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Housing the ‘hard-to-house’: Examination of homelessness and the impact of Housing First programs in Australia

机译：安置“难住者”：检查无家可归者和澳大利亚住房优先计划的影响

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Homelessness is a globally persistent social and public health concern. Individuals who experience homelessness are not, however, a homogeneous group. Two subgroups with particularly poor individual and social outcomes are homeless people who inject drugs and rough sleepers, yet limited research has examined their needs. These subgroups, which have been characterised as ‘hard-to-house’, may be suitable for supported housing programs such as Housing First. However, there has been little evaluation on the impact of Australian adaptations of the Housing First model on individual outcomes, and whether there are differential impacts based on the type of Housing First configuration (i.e., scattered site or congregated site). This thesis addressed these identified gaps through an examination of the prevalence and correlates of homelessness among people who inject drugs; an examination of homeless individuals based on the length of their rough sleeping history; and a 12-month longitudinal evaluation of outcomes associated with scattered site and congregated site Housing First programs in Sydney, Australia.A number of important findings emerged from this thesis. Firstly, almost one-quarter of people who inject drugs were currently homeless and self-reported poorer mental health, including schizophrenia, and a greater history of incarceration than their stably housed counterparts. Secondly, chronic rough sleepers were more likely to have a substance use disorder and experience disabling blackouts, fits, or losses of consciousness than homeless individuals who reported shorter histories of rough sleeping. Finally, the 12-month Housing First evaluation revealed that the provision of housing with attached support, regardless of configuration, resulted in improved quality of life and reduced psychological distress. Contrasting findings were identified for criminal justice system engagement, as the number of self-reported criminal justice system contacts decreased among scattered site participants but increased among congregated site participants over 12 months.Policy and research implications are discussed in terms of service provision. Given that individuals who experience homelessness are not homogeneous, and that configurations of Housing First programs may be associated with differential impacts on individual outcomes, further evidence is needed to identify which configurations of supported housing will be most beneficial for specific homeless subgroups.
机译：无家可归是全球范围内持续存在的社会和公共卫生问题。但是，无家可归的人并不是一个同质的群体。个人和社会成果特别差的两个亚组是无家可归者，他们注射毒品和卧床不起，但有限的研究检查了他们的需求。这些被称为“难以置信”的子群体可能适合于“住房优先”等受支持的住房计划。但是，关于澳大利亚适应住房优先模式对个人结果的影响以及基于住房优先配置类型（即分散地点或聚集地点）的不同影响的评估很少。本论文通过研究注射毒品者的普遍程度及其与无家可归者之间的联系，解决了这些已确定的差距。根据粗暴的睡眠时间长短对无家可归者进行检查；以及对澳大利亚悉尼分散地点和聚集地点“住房优先”计划相关结果的12个月纵向评估。本论文得出了许多重要发现。首先，目前有近四分之一的注射毒品的人无家可归，自我报告的精神健康状况较差，包括精神分裂症，以及比其稳定居住的人更久的监禁史。其次，与流浪者的睡眠历史短的无家可归者相比，慢性流浪者更容易出现物质使用障碍，并且会导致停电，不适或失去知觉。最后，为期12个月的“住房优先”评估显示，无论配置如何，提供带有附加支持的住房都将改善生活质量，并减轻心理困扰。在12个月内，散布地点参与者之间自我报告的刑事司法系统联系数量有所减少，但聚集地点参与者中自我报告的刑事司法系统联系数量有所增加，因此确定了与刑事司法系统互动的不同结果。从服务提供方面讨论了政策和研究意义。鉴于经历无家可归的人不是同质的，并且“住房优先”计划的配置可能与对个人结果的不同影响相关，因此需要进一步的证据来确定哪种支持住房的配置对特定的无家可归的亚组最有利。

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