SOCIAL HEALING: A THEORETICAL MODEL FOR THE SUCCESS OF HOUSING FIRST ________________________________________________________________________ A Dissertation Submitted to the Temple University Graduate Board ________________________________________________________________________ In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY ________________________________________________________________________ By Mary Ellen Gane January 2012 Examining Committee Members: Shanyang Zhao, Advisory Chair, Sociology Michelle Byng, Sociology Matt Wray, Sociology Karin Eyrich-Garg, Social Work i © Copyright 2011 Mary Ellen Gane ii ABSTRACT Social Healing: A Theoretical Model for the Success of Housing First Mary Ellen Gane January 2012 Doctor of Philosophy Doctoral Advisory Committee Chair: Shanyang Zhao, Ph.D. The Housing First program for addressing homelessness offers a new model for re-integrating socially maladapted chronic homeless individuals in society through social mechanisms. This model is in contrast to the predominant paradigm of addressing homelessness (treatment continuum model) which enforces a medical conceptualization of the chronic homeless, encouraging negative labeling and stigmatization of homeless individuals, thus, perpetuating continual homelessness for those individuals who reject this symbiotic paradigm of disease and treatment. Literature on Housing First indicates much success of the program in terms of financial savings and tenant positive outcome evaluations; however, there is limited explanation of how these successful outcomes are produced. In revealing the social mechanisms through which previously homeless tenants transition the main research question addressed is “Does symbolic interactionism provide a reliable (reasonable) theoretical framework for understanding the successes of Housing First?” Within this dissertation, interactions between tenants and case managers are revealed to be the primary intervening variable in a process of transition for tenants. These interactions connect Housing First policy (independent variable) to successful iii outcomes for tenants experienced during continued housing tenure (dependent variable). As measuring a process is difficult, three transitional dimensions were conceptualized from Housing First policy guidelines to produce interactions between case managers and tenants that affect tenant 1) social identity, 2) affective home creation, and 3) socially supported wellness. Interactions are found to produce psycho-social processes and symbolic meaning development in these three social dimensions that are created and received by individual actors as a social product. The measurement methods in the study are triangulated to reflect the fluidity of real life processes and both qualitative and quantitative data types are collected to present different analytical perspectives. Three stages of measurement are used to explain the process of transition that is experienced by tenants. Policy data identify how case managers are directed to interact with tenants, interview data with tenants and case managers explains how both parties experience the interactions, and interview scale data from tenants and case managers confirms successful tenant longitudinal outcomes during housing tenure. From March 2008 until January 2011, twenty tenant case studies were interviewed three times in six month intervals. Nine case managers were also interviewed once and two tenants who discontinued permanent housing tenure were interviewed for an overall total of 71 interviews. Results indicate that Housing First policy guidelines that encourage these social processes experienced by the tenant are: 1) Empowering and strength-based interactions from case managers produce social identity restructuring 2) The provision of permanent housing produces individual and family affective home creation to various degrees, and 3) The case manager provides supportive services and links to the community which iv produces social support to various degrees that are linked to overall wellness and health. Social Identity is found to be primary to tenant transitions, affective home creation is secondary, and socially supported wellness is tertiary. The dimensions of home creation and socially supported wellness reinforce and occasionally detract from the initial social identity restructuring that tenants experience during housing tenure. Also, interactions from case managers are found to be the most consistent form of interaction across all three dimensions. Overall, symbolic interactionism is found to be a reasonable framework for explaining the successes of Housing First. Through highly focused intention in interactions case managers facilitate three social processes for tenants that lead to their successful continued housing tenure. These beneficial processes can be more specifically described as ‘socially healing processes’ or ‘social healing’ as they heal the social dimensions of identity, affective home creation, and wellness networks to various degrees for tenants. Overall, this dissertation is a symbolic interactionist theoretically driven model of the socially healing processes through which individuals transition out of chronic homelessness and re-enter society within the Housing First program. v ACKNOWLEDGEMENTS Thank you to all those who are struggling with chronic homelessness for being strong to make it another day today! Thank you to all the tenants in Housing First who told me their stories and trusted in the goodness of this project. Wade, Kiomm, Mezel, Jospeh, Marie, Merissa, Tonie, Sarah, Walter, Glenn, Cynthia, MaryBeth, Anthony, Ayzel, Richard, Barbara, Curtis, Jean, Johnny, Morgan and James you are my heroes. Thank you to Vivienne, Tamara, Andrea, Marcus, Louis, Myrene, Tracy, Daphne, Jackie, and Karima for generously talking with me about their experiences working with tenants in Housing First. Also, my thanks to the Housing First Collaborative and especially Dr. Kevin Irwin for making this project possible! Thank you to my wonderful advisory committee, Dr. Shanyang Zhao, Dr. Michelle Byng, and Dr. Matt Wray, for reading the many drafts of my work in a short period of time and always offering helpful comments. Thank you to Dr. Karin Eyrich-Garg for being an outside reader. I am particularly grateful to Dr. Shanyang Zhao for helping and guiding me along the right path and for always knowing the right thing to say in any situation. A big thank you to my cohort, Nadine, Helen Marie and Melissa, it was my pleasure to have traveled along the program with such honorable woman. Thank you to Alison, Jen, Ashley, and Jodi for your invaluable friendships - without your positivity and support I would have surely went off the deep end! Thank you to Ryan and Justin for supporting this project in their own unique ways. Thanks to the Chestnut Hill Coffee for helping to connect me with people in ways that directly assisted my dissertation progress. Thank you to Jared and Niall for forcing me to see different perspectives. Thank you to my family, especially my mother, and thank you Joe for your patience and support! vi TABLE OF CONTENTS ABSTRACT ....................................................................................................................... iii ACKNOWLEDGMENTS ................................................................................................. vi LIST OF FIGURES .............................................................................................................x LIST OF TABLES ............................................................................................................. xi CHAPTER 1. HOUSING FIRST SUCCESSES AND SYMBOLIC INTERACTIONISM AS A USEFUL FRAMEWORK....................................................................................1 1.1Housing First and Its Successes ..........................................................................6 History and Implementation of Housing First .................................................6 Cost Benefit of Housing First ........................................................................15 1.2 The Missing Piece: Sociological Factors through Symbolic Interactionism ...17 Symbolic Interactionism as a Useful Framework ..........................................19 The Creative Potential for Positive Change within Interactions ...................15 1.3 Plan of the Dissertation ....................................................................................29 2. SOCIAL PROCESSES OF TRANSITION AS RELATED TO HOMELESSNESS .................................................................................................30 2.1 Social Identity ..................................................................................................30 Housing First Social Processes and Tenant Identity .....................................31 Labeling and Stigma: Consequences of the Homeless Identity .....................32 Institutions, Labeling and Stigma: Is Identity Change Possible? ..................33 Elimination of Medicalized Shelter System Interactions ...............................36 Choice and Power within Housing First Social Processes: Identity Destigmatization ..........................................................................................39 2.2 Affective Home Creation .................................................................................41 Home as a Social Process for Previously Homeless Tenants ........................42 Individual Processes in Home