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Strategies for Sustaining Fidelity: A Multi-state Qualitative Analysis in Housing First Programs

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Abstract

Little is known about long-term fidelity of evidence-based interventions (EBIs) under changing conditions. This study examines how staff at ‘mature’ (eight or more years in operation) Housing First (HF) programs strategize to sustain EBI fit in different geographic areas in the Mid-Atlantic/Northeastern United States. Six focus groups (FGs) at three purposively selected HF programs were conducted with separate FGs for case managers and supervisors at each site. FG discussions elicited participants’ service approaches and strategies in addressing fidelity amidst ongoing changes affecting each program. Thematic content analysis of FG transcripts was conducted using the five HF fidelity domains (housing choice/structure, separation of housing and services, service philosophy, service array, and program structure) as a priori themes with inductive content analyses conducted on data in each theme. Strategies for rigor were employed. Case managers (N = 17) and supervisors (N = 16) were predominantly white (76%) and female (60%). Across the themes, challenges included lack of affordable housing and choice, funders’ restrictions and practice ‘drift.’ Strategies included community engagement and hiring, strong leadership and ‘bending the rules.’ There were no differences across sites. Later-stage implementation challenges show the need for continued vigilance in fidelity to EBIs. Among the strategies used to address fidelity in this study, the pursuit of pro-active community engagement to attract knowledgeable staff as well as increase local buy-in was considered pivotal at all three sites. These findings underscore the need to attend to the external setting as well as to internal program operations.

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Notes

  1. P5 = Participant #5; FG3 = Focus Group #3.

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Funding

This study was funded by the National Institute of Mental Health R01MH084903.

Author information

Authors and Affiliations

  1. University of Minnesota, 1404 Gortner Avenue, St. Paul, MN, 55108, USA

    Mimi Choy-Brown

  2. Rutgers University, 360 Martin Luther King Jr. Boulevard, Newark, NJ, 07102, USA

    Emmy Tiderington

  3. University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA

    Bikki Tran Smith

  4. New York University, 1 Washington Square North, New York, NY, 10011, USA

    Deborah K. Padgett

  5. Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA

    Ana Stefancic

Authors
  1. Mimi Choy-Brown
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  2. Emmy Tiderington
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  3. Bikki Tran Smith
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  4. Deborah K. Padgett
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  5. Ana Stefancic
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Correspondence to Mimi Choy-Brown.

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The authors declare that they have no conflict of interest.

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All study protocols were approved by the authors’ University Committee on Activities Involving Human Subjects (Reference #; 10-0338). This article does not contain any studies with animals performed by any of the authors.

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Choy-Brown, M., Tiderington, E., Tran Smith, B. et al. Strategies for Sustaining Fidelity: A Multi-state Qualitative Analysis in Housing First Programs. Adm Policy Ment Health 48, 36–45 (2021). https://doi.org/10.1007/s10488-020-01041-2

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