Housing First by Deborah Padgett M.P.H

Author:Deborah Padgett M.P.H
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2015-02-15T00:00:00+00:00

Variation in Housing First: High Fidelity, Low Fidelity, No Fidelity?

Whatever the origin or nature of local objections, the institutional logic of homeless services was inexorably shifting toward HF in the United States and elsewhere (see Greenwood, Stefancic, & Tsemberis, 2013; Johnson, Parkinson, & Parsell, 2012; Stanhope & Dunn, 2011; USICH, 2013). In 2010, the U.S. Federal government declared HF the “clear solution” to chronic homelessness in its first ever comprehensive plan to end homelessness (USICH, 2010).

Not surprisingly, rapid growth in HF prompted new and different versions to appear. Also not surprisingly, Pathways researchers worked with other experts in the field to develop a fidelity measure for use with programs seeking to adopt the PHF model (Stefancic, Tsemberis, Messeri, Drake, & Goering, 2013). The measure has five domains—housing choice and structure, separation of housing and treatment, service philosophy, service array, and program structure—and it may be used independently or as part of program site visits by experienced Pathways staff (Stefancic et al., 2013). Detailed instruction on how to implement Pathways Housing First can be found in Tsemberis (2010). With notable exceptions discussed below and in the following chapter (especially Canada’s national HF implementation), research on HF adaptations is just beginning to appear in the literature (Gilmer, Stefancic, Katz, Sklar, Tsemberis, & Palinkas, 2014).

DENVER’S HOUSING FIRST INITIATIVE: EARLY ADOPTION. The Colorado Coalition for the Homeless (CCH) in Denver was one of the organizations funded by the USICH initiative to end chronic homelessness. Already established as a homeless service provider, John Parvensky and his colleagues seized on this new funding opportunity and CCH became part of the Denver Housing First Collaborative (DHFC) in 2003. The DHFC, initially funded for three years, transformed an old YMCA building into apartments for some clients and placed the others in scatter-site apartments with rental assistance, a total of 150 clients in all.

The Denver experience provided a unique opportunity to test consumer preference because the DHFC gave clients the option of choosing between a single-site building or a scatter-site apartment. Contrary to expectations, most chose a modest apartment of their own in the community over the newly renovated downtown YMCA. After the apartments were filled, participants accepted the YMCA over life on the streets.

Parvensky’s efforts stood out for doing something still rare in the world of nonprofits—conducting research on his program’s effectiveness. In line with growing interest in the costs of chronic homelessness, the DHFC study focused on outcomes of residential stability, improving health, and cost effectiveness of the model (Perlman & Parvensky, 2006). The resulting cost benefit analysis tracked clients’ service utilization two years before and two years after entering the Denver HF program. Service use and costs dropped dramatically after program entry, including such services as detox treatment, emergency room visits, jail nights, and emergency shelter stays, which resulted in savings that averaged $31, 545 per person. The net savings after program costs were $4,745 per person. When extrapolated to the over 500 chronic homeless adults in the Denver area, the savings ran into the millions.

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