Short-term impacts of housing first on homeless families: a pragmatic randomized controlled trial in Brno, Czechia

Abstract

ABSTRACT This article examines whether Housing First for homeless families reduces homelessness and use of emergency health services and improves security of tenure and caregivers’ mental health. We present the quantitative data from a mixed-methods design. Homeless families with at least one child under 18, residing in Brno, Czechia were recruited for an open-label pragmatic randomized controlled trial. Families were stratified by number of children and randomized by lottery. Fifty treatment families received intensive case management, housing in municipal flats, and a risk-fund. One hundred control families received services as usual. Structured interviews were conducted at baseline, and six and twelve months after move‒in. For statistical analysis, we used a non-parametric Fisher's exact test for binary variables, a Mann–Whitney U test for categorical and continuous variables, and a parametric negative binomial model for count variables. Treatment families had less homelessness (0, 2 months vs. 11 months) in the year after move-in, were twice as likely to have secure tenure, and showed lower psychological distress. The treatment cut annual emergency room visits in half, ambulance use by three fourths, and hospitalizations by two thirds. This intervention led to greater improvements in health outcomes than previous interventions involving families experiencing homelessness.