VA’s Expansion of Supportive Housing: Successes and Challenges on the Path Toward Housing First

Austin, Erika L.; Pollio, David E.; Holmes, Sally K.; Schumacher, Joseph E.; White, Bert; Lukas, Carol VanDeusen; Kertesz, Stefan G.

doi:10.1176/appi.ps.201300073

Cited by 42 publications

(51 citation statements)

References 19 publications

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“…The OTM looks more broadly at organizational factors associated with organizational change and the implementation of evidence-based clinical practices (Austin et al, 2014; Lukas et al, 2007, 2010). This framework allows us to examine the relationship between middle manager behavior and the larger organizational context in which they operate and explore whether middle manager behaviors differ in organizations that are supportive of structures and processes that facilitate change and the implementation of new practices versus those that are not.…”

Section: Theory/conceptual Modelmentioning

confidence: 99%

What roles do middle managers play in implementation of innovative practices?

Engle

Lopez

Gormley

et al. 2017

Health Care Manage Rev

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Background:Middle managers play key roles in hospitals as the bridge between senior leaders and frontline staff. Yet relatively little research has focused on their role in implementing new practices.Purpose:The aim of this study was to expand the understanding of middle managers’ influence in organizations by looking at their activities through the lens of two complementary conceptual frameworks.Methodology/Approach:We analyzed qualitative data from 17 Veterans Affairs Medical Centers with high and low potential to change organizational practices. We analyzed 98 interviews with staff ranging from senior leaders to frontline staff to identify themes within an a priori framework reflecting middle manager activities.Findings:Analyses yielded 14 emergent themes that allowed us to classify specific expressions of middle manager commitment to implementation of innovative practices (e.g., facilitate improvement innovation, garner staff buy-in). In comparing middle manager behaviors in high and low change potential sites, we found that most emergent themes were present in both groups. However, the activities and interactions described differed between the groups.Practice Implications:Middle managers can use the promising strategies identified by our analyses to guide and improve their effectiveness in implementing new practices. These strategies can also inform senior leaders striving to guide middle managers in those efforts.

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Section: Theory/conceptual Modelmentioning

confidence: 99%

What roles do middle managers play in implementation of innovative practices?

Engle

Lopez

Gormley

et al. 2017

Health Care Manage Rev

Self Cite

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“…As an alternative to the use of scattered sites, congregate HF (i.e., where all accommodations in a building are reserved for program clients) has been implemented in the US [12; 13], Europe [14], and Australia [15:16]. HF in congregate format has produced effective clinical outcomes and cost savings with clients with histories of homelessness and alcohol dependence [17; 18] and has been hypothesized to offer advantages to participants with complex needs including substance dependence [19].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats

et al. 2017

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ObjectiveNo previous experimental trials have investigated Housing First (HF) in both scattered site (SHF) and congregate (CHF) formats. We hypothesized that CHF and SHF would be associated with a greater percentage of time stably housed as well as superior health and psychosocial outcomes over 24 months compared to treatment as usual (TAU).MethodsInclusion criteria were homelessness, mental illness, and high need for support. Participants were randomised to SHF, CHF, or TAU. SHF consisted of market rental apartments with support provided by Assertive Community Treatment (ACT). CHF consisted of a single building with supports equivalent to ACT. TAU included existing services and supports.ResultsOf 800 people screened, 297 were randomly assigned to CHF (107), SHF (90), or TAU (100). The percentage of time in stable housing over 24 months was 26.3% in TAU (reference; 95% confidence interval (CI) = 20.5, 32.0), compared to 74.3% in CHF (95% CI = 69.3, 79.3, p<0.001) and 74.5% in SHF (95% CI = 69.2, 79.7, p<0.001). Secondary outcomes favoured CHF but not SHF compared to TAU.ConclusionHF in scattered and congregate formats is capable of achieving housing stability among people experiencing major mental illness and chronic homelessness. Only CHF was associated with improvement on select secondary outcomes.RegistrationCurrent Controlled Trials: ISRCTN57595077.

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“…Two forms of capacity are important for HF implementation: General capacity and innovation‐specific capacity (Flaspohler, Duffy, Wandersman, Stillman, & Maras, ). General capacities needed for HF implementation include problem‐solving and critical thinking skills, expertise in service provision, leadership, resiliency, ability to navigate opposition, and partnerships and collaboration among services (Austin et al, ; Macnaughton et al, ; Stergiopoulos et al, ). Innovation‐specific capacities for HF implementation include knowledge of the HF approach and fidelity requirements as well as the ability to adapt the model while maintaining fidelity, to coordinate services under the HF approach, to foster consumer representation, and to monitor outcomes (Austin et al, ; Davidson et al, ; O'Campo, Zerger, Gozdzik, Jeyaratnam, & Stergiopoulos, ).…”

Section: Introductionmentioning

confidence: 99%

Examining peer networking as a capacity‐building strategy for Housing First implementation

Loomis

2019

Journal Community Psychology

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Aims: This study examines peer networking as a capacitybuilding strategy for the implementation of Housing First (HF), a complex community intervention targeting chronic homelessness.Methods: A qualitative, multiple case study was conducted to examine the capacity-building activities of two, multicommunity peer networks established by community leaders in the Canadian Homelessness sector. Data collection activities included document analysis, key informant interviews (n = 10), and a follow-up focus group with interview participants in each network. Thematic analyses were conducted for each network, followed by a cross-case analysis. Results: Engaging in a multicommunity peer network enhances leaders' capacity to advance HF by creating opportunities to foster trust and communication, inform continuous improvement, and navigate ambiguity. A number of contextual factors influence connections between peer networking and capacity building.Conclusion: Peer networks are a valuable source of support and timely, contextually relevant knowledge for community leaders advancing local adaptation and implementation of HF.

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VA’s Expansion of Supportive Housing: Successes and Challenges on the Path Toward Housing First

Abstract: The findings highlight the considerable practical challenges and innovative solutions arising from a large-scale effort to implement Housing First, with particular attention to the experiences of individuals at all levels within an organization.

Cited by 42 publications

References 19 publications

What roles do middle managers play in implementation of innovative practices?

What roles do middle managers play in implementation of innovative practices?

A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats

Examining peer networking as a capacity‐building strategy for Housing First implementation

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