title: Social Relationships of Dually Diagnosed Homeless Adults Following Enrollment in Housing First or Traditional Treatment Services.
abstract: OBJECTIVE
  Strong and effective social support is a critical element of mental health recovery, yet social support is often lacking for adults experiencing homelessness. This study examines differences in the social networks of participants newly enrolled in programs that use either a Housing First (HF) approach (i.e., provides immediate access to permanent housing with ongoing consumer-driven support services) or a treatment first (TF) approach (i.e., traditional clinician-driven staircse model that requires temporary or transitional housing and treatment placements before accessing permanent housing).
  
  
  METHODS
  We use a mixed-methods social network analysis approach to assess group differences of 75 individuals based on program type (HF or TF) and program retention.
  
  
  RESULTS
  Quantitative results show that compared with TF, HF participants have a greater proportion of staff members in their network. TF participants are more likely than HF participants to maintain mixed-quality relationships (i.e., relationships with elements of support and conflict). As compared with participants who remain in a program, those who disengage from programs have a greater proportion of mixed relationships and relationships that grow distant. Qualitative analyses suggest that HF participants regard housing as providing a stable foundation from which to reconnect or restore broken relationships. However, HF participants are guarded about close relationships for fear of being exploited due to their newly acquired apartments. TF participants report that they are less inclined to develop new relationships with peers or staff members due to the time-limited nature of the TF programs.
  
  
  CONCLUSIONS
  These findings suggest that HF participants are not more socially isolated than those in traditional care. Implications for practice, policy and future research are discussed.
authors.affiliation: University of Southern California.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Henwood
authors.affiliation: Columbia University.
authors.forename: Ana
authors.initials: A
authors.lastname: Stefancic
authors.affiliation: University of Southern California.
authors.forename: Robin
authors.initials: R
authors.lastname: Petering
authors.affiliation: University of Southern California.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schreiber
authors.affiliation: New York University Medicine.
authors.forename: Courtney
authors.initials: C
authors.lastname: Abrams
authors.affiliation: New York University.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Padgett
keywords: homelessness; mixed methods; recovery; supportive housing