Bringing politics and evidence together: Policy entrepreneurship and the conception of the At Home/Chez Soi Housing First Initiative for addressing homelessness and mental illness in Canada

Mental Health Commission of Canada, Adler School of Psychology (Vancouver), Canada. Electronic address: .
Social Science [?] Medicine (Impact Factor: 2.89). 04/2013; 82:100-7. DOI: 10.1016/j.socscimed.2013.01.033
Source: PubMed


An interesting question concerns how large-scale (mental) health services policy initiatives come into being, and the role of evidence within the decision-making process behind their origins. This paper illustrates the process by which motivation to address homelessness, in the context of the upcoming 2010 Vancouver Olympics, was leveraged into a pan-Canadian project including sites in Vancouver, Winnipeg, Toronto, Montreal and Moncton, New Brunswick. The aim of the initiative was to implement and evaluate an intervention, Housing First, to provide housing and support to previously homeless people with mental illness. This qualitative case study was conducted between December 2009 and December 2010, employing grounded theory, and drawing on archival documents and interviews with 19 key informants involved in the conception of the project. Overall, the findings affirm that policy-making does not follow a rational, linear process of knowledge translation/exchange (KTE) and implementation, whereby evidence-based "products" are brought forward to address objectively determined needs and then "placed into decision-making events" (Lomas, 2007, p. 130). Instead, evidence-based policy making should be understood within the much more complex context of "policy entrepreneurship" (Kingdon, 2003; Mintrom & Norman, 2009) which entails taking advantage of windows of opportunity, and helping to bring together the "streams" of problems, politics, and policy ideas (Kingdon, 2003).

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Available from: Eric Macnaughton, Feb 02, 2015
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    • "The premise is that having the " right " kinds of evidence, framed appropriately and delivered to the right audience, will result in policy change. However, this often ignores the highly politicized nature of policy-making (Macnaughton et al., 2013). "
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    • "Kirby quickly connected with Dr. Paula Goering, a well-respected mental health services researcher, as the Research Lead for the project. She played an important role in framing the project as an evaluation of Housing First, based on research evidence about this approach (Macnaughton et al. 2013). In addition to the positive outcomes of this program for the people being served, there is evidence that the initiative has also begun to transform the way communities and systems frame services for this population in the five cities (Goering and Tsemberis, in press). "
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