Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers, Training/Technical Assistance, and Points of Leverage

Abstract

We present interim findings of a cross-site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence-based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early implementation were conducted in six Canadian communities receiving HF TTA. The primary data are field notes gathered over 1.5 years and evaluations from site-specific training events (k = 5, n = 302) and regional network training events (k = 4, n = 276). We report findings related to: (a) the facilitators of and barriers to early implementation, (b) the influence of TTA on early implementation, and (c) the "levers" used to facilitate broader systems change. Systems change theory enabled us to understand how various "levers" created opportunities for change within the communities, including establishing system boundaries, understanding how systems components can function as causes of or solutions to a problem, and assessing and changing systems interactions. We conclude by arguing that systems theory adds value to existing implementation science frameworks and can be helpful in future research on the implementation of evidence-based practices such as HF which is a complex community intervention. Implications for community psychology are discussed.

Examining peer networking as a capacity‐building strategy for Housing First implementation

“…Complex interventions—such as HF—are difficult to implement because they require engagement across multiple stakeholder groups, adaptation of the original innovation to fit the local context, and changes to existing service provision systems and resource distribution (Moore & Westley, ; Pawson, Greenhalgh, Harvey, & Walshe, ). HF implementation can be considered a form of disruptive innovation because it represents a shift away from the traditional “treatment‐first approach” and involves changes both at program and systems levels (Goering & Tsemberis, ; Worton et al, ).…”

“…To successfully implement HF programs, community homelessness service providers need a high level of capacity both in terms of their knowledge of the HF approach, and their ability to navigate and manage change (Worton et al, ). Organizations need to be able to determine how HF fits with the local context, and adapt the model where possible to improve the fit.…”

“…The implementation of HF requires a high level of involvement from community stakeholders and leaders. The planning process involves framing the issue of homelessness, educating stakeholders and correcting misunderstandings about HF, assessing fit, solving problems, and developing partnerships across sectors (Austin et al, ; Macnaughton et al, ; Worton et al, ). Continued capacity development is important to sustain, improve, and expand HF programs to meet the diverse needs of individuals experiencing homelessness in the community.…”

“…Research examining network approaches within the homelessness sector is promising but is also limited. Collaboration and support among partnering agencies has been shown to positively influence HF implementation by creating opportunities for learning and problem‐solving (Stergiopoulos et al, ; Worton et al, ). Community of practice calls have been used successfully as a component of training and technical assistance initiatives (Nelson et al, ).…”

“…The establishment of the SW5 occurred at a time when HF had a strong evidence‐base in Canada (primarily from the At Home/Chez Soi research demonstration project) and had been incorporated into policy as a requirement in federal funding mandates (i.e., the Homelessness Partnering Strategy). A national training and technical assistance initiative for HF was underway, and a number of SW5 communities received HF training, technical assistance, and fidelity assessments through this initiative (Worton et al, ).…”