Variation in the Implementation of California's Full Service Partnerships for Persons with Serious Mental Illness

Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA.
Health Services Research (Impact Factor: 2.78). 10/2013; 48(6pt2). DOI: 10.1111/1475-6773.12119
Source: PubMed


This study examined variation in the implementation of California's Full Service Partnerships (FSPs), which are supported housing programs that do "whatever it takes" to improve outcomes among persons with serious mental illness who are homeless or at risk of homelessness.
Ninety-three FSPs in California.
A mixed methods approach was selected to develop a better understanding of the complexity of the FSP programs. The design structure was a combined explanatory and exploratory sequential design (qual→QUAN→qual) where a qualitative focus group was used to develop a quantitative survey that was followed by qualitative site visits. The survey was used to describe the breadth of variation based on fidelity to the Housing First model, while the site visits were used to provide a depth of information on high- versus low-fidelity programs.
We found substantial variation in implementation among FSPs. Fidelity was particularly low along domains related with housing and service philosophy, indicating that many FSPs implemented a rich array of services but applied housing readiness requirements and did not adhere to consumer choice in housing.
There remains room for improvement in the recovery-orientation of FSPs. Fortunately, we have identified several processes by which program managers and counties can increase the fidelity of their programs.

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    • "Maximum variation sampling (Patton 1990) was used to select programs that represent diverse geographic areas and client population served across the state. (For more details on the overall sampling strategies, see Gilmer et al. 2013a). For this study, we focused on the four forensic programs that participated in site visits. "
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    ABSTRACT: This mixed-method study used administrative data from 68 supportive housing programs and evaluative and qualitative site visit data from a subset of four forensic programs to (a) compare fidelity to the Housing First model and residential client outcomes between forensic and nonforensic programs and (b) investigate whether and how providers working in forensic programs can navigate competing Housing First principles and criminal justice mandates. Quantitative findings suggested that forensic programs were less likely to follow a harm reduction approach to substance use and clients in those programs were more likely to live in congregate settings. Qualitative findings suggested that an interplay of court involvement, limited resources, and risk environments influenced staff decisions regarding housing and treatment. Existing mental health and criminal justice collaborations necessitate adaptation to the Housing First model to accommodate client needs.
    Community Mental Health Journal 10/2015; DOI:10.1007/s10597-015-9946-5 · 1.03 Impact Factor
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    Health Services Research 12/2013; 48(6 Pt 2):2125-33. DOI:10.1111/1475-6773.12123 · 2.78 Impact Factor
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    ABSTRACT: Objectives This study examined whether and how permanent supportive housing (PSH) programs are able to support aging in place among tenants with serious mental illness.DesignInvestigators used a mixed-method approach known as a convergent parallel design in which quantitative and qualitative data are analyzed separately and findings are merged during interpretation. Quantitative analysis compared 1-year pre-residential and post-residential outcomes for PSH program enrollees, comparing adults aged 35–49 years (n = 3990) with those aged 50 years or older (n = 3086). Case study analysis using qualitative interviews with staff of a PSH program that exclusively served older adults identified challenges to providing support services.ResultsSubstantial declines in days spent homeless and in justice system settings were found, along with increases in days living independently in apartments and in congregate settings. Homelessness and justice system involvement declined less for older adults than younger adults. Qualitative themes related to working with older adults included increased attention to medical vulnerability, residual effects of institutional care, and perceived preference for congregate living.ConclusionsPSH is an effective way to end homelessness, yet little is known about how programs can support housing stability among aging populations. Additional support and training for PSH staff will better promote successful aging in place. Copyright © 2014 John Wiley & Sons, Ltd.
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