How Housing First’s fidelity framework helps tackle homelessness

With the right help and support, people can leave homelessness behind for good. Housing First is a housing and support intervention that aims to help people experiencing homelessness into safe, secure housing that works for their specific needs. At Greater Manchester Housing First, we support people experiencing homelessness into a home through Housing First.

What are the key principles of Housing First?

Housing first is structured around seven key principles. These principles define the ethos and model that informs day to day delivery of Housing First. These are:

• People have a right to a home.
• Flexible support is provided for as long as it is needed.
• Housing and support are separated.
• Individuals have choice and control.
• An active engagement approach is used.
• The service is based on people’s strengths, goals and aspirations.
• A harm reduction approach is used.

How far the support delivered to people experiencing homelessness aligns to these principles is known as fidelity. Our research shows that Housing First services which are delivered to a higher fidelity are more effective. With close fidelity to these principles, between 80% and 90% of those receiving Housing First remain in homes within two years, with reduced criminal justice involvement and health inequalities.

How did we develop the fidelity framework?

When we started delivering one of the national Housing First pilots back in 2019 across Greater Manchester, there was nothing formal in place in this country to assess and review fidelity. Delivering a high fidelity service was key to our partnership and we wanted to make sure that all of our delivery partners were providing person centred, trauma-informed support grounded in the Housing First principles.

In order to review whether services were meeting the housing first principles, we developed a Quality Assurance Framework using good practice guidance around the principles published by Homeless Link. This included a self-assessment of practice, along with Guided Conversations designed to capture fidelity from the perspective of the people receiving support, peer to peer shadowing and audits of case management records.

We used all of this information to reflect with our partners on how support aligned to the Housing First principles. We could use our reflections to pinpoint areas where we could make changes to improve fidelity to certain principles. This also allowed us to identify where training was needed to enhance support and identify any barriers.

Having a fidelity framework in place is crucial to make sure providers of Housing First are able to learn and reflect on their own service delivery in a supportive manner. That’s why we jumped at the chance to be part of the Task and Finish group assembled by Homeless Link. Here we fed in our learning on the development of the national fidelity framework.

How did we pilot the fidelity framework?

As part of our work helping to develop the national fidelity framework, we piloted its use in our Housing First programme. The delivery self-assessment tool was led by our Quality and Assurance Manager with one of our Housing First teams in a supportive session reflecting on current practice. We then convened a ‘reflection group’ that involved our Commissioner, Local Authority representative and Senior Management from the programme and delivery team. We reviewed the self-assessment and support to identify key actions to improve fidelity within our programme.

It was really useful to be able to reflect together, with our key stakeholders outside of the direct delivery partnership, helping us understand the systemic challenges we encountered.

Our top tips for using the fidelity tool

From our experience our top tips when using the fidelity tool:

• Ensure you allocate enough time and space to complete the self-assessment in a trauma-informed, supportive manner.
• Be honest and remember to reflect on the achievements not just focus on the challenges.
• This is not a ‘tick-box’ exercise and needs to be used for real practice development and service improvement keeping the people being supported at the heart.

It’s important to remember that fidelity is an ‘evolution’ and we are all on a journey with our service and practice delivery which the national fidelity framework will support.