A collection of summaries, critiques, and reflections on relevant resources.
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Manon A.M. Krabbenborg, Sandra N. Boersma, William M. van der Veld, Wilma A.M. Vollebergh & Judith R.L.M. Wolf (2017). Self-determination in relation to quality of life in homeless young adults: Direct and indirect effects through psychological distress and social support, The Journal of Positive Psychology, 12:2, 130-140, DOI: 10.1080/17439760.2016.1163404
Data Source Type: A qualitative study measuring perceived expressions of quality of life as defined by self-determination theory.
Summary:
This study used the baseline data from a cluster randomized control trial on the effectiveness of a strength-based approach for homeless young adults.
The control trial interviewed 255 homeless young adults who receive care from 10 Dutch shelter facilities. The median age was 20, 77% were male and 51% identified as Dutch nationality.
In addition to the usual homeless issues of physical health, infectious disease, and substance abuse, the study showed that about 30% had an intellectual disability.
Study cites available research suggesting 75% of such homeless young adults are able to successfully transition out of homelessness.
The authors view homelessness through the lens of self-determination theory, which emphasizes autonomy, competence, and relatedness.
Autonomy is seen as a key because young adults experience psychological distress because of perceived lack of self-determination.
Age range of participants was 17-26 (M age = 20.1, SD = 1.8).
Most common reason for leaving home was family conflict (65.9%), bad relationship with (step)mother (45.9%) or (step)father (40.0%), financial problems (38.8%), and emotional abuse (35.7%).
On average, homeless young adults rated their general quality of life as “equally dissatisfied, satisfied” or “mostly satisfied” (M = 4.55 and SD = 1.24).
The authors underscored the importance of competence, noting that quality of life is most strongly associated with competence, making it the premier psychological need of homeless young adults.
How can we enhance homeless young adults’ experience of autonomy, competency, and relatedness? According to self-determination theory, positive feedback should be provided, and intrinsic motivation should be enhanced.
Evaluation/Critique:
The study would be more revealing if it could incorporate longitudinal data.
The Cronbach’s alpha for both autonomy and competency were low, casting some modest doubt about scale reliability in these two instances.
Reflection:
I was surprised to see that the homeless youth surveyed regarded their quality of life as average or above average!
Much to learn about the role of personal resilience amongst homeless youth!
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Lloyd, K. & Little, D. (2010). Self-determination Theory as a Framework for Understanding Women’s Psychological Well-being Outcomes from Leisure-Time Physical Activity. Leisure Sciences, 32: 369-385.
Data Source Type: A qualitative study utilizing in-depth semi-structured interviews with 20 participants which was analyzed using constant comparison.
Summary:
The World Health Organization reports that depression and distress are more commonly reported amongst women than men.
Alongside an overall decline in women’s mental health has been a decline in women’s physical activity.
Self-determination theory promotes optimal mental health outcomes, but only when the applied social context offers certain conditions, such as choice, support for individual volition, empathy, and a meaningful rationale for engagement.
Participating in a new activity was often an initial boost in women’s confidence as they realized they could be effective participants despite having low expectations of their own abilities.
Confidence and capacity to learn were enhanced by environments described as “safe,” “comfortable,” and “fun.”
Many women commented that participated in a “women only” environment created a “safer” atmosphere because they perceived men to be more competitive in nature.
Feelings of belonging, security and shared values with other participants who were “all in the same boat” provided women with a greater sense of connection to the broader community.
Overall, the findings indicate women’s well-being can be enhanced through experiences that foster social support and self-determination within an autonomy supportive context that facilitates women’s freedom of choice to participate.
Evaluation/Critique:
The qualitative nature of the study is appropriate for the information desired, but it does make it difficult to attribute the findings to women outside of the study.
This study had trouble achieving appropriate cultural diversity. Steps were taken to try and address this. However, the study results should be regarded as tentative pending a sampling of a more diverse group.
