Fidelity and Outcomes: Lessons from the Implementation of California's Full Service Partnerships Todd Gilmer, PhD Department of Family and Preventive Medicine University of California, San Diego AHRQ R01 HS01986

Mental Health Services Act In 2004, California voters approved proposition 63, which was signed into law as the MHSA – Policy history included AB3777 (1988), AB34 (1999), and AB2034 (2000) which funded integrated models 1% tax on incomes > $ million to fund public mental health services in specific areas: – Community Services and Supports Recovery oriented programs targeting the underserved: homeless, Latinos, Asians, older adults, transitional age youth 28% of CSS funding to Full Service Partnerships – Prevention and Early Intervention (eg stigma, suicide) – Innovations (integrated mental and physical health)

Full Service Partnerships FSPs provide supported housing and team based services with a focus on rehabilitation and recovery FSPs are client centered and recovery oriented programs that do whatever it takes to improve residential stability and mental health outcomes FSPs were implemented with substantial stakeholder input, and were adapted to local environments, resulting in a wide diversity in approaches to both housing and services

Housing First Developed in New York City by Pathways to Housing Traditional housing model required treatment adherence and sobriety before placement Housing first model emphasized immediate housing in scatter site apartments with tenancy rights Adherence to the Housing First model can be measured using a fidelity scale – Choice/affordability, scatter site housing, separation of housing and treatment, service philosophy, service array, team structure

Why use a Fidelity Scale to Study FSPs? FSPs provide a natural experiment to study various approaches to housing and services Housing First model provides a gold standard Fidelity to Housing First provides a method of mapping FSP practices Opportunity to identify both best practices among FSPs and the important elements of Housing First

Mixed Methods Study Quantitative data – Administrative data (N=8,553, 60% schizophrenia) Provides information on housing, service utilization and costs Difference-in-difference analysis Propensity score matched control group – Fidelity to Housing First obtained through a survey of 94 FSP practices Survey based on the HF Fidelity Scale Respondents were FSP teams + clients Allows us to link practices to outcomes Qualitative data – Fidelity to Housing First obtained through 20 site visits

Participating Counties

Fidelity Survey Results

Living Situations for FSP Clients in One Year Pre and Post Enrollment Percent of Days

Difference in One Year Standardized Costs for FSP vs. non-FSP clients

Effect of Fidelity to Housing First on Residential Status

Conclusions (so far) FSPs are effective for improving residential and service outcomes Fidelity to Housing First is related to improved residential outcomes Qualitative work will provide a depth of information, and will be used to complement, explore, and expand on findings

Housing First Implementation Pathways to Housing, Inc. – – Housing First Partners Conference – NYC, Westchester County, DC, Burlington VT, Philadelphia Canadian Demonstration Project – Pages/homelessness.aspx Housing First in Veterans Affairs