Program Fidelity and Adaptation: Challenges in Implementing Housing First in Ireland

576 views

Published on

Published in: Business, Real Estate
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
576
On SlideShare
0
From Embeds
0
Number of Embeds
216
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Program Fidelity and Adaptation: Challenges in Implementing Housing First in Ireland

  1. 1. 1 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Next? Berlin, 20th September 2013 Program fidelity, adaptation, & outcomes: Challenges in implementing Housing First in Ireland Dr Ronni Michelle Greenwood Sean Bromfield Dublin Model of Homeless Services Delivery
  2. 2. 2 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Gap in the Plan  No direct access to housing  No supported housing for people to high support needs/”entrenched rough sleepers” EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Dublin Housing First Demonstration Project  No additional resources  Voluntary part-time team  No direct HF experience  Sent a small group to New York  Team leader/CEO of Stepping Stone  HSE – not on board -- no psychiatry –  Steering Committee  Programme Evaluation
  3. 3. 3 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Dublin HF Demonstration: Phase 1Challenges  Housing  Support Services  Overlap between landlord & service provider  Intake & Eligibility criteria  Legal Entity EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Dublin Housing First Phase 1 Challenges: Housing  Housing sources  Four housing units  Social housing  Voluntary agencies  Peter McVerry Trust  Cluid  Private rental  Housing locations  Homeless in ‘wrong’local authorities  Housing types  Bedsits  One bedroom  Two bedroom
  4. 4. 4 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Dublin Housing First Phase 1 Challenges: Team Team leader:  Landlord and service provider  Management style; leadership Team members: Voluntary, part-time Training in housing first approach Compilation  SA specialist/psychiatric nurse  Key workers – part time  Business in the community Turnover Team meetings EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Year 1 Challenges  Intake  ‘The list of 23’  The list of about 100  Eligibility Criteria  Rough sleeping: How much  Motivation/’Buy in’
  5. 5. 5 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 End of the Beginning: Year 1 Review to March 2013  Decline in tenancies  Evictions  Staff turnover and staff non-replacement  Questions raised about management and accountability EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Phase 2: A new beginning  Events  Team leader resigned  Full replacement of team members  Legal entity  Accountability to Dublin Regional Homeless Executive  Outcomes improving  Intake, tenancies, retention  Housing  Staffing  Case notes – transparency and accountability
  6. 6. 6 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Summary of Process Evaluation Findings  Lack of housing  Leadership  Overlap of landlord and service provider  Intake and Eligibility  Accountability EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 OUTCOME FINDINGS
  7. 7. 7 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Outcome Evaluation  Design  Housing First  Non-equivalent Comparison Group  Data  Collected every three months  Moving baseline  Face-to-face data collection  NY Housing Study tracking procedures  Measures from NY Housing Study & Canadian Study will allow cross-site comparisons EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Participant Numbers T1 T2 T3 T4 T5 T6 T7 HF 23 14 11 9 6 6 5 Comparison 14 11 11 9 9 7 6 * 3 Clients Deceased- HF
  8. 8. 8 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Participant Characteristics  Age:  Housing First = 42.09  Comparison = 37.12  Sex:  Housing First: 15 Men, 5 Women  Comparison: 10 Men, 6 Women  Relationship – Single  Housing First: 13  Comparison: 10 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 ETHOS - Stably Housed 0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8 T1 T2 T3 T4 Housing First Comparison
  9. 9. 9 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 ETHOS - Emergency Housing EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 ETHOS - Short Term Housing 0 0,05 0,1 0,15 0,2 0,25 0,3 0,35 0,4 T1 T2 T3 T4 Housing First Comparison
  10. 10. 10 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 ETHOS - Institutions EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 ETHOS - Long Term Residential 0 0,05 0,1 0,15 0,2 0,25 0,3 T1 T2 T3 T4 Housing First Comparison
  11. 11. 11 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 ETHOS - Rough Sleeping 0 0,05 0,1 0,15 0,2 0,25 0,3 0,35 0,4 T1 T2 T3 T4 Housing First Comparison EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Medical Services  Past 3 Months  6 Items Yes/No  Medical / dental  Overnight hospital  Emergency room  Clinic visit  Care for teeth  Other 0 0,5 1 1,5 2 2,5 T1 T2 T3 T4 Housing First Comparison
  12. 12. 12 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 SA/ETOH Services  Past 3 Months  8 items; Yes/No  Any treatment  Detox  Talk about with someone  Meet doctor/nurse  AA meeting  Groups  Other 0 0,5 1 1,5 2 2,5 3 3,5 T1 T2 T3 T4 Housing First Comparison EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Legal Issues  Past 3 Months  4 items; Yes/No  Arrested  Detained overnight  Court  Summons 0 0,5 1 1,5 2 2,5 T1 T2 T3 T4 Housing First Comparison
  13. 13. 13 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Psychiatric Symptoms  Colorado Symptom Index  13 items  0=not at all; 4 = at least every day  Anxiety, depression, psychosis 0 0,5 1 1,5 2 2,5 T1 T2 T3 T4 Housing First Comparison EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 General Well-being  14 Items  0 = Never; 5 = Everyday  Happy, interested in life, satisfied  Something important to contribute to society  People are basically good  Life has a sense of direction or meaning0 0,5 1 1,5 2 2,5 3 3,5 4 4,5 T1 T2 T3 T4 Housing First Comparison
  14. 14. 14 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 SA-related problems  7 items  1 = past month, 5 = Never/Not applicable  Used weekly or more often  Caused social problems  Spent a lot of time getting, using, feeling effects  Withdrawal problems 0 0,5 1 1,5 2 2,5 3 T1 T2 T3 T4 Housing First Comparison EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Coercion (Choice)  6 items  0=Never; 4=Always  Required to engage in SA or take medicine  Housing svc where not allowed SA/ETOH  Required to stay in treatment  SA/ETOH rules too restrictive 0 0,5 1 1,5 2 2,5 T1 T2 T3 T4 Housing First Comparison
  15. 15. 15 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Consumer Choice  16 Items  1 = no choice at all; 5 = completely my choice  Place you stay overnight  People who stay  Who can come over  Food you buy1 1,5 2 2,5 3 3,5 4 4,5 T1 T2 T3 T4 Housing First Comparison EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Reflections on Adaptation and Fidelity  Varied adaptations in early phases limited the demonstration’s reach  Key challenges  Housing availability  Team processes  Adaptations to intake, eligibility  Adaptations to team meetings  Participant outcomes are cause for optimism for the future
  16. 16. 16 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Future: What’s Second?  Dissemination across Ireland  Major housing services providers are publicly aligning themselves with a ‘Housing Led’ approach;  What, exactly, is ‘Housing Led’? – a necessary but not sufficient component of HF  Program Adaptation & Dilution are key concerns  Adopting the name but not the key ingredients  Absorption into continuum of care providers  Working within a system that has a ‘housing shortage’  ‘Housing led’ is not necessarily ‘consumer-led’  Leaving out those who have the most needs EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 THANK YOU FOR LISTENING. Any questions?

×