A longitudinal study would be useful to examine whether intended outcomes were present after an extended period.
Reflection:
The conclusions of this study seem applicable in the homeless space in regard to enhancing motivation toward steps of independent living.
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Ferguson, R., Gutberg, J., Schattke, K., Paulin, M. & Jost, N. (2015). Self-determination theory, social media and charitable causes: An in-depth analysis of autonomous motivation. European Journal of Social Psychology, 45:3, 298-307.
Data Source Type: A quantitative study collecting data from 7500 undergraduates at a Canadian university.
Summary:
This study examined the influence of the motivational regulations for engaging participants in both online and offline support of charitable events for the causes of breast cancer and homeless youth.
In essence, utilizing the framework of Self-determination Theory, the study sought to understand what forces would more significantly motivate people to participate in a choice of two different online charitable events.
Conceptually, self-determined motivation increases on a continuum moving from external, introjected regulation, identified, integrated and onto intrinsic motivation.
External regulation occurs when behavior is imposed upon the person through approval or punishment and rewards.
Introjected regulation explains behavior resulting from feelings of guilt, lowered self-esteem, or attacks on the ego.
Identified regulation of autonomous motivation describes behaviors that are experienced as personally important and worthwhile.
Integrated regulation occurs when behaviors are experienced as an integral part of who they are and is congruent with their sense of self.
Intrinsic autonomous regulation results from the inherently interesting characteristics of the behavior itself.
Three dimensions of Intrinsic motivation are identified as important: to experience stimulation, to know, and to accomplish. These three dimensions were measured in respect to efficacy intensity in this study.
The intrinsic motivation dimension to experience stimulation was a significant predictor of online supportive intentions for both events (β = .30; p < .001, breast cancer, and β = .20; p < .01, homeless youth). To experience stimulation also predicted supportive offline intentions (β = .17; p < .01) for the homeless youth event.
The findings demonstrated that when integrated regulation of autonomous motivation was included in the model, it was the strongest predictor of online and offline supportive intentions. However, identified autonomous regulation was not a significant predictor.
Evaluation/Critique:
Generalization of the findings is poor, primarily because of the novel focus group of university students.
The study utilized self-reported behaviors, which may be less reliable than observed behaviors.
Reflection:
This study had a helpful summary of the continuum of Self-determination theory. This summary is worth referencing again when looking for homeless applications.
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Thompson, S., Pollio, D., Eyrich, K., Bradbury, E., & North, C. (2004). Successfully exiting homelessness: experiences of formerly homeless mentally ill individuals. Evaluation and Program Planning. 27:4, 423-431.
Data Source Type: A quantitative/qualitative hybrid study of twelve previously homeless individuals who had maintained their housing for at least 24 consecutive months.
Summary:
The study focused on subjects that were recruited from a multi-service agency serving the mentally ill homeless in St. Louis, Missouri. The subjects represent a convenience sample, and all were paid $10 for their participation in interviews.
The research on homelessness has documented strong associations between positive outcomes and service use. However, central to achievement of positive outcomes are two factors associated with service use: willingness and timing. The individuals' ‘willingness’ to participate in treatment is crucial to positive outcomes.
Interviews focused on three major areas with open-ended questions:
what was it like to be homeless?
what helped (or did not help) you exit homelessness?
tell me about important people in your life in the past and present.
Interview data were audio-taped, transcribed, and analyzed utilizing standard qualitative procedures. This process resulted in the validation of 10 content categories.
Improving relationships with significant others, changing internal motivation and personal responsibility for improving their lives, and utilizing needed services appeared to play complementary roles that empowered individuals to escape homelessness.
The most frequent category identified as important to gaining housing stability was relationships with family and service providers.
Respondents affirmed the value of substance abuse treatment, and employment and training services as critical to achieving stable housing. Surprisingly, mental illness, assumed to be a critical predictor of continued homelessness, was infrequently mentioned.
