Grant: Knowledge Synthesis Grant

<html> <body> <p>In 2013, the Canadian Government renewed the Homelessness Partnering Strategy to commit $600M over 5 years to work with various stakeholders communities to implement a Housing First (HF) approach to homelessness. A HF approach involves giving homeless people a place to live, and physical, mental, and psychosocial supports to help them improve their lives. HF is characterized by tenant choice and low-barrier tenancy requirements^{.4, 85} <br> <br> HF is a new model with impressive impacts, especially in housing stability. The Mental Health Commission of Canada&rsquo;s At Home/Chez Soi project found that HF is effective in reducing homelessness and helping those with mental illness, addictions, etc. (our team co-led the Vancouver and Toronto sites). <strong>HF gets people into housing, but what next?</strong> Housing stability is viewed as an important pre/co-requisite for improvement in health and other areas of life, and ultimately to function independently in the broader community. Increasingly, studies on HF are measuring other tenant outcomes such as community functioning. However, knowledge on this topic has not yet been synthesized. We propose to conduct the first realist synthesis on HF and community functioning, in order to aid homelessness/HF decision-makers who currently do not have an evidence base to determine which aspects of HF help improve community functioning for tenants. A realist synthesis is the ideal method to study complex approaches such as HF.⁶⁶ <br> <br> Our question is &ldquo;<strong>How do housing/support interventions used in HF help tenants to gain improved community functioning?</strong>" and will specifically address: 1) the expected chain of results of housing/support interventions (program theory); 2) their reported outcomes; 3) who is reported to be affected (both positively/negatively); and 4) the mechanisms/contextual elements that help to explain the outcomes.<br> <br> We will follow the 5 <i>iterative</i> stages of realist synthesis outlined by Pawson ⁶⁶: 1) clarify the scope (e.g., articulate key theories of HF and community functioning); 2) search for evidence (e.g., published and grey literature, snowball); 3) appraise primary studies and extract data (e.g., does the research support the theory under test); 4) synthesize evidence and draw conclusions (e.g., refine program theory); and 5) disseminate (e.g., to key homelessness/HF decision-makers). The initial parameters of our realist synthesis (we will expand/refine these) include a HF program logic model and HF Fidelity Scale, ¹⁰² English language, 1995-current, and the measurement of tenant community functioning as an outcome of HF (primary study/evaluation). We will use the context-mechanism-outcome framework to guide our work. This framework is suited to answer questions about what works for whom under what circumstances. We anticipate that the evidence supporting each linkage in the program chain will be heterogeneous and complex. Conclusions are anticipated to be a series of contextualized decision points (e.g., if A, then B).<br> <br> Our review will provide policy makers, service providers, and professionals with timely and important new insights into the implementation and effectiveness of HF approaches for tenants. Ultimately, our realist synthesis is part of an overall research agenda to inform policy and practice to improve health and quality-of-life outcomes for homeless persons so that they can become engaged in the broader community instead of being ill, marginalized, and isolated.</p> </body> </html>