Do different understandings of people experiencing severe and multiple disadvantage (SMD) influence the attributions and behavioural intentions of staff working in homelessness services?
Publication Date
July 31, 2026
Creator
Nolan, Rachael
Trent Doctorate in Clinical Psychology, University of Nottingham
Abstract
Background: ‘Severe and Multiple Disadvantage’ (SMD) refers to individuals experiencing intersecting difficulties with homelessness, substance use, mental health, domestic violence, and criminal justice involvement. Different theoretical understandings of individuals experiencing SMD could influence the attributions staff make about the causes of a person’s difficulties and how staff provide support to service-users. This study examined whether different understandings of SMD affect the attributions and behavioural intentions of staff to support affected individuals.
Method: A mixed-methods approach was utilised. Seventy-nine professionals working in homelessness services were randomly assigned to view one of three vignettes describing an individual experiencing SMD (biographical, CBT-informed, values-informed). Participants completed an online measure of attribution and two qualitative questions. Quantitative data were analysed using a one-way ANOVA and Kruskal-Wallis tests. Qualitative data were analysed using inductive content analysis.
Results: CBT-informed conceptualisations were associated with higher attributions of dangerousness and emotional responses of fear. No other significant differences were found between groups. Qualitative findings substantiated significant results. Main categories developed across groups included; prioritising risk, multi-agency approaches, influence of past context on present, importance of the therapeutic relationship, flexible approaches and promoting autonomy and engagement.
Conclusions: Findings tentatively indicate staff attributions and emotional responses are sensitive to different understandings of SMD and influence behavioural intentions to support individuals affected. Specifically, CBT-informed understandings may contribute to increased attributions of dangerousness and fear, whilst values-informed conceptualisations may support to reduce them. Implications for incorporating psychologically informed understandings of SMD within interventions and clinical practice are discussed. Further research is needed, but current findings may tentatively offer preliminary support for integrating values-based understandings of service-users into services supporting SMD.
Keywords: severe and multiple disadvantage, attribution, behavioural intention, vignettes, mixed methodology, qualitative, quantitative
Item Type
ethesis
Thesis Type
DClinPsy
Supervisors
Associate Professor and Senior Research Tutor, Trent Doctorate in Clinical Psychology
Cogger-ward Heather
Subjects (LC)
Associated Schools / Departments
UoN Repository URI
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BRP 2025 20411106 26114806 Thesis Second Submissionl.pdf
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