Abstract
BackgroundHousing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants’ early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrolment in a Canadian field trial of Housing First.MethodsThe study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis.ResultsThe majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrolment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support.ConclusionsAdditional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs.Trial registrationCurrent Controlled Trials ISRCTN42520374
Highlights
Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants’ early experiences or trajectories
Interventions for homeless individuals with mental illness have traditionally focused on a treatment first approach, in which program participants typically progress in a stepwise fashion from emergency shelters to transitional housing before they access permanent supportive housing, often after meeting strict requirements of sobriety and acceptance of psychiatric treatment [6,7]
Participants were classified as having high needs if they met all the following 3 criteria: (1) diagnosis of psychotic disorder or bipolar disorder based on the Mini International Neuropsychiatric Interview 6.0
Summary
Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants’ early experiences or trajectories. Interventions for homeless individuals with mental illness have traditionally focused on a treatment first approach, in which program participants typically progress in a stepwise fashion from emergency shelters to transitional housing before they access permanent supportive housing, often after meeting strict requirements of sobriety and acceptance of psychiatric treatment [6,7]. Housing First (HF), developed by Pathways to Housing, has emerged as a popular treatment option for meeting the unique needs of this population [8,9,10]. Rooted in the belief that housing is a basic human right, HF provides individuals with immediate housing, client choice is emphasized in every aspect of treatment, housing is separated from treatment, and a harm reduction approach is followed [8,10]
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