Strategies for Sustaining Fidelity: A Multi-state Qualitative Analysis in Housing First Programs.
Strategies for Sustaining Fidelity: A Multi-state Qualitative Analysis in Housing First Programs.
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DOI：
10.1007/s10488-020-01041-2
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Stefancic A
中科院分区：
文献类型：
--
作者：
Choy-Brown M;Tiderington E;Tran Smith B;Padgett DK;Stefancic A
在不断变化的条件下，循证干预措施（ebi）的长期保真度知之甚少。本研究考察了“成熟”（八年或八年以上）住房优先（HF）项目的员工如何制定战略，以维持美国大西洋中部/东北部不同地理区域的EBI契合度。在三个有目的地选择的HF项目中进行了六个焦点小组（fg），每个地点的病例管理人员和主管分别进行了单独的fg。FG的讨论引出了参与者在影响每个项目的持续变化中解决保真度的服务方法和策略。以5个HF保真度域（住房选择/结构、住房与服务分离、服务理念、服务阵列、节目结构）作为先验主题对FG转录本进行专题内容分析，并对每个主题的数据进行归纳内容分析。采用了严格的策略。病例管理人员（N=17）和主管（N=16）主要是白人（76%）和女性（60%）。在各个主题中，挑战包括缺乏负担得起的住房和选择，资助者的限制和实践的漂移。策略包括社区参与和招聘、强有力的领导和“通融规则”。“不同地点之间没有差异。后期的实施挑战表明，需要继续保持警惕，忠实于ebi。在本研究中用于解决保真度的策略中，追求积极的社区参与以吸引知识渊博的员工并增加当地的支持被认为是三个站点的关键。这些发现强调了既要注意内部程序操作，也要注意外部设置的必要性。
Little is known about long-term fidelity of evidence-based interventions (EBIs) under changing conditions. This study examines how staff at ‘mature’ (eight or more years in operation) Housing First (HF) programs strategize to sustain EBI fit in different geographic areas in the Mid-Atlantic/Northeastern United States. Six focus groups (FGs) at three purposively selected HF programs were conducted with separate FGs for case managers and supervisors at each site. FG discussions elicited participants’ service approaches and strategies in addressing fidelity amidst ongoing changes affecting each program. Thematic content analysis of FG transcripts was conducted using the five HF fidelity domains (housing choice/structure, separation of housing and services, service philosophy, service array, and program structure) as a priori themes with inductive content analyses conducted on data in each theme. Strategies for rigor were employed. Case managers (N=17) and supervisors (N=16) were predominantly white (76%) and female (60%). Across the themes, challenges included lack of affordable housing and choice, funders’ restrictions and practice ‘drift.’ Strategies included community engagement and hiring, strong leadership and ‘bending the rules.’ There were no differences across sites. Later-stage implementation challenges show the need for continued vigilance in fidelity to EBIs. Among the strategies used to address fidelity in this study, the pursuit of pro-active community engagement to attract knowledgeable staff as well as increase local buy-in was considered pivotal at all three sites. These findings underscore the need to attend to the external setting as well as to internal program operations.
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影响因子：
2.9
作者：
O'Campo P;Stergiopoulos V;Nir P;Levy M;Misir V;Chum A;Arbach B;Nisenbaum R;To MJ;Hwang SW
通讯作者：
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影响因子：
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作者：
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通讯作者：
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