Open access

Implementation Evaluation of a Housing First Program in a Small Canadian City

Publication: Canadian Journal of Community Mental Health
1 December 2014

Abstract

This paper describes the implementation of Housing First in a small Canadian city. Given that the majority of Housing First research has been conducted in large American cities, providing a Canadian context in a small city contributes significant insights for similarly sized areas. The main objectives were to determine the adaptations made to the Housing First model and the contextual realities that affected implementation. Data were collected from two sources: (a) a fidelity assessment by an external team of experts; and (b) key informant interviews and focus groups with program staff and consumers. Results demonstrate that Housing First can be successfully implemented in a small city but with certain constraints and adaptations, notably more limited consumer choice of housing, challenges related to consumer access to transportation, and adaptations to program staffing. Implications for practice are discussed.

Résumé

Le travail décrit l'implantation d'un programme de logement d'abord (Housing First) dans une petite ville canadienne. Une étude dans ce contexte contribue des nouvelles connaissances car la majorité des études sur le logement d'abord ont été complétées dans des grandes villes américaines. Les objectifs principaux de la recherche étaient de documenter les adaptations faites au modèle logement d'abord et les facteurs qui affectaient son implantation. Les données ont été collectionnées de deux sources: (a) Une évaluation de fidélité par une équipe d'experts externes au programme; et (b) des entrevues et groupes de discussion avec le personnel et les usagères et usagers affiliés au programme. Les résultats démontrent que le logement d'abord peut être implanté dans une petite ville mais avec certaines limites et adaptations, notamment des limites reliées aux choix des logements par les usagères et usagers, des défis associés avec l'accès au transport, et des adaptations reliés à la composition de l’équipe des intervenants et intervenantes. Les implications des résultats pour l'implantation des programmes de logement d'abord sont discutées.

Formats available

You can view the full content in the following formats:

