IntroductionHousing First is a complex housing and support intervention for homeless individuals with mental health problems. It has a sufficient knowledge base and interest to warrant a test of wide-scale implementation in various settings. This protocol describes the quantitative design of a Canadian five city, $110 million demonstration project and provides the rationale for key scientific decisions.MethodsA pragmatic, mixed methods, multi-site field trial of the effectiveness of Housing First in Vancouver, Winnipeg, Toronto, Montreal and Moncton, is randomising approximately 2500 participants, stratified by high and moderate need levels, into intervention and treatment as usual groups. Quantitative outcome measures are being collected over a 2-year period and a qualitative process evaluation is being completed. Primary outcomes are housing stability, social functioning and, for the economic analyses, quality of life. Hierarchical linear modelling is the primary data analytic strategy.Ethics and disseminationResearch ethics board approval has been obtained from 11 institutions and a safety and adverse events committee is in place. The results of the multi-site analyses of outcomes at 12 months and 2 years will be reported in a series of core scientific journal papers. Extensive knowledge exchange activities with non-academic audiences will occur throughout the duration of the project.Trial registration numberThis study has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374.

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The project revealed both the challenges with situating research within an institution (hierarchy of knowledge, power, and vulnerability) and face-to-face dialogue, as well as positive changes in professional attitudes and consumer empowerment, as providers and patients came to understand what was at stake for each other. The project underscored the need for provider-consumer dialogue as a process to explore tensions and values in promoting recovery-oriented care.

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Les pairs aidants peuvent être intégrés de différentes façons dans les organisations où ils interviennent. Dans cet article, cinq types de structure organisationnelle où l’on fait appel à des pairs aidants en toxicomanie et en santé mentale sont examinés : les groupes de soutien mutuel, les organisations d’entraide, les organisations autogérées par des pairs aidants, les partenariats avec des organismes de pairs aidants et, enfin, l’intégration des pairs aidants dans des organismes pour dispenser certains services. Cet article met en évidence les conditions qui favorisent l’autonomisation des pairs aidants dans ces différentes situations.There are a variety of ways in which peer support workers can be integrated into organizational structures. In this article, five types of organizational structures that operate in the area of mental health and substance misuse are examined: mutual support groups; self-help organizations; organizations managed by peer support workers; partnerships with peer support worker organizations; and, organizations which integrate peer support workers to deliver certain services. This article highlights the conditions that promote empowerment of peer support workers in these situations.Los pares de ayuda pueden integrarse de diferentes maneras en las organizaciones en las que intervienen. En este artículo, se examinan cinco tipos de estructuras organizativas en las que se recurre a pares de ayuda en toxicomanía y salud mental : los grupos de ayuda mutua, las organizaciones de ayuda mutua, las organizaciones autogestionadas por los pares de ayuda, las asociaciones con organismos de pares de ayuda y, finalmente, la integración de los pares de ayuda en los organismos con el objetivo de proveer ciertos servicios. Este artículo pone en evidencia las condiciones que favorecen la autonomización de los pares de ayuda en diferentes situaciones