Fidelity to the Housing First Model and Variation in Health Service Use Within Permanent Supportive Housing

Gilmer, Todd; Stefancic, Ana; Henwood, Benjamin F.; Ettner, Susan L.

doi:10.1176/appi.ps.201400564

Cited by 24 publications

(28 citation statements)

References 31 publications

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“…Case managers' role in connecting clients to services removed barriers to care that clients had previously found difficult or impossible to overcome, and support from case managers in addressing transportation coordination, food insecurity and criminal justice system involvement was vital. While service participation is voluntary within the Housing First paradigm, research suggests the essential role of case management and other supportive services in improving residents' likelihood of success and stability in permanent housing (Gilmer, Stefancic, Henwood, & Ettner, ; Henwood et al, ; Quinn et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…A few participants discussed having supportive relationships with neighbours or other members of the local community, but only if those individuals were family, friends known previously, or other clients receiving services from the organisation. (Johnson, Hayes, Brown, Hoo, & Ethier, 2014;Kent, 2018 likelihood of success and stability in permanent housing (Gilmer, Stefancic, Henwood, & Ettner, 2015;Henwood et al, 2018;Quinn et al, 2018).…”

Section: (Participant 1)mentioning

confidence: 99%

See 1 more Smart Citation

Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States

Chhabra

Spector

Demuynck

et al. 2019

Health Soc Care Community

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In the United States and abroad, health systems have begun to address housing insecurity through programs that adhere to the Housing First model. The model provides permanent supportive housing without disqualification due to current mental health problems or substance use, along with optional case management services. This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital utilisation who were housed as part of a scattered‐site Housing First program in a mid‐size city in the northeastern United States. 26 individual, semi‐structured interviews were conducted with Housing First clients in their homes or day program sites between March and July 2017. Interviews were digitally recorded and transcripts were analysed using a qualitative descriptive methodology until thematic saturation was reached. Findings suggest that housing provided the physical location to manage the logistical aspects of care for these clients, and an environment where they were better able to focus on their health and wellness. Study participants reported less frequent use of emergency services and more regular interaction with primary care providers. Additionally, case managers' role in connecting clients to behavioural health services removed barriers to care that clients had previously faced. Housing also facilitated reconnection with family and friends whose relationships with participants had become strained or distant. Changes to physical and social communities sometimes resulted in experiences of stigmatisation and exclusion, especially for clients who moved to areas with less racial and socioeconomic diversity, but participation in the program promoted an increased sense of safety and security for many clients.

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Section: Discussionmentioning

confidence: 99%

Section: (Participant 1)mentioning

confidence: 99%

Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States

Chhabra

Spector

Demuynck

et al. 2019

Health Soc Care Community

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“…Just as the CONSORT guidelines [120] aim to improve the transparency of RCTs, improved reporting in supported accommodation studies would improve both the quality and impact of research in this field. Detailed and clear descriptions of the critical features of supported accommodation models would allow replication studies, enable ongoing exploration and comparison of effectiveness data and, importantly, allow research evidence to be translated into service development and improved outcomes for service users [121]; these benefits are evidenced within the supported accommodation field by the established link between model fidelity and outcomes in Housing First programs [12,13]. Specifically, we recommend that, at a minimum, articles report on the four domains of the STAX-SA— Staffing location , Level of support , Move-on and Physical setting —however, consensus is necessary; future studies identifying the essential elements of supported accommodation models that would shape these guidelines, perhaps using the Delphi method, would be welcomed.…”

Section: Discussionmentioning

confidence: 99%

“…Fidelity scales for Housing First programs, a model of supported housing for homeless individuals with mental health problems, have been developed [11] and, highlighting the importance of model clarity, research has indicated a relationship between program fidelity and service user outcomes [12,13]. Housing first, however, is a specific approach to supported housing and, as noted, there are countless variations of supported accommodation services currently in operation internationally.…”

Section: Introductionmentioning

confidence: 99%

What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA)

McPherson

Krotofil

Killaspy

2018

IJERPH

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Inconsistent terminology and variation in service models have made synthesis of the supported accommodation literature challenging. To overcome this, we developed a brief, categorical taxonomy that aimed to capture the defining features of different supported accommodation models: the simple taxonomy for supported accommodation (STAX-SA). Data from a previous review of existing classification systems were used to develop the taxonomy structure. After initial testing and amendments, the STAX-SA and an existing taxonomy were applied to 132 supported accommodation service descriptions drawn from two systematic reviews and their performance compared. To assess external validity, the STAX-SA was distributed to a sample of supported accommodation managers in England and they were asked to use it to classify their services. The final version of the STAX-SA comprised of five supported accommodation ‘types’, based on four domains; Staffing location; Level of support; Emphasis on move-on; and Physical setting. The STAX-SA accurately categorized 71.1% (n = 94) of service descriptions, outperforming the comparison tool, and was not affected by publication date or research design. The STAX-SA effectively discriminated between ‘real world’ service models in England and 53.2% (n = 17) of service managers indicated that the taxonomy was ‘Very effective’ or ‘Extremely effective’ in capturing key characteristics of their service. The STAX-SA is an effective tool for classifying supported accommodation models and represents a promising approach to synthesizing the extant effectiveness literature. The authors recommend the development of reporting guidelines for future supported accommodation publications to facilitate comparison between models.

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“…on-site vs. off-site). A study of 93 programmes across California found significant variation in fidelity to housing first and the array of services offered, due to numerous factors including the specific county system in which the programme was located (Gilmer, Katz, Stefancic, & Palinkas, 2013;Gilmer, Stefancic, Henwood, & Ettner, 2015). Other studies of PSH that have considered variation in service delivery have been part of experimental designs to test Housing First rather than reflecting typical programmatic differences (Aubry et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Availability of comprehensive services in permanent supportive housing in Los Angeles

Henwood

Harris

Woo

et al. 2017

Health Soc Care Community

Self Cite

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Studies have often described a specific model or models of permanent supportive housing (PSH), yet few studies have systematically examined what services are typically offered to PSH tenants in any given service system and how those services are offered. Using telephone surveys from 23 PSH agency supervisors and qualitative data collected from 11 focus groups with 60 frontline providers and 17 individual interviews with supervisors from a subset of surveyed agencies-all of which were completed between July 2014 and December 2015-the goal of this study is to better understand what services are being offered in PSH organisations located in Los Angeles and what barriers frontline providers face in delivering these services. Survey findings using statistical frequencies suggest the existence of robust support services for a high-needs population and that single-site providers may offer more services than scatter-site providers. Qualitative thematic analysis of interview and focus group transcripts suggests services may be less comprehensive than they appear. If PSH is to be regarded as an intervention capable of more than "just" ending homelessness, further consideration of the provision of supportive services is needed.

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Fidelity to the Housing First Model and Variation in Health Service Use Within Permanent Supportive Housing

Cited by 24 publications

References 31 publications

Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States

Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States

What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA)

Availability of comprehensive services in permanent supportive housing in Los Angeles

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