Table 3 Dimensions and elements of the fidelity index and rational supporting inclusion in instrument a
Description | |
|---|---|
Dimension I | Human resources-structure and composition: Refers to the composition and structure of the staffing. |
1. Diverse staff | Program staff highly reflects the diversity within the consumer population. |
2. Minimum education requirements | At least 25% of case managers have a Master’s degree or higher. |
3. Harm reduction and crisis intervention knowledge | Program provides or requires ongoing training in harm reduction and crisis intervention for staff[11].b |
4. Staff availability | At least one staff member is available to consumers twenty-four hours a day, seven days a week[11].b |
5. Clinical staffing | Program has psychiatric staff and mental health professional on staff or contract[11, 17]. |
Dimension II | Program boundaries: Limits placed on who the program will serve and the responsibilities of key staff members. |
6. Population served | Program serves only chronically homeless and dually-diagnosed individuals, and it houses current drug users[11].b |
7 .Consumer outreach | There is a designated staff member dedicated to outreach or an outreach department[11].b |
8. Case management responsibilities | Case management responsibilities are limited to case management.b |
9. Termination guidelines | The program only terminates consumers who demonstrate violence, threats of violence, or excessive non-payment of rent.b |
10. Termination policy enforcement | The service termination policy is consistently enforced.b |
Dimension III | Flexible policies: Policies and rules are written to appropriately serve consumers with greatest need/vulnerability and to allow them maximum choice in terms of substance use and housing. |
11. Flexible admissions policy | The program has formal protocol for admitting consumers with the greatest need/vulnerability[11].b |
12. Flexible benefit/income policy | The possession of or eligibility for income benefits is not a prerequisite for housing. |
13. Consumer choice in housing location | The program works with consumers to find desirable housing[11].b |
14. Flexible housing relocation | The program always attempts to relocate consumers when they are dissatisfied with their current housing placement[11].b |
15. Unit holding and continuation of case management | The program holds housing for hospitalization and incarceration for more than 30 days and program continues to offer case management services while unit is unoccupied[9]. |
16. Flexible with missed rent payments | The program is flexible with missed rent payments, but holds the consumer accountable.b |
17. Flexible alcohol use policy | The program allows alcohol use and housing allows alcohol in units[9].b |
18. Flexible drug use policy | The program allows illicit drug use and housing allows illicit drug use in units[9].b |
19. Eviction prevention | The program has a formal policy and protocol to work with consumers to prevent eviction and has a staff member dedicated to eviction prevention.b |
20. Consumer input into program | The program has formal and informal mechanisms for receiving and implementing consumer input.b |
Dimension IV | Nature of social services: The structure, policies, and practices related to social services offered by the program. (there is some overlap with Dimension IV; however, this dimension refers specifically to social services) |
21. Low-demand service approach | Consumers are not required to engage in any services except for case management in order to receive/continue receiving housing[9, 11].b |
22. | Harm reduction approach to service provision: Program uses a harm reduction approach and staff has a strong conceptual understanding[9, 11].b |
23. Regular in-person case management meetings | Consumers meet with their case managers 2-3 times a month on average, but program has a policy that more frequent meetings occur in the first 1-6 months after admissions[11]. |
24. Small case loads | Case managers have 10 or fewer consumers on their case load. |
25. Ongoing consumer education | Consumers receive ongoing education in Housing First and harm reduction policies and practices.b |
Dimension V | Nature of housing and housing services: The structure of housing and housing services offered by the program and/or private landlords. |
26. Structure of housing | Housing is scattered-site in buildings operated by private landlords[11].b |
27. Fast placement into permanent housing | The program places consumers into housing in one week or less[11]. |
28. Temporary housing placement | Temporary housing placement does not last more than one month.b |
29. Consumer is lease holder for housing unit | 100% of consumers are the lease holders of their unit[11]. |