Implementations of Housing First in Europe: Successes and Challenges in Maintaining Model Fidelity

To describe and evaluate the fidelity of Housing First (HF) initiatives in six European countries to the Pathways HF (PHF) model and examine the larger social, historical, and political factors that may foster or impede model fidelity. Key stakeholders representing six European HF initiatives completed semi-structured phone interviews. Interviews were thematically analyzed according to five key fidelity domains and updated with interim results of a recent European research project (Housing First Europe). Dissatisfaction with the status quo was often cited as the catalyst driving searches for system change. PHF's evidence base, consumer-driven philosophy, recovery-oriented services, and view of housing as a basic right swayed local decisions to implement HF programs. Interviews yielded stronger evidence of fidelity on no housing readiness requirements, separation of housing and services, a harm reduction approach, consumer choice in services, and weaker evidence of fidelity on scatter-site housing, choice in housing, and breadth and intensity of services provided. Implementation challenges included resistance from existing programs, availability of affordable housing, and moral judgments of worthiness for housing. Both new and established programs evidenced high commitment to PHF principles and philosophy, but older programs demonstrated greater fidelity on a wider range of indicators. Early evidence indicates that HF can be successfully replicated within the European context, though local historical, social, and political factors may impact fidelity. Many programs committed to fidelity in principle faced external or financial barriers to implementation. Strategic planning and training to ensure that the programs unfold and mature in ways that realize HF principles in practice is recommended.

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American Journal of Psychiatric Rehabilitation