Initial Implementation of Housing First in Five Canadian Cities: How Do You Make the Shoe Fit, When One Size Does Not Fit All?

Abstract

At Home/Chez Soi, a large, $110-million, randomized trial evaluating the effectiveness of Housing First services for 2,235 individuals who are homeless and experiencing mental illness, was implemented in five Canadian cities, beginning in fall 2009. This paper describes initial implementation of the Housing First model, focusing on specific strategies, including centrally coordinated training/technical assistance and local site coordinators as change agents in each city. Implementation of this complex intervention varied across sites but was remarkably consistent regarding the essential ingredients of the program model. A strategy that balanced a strong centrally coordinated approach to technical assistance with customization and adaptation on the local level was essential for achieving a high fidelity implementation.

Keywords:

• Best practice implementation
• Housing First
• Complex intervention
• Program fidelity

Acknowledgments

The At Home/Chez Soi team also includes approximately 40 investigators from across Canada and the U.S. In addition, there are five site coordinators (in each city where the study is carried out) and numerous lead service and housing providers as well as persons with lived experience. The project is funded through a financial contribution from Health Canada to the Mental Health Commission of Canada. The views expressed herein solely represent the authors.

Notes

¹Across Boundaries uses the term “racialized” person or group, in keeping with the Ontario Human Rights Commission's Policy and Guidelines on Racism and Discrimination, which states, “the term racialized person or racialized group is preferred over racial minority, visible minority, person of colour or non-White as it recognizes the dynamic and complex process by which racial categories are socially produced by dominant groups in ways that entrench social inequalities and marginalization.”