Evaluation/Critique:
This study gathered great data and insight into exiting homelessness. However, the low participation number lends to poor overall generalization.
There is some question about the value of limiting the study to a single outcome – exiting homelessness.
Because the interviews were conducted at least two years after the individual’s experience of homelessness, I must wonder how clear their own recollection is.
Reflection:
I think the emphasis upon the role of positive family relationships and social support structure to effectively exit homelessness is important. Must revisit!
Note how participants affirmed the value of substance abuse treatment.
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Chevreau G, Vallat-Azouvi C, Coll M, Barbot F, Castillo M-C. (2021). Homelessness and Research: Methodological Obstacles and Lessons Learned from a Psychological Study in Parisian Homeless Services. Psych. 3(2):184-196. https://doi.org/10.3390/psych3020016
Data Source Type: A quantitative study of cognitive disorders amongst the homeless population of Paris, France.
Summary:
This study summarized the findings of efforts to collect data on the cognitive makeup of the Parisian homeless population.
During the two months of participant recruitment, n = 39 people were randomly selected. Of this initial population, n = 18 were ineligible, mostly because of poor spoken French. A further n = 7 declined the invitation to participate. Therefore, n = 14 individuals were recruited: n = 5 from the women’s shelter, n = 4 from the couples’ shelter, and n = 5 from the men’s shelter. Nine participants fully completed the multiple components of the pilot study.
Providing basic needs for this population, such as a roof or food, is essential but is also insufficient. Social rehabilitation can only be effective when the biopsychosocial causes of homelessness are also addressed.
Studies have shown that homelessness is associated with several risk factors for developing cognitive disorders, such as traumatic brain injuries, neurodevelopmental issues, or alcohol consumption, and that the prevalence of cognitive disorders is higher in people experiencing homelessness.
Homelessness is rarely explained by one simple cause, such as the loss of a job or the break-up of a single relationship. Research has shown that it is multifactorial and due to an accumulation of issues, such as socioeconomic disadvantage, low educational attainment, lack of a familial support network, mental health issues, and childhood adversity.
Homeless research should not always focus on psychosis. Research has shown that only 13% of homeless people in Paris have been diagnosed with a psychotic pathology. While this prevalence is high, so too are the figures in the same population for alcohol dependence (20%) and mood disorders (22%).
Evaluation/Critique:
This study shed important and useful light on the challenges of conducting quantitative or qualitative research amongst the mentally ill homeless population.
A shortcoming of the study was the lack of access to participant medical histories to correlate self-reported information. The very presence of cognitive disorders can affect the accuracy of self-report data.
Reflection:
Although mental health is a key issue in resolving homelessness, the unique focus of this study makes it only modestly valuable to my ultimate research goals.
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Lombas, A.S., Esteban, M.Á. (2018). The Confounding Role of Basic Needs Satisfaction Between Self-Determined Motivation and Well-Being. Journal of Happiness Studies 19, 1305–1327.
Data Source Type: A quantitative study where three different theories – all related to Self-determination macro theory – Basic Psychological Needs Theory, Organismic Integration Theory, and Hierarchical Model of Intrinsic and Extrinsic Motivation Theory were combined to be evaluated against empirical data.
Summary:
Randomized cluster sampling was used to select participants. The unit (cluster) was the school.
The participants of the study consisted of 673 Spanish secondary education students (334 girls and 339 boys) with a mean age of 14.0 years (SD = 1.4).
OIT postulates that the more autonomous the motivational regulation is, the stronger its relation to positive affective, cognitive, and behavioral consequences.
Basic Psychological Needs Satisfaction was measured by the Psychological Needs Satisfaction Scale in Education.
A scale for measuring academic motivation according to SDT principles was developed for first time by Vallerand. This scale consists of 28 items distributed in seven subscales of four items each.
