Variations in Full Service Partnerships and Fidelity to the Housing First Model

In California, the Mental Health Services Act allocated substantial funding to Full Service Partnerships (FSPs): programs that do whatever it takes to improve residential stability and mental health outcomes. The state-guided, but stakeholder-driven, approach to FSPs resulted in a set of programs that share core similarities but vary in their specific approaches. This qualitative study examines FSP variations within the framework of fidelity to the Housing First model. Semistructured interviews with 21 FSP program managers identified through purposeful sampling were coded and analyzed to identify variations across programs in their approaches to housing and services. Through the process of constant comparison, FSP characteristics were condensed into a set of broad themes related to fidelity to the Housing First model. We identified three broad themes: (a) FSPs varied in the degree to which key elements of Housing First were present; (b) program recovery orientation and staff experience were associated with fidelity; and (c) FSPs for older adults, adults exiting the justice system, and transitional age youth made specific adaptations to tailor their programs for the needs of their specific populations. FSPs bring a considerable level of community-based housing and treatment resources to homeless persons with serious mental illness. However, when examined individually, there exists enough variation in approaches to housing and treatment to raise the question whether some programs may be more or less effective than others. An opportunity exists to employ the variation in FSPs implemented under this initiative to analyze the importance of fidelity to HF for client outcomes, program costs, and recovery-oriented care.