Abstract
BackgroundThe At Home/Chez Soi (AH/CS) Project is a randomized controlled trial of a Housing First intervention to meet the needs of homeless individuals with mental illness in five cities across Canada. The objectives of this paper are to examine the approach to participant recruitment and community engagement at the Toronto site of the AH/CS Project, and to describe the baseline demographics of participants in Toronto.MethodsHomeless individuals (n = 575) with either high needs (n = 197) or moderate needs (n = 378) for mental health support were recruited through service providers in the city of Toronto. Participants were randomized to Housing First interventions or Treatment as Usual (control) groups. Housing First interventions were offered at two different mental health service delivery levels: Assertive Community Treatment for high needs participants and Intensive Case Management for moderate needs participants. Demographic data were collected via quantitative questionnaires at baseline interviews.ResultsThe effectiveness of the recruitment strategy was influenced by a carefully designed referral system, targeted recruitment of specific groups, and an extensive network of pre-existing services. Community members, potential participants, service providers, and other stakeholders were engaged through active outreach and information sessions. Challenges related to the need for different sectors to work together were resolved through team building strategies. Randomization produced similar demographic, mental health, cognitive and functional impairment characteristics in the intervention and control groups for both the high needs and moderate needs groups. The majority of participants were male (69%), aged >40 years (53%), single/never married (69%), without dependent children (71%), born in Canada (54%), and non-white (64%). Many participants had substance dependence (38%), psychotic disorder (37%), major depressive episode (36%), alcohol dependence (29%), post-traumatic stress disorder (PTSD) (23%), and mood disorder with psychotic features (21%). More than two-thirds of the participants (65%) indicated some level of suicidality.ConclusionsRecruitment at the Toronto site of AH/CS project produced a sample of participants that reflects the diverse demographics of the target population. This study will provide much needed data on how to best address the issue of homelessness and mental illness in Canada.
Highlights
The At Home/Chez Soi (AH/CS) Project is a randomized controlled trial of a Housing First intervention to meet the needs of homeless individuals with mental illness in five cities across Canada
The purpose of this paper is to describe the unique context of the Toronto site of the AH/CS project, and provide descriptive data on study participants at baseline
In the AH/CS study, we focused on the following modules of the MINI 6.0: 1) major depressive episodes; 2) manic or hypomanic episodes; 3) post-traumatic stress disorder; 4) panic disorder; 5) mood disorder with psychotic features; 6) psychotic disorder; 7) alcohol dependence; 8) alcohol abuse; 9) substance dependence; 10) substance abuse; and 11) suicidality
Summary
The At Home/Chez Soi (AH/CS) Project is a randomized controlled trial of a Housing First intervention to meet the needs of homeless individuals with mental illness in five cities across Canada. In Toronto (population 2.5 million), more than 5,000 people are homeless on any given night [3,4]. Of this number, more than three quarters (79%) live in shelters, 8% on the street, 6% in correctional facilities, 4% in health care or treatment facilities and another 3% in Violence Against Women shelters [5]. The prevalence of physical and mental illness and addictions are significantly higher among people who are homeless than in the general population [7]. Substance abuse is consistently a strong predictor of housing loss and is the most common co-morbidity among individuals who have severe mental illness [10,11,12,13,14,15]
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