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Aims: This study explored community integration within a Moving On initiative that assisted individuals with the transition from permanent supportive housing (PSH) to more independent housing without service requirements. Methods: Participants completed baseline interviews while in PSH (n = 90) and, for those who moved on, a follow‐up 1‐year post‐move (n = 45). Bivariate analyses and OLS regression were used to examine community integration outcomes and potential correlates. Results: For participants who moved on, subjective social quality of life and sense of community were higher post‐move, while physical integration decreased, and time spent at home increased. Gender, mastery, and housing quality were associated with community integration post‐move. Conclusion: Moving On did not adversely impact most aspects of community integration, though PSH residents may need more support to facilitate participation in routine activities outside their home post‐move. Findings also highlight the importance of supporting mastery given its potential role in community integration. [ABSTRACT FROM AUTHOR]

The benefits of Pathways Housing First in addressing chronic homelessness for persons with severe mental illness have been well established. However, the implementation and effectiveness of such programs in rural areas has yet to be examined. We described the model's adaptations in Vermont, including the use of hybrid assertive community treatment-intensive case management teams, which consisted of service coordinators with geographically based caseloads (staff/client ratio of 1:20) and regional multidisciplinary specialists. The program's innovative and widespread inclusion of technology into operations facilitated efficiency and responsiveness, and a pilot telehealth initiative supplemented in-person client visits. The program achieved a housing retention rate of 85% over approximately 3 years, and consumers reported decreased time spent homeless, demonstrating that program adaptations and technological enhancements were successful. INSET: INNOVATION: TECHNOLOGY. [ABSTRACT FROM AUTHOR]

Pathways Housing First (PHF) is an innovative, evidence-based model of providing permanent housing and services to adults with severe mental illness. This approach has been widely and rapidly disseminated across the U.S. and internationally, but sometimes with considerable variability from the original PHF model. This study developed and validated a PHF fidelity scale. The PHF model's guiding principles and prospective ingredients were identified through reviews of PHF literature and relevant fidelity scales, interviews with PHF administrators, and a survey administered to HF providers. An expert panel developed the items into a fidelity scale, which was field-tested as part of two large-scale research initiatives in California and Canada. General guiding principles for PHF included (a) eliminating barriers to housing access and retention, (b) fostering a sense of home, (c) facilitating community integration and minimizing stigma, (d) utilizing a harm-reduction approach, and (e) adhering to consumer choice and providing individualized consumer-driven services that promote recovery. The provider survey demonstrated that 32 key ingredients, derived from these principles, had good face and content validity. An expert panel refined the wording of these ingredients, added new items when there was consensus, and developed operational criteria to measure them. The resulting 38-item fidelity scale generally had good internal consistency; it captured variability in program implementation; it demonstrated discriminant validity; and it was useful in guiding program implementation and technical assistance. In conjunction with other program materials, the fidelity scale can be used as a guide for program development and technical assistance and as a research tool. Examining how these key ingredients relate to the model's success will contribute to a broader understanding of how to end homelessness and facilitate recovery. [ABSTRACT FROM AUTHOR]

To describe and evaluate the fidelity of Housing First (HF) initiatives in six European countries to the Pathways HF (PHF) model and examine the larger social, historical, and political factors that may foster or impede model fidelity. Key stakeholders representing six European HF initiatives completed semi-structured phone interviews. Interviews were thematically analyzed according to five key fidelity domains and updated with interim results of a recent European research project (Housing First Europe). Dissatisfaction with the status quo was often cited as the catalyst driving searches for system change. PHF's evidence base, consumer-driven philosophy, recovery-oriented services, and view of housing as a basic right swayed local decisions to implement HF programs. Interviews yielded stronger evidence of fidelity on no housing readiness requirements, separation of housing and services, a harm reduction approach, consumer choice in services, and weaker evidence of fidelity on scatter-site housing, choice in housing, and breadth and intensity of services provided. Implementation challenges included resistance from existing programs, availability of affordable housing, and moral judgments of worthiness for housing. Both new and established programs evidenced high commitment to PHF principles and philosophy, but older programs demonstrated greater fidelity on a wider range of indicators. Early evidence indicates that HF can be successfully replicated within the European context, though local historical, social, and political factors may impact fidelity. Many programs committed to fidelity in principle faced external or financial barriers to implementation. Strategic planning and training to ensure that the programs unfold and mature in ways that realize HF principles in practice is recommended. [ABSTRACT FROM AUTHOR]

