Pressure on the front lines: Street-level bureaucrats and the 'housing first' approach

The Housing First Model (HFM) was designed as an alternative to the traditional abstinence-based (AB) approach to serving individuals experiencing chronic homelessness and dual diagnoses of substance use disorder and serious mental illness. The model has demonstrated strong efficacy regarding a number of behavioral health outcomes and, as such, is now considered by the U.S. Department of Housing and Urban Development (HUD) in its funding decisions.  As program funding is essential to success and sustainability, housing providers can feel forced into compliance, resulting in the neglect of necessary principles of the HFM.

A 2014 phone-based fidelity study of HUD funded housing providers in the state of Indiana marked a noticeable disconnect between the evaluation respondents’ answers to survey questions and their elaborations of organizational processes.  This reluctance and, in some cases, hostile suspicion of evaluators resulted in the hypothesis that these behaviors were possibly the result of organizational and/or political pressures that advocate for a continuum-wide shift to the evidence-based Housing First model.  In this presentation, I will use a comparative analysis of the phone-based fidelity data and survey data of attitudes toward Housing First implementation to discuss institutional isomorphism and the effect of coercion on the natural process of change in housing organizations.  Additionally, I will analyze the role of street-level bureaucrats in providing housing services and demonstrate how the demands, dilemmas, and pressures of these positions impact successful program implementation and evaluation. Finally, I will discuss the effectiveness and usefulness of the phone-based fidelity for evaluation purposes.