De-Implementation: Lessons to be Learned when Abandoning Inappropriate Homelessness Interventions

Abstract

Evidence on what works to end homelessness is growing. Evidence also highlights that some forms of help are harmful and should be de-implemented. The ability to abandon low-functioning interventions is considered essential to improve conditions for homeless people. It is common for challenges to be encountered when evidence exists claiming that alternative approaches are more effective and/or cost-effective. This is particularly true in the context of the problematic staircase model and the highly effective Housing First. In this study, the aim was to collect published articles on the process of abandoning established methods with low scientific support. This scoping review explores evidence on de-implementation that may clarify why it can be difficult to introduce interventions like Housing First despite having strong scientific evidence. The call for a shift toward greater provision of Housing First in Sweden underlines the timeliness of this problem. Forty-one articles published between 2014 and 2020 were included. The review found no articles focusing on the de-implementation of homelessness services. Findings from other fields show that the important first step is to identify what needs to be phased out. Together with organized demands from users and favorable financial effects, scientific evidence can constitute driving mechanisms for de-implementation. We found a lack of practical frameworks and theoretical explanations that could support successful phasing out of unnecessary interventions in the homelessness field. It is suggested that to support the implementation of new ways of working that better benefit homeless people, we must pay attention to established ways of working. This requires a developed theory of de-implementation of homelessness interventions and calls for more robust research.

Socialt arbete i förändring

“…Cirka 30 procent av samtliga sjukvårdsinsatser i Kanada och USA beräknas tillhöra någon av dessa två kategorier (Born, Kool, & Levinson, 2019). Liknande beräkningar saknas dock för socialt arbete, såväl i Sverige som internationellt (Denvall et al, 2022). Socialstyrelsen utformar stöd för hur evidens ska implementeras och tar fram nationella riktlinjer utifrån befintlig forskning.…”

“I can’t remember the last time I was comfortable about being home”: lived experience perspectives on thriving following homelessness

“…Such services have come to be known as “staircase supports” (SS) or “treatment first” approaches, and emphasize the use of shelters, transitional housing, and abstinence-based services designed to encourage “housing readiness”. SS have long been criticized for creating undignified circumstances that neglect the needs of individuals by denying the right to permanent housing, and have been deemed to be largely ineffective for improving housing and well-being outcomes (Denvall et al, 2022 ). These criticisms have led to widespread abandonment of SS in recent years (Denvall et al, 2022 ).…”

“…SS have long been criticized for creating undignified circumstances that neglect the needs of individuals by denying the right to permanent housing, and have been deemed to be largely ineffective for improving housing and well-being outcomes (Denvall et al, 2022 ). These criticisms have led to widespread abandonment of SS in recent years (Denvall et al, 2022 ). Instead, other approaches including “Critical Time Intervention” (CTI) and “Housing First” (HF) have since been adopted in place of SS (Ponka et al, 2020 ; Tsemberis, 2010 ).…”

Implementation structures at work. Exploring implementation and de‐implementation attempts regarding Housing First and Individual Placement and Support

“…At the same time, national guidelines advocate implementation and person‐centred interventions and thus collaboration between agencies should be based on the users' best interests, but without clarifying how contrasting and often directly contradictory interventions should be addressed. To succeed with implementation, it is proposed that several established procedures and working methods may need to be eliminated if new methods are to replace them (Denvall et al, 2022).…”