Evaluación de un programa Housing First: buscando una solución viable para transformar la vida de las personas sin hogar
DOI:
https://doi.org/10.22325/fes/res.2024.226Palabras clave:
sinhogarismo, housing first, evaluación de programas, ensayo controlado aleatorizado, análisis de costesResumen
En las últimas tres décadas la metodología Housing First se ha extendido desde Norteamérica a otros países. En 2014 se puso en marcha en España —cuando el país todavía estaba sumido en una profunda crisis económica— el programa Hábitat siguiendo ese modelo. Este estudio forma parte de la evaluación socioeconómica llevada a cabo entre 2015 y 2020 mediante un ensayo controlado aleatorizado. El grupo de tratamiento se comparó con un grupo de control haciendo un seguimiento de su evolución a lo largo de 18 meses. Comprobamos que logró mejoras significativas en la mayoría de áreas analizadas, más allá de los servicios específicos de vivienda. Respecto a los costes, resulta evidente que el programa supone una gran inversión en términos de vivienda, pero consigue compensar algunos gastos en otros apartados y, sobre todo, genera mejoras muy valiosas en las personas participantes. Para finalizar nuestro artículo, discutimos el alcance de estos resultados y reflexionamos sobre las limitaciones a superar en próximas evaluaciones de intervenciones similares.
Citas
Aubry, T., Nelson, G., y Tsemberis, S. (2015a). Housing first for people with severe mental illness who are homeless: a review of the research and findings from the at home—chez soi demonstration project. The Canadian Journal of Psychiatry, 60(11), 467-474. https://doi.org/10.1177/070674371506001102
Aubry, T., Tsemberis, S., Adair, C. E., Veldhuizen, S., Streiner, D., Latimer, E., Sareen, J., Patterson, M., McGarvey, K., Kopp, B., Hume, C., y Goering, P. (2015b). One-year outcomes of a randomized controlled trial of housing first with ACT in five Canadian cities. Psychiatric Services, 66(5), 463-469. https://doi.org/10.1176/appi.ps.201400167
Baptista, I., y Marlier, E. (2019). Fighting homelessness and housing exclusion in Europe: A study of national policies. European Social Policy Network (ESPN). European Commission. https://data.europa.eu/doi/10.2767/624509
Basu, A., Kee, R., Buchanan, D., y Sadowski, L. (2012). Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care. Health Services Research, 47(1 Pt 2), 523-543. https://doi.org/10.1111/j.1475-6773.2011.01350.x
Baxter, A. J., Tweed, E. J., Katikireddi, S. V., y Thomson, H. (2019). Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials. Journal of Epidemiology and Community Health, 73(5), 379-387. https://doi.org/10.1136/jech-2018-210981
Bean, K. F., Shafer, M. S., y Glennon, M. (2013). The impact of housing first and peer support on people who are medically vulnerable and homeless. Psychiatric Rehabilitation Journal, 36(1), 48-50. https://doi.org/10.1037/h0094748
Bretherton, J., y Pleace, N. (2015). Housing First in England. An evaluation of nine services. Centre for Housing Policy. University of York.
Brown, M. M., Jason, L. A., Malone, D. K., Srebnik, D., y Sylla, L. (2016). Housing first as an effective model for community stabilization among vulnerable individuals with chronic and nonchronic homelessness histories. Journal of Community Psychology, 44(3), 384-390. https://doi.org/10.1002/jcop.21763
Busch-Geertsema, V. (2012). The Potential of Housing First from a European Perspective. European Journal of Homelessness, 6(2), 209-216.
Busch-Geertsema, V. (2013). Housing First Europe final report. European Commission.
Collins, S. E., Malone, D. K., Clifasefi, S. L., Ginzler, J. A., Garner, M. D., Burlingham, B., Lonczak, H. S., Dana, E. A., Kirouac, M., Tanzer, K., Hobson, W. G., Marlatt, G. A., y Larimer, M. E. (2012). Project-based Housing First for chronically homeless individuals with alcohol problems: Within-subjects analyses of 2-year alcohol trajectories. American journal of public health, 102(3), 511-519. https://doi.org/10.2105/AJPH.2011.300403
Culhane, D.P. (2008). The Cost of Homelessness: A Perspective from the United States. European Journal of Homelessness, 2, 97-114.
