Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers,Training/Technical Assistance,and Points of Leverage

We present interim findings of a cross‐site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence‐based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early implementation were conducted in six Canadian communities receiving HF TTA. The primary data are field notes gathered over 1.5 years and evaluations from site‐specific training events (k = 5, n = 302) and regional network training events (k = 4, n = 276). We report findings related to: (a) the facilitators of and barriers to early implementation, (b) the influence of TTA on early implementation, and (c) the “levers” used to facilitate broader systems change. Systems change theory enabled us to understand how various “levers” created opportunities for change within the communities, including establishing system boundaries, understanding how systems components can function as causes of or solutions to a problem, and assessing and changing systems interactions. We conclude by arguing that systems theory adds value to existing implementation science frameworks and can be helpful in future research on the implementation of evidence‐based practices such as HF which is a complex community intervention. Implications for community psychology are discussed.     

Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada

The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi‐component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team‐based practice, and facilitating case‐based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system—practitioners, teams, and communities—while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.     

Mechanism of action and kinetics of lithium. I. Biochemical and experimental pharmacological findings after administration of lithium-conclusions on the mechanism of the therapeutic effect of lithium]

A comprehensive consideration of biochemical and pharmacodynamic lithium (Li) effects enabled an explanation of the Li mechanism (Fig 1). According to this concept, Li might possibly affect the activity of membrane-bound ATPases in dependence on the initial situation, dose and duration of application. Research into Li-kinetics suggested the participation of active process in the transport of the ion through the organism. Li-kinetics describes distribution within a multiple-compartment system and, with the exception of the resorption phase, its independent of the anion used. The elimination (half-life time 22 to 25 hrs) is limited by backward flow form the tissue.     

Attentional signatures of perception: multiple object tracking reveals the automaticity of contour interpolation

Multiple object tracking (MOT) is an attentional task wherein observers attempt to track multiple targets among moving distractors. Contour interpolation is a perceptual process that fills-in nonvisible edges on the basis of how surrounding edges (inducers) are spatiotemporally related. In five experiments, we explored the automaticity of interpolation through its influences on tracking. We found that (1) when the edges of targets and distractors jointly formed dynamic illusory or occluded contours, tracking accuracy worsened; (2) when interpolation bound all four targets together, performance improved; (3) when interpolation strength was weakened (by altering the size or relative orientation of inducing edges), tracking effects disappeared; and (4) real and interpolated contours influenced tracking comparably, except that real contours could more effectively shift attention toward distractors. These results suggest that interpolation's characteristics-and, in particular, its automaticity-can be revealed through its attentional influences or "signatures" within tracking. Our results also imply that relatively detailed object representations are formed in parallel, and that such representations can affect tracking when they become relevant to scene segmentation.     

Repeatedly reactivated memories become more resistant to hippocampal damage

We examined whether repeated reactivations of a context memory would prevent the typical amnesic effects of post-training damage to the hippocampus (HPC). Rats were given a single contextual fear-conditioning session followed by 10 reactivations, involving a brief return to the conditioning context (no shock). Subsequently, the rats received sham or complete lesions of the HPC. When tested for retention, the HPC rats that experienced the reactivations froze significantly more than nonreactivation HPC rats and did not significantly differ from their respective control group. These findings suggest that memory reactivations contribute to long-term memories becoming independent of the HPC.     

Neural correlates of acquired color category effects

Category training can induce category effects, whereby color discrimination of stimuli spanning a newly learned category boundary is enhanced relative to equivalently spaced stimuli from within the newly learned category (e.g., categorical perception). However, the underlying mechanisms of these acquired category effects are not fully understood. In the current study, Event-Related Potentials (ERPs) were recorded during a visual oddball task where standard and deviant colored stimuli from the same or different novel categories were presented. ERPs were recorded for a test group who were trained on these novel categories, and for an untrained control group. Category effects were only found for the test group on the trained region of color space, and only occurred during post-perceptual stages of processing. These findings provide new evidence for the involvement of cognitive mechanisms in acquired category effects and suggest that category effects of this kind can exist independent of early perceptual processes.     

The Understanding of Pans in 3- to 6-Year-Old Children

In this study, we examined the extent to which preschool children were able to understand pans (continuous sideward shifts of a scene generated by rotating the camera around a virtual axis), one of the most typical technical elements of films. This was done by showing 60 participating children a film in which a teddy bear asked them questions about pan sequences. The questions could be answered correctly only if the underlying pan was understood. The study revealed that the increase in the children's comprehension of the pans was significantly correlated with age and was facilitated by gains in visual working memory (VWM). It was found that VWM in 3 year olds is generally so low that they are still not able to understand any pan sequences. Most of the pans were understood by those children who could remember the locations of two simple objects. This VWM level is sex dependent and is usually reached by boys at age 4 and by girls at age 5; thus, boys understand pans quite a bit earlier. Perception speed, pan speed, and television consumption played rather limited roles. An appropriate model for the understanding of pans is subsequently introduced and discussed.     

Ongoing change in psychoanalytic theory implications for analysis of religious experience

Hans Loewald (1980) once made the distinction between ghosts and ancestors, the former always wanting to return to the land of the living, the latter being able to rest in peace and live forth through their progeny in the present generation. Extending this metaphor, Stephen Mitchell (1991) has noted that the intellectual integrity and vitality of psychoanalysis depends on our shifting our view of Freud from an unburied ghost who haunts us to an honored ancestor. I argue that perhaps nowhere is Freud's enduring presence greater than in psychoanalytic perspectives on religion, and it is often as an unburied ghost. Ongoing change in psychoanalytic theory, however, affords respectful amendment to his work in a way that allows Freud to be a dearly honored ancestor from whom we are all psychoanalytic descendents. Three developments in psychoanalytic theory have special implication for the analysis of religious experience. These areas of change pertain to contemporary understanding of illusion, narrative, and social constructivism. I offer in conclusion seven points for further consideration.