Examining Provider Perspectives Within Housing First and Traditional Programs

Abstract

Pathways' Housing First represents a radical departure from traditional programs that serve individuals experiencing homelessness and co-occurring psychiatric and substance use disorders. This paper considered two federally funded comparison studies of Pathways' Housing First and traditional programs to examine whether differences were reflected in the perspectives of frontline providers. Both quantitative analysis of responses to structured questions with closed-ended responses and qualitative analysis of open-ended responses to semistructured questions showed that Pathways providers had greater endorsement of consumer values, less endorsement of systems values, and greater tolerance for abnormal behavior that did not result in harm to others than their counterparts in traditional programs. Comparing provider perspectives also revealed an “implementation paradox;” traditional providers were inhibited from engaging consumers in treatment and services without housing, whereas Housing First providers could focus on issues other than securing housing. As programs increasingly adopt a Housing First approach, implementation challenges remain due to an existing workforce habituated to traditional services.

Keywords:

• Housing first
• Frontline providers
• Serious mental illness
• Homelessness
• Supportive housing

Acknowledgments

This research was supported by grant 1UD9SM51970 from the Substance Abuse and Mental Health Services Administration and grant R0169865 from the National Institute of Mental Health.

Notes

Note. Higher scores indicate higher presence of given construct; for MEAPS, higher scores indicate policies that exclude deviant clients; for vignettes, higher scores indicate the client would have to leave housing. PHF staff differed from TF and citywide staff separately at p < .001 for both values measures with Bonferroni correction. MEAPS = multiphasic environmental assessment procedure; NA = not available; PHF = Pathways' Housing First; TF = treatment first.

*p < .01; **p < .001.