References

Aubry, T., Cherner, R., Ecker, J., Jetté, J., & Philander, K. (2011). Implementation evaluation report for Mental Health Commission of Canada's At Home / Chez Soi Project: Moncton Site. Ottawa, ON: Centre for Research on Educational and Community Services & Centre de recherche et développement en education.
Aubry, T., Ecker, J., & Jetté, J. (2014). Supported housing a promising Housing First approach for people with severe and persistent mental illness. In M. Guirguis, R. McNeil, & S. Hwang (Eds.), Homelessness and health (pp. 155–188). Ottawa, ON: University of Ottawa Press.
Beardsley K., Wish E. D., Bonanno Fitzelle D., O'Grady K., and Arria A. M. Distance traveled to outpatient drug treatment and client retention Journal of Substance Abuse Treatment 2003 25 4 279 -285
Berg, B. L. (1989). Qualitative research methods for the social sciences. London, England: Allyn and Bacon.
Canada Mortgage and Housing Corporation. (2013). Rental market report: Moncton CMA. (CMHC Publication No. 64407_2013_A01). Retrieved from http://www.cmhc-schl.gc.ca/odpub/esub/64407/64407_2013_A01.pdf
Carling, P. J. (1995). Return to community: Building support systems for people with psychiatric disabilities. New York, NY: Guilford Press.
Charmaz, K. (2006). Coding in grounded theory practice. In K. Charmaz (Ed.), Constructing grounded theory: A practical guide through qualitative analysis (pp. 42–71). Thousand Oaks, CA: Sage.
City of Moncton (2011). Moncton statistics. Retrieved from http://www.moncton.ca/Moncton__Our_Tide_is_Rising.htm
Dealberto M. J, Middlebro A., and Farrell S. Symptoms of schizophrenia and psychosis according to foreign birth in a Canadian sample of homeless persons Psychiatric Services 2011 62 10 1187 -1193
Fortney J. C., Booth B. M., Blow F. C., Bunn J. Y., and Loveland C.A. The effects of travel barriers and age on the utilization of alcoholism treatment aftercare American Journal of Drug and Alcohol Abuse 1995 21 3 391 -406
Goering P. N., Streiner D. L., Adair C., Aubry T., Barker J., Distasio J., and Zabkiewicz D. N. The At Home / Chez Soi trial protocol: A pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities BMJ Open 2011 1 2
Gordon A. J., Haas G. L., Luther J. F., Hilton M. T., and Goldstein G. Personal, medical, and healthcare utilization among homeless veterans served by metropolitan and nonmetropolitan veteran facilities Psychological Services 2010 7 2 65 -74
Greater Moncton. Homelessness Steering Committee. (2013). The sixth report card on homelessness in Greater Moncton. Retrieved from http://monctonhomelessness.org/documents/2013-6th-report-card-gmhomelessness.pdf on January 16, 2014.
Greenwood R. M., Schaefer-McDaniel N. J., Winkel G., and Tsemberis S. J. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness American Journal of Community Psychology 2005 36 3/4 223 -238
Greenwood R. M., Stefancic A., and Tsemberis S. Pathways housing first for homeless persons with mental illness: Program innovation, research, and advocacy Journal of Social Issues 2013 69 4 645 -663
Kales J. P., Barone M. A., Bixler E. O., Miljkovic M. M., and Kales J. D. Mental illness and substance use among sheltered homeless persons in lower-density population areas Psychiatric Services 1995 46 6 592 -595 Retreived from http://www.ncbi.nlm.nih.gov/pubmed/7641001
Kloos B., Zimmerman S. O., Scrimenti K., and Crusto C. Landlords as partners for promoting success in supported housing: “It takes more than a lease and a key.” Psychiatric Rehabilitation Journal 2002 25 3 235 -244
Lee B. A. and Price-Spratlen T. The geography of homelessness in American communities: Concentration or dispersion? City & Community 2004 3 1 3 -27
Macnaughton E., Nelson G., and Goering P. Bridging politics and evidence together: Policy entrepreneurship and the conception of the At Home / Chez Soi Housing First initiative for addressing homelessness and mental illness in Canada Social Science & Medicine 2013 82 100 -107
Maxwell, J. (1998). Designing a qualitative study. In L. Bickman & D. J. Rog (Eds.), Handbook of applied social research methods, (pp. 69–100). Thousand Oaks, CA: Sage.
Nelson G., Aubry T., and Lafrance A. A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless American Journal of Orthopsychiatry 2007 77 3 350 -361
Nelson G., Stefancic A., Rae J., Townley G., Tsemberis S., Macnaughton E., and Goering P. Early implementation evaluation of a multi-site housing first intervention for homeless people with mental illness: A mixed methods approach Evaluation and Program Planning 2014 43 16 -26
Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Thousand Oaks, CA: Sage.
Pearson C., Montgomery A. E., and Locke G. Housing stability among homeless individuals with serious mental illness participating in housing first programs Journal of Community Psychology 2009 37 3 404 -417
Ryan, G. & Bernard, H. R. (2000). Data management and analysis methods. In N. K. Denzin and Y. S. Lincoln (Eds.), Handbook of Qualitative Research (2nd ed., pp.769–802). Thousand Oaks, CA: Sage.
Statistics Canada. (2013). Population of census metropolitan areas. Retrieved from http://www.statcan.gc.ca/tablestableaux/sum-som/l01/cst01/demo05a-eng.htm
Statistics Canada. (2014). Population counts, for Canada, provinces and territories, census divisions, population centre size groups and rural areas, 2011 Census. Retrieved from http://www12.statcan.ca/census-recensement/2011/dp-pd/hlt-fst/pd-pl/Table-Tableau.cfm?LANG=Eng&T=703&PR=13&S=80&O=A&RPP=99
Stefancic A. and Tsemberis S. Housing first for long-term shelter dwellers with psychiatric disabilities in a suburban county: A four-year study of housing access and retention Journal of Primary Prevention 2007 28 3/4 265 -279
Stefancic A., Tsemberis S., Messeri P., Drake R., and Goering P. The Pathways Housing First fidelity scale for individuals with psychiatric disabilities American Journal of Psychiatric Rehabilitation 2013 16 4 240 -261
Tabol C., Drebing C., and Rosenheck R. Studies of “supported” and “supportive” housing: A comprehensive review of model descriptions and measurement Evaluation and Program Planning 2010 33 4 446 -456
Tsemberis S. From streets to homes: An innovative approach to supported housing for homeless adults with psychiatric disabilities Journal of Community Psychology 1999 27 2 225 -241
Tsemberis, S. (2010). Housing First: The Pathways model to end homelessness for people with mental illness and addiction. Center City, MN: Hazelden.
Tsemberis S. and Asmussen S. From streets to homes: The Pathways to Housing consumer preference supported housing model Alcoholism Treatment Quarterly 1999 17 1–2 113 -131
Tsemberis S. and Eisenberg R. F. Pathways to Housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities Psychiatric Services 2000 51 4 487 -493
Tsemberis S., Gulcur L., and Nakae M. Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis American Journal of Public Health 2004 94 4 651 -656 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448313/
United States Census Bureau. (2013). 2010 census urban and rural classification and urban area criteria. Retrieved from http://www.census.gov/geo/reference/ua/urban-rural-2010.html
Whitzman C. At the intersection of invisibilities: Canadian women, homelessness and health outside the “big city.” Gender, Place and Culture 2006 13 4 383 -399
Yanos P. T., Barrow S. M., and Tsemberis S. Community integration in the early phase of housing among homeless persons diagnosed with severe mental illness: Successes and challenges Community Mental Health Journal 2004 40 2 133 -150

Information & Authors

Information

Published In

cover image Canadian Journal of Community Mental Health
Canadian Journal of Community Mental Health
Volume 33Number 4December 2014
Pages: 23 - 40

History

Version of record online: 1 December 2014

Key Words

  1. Housing First
  2. small city
  3. implementation evaluation
  4. fidelity assessment
  5. program design

Mots-clés

  1. Logement d'abord
  2. petite ville
  3. implantation
  4. évaluation de fidélité
  5. développement de programme

Authors

Affiliations

Tim Aubry
Rebecca Cherner
Jonathan Jetté

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

There are no citations for this item

View Options

View options

PDF

View PDF

Get Access

Login options

Check if you access through your login credentials or your institution to get full access on this article.

Subscribe

Click on the button below to subscribe to Canadian Journal of Community Mental Health

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media