Self-esteem was measured by Echeburúa’s Spanish version of the Rosenberg Self-esteem Scale. This scale is a widely used self-esteem measure (e.g., “On the whole, I am satisfied with myself”) and it is composed of 10 items concerning a person’s sense of worthiness and personal value.
Loneliness was measured by the UCLA Loneliness Scale Version 3 using the Spanish version. This 20-item self-report scale is composed of three factors.
Structural model showed that, as was expected, Basic Needs Satisfaction was positively associated with Intrinsic Motivation. The magnitude of this relation was large (.52).
This model predicts that the indirect relation between basic psychological needs satisfaction and psychological consequences is mediated through self-determined motivation. In other words, basic psychological needs satisfaction should be associated to self-determined motivation, which in turn, should be related to well-being.
Evaluation/Critique:
It should be noted that this study was not experimental in design. Therefore, causation is not able to be inferred.
A longitudinal mediation analysis would help avoid some potential statistical bias.
Reflection:
This study suggests that self-determined motivation could have a detrimental effect on well-being by having a negative effect on social life. This idea is worth exploring!
The design and data of this study was in-depth and a good future data analysis resource.
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Markland, D., Ryan, R., Tobin, V., & Rollnick, S. (2005). Motivational Interviewing and Self-Determination Theory. Journal of Social and Clinical Psychology. 24:6, 811-831.
Data Source Type: General article suggesting Self-determination Theory is the correct technical lens with which to view the successful processes of Motivation Interviewing.
Summary:
Motivational Interviewing has grown in popularity as a tool to encourage individual change. It is now utilized in a wide variety of clinical settings. However, it grew organically out of the reflections of a single source (Miller) and not the result of clinical reflection. This study suggests Motivational Interviewing should be paired with the technical lens of Self-Determination Theory to help understand why it is successful.
Motivational interviewing is defined as a “client–centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.”
It is claimed that attempting to directly persuade a client to change will be ineffective because it involves taking one side of the conflict which the client is already experiencing. The result is that the client may adopt the opposite stance, arguing against the need for change, thereby resulting in increased resistance and a reduction in the likelihood of change.
Instead, motivational interviewing allows the client to overtly express their ambivalence to guide them to a satisfactory resolution of their conflicting motivations with the aim of triggering appropriate behavioral changes.
A key assumption underlying motivational interviewing, then, is that it is not the counselor’s function to directly persuade or coerce the client to change. Rather it is the client’s responsibility to decide for themselves whether to change and how best to go about it.
Miller and Rollnick (2002) described four general principles of motivational interviewing which underpin its specific techniques and strategies:
The expression of empathy
The development of discrepancy
Rolling with resistance
Support for self-efficacy
Evaluation/Critique:
This study focused on the importance of autonomy support because this is a feature that is relatively unique to both SDT as a contemporary theory of motivation, and to motivational interviewing as a clinical approach.
Reflection:
Motivational Interviewing could be incorporated well into a program “tool kit” whose aim is to encourage homeless individuals to move toward greater personal responsibility within proper support structures.
Motivational Interviewing appears to be a positive match to efforts based upon SDT.
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Weinstein, N., Przybylski, A., & Ryan, R. (2012). The index of autonomous functioning: Development of a scale of human autonomy. Journal of Research in Personality. 46:4, 397-413.
Data Source Type: A quantitative study the develops the concepts of Self-Determination Theory to create a measurable scale of human autonomy. Participants were 890 men and 542 women (n = 1432 total), ages 17–58 (M = 26 years). Of these, 731 were single, 471 were dating, and 230 were married. Participants identified 21 native countries, including the US, European nations including England and Germany, and Asian countries including Japan and China.
Summary:
An increasing interest in the importance of dispositional autonomy led to the creation of the Index of Autonomous Functioning (IAF). The IAF provides a measure of trait autonomy based on three theoretically derived subscales assessing authorship/self-congruence, interest-taking, and low susceptibility to control.
In use across seven different studies, the IAF showed reliability and predictability.
