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Fidelity to the Housing First Model and Effectiveness of Permanent Supported Housing Programs in California
Todd P. Gilmer, Ph.D.; Ana Stefancic, M.A.; Marian L. Katz, Ph.D.; Marisa Sklar, M.S.; Sam Tsemberis, Ph.D.; Lawrence A. Palinkas, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300447
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Dr. Gilmer with the Department of Family and Preventive Medicine, University of California, San Diego (e-mail: tgilmer@ucsd.edu). Ms. Stefancic and Dr. Tsemberis are with Pathways to Housing, Inc., New York City, and Ms. Stefancic is also with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, also in New York City. Dr. Katz is with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. Ms. Sklar is with the San Diego State University–University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego. Dr. Palinkas is with the School of Social Work, University of Southern California, Los Angeles.

Copyright © 2014 by the American Psychiatric Association

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Abstract

Objectives  Permanent supported housing programs are being implemented throughout the United States. This study examined the relationship between fidelity to the Housing First model and residential outcomes among clients of full service partnerships (FSPs) in California.

Methods  This study had a mixed-methods design. Quantitative administrative and survey data were used to describe FSP practices and to examine the association between fidelity to Housing First and residential outcomes in the year before and after enrollment of 6,584 FSP clients in 86 programs. Focus groups at 20 FSPs provided qualitative data to enhance the understanding of these findings with actual accounts of housing-related experiences in high- and low-fidelity programs.

Results  Prior to enrollment, the mean days of homelessness were greater at high- versus low-fidelity (101 versus 46 days) FSPs. After adjustment for individual characteristics, the analysis found that days spent homeless after enrollment declined by 87 at high-fidelity programs and by 34 at low-fidelity programs. After adjustment for days spent homeless before enrollment, days spent homeless after enrollment declined by 63 at high-fidelity programs and by 53 at low-fidelity programs. After enrollment, clients at high-fidelity programs spent more than 60 additional days in apartments than clients at low-facility programs. Differences were found between high- and low-fidelity FSPs in client choice in housing and how much clients’ goals were considered in housing placement.

Conclusions  Programs with greater fidelity to the Housing First model enrolled clients with longer histories of homelessness and placed most of them in apartments.

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