Abstract
BackgroundThe Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors. The model has been widely diffused across the United States since 2000 as a result of positive findings related to consumer outcomes. However, a lack of clear fidelity guidelines has resulted in inconsistent implementation. The research team and their community partner collaborated to develop a HFM Fidelity Index. We describe the instrument development process and present results from its initial testing.MethodsThe HFM Fidelity Index was developed in two stages: (1) a qualitative case study of four HFM organizations and (2) interviews with 14 HFM "users". Reliability and validity of the index were then tested through phone interviews with staff members of permanent housing programs. The final sample consisted of 51 programs (39 Housing First and 12 abstinence-based) across 35 states.ResultsThe results provided evidence for the overall reliability and validity of the index.ConclusionsThe results demonstrate the index’s ability to discriminate between housing programs that employ different service approaches. Regarding practice, the index offers a guide for organizations seeking to implement the HFM.
Highlights
The Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors
Recognizing wide diffusion of the HFM without fidelity guidelines had resulted in variations from the original model, we took a bottom-up approach to the development of the index that sought to identify and operationalize the critical elements of the HFM that differentiate it from the abstinence-based approach [37,38]
In order to create the groups, we identified all questions in the survey that indicated the presence of abstinence-based policies and/or practices (e.g., Does the program explicitly refuse to admit active substance users?; Does policy dictate that the program terminate consumers for active substance use?; Does your program require drug and/or alcohol abstinence of all consumers? Does your program work with substance abusing consumers using an abstinence-based approach?) and we moved a HF program to the Housing First with abstinence-based principles and/or practices (HF/AB) category if answers to any of these questions indicated the presence of abstinence-based policies and/or practices
Summary
The Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors. While substance abuse likely contributes to housing instability in some way (e.g., potential difficulty managing money and paying rent or increased potential for interpersonal disputes), it is important to recognize that structural-level barriers to stable permanent housing exist. Chief among these barriers are the stated and unstated policies determining. Developed in response to problems such as these, the Housing First Model (HFM) places lower demands on consumers It has become the driving force of policies aimed at ending chronic homelessness due to its success engaging “hard-to-serve” individuals [4,5,6]. In this paper we present results related to the development and testing of the index
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