Implementation Tasks

During the planning stage, your Planning Group was responsible for developing the program model and planning the implementation of your Housing First program. A diverse stakeholder coalition developed a program model, chose the host agency, secured funding, developed a profile of the skills necessary for housing and service staff, developed housing protocols, involved people with lived experience, connected with landlords, and developed a preliminary evaluation plan. During the implementation stage, stakeholders now put the plan into practice.

In the At Home/Chez Soi project, the average annual program costs (for housing and support) was $22,000 for ACT participants, and $14,000 for ICM participants.

What are the key tasks involved in implementing a housing first program?

Task 1: hiring staff and involving people with lived experience

During the planning process, your planning group explored various funding streams and ultimately secured funding for the program. At the early stages of implementing the housing first program, stakeholders must finalize the budget for program resources and begin the process of hiring housing and clinical/support staff. During the planning process, stakeholders identified the specific values and competencies necessary for each staff position, and developed detailed staff profiles and job descriptions. At the implementation stage, stakeholders are ready to interview and hire housing and clinical/support staff.

During the implementation stage, the hiring process should include hiring people with lived experience in a number of capacities, including as peer support workers, peer organizers, peer advisory committee members, and a peer ombudspersons. According to At Home/Chez Soi staff, it is helpful to hire peers who are well experienced in supporting their own and others through their recovery journeys. It is also important to hire peers in full-time roles, to convey that people with lived experience are valued and equal to staff who do not have first-hand experience of homelessness. Moreover, it is important to hire staff that is committed to the housing first philosophy and methods of practice that focus on recovery, strengths, and harm reduction. Additionally, it is important to consider strategies for employee retention at an early stage. To retain quality employees, programs can consider providing advanced training, reflective supervision, constructive performance reviews, and adequate benefits.

Johanne and Laszlo share their experiences with the At Home project. (NFB)

Task 2: establishing staff supervision and communication protocols

A critical implementation task is to establish processes for staff supervision and communication for housing and clinical/support staff. Staff supervision should entail regular meetings with individual staff to review work and to provide support and training. At Home/Chez Soi staff indicated that a strong supervisor stresses fidelity to the Housing First model, and develops a culture of learning and respect among staff members. Effective supervisors demonstrate the importance of listening, and show staff that it is possible to disagree, but to still work together effectively.

Supervision of peer workers may include supervision by a person with lived experience, in addition to the staff supervisor. Staff from At Home/Chez Soi noted that at times, peer workers were hesitant to ask for help when they were struggling, as they did not want to be seen as “moving backward” by the team. The presence of a supervisor with lived experience may provide a safer space for peer workers to get the support needed to effectively perform their roles.

According to stakeholders from the At Home/Chez Soi sites, housing and clinical/support teams should meet together on a weekly basis to discuss progress and issues (although some clinical/support teams met daily). These meetings provide important opportunities to build relationships among team members. Meetings remind staff that they are not working alone, and that they have outlets for support and assistance. In addition to fostering the exchange of program-related information, these meetings can provide a mechanism for staff to support one another and recommend diverse strategies for engaging with participants. Staff meetings also present an opportunity for staff to debrief following challenging times, and also to celebrate successes. In addition to separate meetings for housing and clinical/support staff, it is important to hold meetings for staff across the different teams to share information and knowledge. This is also an ideal way for staff working in different roles to better understand each other’s work.

Task 3: training staff

Upon hiring housing staff, clinical/support staff it is important to provide a thorough initial training. Stakeholders should also develop a mechanism for continued training of all new staff as they begin working in the program. The initial training should formally orient staff to the housing first model, including the values and principles of the Housing First Approach. The initial training is an opportunity to explain all aspects of the program to new staff, including the nature of the roles of each staff member. The initial training should also describe processes for staff supervision and coaching. Additionally, initial training should address the importance of participant choice and self-determination, along with the recovery-orientation of the program. The initial training should also provide a foundational understanding of harm reduction and practices to support social and community integration of participants.

Many stakeholders involved in the At Home/Chez Soi program noted the experience of tension and confusion about roles between the housing and clinical/support teams. To address this concern proactively, initial staff training should provide a program overview and explain clearly delineated roles between the teams. Initial training can be a way to foster strong communication between the housing and clinical/support teams at an early stage.