The IAF has been shown to predict well-being above and beyond any previously existing measures.
Behavior that is more autonomous has been associated with more creative learning and engagement, greater energy and vitality, lower stress and higher well-being, and more rewarding socialization and relationships, among other positive outcomes.
A central and long recognized characteristic of autonomy is that when autonomous, the individual experiences him or herself as the author of behavior, and fully assents to the actions he or she undertakes.
A second facet of autonomy is interest-taking. Interest-taking is the spontaneous tendency to openly reflect on inner and outer events.
Where authorship and interest-taking characterize positive features of autonomy, feelings of pressure and of control mark its absence. So, a third facet of autonomy is the absence of external and internal pressure as motivators for behaving.
Evaluation/Critique:
This is a serious study. The design methodology was rigorous, and thus generalization would be high.
Much attention was given to the issue of reliability. I believe the study’s designers are accurate when they claim that the IAF tool proved to be reliable.
Reflection:
Autonomy is an important concept in the homeless services space. It is noteworthy to recognize that the IAF tool should be a component in serious efforts to design programs that encourage personal autonomy amongst the homeless population.
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Ryan, R., Plant, R., & O’Malley, S. (1995). Initial motivations for alcohol treatment: Relations with patient characteristics, treatment involvement, and dropout. Addictive Behaviors. 20:3, 279-297.
Data Source Type: A quantitative study utilizing a treatment motivation questionnaire administered to 109 patients entering an alcoholism clinic. The sample was predominantly male with an mean age of 30.5 years.
Summary:
Motivation is considered a critical component of a person’s readiness for any interventions intended to change behavior. A lack of motivation is one of the most frequently cited reasons for patient dropout, failure to comply, relapse, and other negative treatment outcomes.
This study challenges the standard line of questioning, “How motivated is the individual to change?” Instead, the study emphasizes Self-Determination Theory which suggests the source of the motivation is as important as the perceived intensity.
In alcoholism treatment literature, perceived locus of causality is an especially important issue. The study suggests that it is well-documented that many alcoholics are coerced into treatment.
The evidence generally indicates that patients self-referred for treatment show the lowest dropout rate and the best treatment outcomes, while those referred by impersonal sources such as the police or court system have the highest dropout rates and poorest outcomes.
The questionnaire focused on three types of motivation:
External motivation – “If I remain in treatment, it will probably be because I get in trouble if I don’t.”
Introjected motivation – “If I remain in treatment, it will probably be because I’ll feel very bad about myself if I don’t.”
Identified motivation – “If I remain in treatment, it will probably be because it’s in my best interest to complete treatment.”
The study found that a “mixed” motivation of both Introjected and Identified was somewhat common. They suggested further study is required to draw out the implications of this.
Descriptive statistics revealed that 57 (58%) of study participants dropped out of treatment and 41 (42%) had remained in treatment by the eight-week follow-up.
Evaluation/Critique:
A major shortcoming of this study was the relatively small number of participants involved. Thus, the factor analytic outcomes should be regarded as tentative until the study can be expanded.
Reflection:
This study gets right to the heart of my intended research question about the nature of motivation in homeless that move toward personal responsibility and autonomy.
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Cory B. Dennis, Philip McCallion & Lisa A. Ferretti. (2012). Understanding Implementation of Best Practices for Working with the Older Homeless Through the Lens of Self-Determination Theory, Journal of Gerontological Social Work, 55:4, 352-366.
Data Source Type: A qualitative study summarizing five in-depth, semi structured interviews that focused on best practices in serving the homeless population.
Summary:
Of the homeless that were sheltered in 2009, 17.2 percent were over the age of 50 according to HUD data. Demographic trends in the United States point to an aging population, so it is anticipated the mean age of the homeless in the United States may continue to increase.
In San Francisco, a study spanning 14 years (N = 3534) noted that the medium age of the homeless increased by 9 years over that time.
