title: Further Validation of the Pathways Housing First Fidelity Scale.
abstract: OBJECTIVE
  This study examined whether Housing First fidelity ratings correspond to program operation descriptions from administrative data and predict client outcomes.
  
  
  METHODS
  A multisite, randomized controlled trial (At Home/Chez Soi) in five Canadian cities included two assessments of 12 programs over two years. Outcomes for 1,158 clients were measured every six months. Associations between fidelity ratings and administrative data (Spearman correlations) and participant outcomes (mixed-effects modeling) were examined.
  
  
  RESULTS
  Fidelity ratings were generally good (mean ± SD=136.6 ± 10.3 out of a possible range of 38-152; 87% of maximum value). Fidelity was significantly associated with three of four measures of program operation, with correlations between .55 and .60. Greater program fidelity was associated with improvement in housing stability, community functioning, and quality of life.
  
  
  CONCLUSIONS
  Variation in program fidelity was associated with operations and outcomes, supporting scale validity and intervention effectiveness. These findings reinforced the value of using fidelity monitoring to conduct quality assurance and technical assistance activities.
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Paula
authors.initials: P
authors.lastname: Goering
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Scott
authors.initials: S
authors.lastname: Veldhuizen
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Nelson
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Ana
authors.initials: A
authors.lastname: Stefancic
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Sam
authors.initials: S
authors.lastname: Tsemberis
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Adair
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Jino
authors.initials: J
authors.lastname: Distasio
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Tim
authors.initials: T
authors.lastname: Aubry
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
authors.affiliation: Dr. Goering is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, where Dr. Stergiopoulos and Dr. Streiner are affiliated, and with the Centre for Addiction and Mental Health, Toronto (e-mail: paula_goering@camh.net ). Dr. Stergiopoulos is also with the Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto. Dr. Streiner is also with the Department of Psychiatry and Behavioral Neurosciences, and Mr. Veldhuizen is with the Department of Family Medicine, McMaster University, Hamilton, Ontario. Dr. Nelson is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Dr. Stefancic is with the Department of Psychiatry, Columbia University, New York City. Dr. Tsemberis is with Pathways National, Inc., New York City. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Distasio is with the Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario.
authors.forename: David L
authors.initials: DL
authors.lastname: Streiner
mesh_terms: D002170:Canada; D003156:Community Mental Health Services / Q000458:organization & administration*; D017144:Focus Groups; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis*; D015397:Program Evaluation; D011788:Quality of Life / Q000523:psychology*