People at risk of homelessness : a qualitative study of housing support initiatives

Homeless people tend to have a number of complex medical healthcare needs sometimes exacerbated by mental illness and substance use disorders. A number of diverse programs and services are available for people who are at risk of homelessness, many of which have not been researched, particularly from clients' and service providers' perspectives. This qualitative descriptive study was informed by the conceptual framework of Social Cognitive Theory, which was used to explore a Housing Support Program (HSP) from the perspective of the clients, case managers and housing support professionals. A Maintenance Support Program (MSP) from the perspective of clients, case managers and health professionals was also investigated. Interviews and focus groups were conducted, and data were analysed using thematic analysis. Two major themes emerged. The major theme from the HSP data provided a positive overarching theme of A life-changing event: I now have a home‚ÄövÑvp for the client with three sub-themes comprising of: continuity of care, bridging the gap, and inclusion in the world. The clients described their experience as a positive one related to the assistance of the supportive case managers. The health professionals reported that the HSP is an organisation that provides a holistic approach to caring for the clients that is different from other agencies or services that are provided by both non-government and government organisations. The overarching theme that emerged from the themes and subthemes from the client data in the MSP study was A life-changing event: I have the power to change‚ÄövÑvp also consisting of three sub-themes: personal, situational and societal dimensions. This life-changing event resulted from the clients' experience of both enabling and constraining factors and this led to a feeling of power to change towards a better future. The enabling and constraining factors worked together to influence, develop and maintain the many themes of a life-changing event. At times, the constraining factors outweighed the enabling factors. In this case, the clients maintained or returned to a state of instability that limited or minimised their ability to have the power to change. The enabling aspects on the other hand provided the client with a sense of self, of movement, power and of a new beginning. This study contributes to new knowledge concerning the experience of people in a HSP and a MSP who are homeless or at risk of homelessness. Through the involvement of case managers and health professionals within these programs, a life-changing event occurs. Clients within the HSP and MSP had the time to reconsider and review their lives, and are able to develop a sense of future. The findings provide insight into the constraints and enabling factors, as well as the dimensions and outcomes related to homeless support programs which could further improve the services provided to this vulnerable population.