All staff should receive training in self-care and how to seek support to prevent burnout, as these positions are inherently challenging. It is important to discuss protocols for debriefing (such as “sharing circles”) and support seeking with staff during the initial training. Some stakeholders involved in the At Home/Chez Soi program suggested inviting peers/people with lived experience to provide training for housing and clinical/support staff to educate staff about the peer perspective, and to provide insights from lived experience.

As well, initial training should be tailored for peer workers and peer advisory group members/people with lived experience. For instance, peer advisory group members can receive training in how to participate on the board to build skills and confidence. Peer workers should receive training on the nature of their roles, including issues around confidentiality, boundaries, and supervision/support. Channels for seeking support and supervision should be made clear during initial training.

Task 4: housing/re-housing participants and providing support

Essential ingredients of a Housing First program are the provision of housing and clinical/support services, both of which occur during the implementation stage. During the planning process, stakeholders developed housing protocols and connected with landlords. During the implementation stage, stakeholders come to the table with an understanding of the housing environment, along with the clinical needs of the target population.

In the context of housing and support services, it is important for stakeholders to focus on the following subtasks (click to expand):

Task 5: Providing ongoing supervision and support

As described in Task 2, it is important to develop staff supervision and communication procedures during the implementation stage. During early and later implementation of the program, it is crucial for supervision and support to occur on an ongoing basis. Supervision and support are an important way to normalize the challenges that are to be expected within the teams, and the challenges associated with engaging participants. According to At Home/Chez Soi staff, supervisors have the important role of ensuring that housing and clinical/support teams are working together effectively. Effective supervisors promote a culture of continuous learning and improvement. As a housing staff member in Moncton explained, “when you go along, be flexible – willing to try a different path. When it’s not working, stick with the fidelity of the program, but try a different way.”

Supervision needs are likely to change over time. From a housing perspective, at an early stage of the implementation process, staff may require support in helping participants adjust to their homes, including addressing the social isolation and loneliness that some participants experience. At a later stage, staff may require support in engaging participants in their recovery and in developing and re-establishing relationships. Ongoing supervision and support is also essential for preventing staff burnout. According to At Home/Chez Soi staff, supervisors should stress the importance of self-care, and should support staff in executing self-care strategies to prevent burnout.

Task 6: Offering ongoing/advanced training and technical assistance

In addition to initial training, it is important to provide ongoing training opportunities to housing and clinical/support staff. According to At Home/Chez Soi staff, additional training in the areas of recovery, inter-generational trauma and trauma-informed care, addictions, cultural competency, motivational interviewing, harm reduction strategies, anti-oppressive frameworks, and dealing with difficult tenancy issues (such as hoarding) were particularly important and helpful. Supervisors should consult with staff to determine areas where additional and ongoing training can be most helpful.

For programs to continue to grow and improve, technical assistance serves an important function. Consultants can provide technical assistance to the program. According to At Home/Chez Soi staff, it is important to ensure that consultants understand the context of the program and population served, so the strategies they propose are appropriate and relevant, particularly when working with ethnoracial and Aboriginal populations. Others indicated that it is helpful to bring in individuals with diverse backgrounds and experiences in the field to provide technical assistance.

Advanced training can also be provided through conferences and professional development opportunities. Additionally, Communities of Practice – groups of individuals interested and engaged in working on a common issue (such as Housing First) offer a continued mechanism for support and learning. Staff can connect with other Housing First programs to develop a Community of Practice that meets on a monthly basis, or as needed.

Task 7: Assessing and improving the program: evaluation and fidelity

A key task during the planning process was to develop an evaluation plan, including the selection of an evaluation team. During the planning stage, a logic model was developed and the team worked collaboratively with program stakeholders to select what to track and measure.

During the implementation stage (if you have an evaluation team), the evaluator(s) will collect data on an ongoing basis. The implementation stage is also when the evaluation team can assess the program’s fidelity to the Housing First model. During program implementation, it is important to establish a mechanism for the evaluation team to provide early and ongoing feedback to the team. Evaluation feedback is critical to improving the program and ensuring its sustainability. As staff receive evaluation findings, concrete plans should be developed to address the program and system issues identified as requiring change.