Implementation and Outcomes of Forensic Housing First Programs

Background: HF models are increasingly being considered for individuals with serious mental illness and justice system histories. Providing HF for these individuals, especially when linked to jail diversion strategies, challenges the core HF principles of harm reduction, consumer-driven services, and client self-determination. The degree to which mandated treatment and reporting mandates affects the implementation and outcomes of a HF model is an important consideration that has largely gone unaddressed in the literature.

Methods: Using a mixed-method approach, this study used administrative data from 93 supportive housing programs to compare fidelity to the Housing First model and residential client outcomes between forensic and nonforensic programs. Qualitative data from evaluative site visits from a subset of four forensic programs was used to investigate whether and how providers working in forensic programs can navigate competing Housing First principles and criminal justice mandates. Quantitative data was analyzed using generalized estimating equations (GEEs); informed by these results, qualitative data was analyzed using a template coding approach to thematic analysis.

Findings: Quantitative findings suggested that forensic programs were less likely to follow a harm reduction approach to substance use and clients in those programs were more likely to live in congregate settings. Qualitative findings suggested that an interplay of court involvement, limited resources, and risk environments influenced staff decisions regarding housing and treatment that helps explain higher placement rates in congregate settings.

Implications: Existing mental health and criminal justice collaborations necessitate adaptation to the Housing First model to accommodate client needs.