Diener, E., Lucas, R. E., y Scollon, C. N. (2009). Beyond the hedonic treadmill: Revising the adaptation theory of well-being. In E. Diener (Ed.), The science of well-being. The Collected Works of Ed Diener (pp. 103-118). Dordrecht. https://doi.org/10.1037/0003-066X62.6.611
European Anti Poverty Network [EAPN] (2013). El modelo Housing First, una oportunidad para la erradicación del sinhogarismo en la Comunidad de Madrid. Red Madrileña de Lucha contra la Pobreza y la Exclusión Social. Grupo de Alojamiento.
Gilmer, T., Stefancic, A., Ettner, W., Manning, G., y Tsemberis, S. (2010). Effect of Full-Service Partnerships on Homelessness, Use and Costs of Mental Health Services, and Quality of Life among Adults with Serious Mental Illness. Archives of General Psychiatry, 67(6), 645-652. https://doi.org/10.1001/archgenpsychiatry.2010.56
Gilmer, T. P., Stefancic, A., Henwood, B. F., y Ettner, S. L. (2015). Fidelity to the Housing First model and variation in health service use within permanent supportive housing. Psychiatric Services, 66(12), 1283-1289. https://doi.org/10.1176/appi.ps.201400564
Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., Nelson, G., MacNaughton, E., Streiner, D., y Aubry, T. (2014). National At Home/Chez Soi Final Report. Mental Health Commission of Canada.
Goldberg, D. (1996). Cuestionario de salud general de Goldberg (GHQ28).
Greenwood, R.M., Manning, R.M., O'Shaughnessy, B.R., Vargas-Moniz, M.J., Loubière, S., Spinnewijn, F., Lenzi, M., Wolf, J.R., Bokszczanin, A., Bernad, R., Källmén, H., y Ornelas, J. (2020), Homeless Adults’ Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries. Journal of Community Psychology, 65(3-4), 353-368. https://doi.org/10.1002/ajcp.12404
Groton, D. (2013). Are Housing First Programs Effective? A Research Note. Journal of Sociology & Social Welfare, 40(1), 51-63. https://doi.org/10.15453/0191-5096.3714
Gulcur, L., Stefanic, A., Shinn, M., Tsemberis, S., y Fischer, S.N. (2003). Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes. Journal of Community & Applied Social Psychology, 13(2), 171-186. https://doi.org/10.1002/casp.723
Henwood, B. F., Stefancic, A., Petering, R., Schreiber, S., Abrams, C., y Padgett, D. K. (2015). Social relationships of dually diagnosed homeless adults following enrollment in housing first or traditional treatment services. Journal of the Society for Social Work and Research, 6(3), 385-406. https://doi.org/10.1086/682583
Instituto para la Evaluación de Políticas Públicas (IEPP) (2020). Evaluación intermedia de la Estrategia Nacional Integral para Personas Sin Hogar (2015-2020). IEPP.
Johnson, G., Parkinson, S., y Parsell, C. (2012). Policy shift or program drift? Implementing Housing First in Australia. Australian Housing and Urban Research Institute.
Kerman, N., Sylvestre, J., Aubry, T., y Distasio, J. (2018). The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first. BMC health services research, 18(1), 190. https://doi.org/10.1186/s12913-018-3028-7
Latimer, E. A., Rabouin, D., Cao, Z., Ly, A., Powell, G., Adair, C. E., Sareen, J., Somers, J. M., Stergiopoulos, V., Pinto, A. D., Moodie, E. E. M., Veldhuizen, S. R., y At Home/Chez Soi Investigators (2019). Cost-effectiveness of Housing First Intervention With Intensive Case Management Compared With Treatment as Usual for Homeless Adults With Mental Illness Secondary Analysis of a Randomized Clinical Trial. JAMA Network Open, 2(8), e199782. https://doi.org/10.1001/jamanetworkopen.2019.9782
Leclair, M. C., Deveaux, F., Roy, L., Goulet, M. H., Latimer, E. A., y Crocker, A. G. (2019). The impact of housing first on criminal justice outcomes among homeless people with mental illness: A systematic review. The Canadian Journal of Psychiatry, 64(8), 525-530. https://doi.org/10.1177/0706743718815902
Lehman, A. F., Postrado, L. T., y Rachuba, L. T. (1993). Convergent validation of quality of life assessments for persons with severe mental illnesses. Quality of life research, 2, 327-333. https://doi.org/10.1007/BF00449427
Lemoine, C., Loubiere, S., Tinland, A., Boucekine, M., y Auquier, P. (2019). Cost-effectiveness analysis of the Un Chez Soi d’Abord randomized controlled trial: a Markov model. European Journal of Public Health, 29(4), 148-187. https://doi.org/10.1093/eurpub/ckz187.148
Ly, A., y Latimer, E. (2015). Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature. Canadian Journal of Psychiatry, 60(11), 475-487. https://doi.org/10.1177/070674371506001103
Mackelprang, J. L., Collins, S. E., y Clifasefi, S. L. (2014). Housing First is associated with reduced use of emergency medical services. Prehospital Emergency Care, 18(4), 476-482. https://doi.org/10.3109/10903127.2014.916020
Mangano, P. (2009). Housing when? Evidence based practice for solving homelessness. Presentation to the Mercy Foundation, 2 April 2009.
