Development and Initial Validation of the Observer-Rated Housing Quality Scale (OHQS) in a Multisite Trial of Housing First

Abstract

Quality of housing has been shown to be related to health outcomes, including mental health and well-being, yet "objective" or observer-rated housing quality is rarely measured in housing intervention research. This may be due to a lack of standardized, reliable, and valid housing quality instruments. The objective of this research was to develop and validate the Observer-Rated Housing Quality Scale (OHQS) for use in a multisite trial of a "housing first" intervention for homeless individuals with mental illness. A list of 79 housing unit, building, and neighborhood characteristics was generated from a review of the relevant literature and three focus groups with consumers and housing service providers. The characteristics were then ranked by 47 researchers, consumers, and service providers on perceived importance, generalizability, universality of value, and evidence base. Items were then drafted, scaled (five points, half values allowed), and pretested in seven housing units and with seven raters using cognitive interviewing techniques. The draft scale was piloted in 55 housing units in Toronto and Winnipeg, Canada. Items were rated independently in each unit by two trained research assistants and a housing expert. Data were analyzed using classical psychometric approaches and intraclass correlation coefficients (ICC) for inter-rater reliability. The draft scale consisted of 34 items assessing three domains: the unit, the building, and the neighborhood. Five of 18 unit items and 3 of 7 building items displayed ceiling or floor effects and were adjusted accordingly. Internal consistency was very good (Cronbach's alpha=0.90 for the unit items, 0.80 for the building items, and 0.92 total (unit and building)). Percent agreement ranged from 89 to 100 % within one response scale value and 67 to 91 % within one half scale value. Inter-rater reliability was also good (ICCs were 0.87 for the unit, 0.85 for the building, and 0.93 for the total scale). Three neighborhood items (e.g., distance to transit) were found to be most efficiently rated using publicly available information. The physical quality of housing can be reliably rated by trained but nonexpert raters using the OHQS. The tool has potential for improved measurement in housing-related health research, including addressing the limitations of self-report, and may also enable documenting the quality of housing that is provided by publicly funded housing programs. Adair is with the

SÉCuRE: A clinical tool for comprehensively assessing home safety of people with mental illness

“…An increasing number of persons with mental illness, including those with more severe forms of mental health illnesses, live in independent housing, an environment requiring the accomplishment of various activities and involving activity patterns (for example, time management, engagement) with ranging levels of complexity, which may raise safety issues. Moreover, they often have to live in substandard living environments (Bengtsson-Tops et al., 2014; Byrne et al., 2013), which go hand-in-hand with increased health and safety risks (Adair et al., 2014). However, although the occurrence of the risk could actually lead to incidents and thus be a source of damage, the presence of risk factors is not sufficient in and of itself to compromise home safety.…”

Housing Quality in a Randomized Controlled Trial of Housing First for Homeless Individuals with Mental Illness: Correlates and Associations with Outcomes

“…Internal consistency and inter-rater reliability were established in a pilot study for the unit and building subscales. 1 The neighborhood items were not populated in the pilot, so less is known about their performance.…”

“…1 The evidence for connections between housing quality (HQ) and mental health is more recent but is also accumulating. 2 , 3 Two examples of single exposure/outcome associations are those between insufficient daylight and depressive symptoms and between noise levels and psychological distress.…”

“…13 We previously reported on the development and initial validation of an instrument for this purpose (the Observer-rated Housing Quality Scale, or OHQS). 1 This article describes the systematic measurement of HQ and its relation to outcomes in a multi-site randomized controlled trial (RCT) investigating the effectiveness of Housing First (HF) for adults with serious mental illness (and substance use disorders if concurrent) in five Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, and Moncton). Housing First involves relatively immediate provision of housing and supports, through rent subsidies and usually in scattered site apartments in the private housing market, that is not conditional on treatment compliance or sobriety.…”

Measuring deterioration of small-area housing environment: Construction of a multi-dimensional assessment index and validation in shared refugee accommodation

“…Existing housing quality indices, e.g. the Observer-Rated Housing Quality Scale ( Adair et al, 2014 ) the Housing Quality Index ( Elsinga & Hoekstra, 2005 ; Hoekstra, 2009 ) or the domain on physical and architectural resources of The Multiphasic Environmental Assessment Procedure ( Moos & Lemke, Thousand Oaks ) and other instruments ( Shenassa, Daskalakis, Liebhaber, Braubach, & Brown, 2007 ; Suglia, Duarte, & Sandel, 2011 ; Wells & Harris, 2007 ), mainly focus on structural aspects. Such aspects are of permanent nature and do not include questions of deterioration which could be prevented by care and maintenance in due time.…”