We focus on two bodies of literature. One describes the roles consumers are undertaking in research, policy, planning, and service delivery; the other considers the evidence for choice-based, consumer-centered housing and service programs. Both bodies of literature include primary documents; Web sites; descriptive material on meetings, trainings, policies, and programs; research reports; conference proceedings; journal articles; and book chapters. The literature varies in the extent to which it is research-based and in the type and rigor of study design and methods. Research includes qualitative studies, surveys, case studies, controlled quasi-experimental outcome evaluations, and randomized clinical trials. Its focus also varies: people who are homeless versus related groups such as consumers of mental health services who may or may not be homeless; or interventions aimed at homelessness versus those addressing clinical outcomes, employment, well-being, or recovery.
Although work in these two areas has proceeded independently, we argue that they are best understood as two dimensions of an overarching theme that is expressed in such concepts as self determination and agency. The first dimension (consumer involvement in research, policy, planning and service delivery) is concerned with consumer participation in the collective deliberations and actions that determine how homelessness is understood and addressed; the second focuses on identifying and assessing the effectiveness of service and housing configurations that maximize individual choice and control among people who experience homelessness. Exhibit 1 offers a provisional model of the how these are related and the barriers and strategies that influence individual outcomes and system-level change.
We begin this review with a discussion of consumer involvement in research, policy, planning, and service delivery. To document consumer involvement in research, we draw on both publications describing consumer experiences in new research roles and studies that evaluate consumer performance as interviewers or assess the quality of research using participatory approaches. When we turn to involvement in policy and planning, there are no formal evaluations. The evidence lies in position papers, minutes of meetings posted on Web sites, conference slideshow presentations, and a few published conceptual articles. In contrast, work on consumer involvement in service delivery encompasses qualitative descriptions based on observations, focus groups, and interviews; quasi-experimental studies of effects of consumer staff on client outcomes; and randomized trials of consumer-delivered interventions.
Within each domain of involvement, our review documents both the roles consumers are assuming and the strategies that they and their allies have developed for moving beyond token participation toward full integration. We conclude the review of consumer integration in research, policy, planning, and service delivery with a discussion of common barriers that obstruct this effort, both at the societal level and within each domains institutional structures, and current or proposed approaches to addressing them.
Since the purpose of consumer involvement in research, policy, planning, and service delivery is to ensure that decisions in these domains incorporate the experiences, perspectives, and preferences of those whose lives they affect, integration should lead to enhanced self-determination for individuals who are experiencing homelessness, creating the conditions for expanding their options and honoring their choices. In the second part of the paper we review the literature on choice-based services and housing. Here we describe surveys of housing and service preferences of people who are homeless and a number of quasi-experimental studies and randomized trials of a consumer-driven housing first model of supported housing. Other choice-based approaches are yet to be studied systematically, though we cite descriptive accounts of emerging practices.