Using Participatory Strategies to Improve Housing Programs

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Using Participatory Strategies to Improve Housing
Programs

• John Sylvestre
• School of Psychology Centre for Research on
  Community Services

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Evidence-Based Practices

• A social movement with roots in evidence-based
  medicine (Pope, 2003).
• The conscientious, explicit, and judicious use
  of current best evidence in making decisions
  about the care of individual patients (Sackett,
  Rosenberg, Gray, Haynes Richardson, 1996, p.
  71).
• In essence, using evidence from research to
  determine which practices produce the best
  outcomes for consumers.

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Evidence-Based Practices

• Increasingly being promoted in community mental
  health.
• Mueser et al. (2003) identified 6 evidence-based
  practices assertive community treatment (ACT),
  collaborative psychopharmacology, family
  psycho-education, supported employment, illness
  management and recovery, and integrated dual
  disorders treatment.
• Supported Housing has been identified as an
  emerging evidence-based practice (Bond, 2004).

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Evidence-Based Practices

• Advantages
• Rigorous research can help to distinguish
  practices with more potential from ones with less
  potential
• Addresses concern that some services are not
  effective

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Evidence-Based Practices

• Limitations
• Issues of Applicability to real world settings
• Studies of models rather than practices
• Relatively few models have been examined
• Focus on a limited range of outcomes
• Threats to consumer choice
• Limited or no role for other stakeholders

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Program Evaluation

• Determining the effectiveness of social programs
• Evaluability Assessment - Program Theory/Logic
  Models
• Process Evaluation
• Outcome Evaluation
• Participatory Evaluation
• Limitations
• Typically focused on single programs
• Who participates? How?

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Benchmarking

• Looking to best performers to identify strategies
  for service improvement
• Collaborative
• Can focus on processes and outcomes

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Practice-based evidence

• Efforts to develop a comprehensive description of
  current practices
• Collaborative or Program Specific
• Current practices inform research directions and
  evaluation

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Limitations

• Whats the vision?
• Whos involved?

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Participatory Action Research

• Participatory People most affected by research
  are fully involved
• Action Research organized in phases defining
  problem, collecting data, planning action,
  implementing change, evaluation of effects
• Limitations
• Not specifically oriented toward practice
  improvement
• Suggests no system for collaborative service
  improvement

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Elements of a collaborative participatory
approach for service improvement

• Develop a community of interest
• Define vision and values
• Describe common service objectives
• Describe current practices
• Identify promising practices
• Dissemination, Use in Service Improvement,
  Research

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Case Example

• Developing a participatory and collaborative
  benchmarking strategy for supportive housing
  providers in Toronto
• Work subsequently validated in Ottawa and Halifax

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1. Develop a Community of Interest

• Identify range of stakeholders
• System level community development
• Acknowledge differences in perspectives/power
• Focus on common purpose

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2. Define Vision and Values

• Vision what are we trying to accomplish
  together?
• Values what are the principles that guide our
  actions?

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Vision

• Housing Stability
• The ongoing ability to gain access, over the
  course of a persons life, to housing that
  promotes optimal health and quality of life.
• Key assumptions
• Four key interdependent dimensions in housing
  Person, Housing, Support, Systems
• Housing situations are dynamic, constantly
  changing
• Change can create unstable housing situations
  that require change
• Housing problems arise when people cannot modify
  housing or find new housing

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Values

• Therapeutic values
• choice and control
• housing quality
• community integration
• Citizenship values
• fair and equitable access to resources,
• resources are responsive and accountable
• informed and able to act on rights in acquiring
  and maintaining housing

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3. Describe Common Service Objectives

• Service Objectives or Benchmarks specific
  objectives that will support the achievement of
  our broad vision
• Objectives in Four Dimensions Person, Housing,
  Support, Systems

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4. Describe Current Practices

• Survey of 10 housing providers
• What do you currently do to achieve each of these
  objectives?

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5. Identify Promising Practices

• 4 Multi-stakeholder working groups
• Do the identified practices achieve the
  benchmarks?
• Would these benchmarks apply to the housing
  program that you are most familiar with?
• What would be the major barriers to achieving
  these benchmarks and implementing these
  practices?

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Next Steps (and ongoing challenges)

• Dissemination
• Use in Service Improvement
• Currently Trying to Create Self-Evaluation Tools
• Research
• Verify that dimensions and identified practices
  are important

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Practice Realm



Research Realm