Compared to younger cohorts, homeless adults over the age 50 are more likely to report physical and mental health problems, but less likely to report drug abuse. They are equally as likely to report alcohol abuse. Older homeless adults also have a higher rate of health insurance and access health networks more frequently than younger cohorts.
Three major themes emerged from the transcripts of the interviews with the five professionals: Client-Worker-Services relationships, obstacles, and self-determination.
The study argued that a “Housing First” approach gave the homeless a “foothold” in their recovery process and encouraged their direct participation.
The coercive power of personal addictions was noted by many. “Their addictions – those things take over – and usually end up deciding the fate of everything.”
“Their awfully resistant. They see nothing wrong with the way they’re living, you know, it’s trying to convince themselves that there’s a much better way of life out there.”
Evaluation/Critique:
This study was extremely limited in scope – five participants selected based upon their recognized professional expertise in the field of homeless services.
Because of this scope, generalization would be extremely limited.
Nevertheless, the years of experience in the homeless services space combined with the personal professional aptitude involved made the data and transcripts from this study compelling.
If digested at face value – the professional perspective of five experienced leaders in the field of homeless care – the reliability of the data would be high.
Reflection:
The transcripts quoted in this study are great as reminders that the work is personal first, and not inherently academic. Theories and strategies have an important place, but that place is within the context of a positive personal relationship.
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Horan, W. P., Wynn, J. K., Gabrielian, S., Glynn, S. M., Hellemann, G. S., Kern, R. S., Lee, J., Marder, S. R., Sugar, C. A., & Green, M. F. (2020). Motivational and cognitive correlates of community integration in homeless veterans entering a permanent supported housing program. The American journal of orthopsychiatry, 90(2), 181–192.
Data Source Type: A qualitative study examining whether interview- and performance-based assessments of motivation, non-social and social cognitive ability, and psychiatric symptoms were associated with community integration.
Summary:
This report includes baseline data from 176 participants drawn from two separate VA-funded longitudinal studies of community integration in homeless Veterans.
Generally speaking, community integration refers to the extent to which people live, participate, and socialize in their community.
In homelessness research, it has become clear that community integration does not arise automatically once housing is provided. Among recently housed Veterans, recidivism into homelessness is common, unemployment levels are extremely high, and engagement in social networks and community-based treatment services are low.
This study and others have found that variables in the broad categories of “ability”, what one can do, and “motivation”, what one is willing/driven to do, are robust determinants of poor functioning.
Of note, across the nation, an average of 113 days passes between HUD-VASH enrollment and apartment move-in.
The most striking result was that, across samples, motivation measures were similarly robust correlates of community integration.
Regarding treatment implications, motivational disturbances are also interesting because of the existence of relevant evidence-based psychosocial treatment approaches. For example, Motivational Interviewing has been useful in helping individuals, including those with substance use and SMI, to progress toward personal behavioral goals.
Cognitive behavior therapy has been found to improve experiential negative symptoms, as well as associated defeatist performance beliefs and community integration, in people with psychosis.
Evaluation/Critique:
Because this study focuses on cross-sectional bivariate correlations from two longitudinal studies, it is unable to make any inferences about causality.
Because this study focused on Veterans, participants were older, were a higher percentage male, and had a higher level of education compared with other homeless cohorts.
Reflection:
This study introduced the functional concept of “motivational disturbances,” and suggested that addressing such disturbances is a key to homeless community integration.
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Usborne, E., Lydon, J., & Taylor, D. (2009). Goals and Social Relationships: Windows into the Motivation and Well-being of “Street Kids.” Journal of Applied Psychology. 39:5, 1057-1082.
Data Source Type: A qualitative study exploring the personal relationship network of 50 so-called “street kids” and the role their networks play on personal motivation.
Summary:
Participants were 50 homeless youths (29 men, 20 women, 1 did not indicate gender) who frequent a drop-in center in Montreal. The participants’ mean age was 20.4 years (SD = 2.4), ranging from 15 to 26 years.
