Mittuniversitetet

Nussbaum’s Central Capabilities refer to the elements of a well-lived life, and many adults who experience homelessness are deprived of these capabilities. The study aim was to investigate whether service users experience different homeless services as affording or constraining capabilities. We conducted semi-structured interviews with homeless service users (n = 77) in Housing First (HF) and staircase services (SS) in eight European countries. We used thematic analysis to identify three themes: autonomy and dependency, the relational impact of living arrangements, and community interaction and stigma. While SS participants were able to address their bodily integrity and health, their higher-order capabilities were constrained by their homeless situations. HF participants described home as a base from which they could enact a wide range of capabilities indicative of a well-lived life. We conclude that housing-led service models with appropriate supports are key to affording service users’ capabilities. Practical and policy implications are discussed.

Introduction: Homelessness is as large political question globally as it is in Sweden with a growing number of homeless. “Housing First” is a municipality based program aiming to offer stable and enduring housing to homeless people immediately. This model was imported to Sweden and was tried in Stockholm and Helsingborg, a provincial town in the southwest of Sweden. This prevailing study is to test the feasibility of making longitudinal studies on homeless individuals.

Method: A longitudinal study using repeated measures of selfreports on questionnaires.

Result: This study report results from baseline and a 24 month follow-up of the program compared to a treatment-as-usual control group. It was shown that although the former homeless in the Housing First group perceived an increased housing normality and empowerment there were no significant differences between groups across time.

Conclusion: Although individuals living in a Housing First apartment tended to have a more normal way to live they seem to not improve psychologically. However some problems that is connected to longitudinal research on the homeless was detected. Since Housing First is a program consisting of housing and support the effect is dependent on both. The null result in this study was discussed as a consequence of foremost insufficient support in housing.

Frequent attenders in substance misuse care

Inom ramen för regeringens hemlöshetsstrategi har Socialstyrelsen haft iuppdrag att, i samråd med Boverket, ta fram en kunskapsöversikt om olikaboendelösningar för att lösa hemlöshet.Grunden för kunskapsöversikten är en systematisk kartläggning avgenomförda effektutvärderingar av olika boendeprogram. Den systematiskakartläggningen bygger på internationellt publicerad forskning. De flesta avstudierna kommer från USA och avser till största delen grupper med svårsocial problematik.Kunskapsöversikten ska ses som ett steg i utvecklingen mot en evidensbaseradpraktik på hemlöshetsområdet. Innehållet i rapporten är komplextoch ger snarare en bild av forskningens kvalitet och inriktning än en direktvägledning i det praktiska arbetet. Materialet utgör dock en förutsättning föratt kunna gå vidare mot en konkretisering av insatserna. Nästa steg blir attSocialstyrelsen kommer att utarbeta ett konkret, vägledande material riktattill relevanta aktörer. Arbetet ska ske i samverkan med forskares kommuneroch brukarorganisationer.Ett antal slutsatser av övergripande principiell karaktär kan dras utifrånrapporten.En övergripande slutsats är att en så permanent boendelösning som möjligt– kompletterad med individuellt, behovsanpassat stöd – är ett krav.Hemlösa personer har samma behov som andra av ett tryggt och långsiktigtboende, oavsett eventuella övriga problem. Ett resultat tyder på att ett tryggtboende ibland också är en förutsättning för att stöd och vård i olika formerska ha effekt. Vägen till ett självständigt boende sker i många fall stegvis,med successivt minskat behov av vård och stöd. Den minskningen kanmycket väl ske i en och samma bostad.Ett könsperspektiv behövs i valet av boendelösningar. Ett resultat tyder påatt om insatser ska ha god effekt för kvinnor bör de vara direkt riktade tilldem.Två huvudtyper av boendeprogram har kunnat urskiljas – ”Bostad först”(parallellt boende) och vårdkedjemodellen (integrerat boende). Det bör poängterasatt inget av de program som beskrivs är renodlade, utan snararehybrider där man tillämpar inslag från olika program. Kopplade till de olikaboendeprogrammen finns ofta ett antal specifika metoder för vård och stöd.Dessa kan kombineras på olika sätt.I den internationellt publicerade forskningen saknas effektutvärderingarav boendetrappor, som är den vanligaste modellen i Sverige. Det är dockmöjligt att peka på likheter i bakomliggande tankesätt mellan boendetrapporoch de program som internationellt beskrivs i termer av vårdkedjemodeller.Detta, plus det faktum att ”Bostad först” börjat praktiseras i svenska kommunergör att de resultat som framkommit vid genomgången av studierna ärrelevanta för svenska förhållanden.

