University of Plymouth PEARL https://pearl.plymouth.ac.uk 04 University of Plymouth Research Theses 01 Research Theses Main Collection 2018 Transitioning from homelessness into a sustained tenancy: What enables successful tenancy sustainment? (The Moving on Project) Boland, Leonie http://hdl.handle.net/10026.1/11660 University of Plymouth All content in PEARL is protected by copyright law. Author manuscripts are made available in accordance with publisher policies. Please cite only the published version using the details provided on the item record or document. In the absence of an open licence (e.g. Creative Commons), permissions for further reuse of content should be sought from the publisher or author. Transitioning from homelessness into a sustained tenancy: What enables successful tenancy sustainment? (The Moving on Project) Leonie Boland A thesis submitted to Plymouth University in partial fulfilment for the degree of Doctor of Philosophy School of Health Professions Faculty of Health and Human Sciences May 2018 Copyright statement This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with its author and that no quotation from the thesis and no information derived from it may be published without the author’s prior consent. ii This thesis is dedicated to UM who spoiled us with his absolute generosity and to LC, an inspiration for this study in so many ways, whose life was tragically cut short. iii ACKNOWLEDGEMENTS First and foremost, I want to thank all the participants who gave so generously of their time and shared their expert knowledge with me. Spending time with them and hearing their stories was a privilege and my favourite part of whole process. This dissertation would not have been possible without the expert guidance, time, attention to detail and encouragement of my supervisors Dr Katrina Bannigan and Prof Richard Yarwood. A heartfelt thank you to you both. I would also like to thank Dr Anita Slade for her guidance and contribution at the earlier parts of the study. I would like to acknowledge and thank the Catherine Mounter Scholarship, Plymouth University without whose support this would not have taken place. I am also particularly grateful to all the services that supported the study and enabled the interviews take place. In particular to each of the gatekeepers, with a special word of thanks to Lyndsey Withers. To all my friends, old and new, I am truly thankful and grateful. You continued to provide me with both generous practical support (food, coffee, beds, writing tables) as well as emotional support (calls, texts and trips away from the library) despite my reducing level of proactive contact. A special acknowledgement to my PhD student colleagues in PAHC and squatting office – I am lucky to have made friends for life. Finally to my family, who I knew were always there for me. iv AUTHOR’S SIGNED DECLARATION At no time during the registration for the degree of Doctor of Philosophy has the author been registered for any other University award. Work submitted for this research degree at the Plymouth University has not formed part of any other degree either at Plymouth University or at another establishment. This study was financed with the aid of the Catherine Mounter studentship from Plymouth University. Relevant scientific seminars and conferences were regularly attended at which work was often presented (listed overleaf). Word count of main body of thesis: 87,194 Signed: ……………………………….. Date: ………………………………..... v Publications and presentations in relation to this research: Boland, L., Yarwood, R. and Bannigan, K. (2017) An occupational perspective of using homeless hostels. Paper presentation, Postgraduate Showcase, Plymouth University. Boland, L., Yarwood, R. and Bannigan, K. (2017) Being a service recipient: An occupational perspective of using homeless hostels. Paper presentation, Occupational Science Europe Conference, Hildesheim, Germany. Boland, L., Yarwood, R. and Bannigan, K. (2016) Leaving homelessness: A systematic review. Paper presentation, Postgraduate Showcase, Plymouth University. Boland, L., Slade, A. and Bannigan, K. (2016) Leaving homelessness: A systematic review. Paper presentation, Council of Occupational Therapists in European Countries (COTEC) and European Network of Occupational Therapists in Higher Education (ENOTHE) Congress, Galway, Ireland. Boland, L., Slade, A. and Bannigan, K. (2016) Transitioning from homelessness: The role of occupation. Workshop, COTEC and ENOTHE Congress, Galway, Ireland. Boland, L., Slade, A. and Bannigan, K. (2015) Leaving Homelessness: A Narrative Synthesis. Paper presentation, School of Health Profession Research Conference, Plymouth University. Boland, L., Slade, A., Bannigan, K. (2015). Leaving homelessness: a narrative synthesis. PROSPERO 2015 CRD42015019361. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015019361. vi ABSTRACT Leonie Boland Transitioning from homelessness into a sustained tenancy: What enables successful tenancy sustainment? (The Moving on Project) For individuals with multiple and complex needs, leaving homelessness is recognised as a dynamic and complex process. Furthermore, despite the provision of supports, tenancies may not be maintained and individuals return to using homelessness services. Tenancy sustainment—the maintenance of a tenancy to avoid a premature end of tenure—is fundamental to the resolution and prevention of homelessness. There is a paucity of research about the occupations of individuals as they establish and maintain tenancies. This thesis aimed to understand the transition process from homelessness, and tenancy sustainment, from an occupational perspective, to inform a potential occupational therapy intervention. Underpinned by the Medical Research Council (2008) framework for the development and evaluation of complex interventions, a systematic review and a constructivist grounded theory study were conducted in a convergent mixed method study design. The systematic review synthesised the evidence on tenancy sustainment following homelessness from a broad range of studies. It presented positive determinants of tenancy sustainment at individual, interpersonal, community and structural levels. The constructivist grounded theory study was conducted with people who were experiencing or had experienced multiple exclusion homelessness as well as staff in homelessness services. Individuals (n=35) were purposively sampled and interviews vii using reflexive photography were conducted. A substantive theory about the core process of tenancy sustainment was conceptualised as ‘Making a Home’. This was enacted through identified occupational strategies of ‘putting your stamp on it’, ‘seeing a new self’ and ‘living the life’. Tenancy sustainment was experienced as ‘feeling at home’, which had two sub-categories: ‘belonging’, which was a sense of connection to place, as well as, ‘having connections’ to other people. The key mediating factor to enable tenancy sustainment was taking control over activities. The findings were synthesised to propose a framework of factors that influence successful tenancy sustainment. Engagement in occupations, as individuals established and sustained tenancies, provided a sense of well-being, a sense of control as well as social connections. This indicates the value, to all who support individuals leave homelessness, of providing opportunities and supporting tenants to engage in personally meaningful occupations. In addition, this thesis provides a foundation for the development of an occupational therapy intervention for tenancy sustainment following homelessness. viii TABLE OF CONTENTS CHAPTER 1 INTRODUCTION ............................................................................................... 1 1.1 Occupational therapy ........................................................................................ 2 1.2 Occupational science ......................................................................................... 5 1.2.1 Occupational justice .......................................................................................... 6 1.3 Homelessness ................................................................................................... 7 1.3.1 Definition of homelessness ............................................................................... 7 1.3.2 Causes of homelessness .................................................................................. 10 1.3.3 Homeless service users with complex needs .................................................. 11 1.3.4 Service provision and pathways (models) ...................................................... 13 1.3.5 UK and Ireland policy context ......................................................................... 15 1.4 Personal background to the research ............................................................... 18 1.5 Assumptions underpinning the research .......................................................... 20 1.6 Rationale of the research ................................................................................ 20 1.7 Research questions ......................................................................................... 21 1.8 Theoretical framework .................................................................................... 22 1.8.1 Occupational science ...................................................................................... 22 1.8.2