This study takes a close look at both relationship networks and personal goals of surveyed “street kids” to determine personal motivation through the lens of Self-Determination Theory.
Social support has consistently been found to play an important role in self-determined motivation. In addition, some studies have suggested that good personal relatedness is essential to a person’s overall well-being.
In addition to relationships, the pursuit of personal goals has been identified as a key in individual well-being. Indeed, internalization involves the process of valuing a goal personally.
To analyze goals, this project used a personal project analysis. Personal projects are self-generated accounts of what an individual is thinking and hoping to achieve.
The study used self-determination theory and subjective well-being to form two hypotheses:
Hypothesis 1: there will be a positive relationship between the number of close relationships in a street kid’s network and subjective well-being.
Hypothesis 2: once street kids have articulated a personal project, the pursuit of that project will positively effect motivation and subjective well-being.
Evaluation/Critique:
This was a difficult study to undertake. It was hard to find a time to engage the cohort. It was a challenge to get them to open up in a substantive way. And it was a challenge to determine how to frame the questions in a manner that would arrive at the desired result.
Street kids reported significantly greater positive well-being (M = 6.58, SD = 2.66) than negative well-being (M = 5.11, SD = 2.72), t(49) = 2.23, p < .05 (see Table 1).
The street kids appeared to be self-determined, as would a normally motivated individual, as they gave their highest ratings to intrinsic motivation and their lowest ratings to amotivation.
Reflection:
The data on the power of a personal pursuit in such a vulnerable population group seems valuable to further studies on motivation theory and homelessness.
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Silverman, K., Holtyn, A., & Morrison, R. (2016). The Therapeutic Utility of Employment in Treating Drug Addiction: Science to Application. Translation Issues in Psychological Science. 2016 June; 2(2): 203–212.
Data Source Type: A general article summarizing research into the efficacy of employment in treating substance abuse.
Summary:
Research indicates that incentives for drug abstinence can be highly effective in both initiating and maintaining abstinence in many of the most common drugs.
These abstinence reinforcement interventions, commonly referred to as incentive or contingency management interventions, are relatively simple procedures in which patients receive a tangible benefit for providing objective evidence of drug abstinence.
To investigate the efficacy of this employment intervention model, an intervention model known as the Therapeutic Workplace was created.
Adults who have failed other more conventional drug treatment programs were hired – and paid - to work in the Therapeutic Workplace.
Therapeutic Workplace participants are required to provide drug-free urine samples to gain access to the workplace and/or to maintain their maximum rate of pay.
Studies have shown that the Therapeutic Workplace intervention can initiate and maintain cocaine abstinence in injection drug and crack cocaine users who are enrolled in methadone treatment but continue to use cocaine; initiate abstinence from opiates and cocaine in pregnant and postpartum women who continue to use cocaine during treatment; initiate abstinence from opiates and cocaine in out-of-treatment injection drug users; promote abstinence from alcohol in homeless, alcohol-dependent adults; and, with a change in the nature of the contingency, promote adherence to the opioid antagonist naltrexone in opioid-dependent adults who have completed opioid detoxifications.
Research has shown that employment alone is not sufficient to promote sustained abstinence in study participants; study participants achieve sustained abstinence primarily when required to provide drug-free urine samples to maintain access to the workplace and to maintain maximum pay.
The study showed that Therapeutic Employment was not effective in maintaining long-term substance abuse sobriety once participants left the work program. Many relapsed without the program structure.
Evaluation/Critique:
The program study offered a valuable suggestion on models of Therapeutic Workplace applications: The Social Business Model; The Cooperative Employer Model; and The Wage Supplement Model.
Reflection:
This is a fascinating concept that may have a place within an adult recovery model!
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Vlaev, I., King, D., Darzi, A., & Dolan, P. (2019). Changing health behaviors using financial incentives: a review from behavioral economics. BMC public health, 19(1), 1059.
