The housing first model (HFM) fidelity index: designing and testing a tool for measuring integrity of housing programs that serve active substance users

Background The Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors. The model has been widely diffused across the United States since 2000 as a result of positive findings related to consumer outcomes. However, a lack of clear fidelity guidelines has resulted in inconsistent implementation. The research team and their community partner collaborated to develop a HFM Fidelity Index. We describe the instrument development process and present results from its initial testing. Methods The HFM Fidelity Index was developed in two stages: (1) a qualitative case study of four HFM organizations and (2) interviews with 14 HFM "users". Reliability and validity of the index were then tested through phone interviews with staff members of permanent housing programs. The final sample consisted of 51 programs (39 Housing First and 12 abstinence-based) across 35 states. Results The results provided evidence for the overall reliability and validity of the index. Conclusions The results demonstrate the index’s ability to discriminate between housing programs that employ different service approaches. Regarding practice, the index offers a guide for organizations seeking to implement the HFM

Development and testing of an implementation strategy for a complex housing intervention: protocol for a mixed methods study

Background: There is currently a lack of scientifically designed and tested implementation strategies. Such strategies are particularly important for highly complex interventions that require coordination between multiple parts to be successful. This paper presents a protocol for the development and testing of an implementation strategy for a complex intervention known as the Housing First model (HFM). Housing First is an evidence-based practice for chronically homeless individuals demonstrated to significantly improve a number of outcomes. Methods/design: Drawing on practices demonstrated to be useful in implementation and e-learning theory, our team is currently adapting a face-to-face implementation strategy so that it can be delivered over a distance. Research activities will be divided between Chicago and Central Indiana, two areas with significantly different barriers to HFM implementation. Ten housing providers (five from Chicago and five from Indiana) will be recruited to conduct an alpha test of each of four e-learning modules as they are developed. Providers will be requested to keep a detailed log of their experience completing the modules and participate in one of two focus groups. After refining the modules based on alpha test results, we will test the strategy among a sample of four housing organizations (two from Chicago and two from Indiana). We will collect and analyze both qualitative and quantitative data from administration and staff. Measures of interest include causal factors affecting implementation, training outcomes, and implementation outcomes. Discussion: This project is an important first step in the development of an evidence-based implementation strategy to increase scalability and impact of the HFM. The project also has strong potential to increase limited scientific knowledge regarding implementation strategies in general

Impact of a childhood history of physical abuse and social support on aggresive behavior, attributions, and affect in male adolescents

Includes bibliographical references (pages [90]-105).The belief that a childhood history of physical abuse is associated with negative outcomes is several decades old, and over the years it has been hypothesized that abused and maltreated children grow up to become aggressive and perpetuate a cycle of violence on their own children. According to social information-processing models, children's social behavior is a function of sequential steps of processing that involve encoding of social cues, interpretation of social cues, clarification of goals, response access or construction, response decision, and behavioral enactment. Research has provided evidence that aggressive, physically abused children perceive, evaluate, interpret, and make decisions about social interactions in a manner that tends to increase the probability of future aggressive encounters and that affective experiences may influence processing styles. Research has also focused on factors such as social support that may protect individuals from the deleterious effects of childhood history of physical abuse. The present study, based on a social-information processing model of child physical abuse and aggression, examined the individual effects of a childhood history of physical abuse, perceived availability of social support, and satisfaction with social support on the existence of aggressive behavior, attributions, hostile intent, and evaluations of wrongness in male adolescents. One hundred forty-six of an original group of one hundred forty-eight male adolescents served as participants for the study. Due to significant findings in the zero-order correlation analyses matrix, multiple regression analyses were performed in order to examine the experience of a childhood history of physical abuse, level of perceived availability of social support, and level of satisfaction with social support on each of the dependent measures. A significant relationship was found between aggression and childhood history of physical abuse when abuse history, level of perceived availability of social support, and level of satisfaction with social support were simultaneously considered. Analyses also indicated a significant relationship between internal/external attributions and childhood history of physical abuse. Likewise, a significant relationship was found between internal/external attributions and satisfaction with social support. As for affective state, a significant relationship was found between level of satisfaction with social support and negative affect.Ph.D. (Doctor of Philosophy

Childhood history of physical abuse and social support on aggressive behavior and attributions in male adolescents

Includes bibliographical references (pages [85]-99)Existing research suggests that experiencing childhood physical abuse is associated with aggressive behavior and that aggressive children tend to make more misattributions about social situations. Research also suggests that an individual?s social support is a significant factor in determining the effects of childhood physical abuse. The present study, based on a social interactional, social-information processing model of child physical abuse and aggression, examined the difference between males with a childhood history of physical child abuse and low levels of social support and males without a childhood history of physical child abuse and high levels of social support on measures of aggression and attributions of hostile intent, internal/external, stable/unstable, global/specific, and evaluations of wrongness. Thirty males were selected from a larger pool of two hundred males and matched on five demographic variables: 15 with a childhood history of physical abuse and low levels of social support and 15 without a childhood history of physical abuse and high levels of social support. Differences between the two groups on measures of aggressive behavior and attributions were analyzed using two independent-samples t-test procedures. As hypothesized, there exists a significant difference between the two groups on levels of aggression. Significant differences were also found between the two groups on internal versus external attributions. No significant differences were found between the two groups on measures of hostile intent/unintentional, stable/unstable, global/specific, or evaluations of wrongness. The difference found between the two groups on aggression is consistent with existing research. The lack of findings related to attributions may be due to the fact that the present study, focused solely on cognitive-based attributional styles, failed to examine affect, another factor that may contribute to aggression and attributional styles. Findings suggest that the cumulative factors of a childhood history of physical abuse and low levels of social support are markers for later aggressive behavior. Although future investigations need to be conducted to examine the impact of a childhood history of physical abuse and social support on various cognitions, emotions and behaviors, the present study is likely to further clinical understanding of aggressive male adolescents.M.A. (Master of Arts