Explaining Housing First implementation variation: The role of fit

Background

Housing First [HF], an evidence-based strategy to address chronic homelessness, has been increasingly implemented throughout the U.S. and internationally. Although research has established that variation exists in how HF is implemented, our understanding of why this variation exists is less clear. We use a framework by Ansari et al. (2010) to examine how technical, cultural, and political fit between the HF model and an adopting organization explains two critical implementation outcomes: fidelity and extensiveness. Fidelity captures the rigor of implementation efforts, while extensiveness captures the scope.

Methods

This study employs a mixed methods approach with a purposive sample of 20 supportive housing programs that were newly funded throughout California to improve residential stability for individuals who are homeless or at risk of homelessness.  We categorize programs as high or low along dimensions of fidelity and extensiveness based on program director survey responses, and determine fit by coding qualitative interviews conducted with program directors.  We assess whether fidelity and extensiveness are associated with each type of fit using Fisher’s exact tests.   

Results

High practice-organization fit is associated with high fidelity and extensiveness.  Low fidelity programs are more likely to have low technical (p < .01) and cultural (p <.01) fit, whereas high extensiveness programs are more likely to have high technical (p<.01) and political fit (p<.05). 

Discussion

Findings highlight how fit can influence and shape fidelity and extensiveness of program implementation.  Creating technical, cultural, and political alignment between adopting organizations and evidence-based practices facilitates implementation and enhances quality of care.