Data Source Type: A qualitative study summarizing the collective data on the role of fiscal incentives to change health behaviors as seen through the lens of behavioral economics.
Summary:
There has been recent increased interest in using financial incentives to change health behaviors across the general population.
Behavioral economics integrates insights from psychology with the laws of economics and provides several robust psychological phenomena that help to better explain human behavior.
Reducing morbidity and mortality losses in the future is likely to depend as much on motivating changes in behavior as on developing new treatments.
Incentives can take several forms including cash or alternatively vouchers that can then be exchanged for desirable items.
Insights from across the behavioral sciences suggest that human behavior is influenced greatly by the context or environment within which many of our decisions are taken.
It has been demonstrated that we react more to losses than to gains of equivalent magnitude, which is embedded into the well-known (Nobel prize winning) Prospect Theory of risky choice. Loss aversion implies that someone who loses $10 from his or her pocket will lose more satisfaction than another person would gain satisfaction from a $10 windfall.
One study examined the impact of financial incentives on STD screenings amongst college students:
This was a in a cluster randomized trial (N = 1060; age 18–24 years).
The students were offered a $10 voucher or enrollment in a $500 lottery.
The control group screening rate was 1.5%.
The lottery increased screening to 2.8%.
The voucher increased screening to 22.8%.
Hyperbolic discounting is also known as ‘present bias.’ In other words, people would rather receive $18 today than the promise of $25 next week.
Evaluation/Critique:
Financial incentives have been shown to be more effective in encouraging irregular behaviors (getting a vaccine) compared with long term behaviors (committing to weight loss).
This study was interesting, but it stopped short of offering a complete picture of which stimulants would work best.
Reflection:
I believe financial incentives have a role to play in a comprehensive homeless recovery plan. But close attention must be given to size, social context, and program design.
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Keuntae, K., & Garcia, I. (2019). Why Do Homeless Families Exit and Return to the Homeless Shelter? Factors Affecting the Risk of Family Homelessness in Salt Lake County (Utah, United States). A Case Study. International Journal of Environmental Research and Public Health. 16:4328.
Data Source Type: A quantitative study of 2348 records for 1462 homeless families registered to the HMIS database in 2017.
Summary:
HUD annual Point-In-Time data indicates that about 1 in 4 families that were once homeless are in danger of becoming homeless again.
Holding all other variables constant, one additional person in household size or one additional adult is less likely to exit their homeless episode by 9.6 percent and 21 percent, respectively.
Having drug abuse and mental health problems also leads to a lower probability of exiting the homeless episode by 26.4 percent for drug abuse and 17.9 percent for mental health.
The housing programs a homeless enrolled during their homeless episode play significant roles in decreasing the likelihood of shelter exit.
Magnitudes of estimates for each housing program suggest that permanent supportive housing programs decrease the probability of shelter exit among all four housing programs, while transitional housing programs are least likely to decrease the likelihood of shelter exit.
Homeless families living in their housing for either one to three months or more than one year are 1.6 and 1.5 times more likely to exit the shelter than homeless families not living in their housing prior to shelter entry. In the case of doubling up, homeless families staying at their relative’s or friend’s houses before entering the shelter are more likely to exit the shelter by 1.2 times to 1.6 times, depending on their length of stay.
Having higher levels of average earned income and family support income decrease the probability of shelter exit by about 1.9 and 3.2 percent, respectively.
For homeless families enrolling subsidized housing programs, one hundred dollars increase in the average monthly rent assistance decrease the probability of exiting the homeless episode by about 14.5 percent.
Evaluation/Critique:
Structural factors, like a change in personal economic conditions, play a larger role in shelter exit success than do personal factors. This study confirmed that transitional housing and Housing First policies work well for those placed in them.
This study did not incorporate either educational attainment and crime data. Both could help speak to the data narrative being presented.
Reflection:
The correlation between rent assistance and existing homelessness needs more research!
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