Martínez-Cantos, J.-L., y Martín-Fernández, J. (2024). Cost-effectiveness of a ‘Housing First’ programme implemented in Spain: An evaluation based on a randomised controlled trial. International Journal of Social Welfare, 33(1), 106-122. https://doi.org/10.1111/ijsw.12589
Mason, C., y Grimbeek, P. (2013). A Housing First approach to homelessness in Brisbane: Sustaining tenancies and the cost effectiveness of support services. The Ian Potter Foundation.
Muñoz, M., Vázquez, J. J., Panadero, S., y Vázquez, C. (2003). Características de las personas sin hogar en España: 30 años de estudios empíricos. Cuadernos de Psiquiatría Comunitaria, 3(2), 100-116.
NASEM, National Academies of Sciences, Engineering, and Medicine (2018). Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press.
Nelson, G., Patterson, M., Kirst, M., Macnaughton, E., Isaak, C. A., Nolin, D., McAll, C., Stergiopoulos, V., Townley, G., MacLeod, T., Piat, M., y Goering, P. N. (2015). Life changes among homeless persons with mental illness: a longitudinal study of Housing First and usual treatment. Psychiatric Services, 66(6), 592-597. https://doi.org/10.1176/appi.ps.201400201
Nieto, J. M., Santamaría, L. y Vega, M. (2024). Marco financiero y presupuestario para los procesos de desinstitucionalización y el desarrollo de alternativas de vida en comunidad y de base familiar. Proyecto EDI. Instituto de Derechos Humanos Gregorio Peces Barba. Universidad Carlos III de Madrid. https://estudiodesinstitucionalizacion.gob.es/wp-content/uploads/2024/01/Estudio-Economico-y-Financiero.pdf
O'Campo, P., Stergiopoulos, V., Nir, P., Levy, M., Misir, V., Chum, A., Arbach, B., Nisenbaum, R., To, M. J., y Hwang, S. W. (2016). How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial. BMJ open, 6(9), e010581. https://doi.org/10.1136/bmjopen-2015-010581
OECD (2020). Revenue Statistics 2020. OECD Publishing. https://doi.org/10.1787/8625f8e5-en
ONU (2015). Resolution adopted by the General Assembly on 25 September 2015. 70/1. Transforming our world: The 2030 Agenda for Sustainable Development. https://undocs.org/en/A/RES/70/1
Padgett, D. K. (2007) There’s no Place like (a) Home: Ontological Security among Persons with Serious Mental Illness in the United States. Social Science & Medicine 64(9), 1925-1936. https://doi.org/10.1016/j.socscimed.2007.02.011
Panadero, S., y Vázquez, J. J. (2013). Avances en investigación e intervención en personas sin hogar: Editorial. Revista de Psicología, 22(2), 1-2. https://doi.org/10.5354/0719-0581.2013.30848
Panadero-Herrero, S., Martín-Fernández, J., y Martínez-Cantos, J. L. (2021). Soluciones al sinhogarismo. Evaluación de la metodología Housing First en España. https://doi.org/10.13140/RG.2.2.34250.34249.
Patterson, M., Moniruzzaman, A., Palepu, A., Zabkiewicz, D., Frankish, C. J., Krausz, M., y Somers, J. M. (2013). Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Social psychiatry and psychiatric epidemiology, 48(8), 1245-1259. https://doi.org/10.1007/s00127-013-0719-6
Pauly, B., Reist, D., Belle-Isle, L., y Schactman, C. (2013). Housing and harm reduction: what is the role of harm reduction in addressing homelessness? International Journal of Drug Policy, 24(4), 284-290. https://doi.org/10.1016/j.drugpo.2013.03.008
Pearson, C., Montgomery, A. E., y Locke, G. (2009). Housing stability among homeless individuals with serious mental illness participating in housing first programs. Journal of Community psychology, 37(3), 404-417. https://doi.org/10.1002/jcop.20303
Pleace, N. (2011). The Ambiguities, Limits and Risks of Housing First from a European Perspective. European Journal of Homelessness, 5(2), 113-127.
