Moving on from Permanent Supportive Housing: Implementation Challenges and Strategies for the Moving on Initiatives

Background and Purpose:  Permanent supportive housing (PSH) is an evidence-based practice that combines housing and supportive services to end homelessness for individuals who experience barriers to housing stability. However, PSH remains in very short supply relative to demand.Moving On Initiatives (MOIs) are an emerging innovation in homeless services now being utilized to address this system capacity issue. These initiatives utilize a combination of transitional supports and mainstream forms of rental assistance (e.g. Section 8 Housing Choice Vouchers) or other forms of non-service linked affordable housing to help willing and able residents exit the intensive services component of PSH. Programs can then backfill vacant units with an individual or family in greater need of the intensive supports thereby opening up the supply of PSH. These initiatives also provide residents who no longer need or want the intensive supports with the opportunity to live in the least restrictive setting possible, a goal of recovery-oriented service systems.This emerging model has the potential to increase homeless service system capacity and shape the recovery-orientation of the homeless service system. However, few empirical studies have examined MOIs and little is known about the implementation challenges providers face and strategies they use to realize these initiatives in practice.

Methods: To identify these challenges and strategies, this study utilized over two years of observations at MOI implementer “learning collaboratives”, as well aseight retrospective post-implementation focus groups with key stakeholders participating in two MOIs. Qualitative analysis was conducted in two stages. In the first phase of analysis, the first author open-coded and memo-ed field notes and focus group data in order to generate preliminary, inductive codes and initial themes. Referring back to the literature on implementation science, initial categories and concepts were found to resonate with theoretical concepts within the Consolidated Framework for Implementation Research (CFIR). Template analysis using an a priori coding system informed by the CFIR was then used to code the materials and further identify themes regarding implementation challenges and strategies associated with Moving On initiatives.

Findings: Primary factors influencing MOI implementation occurred at four of five levels in the CFIR: inner setting, outer setting, characteristics of the individuals involved, and characteristics of the intervention. Several sub-constructs within these levels were less present in the data or were not mentioned at all by participants. Outer setting factors were most prominent and one overarching construct not included in CFIR, macrosystemic characteristics, arose inductively from these data.

Conclusion and Implications: MOI implementation challenges remain but implementers have developed strategies in response to these challenges which may be transferrable to other contexts. With further research and consideration of these implementation barriers, Moving On could become an integral part of the homeless service system. Implications of these findings particularly as they relate to understanding social/political contexts, housing policy, mitigating risk for tenants, and potential sustainability will be discussed.