The Pathways Housing First Fidelity Scale for Individuals With Psychiatric Disabilities

Abstract

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.

Keywords:

• Housing first
• Fidelity
• Mental illness
• Homelessness
• Supportive housing

Acknowledgments

This study was partially funded through the American Recovery and Reinvestment Act of 2009 by an award from the Agency for Health Care Research and Quality for Healthcare Delivery Systems Research (1R01HS019986) and through a financial contribution from Health Canada to the Mental Health Commission of Canada. The views expressed herein solely represent the authors. The authors express their deepest gratitude to Geoffrey Nelson, Soo-Min Shin, and Juliana Walker for their assistance in the development of this manuscript, as well as to Todd Gilmer, Sue Goodfellow, Marian Katz, and Jijian Voronka.

Notes

Note. *Modifications for PHF-ICM model specified in text.

**% rating v/e important = % of providers surveyed rating item as very or extremely important.

***Source: Indicates whether item came from an existing scale or was newly developed; m = item was modified from existing scale;.

e = item was based on an earlier draft version of the existing scale.