En slutsats från genomgången av de två huvudtyperna av boendeprogramtalar för att ”Bostad först” är en lovande strategi. Det finns goda skäl att iSverige bygga vidare på de erfarenheter man gjort i arbetet med dessa program.Kunskapsöversikten ger dock inte underlag för att avfärda vårdkedjemodellensom ett verkningslöst program. För svenskt vidkommande betyderdet att boendetrappor kan vara verksamma program om det finns behovsanpassadevård- och stödinsatser kopplade till dessa.I en evidensbaserad praktik vägs tre kunskapskällor samman i dialog: bästavetenskapliga kunskap, de professionellas erfarenhet och brukarnas erfarenhetoch önskemål. Det sätt på vilket informationen från dessa källor vägssamman beror på det nationella och lokala sammanhanget, till exempel lagstiftning,riktlinjer och de resurser som finns tillgängliga.För att kunna jämföra de insatser som görs i Sverige med dem som kunskapsöversiktenavser är det nödvändigt att utförligt beskriva de svenskainsatserna vad gäller innehåll och metod. Att insatserna dokumenteras ochföljs upp är ett grundläggande krav. Detta är en viktig del i utvecklingenmot en evidensbaserad praktik.Efter den systematiska kartläggningen finns nu förutsättningar att gå vidaremed en systematisk översikt där analysen kan fördjupas. Institutet förutveckling av Metoder i Socialt arbete (IMS) planerar att under 2009–2010,inom ramen för det internationella samarbete som koordineras av CampbellCollaboration, genomföra en sådan systematisk översikt.Det som framförallt diskuteras i denna rapport är insatsernas utformning iSverige inom ramen för det handlingsutrymme som den kommunala socialtjänstenhar. En annan aspekt är hur kommunerna ska få tillgång till bostäderatt fördela till hemlösa personer och därigenom få ett reellt handlingsutrymmei valet av olika typer av insatser. För att komma tillrätta med hemlöshetsproblemetkrävs en samlad politisk vilja och insatser på flera nivåer.

The overarching aim of this dissertation is to explore and describe Swedish local authorities’ measures to prevent and manage homelessness; how these measures diverge between different municipal categories; what factors predict homelessness, provisions of accommodation and cov-erage rates between the number of accommodations and the respective municipalities’ housing interventions.

Measures studied are policies and housing interventions. The housing interventions re-ferred to here are those provided by or through the social welfare authorities to persons living with unstable housing or who are homeless. The interventions can be divided into two main categories: 1) preventive interventions in the form of daily-life support, usually in the form of personnel support in the individual’s own apartment, designed to help persons at risk of becom-ing homeless to remain housed and prevent eviction; 2) accommodation support for persons who are already homeless and in need of housing. Such accommodations may be more or less temporary, more or less integrated and include a greater or lesser amount of care.

Two sets of data were collected for the study: 1) a case study of two category-housing programmes using both qualitative and quantitative data; 2) a survey of 147 randomly chosen municipalities (about half of the municipalities in Sweden) to explore the prevalence and charac-teristics of policies and housing interventions.

Findings from the case study show that special-category housing has positive direct effects on the housing stability of the residents and their feelings regarding their quality of life, but does not have a direct effect on their substance misuse. Moreover, the increased housing stability seems to be more a direct effect of the person having stayed on the programme, rather than a long-term effect. Furthermore, although their quality of life improves, the residents still experi-ence a lack of belonging and feel that their lives lack meaningful content.

On the national level, the findings show that an array of housing interventions divided into 12 sub-categories is offered to counteract homelessness. These categories vary along two central dimensions: care and normality. The two most frequent types of housing interventions in all types of municipalities are daily-life support and social contracts. Other housing interventions are marginal compared with these two. There is greater fluctuation between municipalities in the level of care provided than in the level of normality. Furthermore, the more densely populated municipalities are more highly engaged in developing housing policies and the administrative means to handle them. Such policies, however, seem to decrease the level of normality without promoting levels of care.

