There is currently a lack of knowledge regarding effective implementation strategies for evidence-based practices (EBPs) for substance abuse treatment and prevention. The Housing First Technical Assistance and Training program (HFTAT) is an implementation strategy for an EBP known as the Housing First Model (HFM). The HFM is an approach to housing the chronically homeless that has been demonstrated to lead to a number of improved substance use outcomes, but has proven difficult to implement in many instances due to its complexity. While an initial evaluation and quality assurance work related to the HFTAT has demonstrated its effectiveness as an implementation strategy, the face-to-face format in which its content is delivered requires a large amount of time and resources, which limits its attractiveness to organizations seeking to implement the HFM. This study has three aims.
Aim 1 is to adapt the HFTAT to be delivered over a distance, thus requiring less time and resources for organizations to utilize. The adaptation process will be guided by existing empirical knowledge regarding effective implementation practices, HFM fidelity measures, and theory and best practices from the field of education. We will conduct an alpha test of the adapted HFTAT among a sample of housing practitioners. Data collected for the alpha test will be primarily qualitative, and findings will guide refinement of the implementation strategy.
Aim 2 is to develop an instrument to measure structural-level factors affecting HFM implementation. We will conduct a literature review of existing implementation and HFM studies to identify items to include in this measurement tool.
Aim 3 is to conduct a pilot study to assess the feasibility for a larger study that will test the HFTAT's effectiveness as an implementation strategy. We will employ a quasi- experimental, mixed methods design to collect data related to training and implementation outcomes from four organizations. The larger study that will result from this project will test the utility of different HFM implementation strategiesto affect change at the program-, staff-, and consumer-levels. Both of these projects will increase the limited scientific knowledge regarding implementation strategies for evidence-based substance abuse practices, and knowledge acquired through this study can potentially be applied to other efforts to develop and test similar implementation strategies. Additionally, development of an evidence-based HFM implementation strategy will be of interest to a wide range of stakeholders given that the model has been placed at the center of national and local strategies for addressing homelessness.

Public Health Relevance

This project seeks to adapt and study an implementation strategy for the Housing First Model (HFM), which is an evidence-based practice (EBPs) for housing chronically homeless individuals with substance use problems. The HFM is wide-spread, and stronger implementation of its core components is likely to result in more effective programming that will have a larger public health impact. Additionally, findings from this study have the potential to inform implementation strategies for a wide range of EBPs for substance use treatment and prevention.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Planning Grant (R34)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Wiley, Tisha R A
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Indiana University-Purdue University at Indianapolis
Public Health & Prev Medicine
Schools of Public Health
United States
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Watson, Dennis P; Ahonen, Emily Q; Shuman, Valery et al. (2018) The housing first technical assistance and training (HFTAT) implementation strategy: outcomes from a mixed methods study of three programs. Subst Abuse Treat Prev Policy 13:32
Watson, Dennis P; Adams, Erin L; Shue, Sarah et al. (2018) Defining the external implementation context: an integrative systematic literature review. BMC Health Serv Res 18:209
Watson, Dennis P; Shuman, Valery; Kowalsky, James et al. (2017) Housing First and harm reduction: a rapid review and document analysis of the US and Canadian open-access literature. Harm Reduct J 14:30
Ahonen, Emily Q; Watson, Dennis P; Adams, Erin L et al. (2017) Alpha test results for a Housing First eLearning strategy: the value of multiple qualitative methods for intervention design. Pilot Feasibility Stud 3:46
Watson, Dennis P; Young, Jeani; Ahonen, Emily et al. (2014) Development and testing of an implementation strategy for a complex housing intervention: protocol for a mixed methods study. Implement Sci 9:138