The Housing First approach used by Pathways to Housing, Inc., was used to enhance residential independence and treatment retention of homeless, seriously mentally ill methadone patients. The Keeping Home project first secured scattered-site apartments and assertive community treatment services and then addressed patients’ service needs. Three years post-implementation, methadone treatment retention for 31 Keeping Home patients versus 30 comparison participants (drawn from an administrative database) was 51.6% vs. 20% (p < .02); apartment/independent housing retention was 67.7% vs. 3% or 13% (both p's < .01). Although results firmly support Keeping Home, future research needs to address study's possible database limitations. [ABSTRACT FROM PUBLISHER]

The Collaborative Initiative to Help End Chronic Homelessness (CICH) was established to provide housing and supportive services for individuals experiencing chronic homelessness. As part of this initiative, 11 projects across the country received funding to apply models of best practices to support their clients in housing. This paper reports on the experiences of the CICH projects in their use of Assertive Community Treatment (ACT) and Motivational Interviewing (MI), clinical practice models commonly used by CICH projects. A qualitative analysis identified five areas of challenge for the projects: (1) Incomplete and underdeveloped staff teams; (2) Incomplete understanding of the practice models; (3) Using the elements of the practice models; (4) Interagency teaming; and (5) Competing expectations of multiple federal agencies. The paper describes the specific challenges in each of the five areas as well as training approaches and gaps in training and the perceived benefits of the practice models as reported by project staff. [ABSTRACT FROM AUTHOR]

Reliable and valid longitudinal residential histories are needed to assess interventions to reduce homelessness and increase community tenure. This study examined the test-retest reliability, sensitivity to change, and concurrent validity of the Residential Time-Line Follow-Back (TLFB) Inventory, a method used to record residential histories in the Collaborative Program to Prevent Homelessness (n = 1,381). The Residential TLFB Inventory yielded temporally stable aggregate measures of duration in residential categories, and it revealed significant differences in change over time when contrasting study groups. A comparison of agency and participant data at one site. [ABSTRACT FROM AUTHOR]

This article compares two approaches to housing chronically homeless individuals with psychiatric disabilities and often substance abuse. The experimental Housing First programme offered immediate access to independent housing without requiring psychiatric treatment or sobriety; the control Continuum of Care programmes made treatment and sobriety prerequisites for housing. A total of 225 participants were interviewed prior to random assignment and every 6-months thereafter for 2 years. Data were analysed using repeated measures analysis of variance. Participants randomly assigned to the experimental condition spent significantly less time homeless and in psychiatric hospitals, and incurred fewer costs than controls. A sub-sample recruited from psychiatric hospitals (n = 68) spent less time homeless and more time hospitalized, and incurred more costs than a sub-sample (n = 157) recruited from the streets. Recruitment source by programme interactions showed that the experimental programme had greater effects on reducing hospitalization for the hospital sub-sample and reducing homelessness for the street sub-sample. Three-way interactions including time indicated that in the experimental group, hospitalization and homelessness declined faster for the hospital and street sub-samples, respectively, than for comparable controls. Overall results support the Housing First approach. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This 1-year longitudinal study of adults who have recently transitioned from homelessness to Permanent Supportive Housing (PSH) focuses on quality of life as a primary outcome of interest. Eighty of 103 new tenants participated in structured interviews at the time of entry into their new home and at 12-months post-housing. t -tests assessed differences in community participation and quality of life measures at the 2 time points. Mixed effects models examined the impact of community participation on quality of life. Results show that time in independent housing was significantly associated with several domains of quality of life. Symptom severity was also significantly and negatively related to quality of life domains. Community participation was significantly related to frequency of social contacts only. These findings suggest that community participation is not critical to improving quality of life, and that despite concerns that individuals may feel isolated and lonely when living independently, satisfaction with one׳s living situation and family relationships nevertheless improves with housing tenure. [ABSTRACT FROM AUTHOR]