed a subgroup of stably housed but not satisfied participants and changed the significant predictors, this seems a relevant addition to the customary definition of housing stability. Participants with characteristics negatively associated with housing stability should receive more extensive and individually tailored support services to facilitate achievement of housing stability.
Summary Self-managed shelters claim that participants who have been homeless, are better able to run a shelter than regular providers. Little research has investigated self-managed shelters. In this paper we described the experiences of participants and peer workers with empowerment processes in Je Eigen Stek (Your own place, JES), a self-managed shelter, based on an eight year qualitative responsive evaluation. FindingsWe distinguish three clusters of individual experiences: 1) enthusiastic, 2) moderate to critical, and 3) negative, respectively associated with decreasing engagement with social life in and management of JES. Those not engaged can still benefit materially and from the freedom of choice JES offers, which is generally appreciated. Empowerment provides a useful framework and JES in turn offers new insights into the dialectical nature of empowerment. Empowerment consists of freedom of choice and capacity development and neither should be emphasized over the other. The emphasis in JES is on freedom of choice, which does not automatically lead to developing capacities. Social workers try to balance both aspects of empowerment.Applications Our analysis shows how offering freedom of choice can contribute to empowerment, although social workers need to be aware that participants might opt not to work on capacity development.
