Kertesz Stefan G, Austin Erika L, Holmes Sally K, DeRussy Aerin J, Van Deusen Lukas Carol, Pollio David E
Birmingham VA Medical Center.
Boston VA Medical Center.
Psychol Serv. 2017 May;14(2):118-128. doi: 10.1037/ser0000123.
Housing First (HF) combines permanent supportive housing and supportive services for homeless individuals and removes traditional treatment-related preconditions for housing entry. There has been little research describing strengths and shortfalls of HF implementation outside of research demonstration projects. The U.S. Department of Veterans Affairs (VA) has transitioned to an HF approach in a supportive housing program serving over 85,000 persons. This offers a naturalistic window to study fidelity when HF is adopted on a large scale. We operationalized HF into 20 criteria grouped into 5 domains. We assessed 8 VA medical centers twice (1 year apart), scoring each criterion using a scale ranging from 1 () to 4 (). There were 2 HF domains (no preconditions and rapidly offering permanent housing) for which high fidelity was readily attained. There was uneven progress in prioritizing the most vulnerable clients for housing support. Two HF domains (sufficient supportive services and a modern recovery philosophy) had considerably lower fidelity. Interviews suggested that operational issues such as shortfalls in staffing and training likely hindered performance in these 2 domains. In this ambitious national HF program, the largest to date, we found substantial fidelity in focusing on permanent housing and removal of preconditions to housing entry. Areas of concern included the adequacy of supportive services and adequacy in deployment of a modern recovery philosophy. Under real-world conditions, large-scale implementation of HF is likely to require significant additional investment in client service supports to assure that results are concordant with those found in research studies. (PsycINFO Database Record
“先住房后治疗”（HF）模式将永久性支持性住房与为无家可归者提供的支持性服务相结合，并取消了与住房准入相关的传统治疗前提条件。除了研究示范项目之外，几乎没有研究描述HF模式实施的优势和不足。美国退伍军人事务部（VA）已在一个为超过85000人提供服务的支持性住房项目中转向HF模式。这为大规模采用HF模式时研究其实施的保真度提供了一个自然观察窗口。我们将HF模式细化为20条标准，分为5个领域。我们对8个VA医疗中心进行了两次评估（间隔1年），使用从1（差）到4（优）的量表对每个标准进行评分。有两个HF领域（无前提条件和快速提供永久性住房）很容易实现高保真度。在将最脆弱的客户列为住房支持优先对象方面进展不均衡。有两个HF领域（充足的支持性服务和现代康复理念）的保真度要低得多。访谈表明，人员配备和培训不足等运营问题可能阻碍了这两个领域的表现。在这个迄今为止规模最大的雄心勃勃的全国性HF项目中，我们发现在关注永久性住房和取消住房准入前提条件方面有很高的保真度。令人担忧的领域包括支持性服务的充足性以及现代康复理念的实施力度。在现实世界条件下，大规模实施HF模式可能需要在客户服务支持方面进行大量额外投资，以确保结果与研究中的发现一致。（《心理学文摘数据库记录》 ）
