When you hear the term “Housing First”, a lot can come to mind. At its core, it’s about providing housing without pre-conditions and linking people up with individualized, community-based supports with no time limits (e.g., an Assertive Community Treatment team, an Intensive Case Management team). But there are many other moving parts to a Housing First program. For example, the core principles of Housing First for Youth (HF4Y) are:
- A right to housing with no preconditions.
- Youth choice, youth voice and self-determination.
- Positive youth development and wellness orientation.
- Individualized, client-driven supports with no time limits.
- Social inclusion and community integration.
So, how can Housing First and HF4Y programs ensure that they are aligning with these principles? One way is to participate in a fidelity review. Fidelity reviews help to ensure that a program is delivered as planned through the use of defined standards. Fidelity reviews can vary, but typically they involve several steps: 1) A fidelity scale; 2) A site visit; and 3) A final report outlining the results of the fidelity scale and feedback from the fidelity review team. Fidelity reviews are particularly important for Housing First programs since good program fidelity to the Housing First model has been associated with improvements in housing stability, community functioning, and quality of life.
Fidelity reviews were a major part of the work we did with the HF4Y sites of Making the Shift Youth Homelessness Demonstration Lab (MtS DEMS), a collaborative effort between A Way Home Canada and the Canadian Observatory on Homelessness. Following a standard fidelity review procedure, we used a version of the Pathways Housing First Program Fidelity Scale that was tailored to the HF4Y model. We needed to tailor the scale since there are several notable differences between Housing First for adults and HF4Y.
We conducted site visits at each of our three HF4Y locations (Hamilton, Ottawa, and Toronto). Site visits included sitting in on staff meetings, a review of case notes, interviews with case managers and other program staff, shadowing a home visit, and, most importantly, interviews and focus groups with young people enrolled in the programs. Recognizing the importance of Indigenous-led practices, the fidelity review for Hamilton’s Endaayaang program was customized so that it aligned with the traditional teachings and cultural practices of the program. This included holding a circle with young people led by the program’s Knowledge Keeper. A blog focused specifically on the Endaayaang fidelity review is in the works.
Once we had a solid understanding of the programs, we used the fidelity scale to score how the programs were meeting the standards of HF4Y. Along with the rating scale, we created a report for each program with some of the qualitative feedback we received from interview participants, emphasizing the voice of young people. The report included a series of recommendations to help the programs enhance their fidelity to the HF4Y standards.
Typically, this is where the story ends BUT given that MtS DEMS is focused on continuous improvement, we took fidelity reviews a step further. Along with the report, our team created an implementation plan in collaboration with the HF4Y sites. The implementation plan provided concrete actions that each program could take to meet the recommendations we provided. The plan was focused on short-term, medium-term, and long-term goals. Examples included strategies to increase peer support opportunities, strengthening the program’s ability to work with family and natural supports, and enhancing opportunities for young people to connect with their culture. Our team continues to work with the sites on meeting the goals outlined in the implementation plans.
Mandy Faulkner, project administrator for the Making the Shift project in Ottawa, and Erik Wexler, program manager of WoodGreen Community Service’s Free2Be program, shared their experiences participating in the MtS DEMS fidelity review:
Mandy: The process of our HF4Y fidelity review was unique, as this was one of collaboration. While the program staff worked hard to provide the documentation and narratives required to demonstrate our work within the core principals, the review team worked hard to gain an understanding of our work within our local context and how we operated. The fidelity review supported us in knowing where we were strong and the areas for growth and attention. The collaborative process had fulsome recommendations but also included the implementation plans and feedback loop which proved to be invaluable. This innovative way of including an implementation plan was key for us as it was clear with its recommendations and it provided an actionable road map that made our ability to reach our goals outlined in the recommendations more successful.
Erik: The value of the fidelity review has been in its ability to provide an objective measure of the program’s service delivery against the original HF4Y model. Without that ability to reflexively engage with a baseline understanding of the core principles and practices to adhere to them, it can be challenging to know when and under what condition we steered off course and where we should be correcting our path. In this way, the review is proving to be instrumental in establishing that needed chorus of research, policy and practice in community, working together in concert to create better outcomes for young people. It also provides a more precise and accurate knowledge of the reasons why practices in HF4Y are in fact yielding more impact and where they can continue to be improved!
The innovative fidelity review process used in MtS DEMS has been helpful for our program partners and has improved our ability to conduct meaningful fidelity reviews. By introducing the implementation plans, we can be assured that young people are being offered services that meet the high standards of HF4Y. We hope other fidelity review teams can learn from this process.
If you are interested in learning more about fidelity reviews or would like to set up one for your agency, please contact Heidi (hwalter@awayhome.ca) or John (jecker@yorku.ca).