Adapting the Pathways Housing First Fidelity Scale for Project-Based Permanent Supportive Housing

Background and Purpose: Housing First (HF) is an evidence-based approach to addressing chronic homelessness, with fidelity associated with improved housing stability and quality of life. The Pathways Housing First fidelity scale has been widely used and validated but was developed for scatter-site permanent supportive housing (SS-PSH), where tenants live in dispersed units. In contrast, project-based permanent supportive housing (PB-PSH)—in which tenants reside in a single building with on-site services—has become increasingly prevalent, particularly in high-cost urban markets. Structural and operational differences between SS-PSH and PB-PSH have important implications for how HF principles are implemented and assessed, especially regarding building-level dynamics such as shared spaces, safety practices, and service coordination. This study describes a systematic effort to adapt the Pathways HF fidelity scale for PB-PSH and presents preliminary evidence of the adapted tool’s measurement properties.

Methods: This study followed a two-phase, theory-informed adaptation process. In Phase 1, a PB-PSH best practice framework was developed through a landscape analysis that included 41 stakeholder interviews with 69 participants, site visits to nine PB-PSH programs, a targeted literature review, and consultation with system partners. The goal was to identify core domains of effective PB-PSH practice without imposing predefined fidelity constructs. In Phase 2, this framework guided a structured, iterative adaptation of the original Pathways HF fidelity scale in collaboration with scale developers and practitioners. Each item was reviewed to determine whether it should be retained, modified, or reconceptualized for PB-PSH contexts. The adapted scale was pilot tested in two PB-PSH buildings using a standardized fidelity assessment protocol that included document review, site visits, staff interviews, tenant listening sessions, and consensus-based scoring.

Results: Preliminary findings indicate that the adapted PB-PSH fidelity scale demonstrates good internal consistency across domains. Fidelity scores varied meaningfully between the two pilot sites, suggesting that the instrument captures differences in program implementation rather than producing uniform ratings. Evidence of discriminant validity was observed, as domains related to housing and building operations did not move in lockstep with service-oriented domains, indicating conceptual distinction. Qualitative data supported the interpretability of domain scores and item ratings. The final instrument includes five domains: Housing to Match Participant Needs; Services to Match Participant Needs; Separation and Coordination of Housing and Services; Recovery Orientation and Participant Choice; and Program Operations and Building Environment, with several new items addressing building-level features unique to PB-PSH.

Conclusions and Implications: This study demonstrates the feasibility of adapting a well-established HF fidelity measure for PB-PSH through a systematic, collaborative process grounded in implementation science. Findings highlight the importance of building-level dynamics in PB-PSH and the need for fidelity measures that reflect these contextual realities while preserving core HF principles. Although based on a small pilot sample, the adapted scale shows promise as a tool for program implementation, quality improvement, and technical assistance. Future research should examine psychometric properties in larger samples and assess associations between fidelity and tenant outcomes. As PB-PSH continues to expand, this tool can help ensure alignment with Housing First principles and support high-quality service delivery.