Sustainability of Housing First can be thought of in terms of continued operation of the interventionâ€™s critical ingredients. Additionally, there are contextual factors and processes that promote sustainability (e.g., organizational support, influences, and strategies for continued operation of the program).1
Housing First has several different types of sustainability outcomes:
Continued funding for housing and support services
Housing and support services (e.g., housing subsidies, funding for Assertive Community Treatment [ACT] and Intensive Case Management [ICM] teams) are fundamental to the Housing First approach. When funding is withdrawn or reduced, the key components of the Housing First approach are jeopardized.
Fidelity or adherence to housing and clinical services to the Housing First model
Sometimes programs drift away from the original model, thus compromising the integrity of the approach. This is why it is important to conduct fidelity assessments on an ongoing basis to ensure continued adherence to the Housing First model.
Benefits to project participant
If funding for Housing First is cut or reduced, and/or the program is no longer implemented with fidelity to the core principles of Housing First, benefits to participants, such as stable housing and improved quality of life, are likely to suffer as well. Housing First programs need to incorporate a minimum data set of outcome measures to ensure that participants continue to reap the benefits of the Housing First approach.
Housing First as an integral component of the service system
When Housing First becomes â€śnormalâ€ť or â€śtypicalâ€ť in service-delivery, rather than a pilot project or a demonstration project, we say that it has become â€śroutinized.â€ť Adoption of Housing First values, policies, and procedures indicate that it is routinized. Additionally, this aspect of sustainability indicates that the Housing First program has a clear role and fit with other housing and homeless programs in the community.
When the housing sector, mental health service providers, funders, and other key stakeholders continue to work together to implement Housing First, the capacity of the community to respond to homelessness is sustained.
Dissemination, expansion, and scaling up of the Housing First model across a wider geographic area
For system-level sustainability, it is important to disseminate and scale up Housing First in other communities. In Alberta, Housing First started in Calgary. Over time, however, Housing First has been adopted by many other communities in Alberta.
The organizational, community, systems, and policy contexts are important for promoting the sustainability of Housing First.2 As well, individuals and organizations that support Housing First can engage in various educational, public relations, and advocacy activities to promote sustainability.
Contextual factors and processes that promote sustainability include:
Characteristics of the organizational environment in which Housing First operates
Some organizational factors include leadership, fit with the vision, values and mission of the host organization, and beliefs of staff regarding the effectiveness of the Housing First approach. Having Housing First champions and supportive organizations are important for the sustainability of Housing First.
The surrounding community environment
When community organizations provide in-kind resources, including staff, the Housing First approach is more likely to be sustained.
Fit among community systems
Sustainability ultimately depends on creating and maintaining a fit or alignment amongst different community systems, which in turn depend on the host organizationâ€™s ability to monitor and adapt the intervention to its surrounding context.3 Building communities of practice is an important component in ensuring alignment amongst different community systems.
Political, economic, administrative, and policy context
The wider political, economic, administrative, and policy context in which the intervention operates is important for the promotion of sustainability.4 Municipal, provincial, and federal departments that fund and oversee the organizations that deliver Housing First need to be flexible about policies and procedures and work across sectorial boundaries. The Alberta Interagency Council on Homelessness is an excellent example of a body that facilitates this multisectorial cooperation.
Regarding the sustainability influences
On At Home/Chez Soi, the Mental Health Commission of Canada, researchers, local project staff, people with lived experience, and community/government partners played an active role since the beginning of the project to promote different facets of the sustainability of the project: continued funding, fidelity of implementation, and expansion and dissemination.