EVALUATION OF PSYCHOSOCIAL PROGRAMS TO HOMELESS PEOPLE IN MADRID (SPAIN)
M. Muñoz y S. Panadero
Self presentation: The authors are members of a team of the Complutense University of Madrid (Spain) that research on homelessness and had collaborated in different national and European projects like To live in Health and Dignity, project set out by SMES.
There are very few studies about evaluation and description of programs for homeless people in Europe. An important study in this context was To Live in Health and Dignity (H&D), project set out by SMES – SME to identify good practice in the delivery of health and social care to some of the most vulnerable and deprived populations in Europe. This study presented and evaluated sixty innovative and efficient practices in 10 European capital cities, as well as testing the quality of life, health, self-esteem and satisfaction degree of the users of those practices.
Based on this study was developed another study in Spain. The general aim of this research was to assess the effectiveness of a net of programs for homeless people in Madrid (Spain). Three studies were carried out:
The first one, was a study to develop an instrument to describe programs to social inclusion, a structured interview, Módulos de Inclusión Social, based on the interview used in the H&D Project. Different mathematical analyses were carried out with the data of that project and the instrument was change because of the results. Other changes were made based on the opinion of experts in evaluation and in homeless people.
The main characteristics of this structured interview are:
· Interviewed: a technical responsible of the program
· Brief
· Information about different and relevant areas for programs to social inclusion: kind of professionals, formation activities for professionals and voluntaries, needs of the users and activities to attend those needs, number of users, etc.
· 4 modules:
o Needs of users
o Functioning strategies
o Dignity
o Health
The functioning of this interview was proved in a small study with 12 programs for social inclusion. The results show that the interview is a very brief and easy to apply instrument.
The second study described 11 programs (best practices) for homeless people in Madrid (selected based on experts opinions and good practices criteria (H&D)). Different instruments were used to describe different aspects of these programs:
· Módulos de Inclusión Social
· Community Oriented Program Environment Scale (COPES; Moos, 1996)
· Dartmouth Assertive Community Treatment (DACTS; Teague, Bond y Drake, 1998)
Using these instruments the main results about the programs was:
· Diversity of actions and activities
· Active involvement of users in the programs
· Individual intervention
· Multidisciplinary teams
· Participation of voluntaries
· Multiple need of users
· Small size of the programs
· Few formation activities and supervision for professionals and voluntaries
· Few activities of outreach and on the street
· Few evaluation users satisfaction
The third study, the last one, assessed the situation of 130 users of those (11) programs for homeless people in different variables: quality of live, health, self-esteem, satisfaction with programs, consume of drugs and alcohol, in three different moments (wave one, wave two (6 months later (55 persons)) and wave three (12 months later first wave one (55 persons)). The interview used included the follow instruments:
· Quality of life interview (Lehman, 1988)
· General Health Questionnaire (Goldberg, 1978)
· Self-esteem questionnaire (Rosenberg, 1965)
· Client Satisfaction Questionnaire (Larsen, Atkinson, Greaves et al., 1979)
· Some questions “ad hoc” for some aspects
Results show significant improvement in different variables, mainly 12 months later: accommodation (homeless situation, stability of accommodation and independent housing), health, economic situation, and satisfaction with life and with family relationships and a tendency to improve in others areas like use of alcohol and family relationship. These changes are coincident with the users perception. Moreover did not appear deterioration in any of the considered variables. Data show very high satisfaction with the programs in general.
The results of these three studies are relevant because:
1. It has been developed a structured interview that included questions about very important aspects to describe programs for homeless people (people in social exclusion in general).
2. A net of programs for homeless people (good practices) has been described, identifying problems and “strong points”.
3. Changes in the users are identified (along the time), suggesting the utility of these programs to stop the deterioration and improve some areas of the live of these persons.
References
Goldberg, D.P. (1972). The detection of psychiatric illness by questionnaire. Oxford, England: Oxford University Press.
Larsen, D.L., Attkinsson, CC., Hargreaves, W.A., LeVois, M., Nguyen, T.D., Roberts, R.E., y Stegner, B. (1979). Assessment of client / patient satisfaction: development of a general scale. Evaluation and program planning, 2, 197-207.
Lehman, A.F. (1988). A Quality research of Life Interview for the chronically mentally ill. Evaluation and program planning, 11, 51-62.
Moos, R.H. (1996). Community Oriented Programs Environment Scale. A social climate scale. Manual. Mind Garden: Redwood city.
Teague, G.B., Bond, G.R. y Drake, R.E. (1998). Program fidelity in Assertive Community Treatment: Development and use of a measure. American journal of orthopsychiatry, 68, 2, 217-232.