When exploring factors that predict homelessness, the findings show that urbanisation is central to understanding variations in homelessness, not only in the largest cities but also in less densely populated areas. In addition, higher rent levels and more of aggregated psychiatric prob-lems in the municipality seem to increase homelessness. The apartment rate and the proportion of public housing within the stock of apartments are both important for the possibility to pro-vide accommodations. Moreover, the proportion of single-parent households seems to enhance the need to provide such accommodations. Political majority and the functional organisation of the social services both seem to have an impact on the coverage rates. Thus, the findings indicate that the municipalities have various options for managing factors that impact on the homeless-ness rate.

Keywords: housing interventions, level of care, level of normality, policies, municipality, predicting homelessness

This article presents an inventory of policies and housing support interventions to the homeless and those at risk of becoming homeless in a representative sample of Swedish municipalities. Two types of intervention are included: various types of accommodation for those who are already homeless and daily life support for those at risk, either provided or financed by the social services in the municipality. Data were collected in 2004-2005 through a questionnaire e-mailed to local authority officials, in a stratified sample of about half of the Swedish municipalities (n=147). The results show that two types of housing intervention dominate the field: daily life support and sublet contracts, both of which have a relatively high normality factor, with a setting in normal housing. Daily life support includes care and is usually implemented before the tenant is evicted. The level of care related to various interventions fluctuates more between the municipalities than normality does. The more densely populated municipalities were more engaged in developing housing policies and administrative bodies to handle these. However, the implementation of housing policies does not seem related to improvements in the qualities of the interventions. On the contrary, the local authorities that have housing policies and administrative tools adapted to these policies provided a lower degree of both normality and care in the interventions. The results suggest that aspects of normality and care in the same type of housing interventions vary depending on the type of municipality, while the existence of policies has no influence on care and a negative effect on the degree of normality provided through the interventions.

This article explores key predictors of homelessness rates in different Swedish munici-palities, the accommodation provided and the coverage of accommodation to homeless-ness. In order to create realistic models, seven sets of factors represent various structural levels in stepwise regressions. These sets are urbanisation, economy, demographic com-position, housing market, aggregated individual problems, political majority and policies and organisational features of the social services. The findings show that urbanization is central to understanding variations in homelessness and has also impact on housing pro-visions. In addition, higher rent levels as well as aggregated psychiatric problems seem to increase the level of problems. Overall supply of apartments and the proportion of public housing are important factors in providing accommodation, and a demographic factor, such as the proportion of single-parent households, seems to enhance such a provision. Political majority as well as the functional organization of the social services seems to independently impact coverage rates. Despite the importance of urbanization, findings indicate that a number of factors with impact on the problem and on the possibilities to handle them are manageable by the municipalities. Key words: predicting homelessness, accommodation, housing provisions, local author-ity, social services.

Problem: The study explores predictors of homelessness in Swedish municipalities and of the amount of accommodations provided to the homeless. Theoretically, structural factors (e.g. housing market) and individual factors (e.g. social and health factors) have competed in theories explaining homelessness. Here, the focus is not on individuals, but rather the aggregated levels of such problems. Methods: Homelessness rates were collected in a national inventory (NBHW 2006.) and data on municipal support provisions were collected in a representative sample of half of the Swedish municipalities. Candidate explaining factors of homelessness studied here are variables related to urbanisation, economy of the municipality, various housing market factors, level of social and health problems and demographic factors. Level of homelessness and political majorities are also used as predictors of provisions. Results: Homelessness rate (per 10 k inhabitants) is predicted (R2= .36) by urbanisation (no of inhabitants), market (rent level) and level of psychiatric health problems in the municipality. Amount of accommodations (per 10 k inh.) is predicted (R2= .18) by homelessness rate, social welfare costs and structure of housing market, i.e. greater public owned sector in normal housing. Conclusions: Structural factors and level of individual problems both add to the explanation of homelessness. In addition, degree of urbanisation seems to be an additional factor. This however, may in turn indicate more specific factors not studied here. The amount of accommodations per inh. is, as expected, related to the level of homelessness and the level of social problems in the municipality. Additionally, the structure of the housing market seems to have important impact on the amount of provisions, independent of problem levels.