Evaluation of Housing First in
Sweden. A comparison with
the staircase model
Håkan Källmen, Karolinska institutet
and
Mats Blid, MidSweden University
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Background



Homelessness can be considered as due to
structural problems on an aggregated level (low
housing construction) or as an individual
problem with substance abuse/psychiatric
problems.
The usual housing support to the homeless in
Sweden is called the “Staircase model”.
According to that model the homeless have to
learn and prove step by step the ability to live in
an own apartment and adapt to a proper life.
.
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Background

Although large resources has been allocated to
solve the homelessness problem. The
prevalence rate increase.

To solve the problem a new paradigm ”Housing
First” was suggested. This is a concept
combining housing before optional support to
solve individual problems.
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Evaluation


This evaluation compares the usual staircase
model to ”Housing First” regarding perceived
normal housing, psychological factors and
misuse of alcohol and drugs over a three year
follow-up period.
In the evaluation a comparison regarding
criminality, incomes and health care
consumption is made although not presented
here.
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
First aim

To evaluate if Housing First leads to
perception of a more normal and stable
housing over time than the staircase
model.
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Second aim

Another aim is to compare the
development of misuse of alcohol and
drugs and also the changes in
psychological factors over time.
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Third aim

The third aim is to compare the
consumption of health care, incomes and
criminality over time
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
A longitudinal non-equivalent control group design
Baseline assessment
Housing first group
Controlgroup
Assessments every sixth month during three years
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Participants


Participants in this study are 36 homeless
persons assessed both at baseline and
follow-up. They have a long period without
a stable housing and are considered as
inable to get a housing within the stair
case model.
They will have a wish to live in an own
apartment and also wish to cooperate with
the social sevice
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Data collection
After informed consent, data from the housing first
group were collected by the city mission in
Stockholm and the social service in Helsingborg.
Data from the control group were collected at
ordinary appointments at the social service in
Stockholm.
Each respondent received a voucher of 8 Euro
worth and each datacollector received a ticket to
cinema at 9 Euro worth.
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Results at baseline
Table 1. Means and standarddeviation for groups on the assessed variables
differences between groups (T-test).
Interventionat baseline and p-values
Controlfor
group
group
SD
M
SD
P
M
Normality in
housing
4,08
1,44
4,28
1,64
0,74
Stability in
3,62
0,50
3,60
1,19
0,21
housing
Locus of control
28,50
4,60
27,95
6,70
0,80
KASA M
53,77
13,63
51,45
13,78
0,64
Comprehensibilit
20,69
5,59
20,95
6,21
0,90
y
Manageability
16,00
5,00
15,60
5,65
0,84
Meninfulness
17,08
4,86
14,90
4,83
0,22
AUD IT
12,18
11,20
11,68
10,33
0,95
DUDIT
9,85
10,41
14,06
11,54
0,84
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Results at six month follow-up.
Table 2. Means and standarddeviation on study variables at six month follow-up
P-values for differences between groups with T-test.
Intervention
Control group
group
M
SD
M
SD
p
Normality in
housing
7,85
1,95
4,65
1,88
<0,001
Stability in
4,00
0,85
3,78
1,06
housing
0,292
Locus of control
28,46
6,05
29,13
5,30
0,568
KASA M
59,23
13,73
56,74
14,24
0,926
Comprehensibilit
22,23
6,57
21,91
5,98
0,664
y
Manageability
17,38
4,73
16,56
4,67
0,814
Meningfullness
19,61
4,44
18,26
3,85
0,269
AUD IT
10,50
12,44
10,39
11,80
0,693
DUDIT
9,54
10,96
6,70
7,85
0,603
European Research Conference
Access to Housing for Homeless People in Europe
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Results over time
Table 3. Testof main effekt of time and interaction time x group
Variable
Housing normality
Housing Stability
Locus of Control
KASAM (total)
Comprensibiity
Manageability
Meningfullness
Alcohol habits
Drug habits
Effect
Time
Time x Group
Time
Time x Group
Time
Time x Group
Time
Time x Group
Time
Time x Group
Time
Time x Group
Time
Time x Group
Time
Time x Group
Time
Time x Group
F
18,40
10,79
1,93
0,43
0,43
0,19
4,60
0,00
0,94
0,052
1,55
0,07
11,61
0,38
2,66
0,730
4,63
4,34
European Research Conference
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df
1,29
1,29
1,30
1,30
1,30
1,30
1,31
1,31
1,31
1,31
1,31
1,31
1,31
1,31
1,28
1,28
1,31
1,28
p
0,001
0,003
0,175
0,518
0,516
0,664
0,040
0,994
0,341
0,821
0,222
0,793
0,002
0,545
0,114
0,400
0,027
0,039
Results cont.


The normality of housing, KASAM and
Meningfullness improved and drug habits
mitigated on average among all homeless during
6 months.
However, housing normality improved even as a
consequence of ”Housing First” but drug use did
not mitigate as much as in the control grup
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012
Discussion

The fact that all homeless individuals
improved their housing conditions and
their structure/meaningfullness in life over
time maybe is a consequence of
supervision and social support. The harm
reduction philosofy of ”Housing First” can
be responsible of a less decrease in drug
use among those who received an
apartment from the project.
European Research Conference
Access to Housing for Homeless People in Europe
York, 21st September 2012