Early implementation evaluation of a multi-site housing first intervention for homeless people with mental illness: a mixed methods approach

Eval Program Plann. 2014 Apr;43:16-26. doi: 10.1016/j.evalprogplan.2013.10.004. Epub 2013 Oct 24.


This research sought to determine whether the implementation of Housing First in a large-scale, multi-site Canadian project for homeless participants with mental illness shows high fidelity to the Pathways Housing First model, and what factors help or hinder implementation. Fidelity ratings for 10 Housing First programs in five cities were made by an external quality assurance team along five key dimensions of Housing First based on 84 key informant interviews, 10 consumer focus groups, and 100 chart reviews. An additional 72 key informant interviews and 35 focus groups yielded qualitative data on factors that helped or hindered implementation. Overall, the findings show a high degree of fidelity to the model with more than 71% of the fidelity items being scored higher than 3 on a 4-point scale. The qualitative research found that both delivery system factors, including community and organizational capacity, and support system factors, training and technical assistance, facilitated implementation. Fidelity challenges include the availability of housing, consumer representation in program operations, and limitations to the array of services offered. Factors that accounted for these challenges include low vacancy rates, challenges of involving recently homeless people in program operations, and a lack of services in some of the communities. The study demonstrates how the combined use of fidelity assessment and qualitative methods can be used in implementation evaluation to develop and improve a program.

Keywords: Fidelity; Homelessness; Housing First; Implementation; Mental health; Mixed methods.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Consumer Behavior*
  • Focus Groups
  • Health Plan Implementation / methods
  • Health Plan Implementation / organization & administration*
  • Health Services Research / methods
  • Health Services Research / organization & administration*
  • Homeless Persons / psychology*
  • Housing / economics
  • Housing / standards
  • Housing / statistics & numerical data*
  • Humans
  • Interviews as Topic
  • Mentally Ill Persons / psychology*
  • Models, Organizational
  • Program Evaluation
  • Qualitative Research
  • Randomized Controlled Trials as Topic