Pleace, N. (2016). Housing First Guide Europe. FEANTSA.
Pleace, N. (2018). Using Housing First in Integrated Homelessness Strategies: A Review of the Evidence. Centre for Housing Policy.
Pleace, N., Baptista, I., Benjaminsen, L., y Busch-Geertsema, V. (2013) The cost of homelessness in Europe. An assessment of the current evidence base. European Observatory of Homelessness.
Pleace, N., Baptista, I., y Knutagård, M. (2019). Housing First In Europe. An Overview of Implementation, Strategy and Fidelity. Housing First Europe Hub.
Pleace, N., y Bretherton, J. (2019). The cost effectiveness of Housing First in England. Research Report. Homeless Link.
Polvere, L., Macnaughton, E., y Piat, M. (2013). Participant perspectives on Housing First and recovery: early findings from the At Home/Chez Soi project. Douglas Mental Health Institute.
Quilgars, D., y Pleace, N. (2016). Housing First and Social Integration: A Realistic Aim?. Social Inclusion, 4(4), 5-15. doi:https://doi.org/10.17645/si.v4i4.672.
Rodríguez Cabrero, G., Marbán, V., Arriba, A., y Montserrat, J. (2019). Informe temático de ESPN sobre estrategias nacionales para combatir la falta de vivienda y la exclusión de la vivienda – España. Red Europea de Política Social (ESPN). Comisión Europea.
Sánchez, F., Martínez, J., y Abellán, J. M. (2019). Estudio Eficacia y Eficiencia Económica del Programa Hogares Asun Almajano de atención sociosanitaria para la convalecencia de personas sin hogar. Universidad de Murcia – RAIS Fundación.
Sheldon, K. M., Boehm, J., y Lyubomirsky, S. (2013). Variety is the spice of happiness: The hedonic adaptation prevention model. In The Oxford handbook of happiness (pp. 901-914). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199557257.013.0067
Stefancic, A., y Tsemberis, S. (2007). Housing First for long-term shelter dwellers with psychiatric disabilities in a suburban county: A four-year study of housing access and retention. The journal of primary prevention, 28(3-4), 265-279. https://doi.org/10.1007/s10935-007-0093-9
Tsemberis, S. (2010). Housing First. The Pathways Model to End Homelessness for People with Mental Illness and Addiction. Hazelden.
Tsemberis, S., Gulcur, L. y Nakae, M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651-656. https://doi.org/10.2105/AJPH.94.4.651
Waegemakers Schiff, J., y Rook, J. (2012). Housing First: Where Is The Evidence?. Homeless Hub.
Watson, D. P., Shuman, V., Kowalsky, J., Golembiewski, E., y Brown, M. (2017). Housing First and harm reduction: a rapid review and document analysis of the US and Canadian open-access literature. Harm Reduction Journal, 14(1), 30. https://doi.org/10.1186/s12954-017-0158-x
Williams, I. L. (2020). A reappraisal of contemporary homelessness policy: the new role for transitional housing programmes. International Journal of Housing Policy, 20(4) 578-587. https://doi.org/10.1080/19491247.2019.1663070
Woodhall-Melnik, J. R., y Dunn, J. R. (2016). A systematic review of outcomes associated with participation in Housing First programs. Housing Studies, 31(3), 287-304. https://doi.org/10.1080/02673037.2015.1080816.
Wright, L. y Peasgood, T. (2018). Cost-effectiveness analysis of Housing First. What Works for Wellbeing, Communities Evidence Programme.
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2024 Juan-Ángel Martín-Fernández, Sonia Panadero Herrero, José-Luis Martínez-Cantos
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Todas las publicaciones de la Revista Española de Sociología se realizarán bajo una licencia abierta Creative Commons de Reconocimiento 4.0 Internacional (CC BY 4.0). Dicha licencia establece que los autores son los poseedores de los derechos de propiedad intelectual de sus trabajos, que pueden redistribuirse a cambio de un reconocimiento adecuado. Para más información de la licencia Creative Commons, consultar aquí.
Una vez aceptado un artículo para su publicación, la Revista Española de Sociología solicitará al denominado "autor para la correspondencia" la aceptación de una licencia obligatoria Creative Commons incluida en un acuerdo o contrato de publicación.
