Housing and Support Program (HASP): Final Evaluation Report

8
Section 1 Introduction
While there appears to be some consensus on the
interventions to be provided by the non-government
support sector, there are clear differences in the way
in which these components are delivered. This makes
it diffi cult to compare the outcomes of the different
approaches described. As outlined, the intensity
of support provided (i.e. hours of support) and the
professional backgrounds of those providing the
support vary among the studies. For example,
clients in the study by Clarkson et al. (1999) received
an average of 35 hours per month, while those in the
study by Mak & Gow (1996) had only one worker for
32 clients. It is also clear that the clients in the various
studies differed in important ways. While some of the
studies involved ‘new’ long-stay clients, others involved
clients leaving psychiatric hospitals after many years of
hospitalisation (e.g. Project 300).
In many of the studies reviewed, support staff were
employed directly by mental health services rather than
separate support agencies. For example, in three of
the studies (Oliver et al., 1996; Clarkson et al., 1999;
Anthony et al., 1999), support services were provided
via specially designated rehabilitation teams, led by
professionally trained rehabilitation workers. This
raises questions about the independence of the
support agencies involved and their ability to provide
a range of ‘alternate’ services based on their
assessment of client needs. While it is acknowledged
that all the agencies involved in the treatment of
the client must cooperate, there needs to be some
independence in decision-making around the services
that agencies provide.
Most of the studies relied on a single outcome measure
– most employed the number of rehospitalisations over
the study period. Those studies that did evaluate other
domains, such as symptoms and clinical functioning,
found that these components were unlikely to change
despite an increase in service intensity. While there
was a trend for general functioning (ADLs, self-care,
work) to improve (Warner et al., 1998), the extent
of this improvement in most of the studies reviewed
did not reach signifi cance. Indeed, social networks
tended to decline following the introduction of support
workers; in that support staff replaced the role of family
and friends.
Final Evaluation Report
Overall, there appears to be general agreement that
the provision of disability support can be a useful
adjunct to current treatment options, such as case
management (Mak & Gow, 1996; Clarkson et al., 1999;
Lord & Hutchison, 2003). However, a major limitation
of the literature has been the lack of clarity regarding
the active ingredients of disability support that lead
to a reduction in admissions and improvements in
general functioning and the quantity of support
to be provided to maximise outcomes. For example,
Prince (2006) demonstrated that support services
that enhanced daily structure, service continuity,
and provided symptom education, reduced the
chances of readmission by 50%. However, most of
these support services were provided by professionally
trained workers who held tertiary qualifi cations in
mental health (e.g. mental health nurses).
1.2.3 Australian Studies — Overview
The number of supported housing models in Australia
has steadily increased over the past 10 years. While
many of these have not been subjected to evaluation,
a small number have and the main fi ndings from these
are described below.
The Housing and Support Initiative — (NSW)
The Housing and Support Initiative (HASI)
(Morris et al., 2005) is a jointly funded program
provided by the Department of Health and Department
of Housing in New South Wales. The program was
designed to assist people with mental illness acquire
accommodation, to maintain the tenancy of that
accommodation, and to improve their quality of life.
A primary objective of the program was to reduce the
need for hospital admission. The program provides
support in three areas — housing, disability support
and clinical stability.
Housing was provided by a combination of community
housing agencies and the Department of Housing.
A range of housing options were available, including
units, townhouses and detached houses in the
community. Properties were either leased or owned
by the housing providers through a landlord system.
Disability support was provided by a range of NGOs,
and focused on domestic, emotional, vocational,
advocacy and living skills. Community integration
was a major focus of the support provided. Some
of the agencies linked clients into community-based