Strategies for Sustaining Fidelity: A Multi-state Qualitative Analysis in Housing First Programs

This study examines how staff at ‘mature’ (eight or more years in operation) Housing First (HF) programs strategize to sustain EBI fit in different geographic areas in the Mid-Atlantic/Northeastern United States. Six focus groups (FGs) at three purposively selected HF programs were conducted with separate FGs for case managers and supervisors at each site. FG discussions elicited participants’ service approaches and strategies in addressing fidelity amidst ongoing changes affecting each program. Thematic content analysis of FG transcripts was conducted using the five HF fidelity domains (housing choice/structure, separa tion of housing and services, service philosophy, service array, and program structure) as a priori themes with inductive content analyses conducted on data in each theme. Strategies for rigor were employed. Case managers (N = 17) and supervisors (N = 16) were predominantly white (76%) and f emale (60%). Across the themes, challenges included lack of affordable housing and choice, funders’ restrictions and practice ‘drift.’ Strategies included community engagement and hiring, strong leadership and ‘bending the rules.’ There were no differences across sites. Later-stage impleme ntation challenges show the need for continued vigilance in fidelity to EBIs. Among the strategies used to address fidelity in this study, the pursuit of pro-active community engagement to attract knowledgeable staff as well as increase local buy-in was considered...

Source: Administration and Policy in Mental Health and Mental Health Services Research - April 22, 2020 Category: Psychiatry Source Type: research