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Biomedical subjects

Kim Hopper

Publications and source records attributed to Kim Hopper.

7 recordsLinked to original sources
PubMed2006

Tenant outcomes in supported housing and community residences in New York City.

OBJECTIVE: This study examined whether outcomes in housing, clinical status, and well-being of persons with severe mental illness and a history of homelessness differ between those in supported housing and those in community residences, two housing arrangements that substantially differ in the level of independence that is offered to its tenants. METHODS: A quasi-experimental 18-month follow-up study was conducted with 157 persons newly entering supported housing and community residences. The housing models accepted persons with similar illness characteristics and homelessness histories, so that the inability to randomly assign tenants to housing types could be compensated for by propensity scoring methods. Tenure in housing was examined by using survival models. Analyses of other outcomes used hierarchical linear and regression models in both intent-to-treat (N=139) and true-stayer (N=80) analyses. RESULTS: Tenure in housing did not differ by housing type. Substantial proportions of tenants in both models remained housed during the follow-up period. Tenants in supported housing reported greater housing satisfaction in terms of autonomy and economic viability. Over time some tenants in supported housing reported greater feelings of isolation. Independent of housing type, symptoms of depression or anxiety at housing entry increased the risk of poorer outcomes. CONCLUSIONS: The models of supported housing were viable portals of entry into community housing for homeless persons, even for consumers with characteristics indicating that they would have been more likely to be placed in community residences. The results suggest that greater clinical attention should be paid to persons who exhibit depression or anxiety when entering housing.

Adult↗
PubMed2005

Psychiatric advance directives: qualitative study of informed deliberations by mental health service users.

BACKGROUND: Established legal mandates and high expectations for psychiatric advance directives are not matched by empirical evidence documenting their actual implementation. AIMS: To explore the interests, concerns and planning activities of informed mental health service users contemplating such directives. METHOD: Standard qualitative research techniques were used: field observations, interviews, focus groups, archival research and key informant interviews; 33 persons participated in the interviews and focus groups. Transcripts were coded and analysed for thematic content, and results were member-checked. RESULTS: Training set in motion labour-intensive projects: conceptualising how a psychiatric advance directive would work in one's life, mobilising resources, reviewing past experiences and assessing risks. Especially meaningful was the prospect of being treated as a responsible agent in future interactions with the mental health system. CONCLUSIONS: Advance directives are best thought of as complex planning tools for future psychiatric crisis management, rather than focal interventions to enhance compliance. Research is needed to explore the institutional response to this prospective decision-sharing initiative.

Adult↗
PubMed2003

Two genealogies of supported housing and their implications for outcome assessment.

Drawing on ongoing fieldwork in New York City, the authors distinguish two "genealogies," or developmental traditions, of supported housing. "Housing as housing" originated in the mental health field to champion normalized, less-structured alternatives to clinically managed residential programs. "Integrated housing development" traces its origins to the movement to combat homelessness by preserving and creating affordable housing. The authors detail the distinctive premises, guiding concerns, and developmental logic of each lineage, contrasting the consumer advocate focus of the first genealogy with the emphasis on housing supply of the second. As housing and service investment strategies, the two approaches run different risks, speak to distinctive constituencies, and play to specific strengths. The authors argue that any attempt to take the measure of their success or to assess their comparative value as social investments must go beyond client outcome and come to terms with discrepant notions of the social good that they represent.

Community Mental Health Services↗
PubMed1982

The new mendicancy: homeless in New York City.

An ethnographic study of the homeless poor in New York City suggests that significant changes have taken place in the size and composition of that population during the past 15 years. Among the disenfranchised, the mentally disabled figure prominently, many of them casualties of state deinstitutionalization and restricted admission policies. This paper argues that in the absence of safe and accessible shelter, rehabilitation efforts are doomed to failure. It is suggested that clinicians could play a critical advocacy role for an approach that sees therapeutic and social needs as intimately linked.

Chronic Disease↗