title: Sustaining Housing First After a Successful Research Demonstration Trial: Lessons Learned in a Large Urban Center.
abstract: OBJECTIVE
  This study aimed to identify challenges and facilitators of sustaining a Housing First intervention at the conclusion of a research demonstration project in Toronto.
  
  
  METHODS
  This qualitative study included key informant interviews with organizational leaders (N=13) and focus groups with service team members (N=14) and program participants (N=9) of the At Home/Chez Soi Research Demonstration Project. Thematic analysis was used to identify key themes related to sustainability of Housing First beyond the demonstration phase.
  
  
  RESULTS
  Factors that helped secure long-term funding support for Housing First included the positive findings of a rigorous evaluation, early stakeholder engagement, and strong local leadership. Reduced funding, poor intersectoral integration, and lack of central oversight threatened fidelity to the evidence-based model and challenged sustainability.
  
  
  CONCLUSIONS
  Evidence-based complex interventions such as Housing First require robust intersectoral collaboration and flexible systems for funding and monitoring to ensure continuing model fidelity and responsiveness to changing contexts.
authors.affiliation: Ms. Kumar is with the Wellesley Institute, Toronto. Ms. Plenert is with the Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto. Dr. Hwang and Dr O'Campo are with the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto. Dr. Hwang is also with the Department of Medicine, University of Toronto. Dr. Stergiopoulos is with the Centre for Addiction and Mental Health, Toronto. Send correspondence to Dr. Stergiopoulos (e-mail: stergiopoulosv@smh.ca ).
authors.forename: Nishi
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Ms. Kumar is with the Wellesley Institute, Toronto. Ms. Plenert is with the Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto. Dr. Hwang and Dr O'Campo are with the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto. Dr. Hwang is also with the Department of Medicine, University of Toronto. Dr. Stergiopoulos is with the Centre for Addiction and Mental Health, Toronto. Send correspondence to Dr. Stergiopoulos (e-mail: stergiopoulosv@smh.ca ).
authors.forename: Erin
authors.initials: E
authors.lastname: Plenert
authors.affiliation: Ms. Kumar is with the Wellesley Institute, Toronto. Ms. Plenert is with the Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto. Dr. Hwang and Dr O'Campo are with the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto. Dr. Hwang is also with the Department of Medicine, University of Toronto. Dr. Stergiopoulos is with the Centre for Addiction and Mental Health, Toronto. Send correspondence to Dr. Stergiopoulos (e-mail: stergiopoulosv@smh.ca ).
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.affiliation: Ms. Kumar is with the Wellesley Institute, Toronto. Ms. Plenert is with the Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto. Dr. Hwang and Dr O'Campo are with the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto. Dr. Hwang is also with the Department of Medicine, University of Toronto. Dr. Stergiopoulos is with the Centre for Addiction and Mental Health, Toronto. Send correspondence to Dr. Stergiopoulos (e-mail: stergiopoulosv@smh.ca ).
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.affiliation: Ms. Kumar is with the Wellesley Institute, Toronto. Ms. Plenert is with the Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto. Dr. Hwang and Dr O'Campo are with the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto. Dr. Hwang is also with the Department of Medicine, University of Toronto. Dr. Stergiopoulos is with the Centre for Addiction and Mental Health, Toronto. Send correspondence to Dr. Stergiopoulos (e-mail: stergiopoulosv@smh.ca ).
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
mesh_terms: D000328:Adult; D055317:Evidence-Based Practice / Q000458:organization & administration* / Q000592:standards; D017144:Focus Groups; D006703:Ill-Housed Persons; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation*; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D009864:Ontario; D011638:Public Housing / Q000458:organization & administration* / Q000592:standards; D036301:Qualitative Research; D014505:Urban Population
keywords: Community psychiatry; Community residences/supported housing; Homelessness