Table 2.

Emergent themes and illustrative quotes

Theme 1. Person-Centered versus System-Centered

1a. HF provider: “I don't really have a set approach. It's sort of working within the relationship, first establishing the relationship, and that could take a while, trust-wise. And then being able to sort of use that relationship and approach somebody around whatever it is they want.”

1b. HF provider: “The reason why I'm here [at the agency] is because we have a very strong Housing First mission where we believe that everyone has the right to have their own apartment and live independently whether or not they're taking meds or sober or what have you.”

1c. HF provider: “Coming [here] changed my perspective on everything because I worked at a drug TC [therapeutic community] program before, where abstinence is definitely a must before they even try to get you housing.”

1d. TF provider: “If you really look at this whole thing, the client is a commodity. And you are here to sell that client. That's the big picture. ... So, I'm a salesman, and that's the product, and that's the way I see it. I have to do whatever I can to sell the product [to potential housing providers].”

1e. TF provider: “I take a very tough approach, tough approach in a loving way. I have my own set of rules. You know, the rules here are they're not allowed a cell phone, it's fine but they're not allowed to use it in the building. My thing is if I catch them in the building using it, I'll take your phone away for a day or two.”

Theme 2. Acceptance versus Conformity

2a. HF provider: “Most programs are like that. ... If you were tested positive for drugs, you were kicked out, maybe given a second chance or if you didn't take your meds. I mean [our program] is very different that way. Most places are like that because they don't want to deal, they want people to just be medicated and off drugs. They don't want to deal with them on drugs, you know all paranoid. We're saying we'll take you as you are.”

2b. HF provider: “We don't require medications, and it is very client-driven. ... I think some of the clients who are very psychotic and paranoid, we can't ... I think it's just hard sometimes to work with them. I struggle with that sometimes because I question what we are doing.”

2c. TF provider: “I would basically tell them something like, if that's the case [consumer is using drugs], you need to decide where you're gonna live. Because I'm not gonna be able to get you housed unless you're psychiatrically stable. And if I'm not gonna be able to get you housed, you're not gonna stay here very long because I only have [a certain amount of] beds. ... And I tell all the clients if they're not serious, don't waste my time.”

2d. TF provider: “We're not taking bets, but sometimes me and the case managers, we'll get together and the clients will come in, and we can look and say, you know what, the client ain't going to make it. You could just tell sometimes by the way they come in, their behavior.”