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Table 3 Example of quotes

From: Evaluation of the implementation of the Montreal at home/chez soi project

Intervention Characteristics
Adaptability: “I am frustrated a bit by certain types of information, or certain ways of seeing things. I did not have a chance to explain how we, especially in Quebec in our specific culture, see things. I learned this later in life and when you react later, it is often not seen as it should have been seen.” (12-Manager)
Adaptability: “Well, we came with a housing first approach, which really disrupted things […]. This is something different, so it always requires efforts on the part of those involved in spite of the information and everything. For some, it’s easy, and for others it’s more difficult. I think it is not over. One cannot acquire the skills and abilities in one year… there is still work to be done.” (31-Manager)
Complexity: “For owners who were not aware, because they never had had previous experience, we took the time to explain our agreement to them, in what we were getting ourselves into, and told them that it was the person that we would introduce them to would be signing the lease, and that that person would be a tenant like everyone else, committed to his or her responsibilities and his or her rights on both sides, and that we were a team there to support them in this project, that we would be real partners. Yes, it is a bit long, because we really have to make this long-winded speech; we really have to fully inform the owners so that they knew what type of project they were embarking on.” (27-Housing Team)
Conplexity “I think that this is a complex, large project […]. And I must say that I am still learning about this project. I still feel like I am learning about what is happening, what the issues are…” (32- Manager)
Context of Implementation
Opposition to Housing First: “In the community, in other organizations, we heard people speaking against it. It was a bit of a wave against the Housing First Project. It will be like taken over. They (the users) will be used. After that, they will be dropped, etc. There was a lot of prejudice in that regard.” (28- ICM Community Agency Team)
Shock of culture: “It is the basis of the Housing First approach, the subsidies for rent in the private sector that they found morally wrong […]. It is their way of seeing the world, that many of us do not share…” (01-Manager)
Incentives: “There were many meetings, and basically it was to generate some interest in those in the grassroots so that this project could come to Montreal […] to try to see how we could deal with the problems with intergovernmental affairs, the resistance of the Government of Quebec, and thus the Health and social services ministry and the Health regional agency regarding this project. Essentially, to develop an interest by the grassroots…” (04-Manager)
Implementation Process
Conflicts between the Housing Team and the Clinical Teams: “There is indeed an issue about the mandate, the housing team, their clients… they are the owners. We, our clients, they are participants who sometimes have a relationship with the owner that is not always satisfactory. When we speak, we do not have the same objective.” (11-Manager)
Shock of cultures: “With the clinical team, it was more focused on the participant and the participant’s problems, and history. […] We, by definition the Housing Team, are more associated with the “Community”. We are not in the life of the participant. We deal with the owner, the territory, the resources, etc.” (27-Housing Team)
Lack of Qualification of the Teams: As nurses, this is also new. We do a lot of legwork, observation, evaluation, whereas we work far more now with the social worker, paperwork, the local job centre… all that for us is major. It’s new. We do not see that at school.” (49- HSSC ACT Team)
Lack of Qualification of the Teams: “What is an issue between ICM and Housing, as with ACT and Housing, is that the Housing Team was not made up of people trained in mental health.” (30- HSSC ICM Team)
Staff Turnovers: “We got to know them at the time, and then we had new stakeholders, and then… I mean, we had to start everything all over. Then… No matter how much they talk among themselves, but I mean, you know, it’s…” (User HSSC ACT Team)
Loneliness: “So I will say like she did: “You say…” I will come back to that, the loneliness and then … The loneliness, and that’s it… At the start, for the first four months, it was hell.” (User ICM Community Agency Team)
Organizational Characteristics
Climate: “We are far smaller and more flexible machines. And we have always been flexible, we can easy turn around and I wonder whether we are more open […]. So, if there is a problem I think it is easier to talk about it and find a solution.” (05-Manager)
Difficulty to integrate activities for big organizations: “You know, the HSCC is a strange machine. I can’t believe we have this in Quebec, but it’s a strange machine. It’s complex, you have very little autonomy, everything is regulated, even the furniture.” (03-Manager)
Culture: “In fact, these problems, these are the problems with the entire project, i.e., that it is an ad-hoc alliance between several partners with philosophies from the outset that are not necessarily that similar, which have been brought together by the project and are starting off from very different traditions, which do not have a long history of working together, so we still talking about institutions that are not accustomed to working together, with each having its own particular culture.” (04-Manager).
Positive Outcomes: “What we are in the process of creating that will remain is all the learning in terms of daily living activities and domestic life. We are teaching them ways of living in a healthier apartment setting. I think that will remain with them.” (44-HSSS ICM Team)
Strategies of Implementation
Loss of Meaning and Lack of Discretion: “I know that, in the first planning report that was produced as part of this study, there was an issue that there was not enough discretionary powers given to the local level during the planning and development phase. I did not think that there would be more latitude. And that we would still have to refer to the national level for fundamental questions. It is more the national level that provides direction.” (05-Manager)
About the Steering Committee: “I do not personally believe that is vested managerial power. Because the real management issues are a matter for the national level. I believe this, because after all it is a multi-site party, so we are just one site among others, yes…” (07-Manager)
About the Peer Users Council: “We did not really participate in the planning. It was a housing program first and foremost, and then the Housing Team came at the same time as us, so, to me, it was like you starting a car, and you did not have your two main wheels. Honestly, I really felt like that.” (18- Peer User Council)
Expectation from the Peers Users Council: “The Peer Users Council was supposed to be really involved at the clinical level. That was at least what I thought, and it is not that at all […] Absolutely no one knows it. It’s sad […] and perhaps if we think of involving the participants, we are miles from there.” (47-S HSSC ACT Team)