The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial

Abstract

BackgroundLittle is known about the effectiveness of Housing First (HF) among ethnic minority groups, despite its growing popularity for homeless adults experiencing mental illness. This randomized controlled trial tests the effectiveness of a HF program using rent supplements and intensive case management, enhanced by anti-racism and anti-oppression practices for homeless adults with mental illness from diverse ethnic minority backgrounds.MethodsThis unblinded pragmatic field trial was carried out in community settings in Toronto, Canada. Participants were 237 adults from ethnic minority groups experiencing mental illness and homelessness, who met study criteria for moderate needs for mental health services. Participants were randomized to either adapted HF (n = 135) or usual care (n = 102) and followed every 3 months for 24 months. The primary study outcome was housing stability; secondary outcomes included physical and mental health, social functioning, quality of life, arrests and health service use. Intention to treat statistical analyses examined the effectiveness of the intervention compared to usual care.ResultsDuring the 24-month study period, HF participants were stably housed a significantly greater proportion of time compared to usual care participants, 75 % (95 % CI 70 to 81) vs. 41 % (95 % CI 35 to 48), respectively, for a difference of 34 %, 95 % CI 25 to 43. HF also led to improvements in community integration over the course of the study: the change in the mean difference between treatment groups from baseline to 24-months was significantly greater among HF participants compared to those in usual care (change in mean difference = 2.2, 95 % CI 0.06 to 4.3). Baseline diagnosis of psychosis was associated with reduced likelihood of being housed ≥ 50 % of the study period (OR = 0.37, 95 % CI 0.18 to 0.72).ConclusionHousing First enhanced with anti-racism and anti-oppression practices can improve housing stability and community functioning among ethnically diverse homeless adults with mental illness.Trial registrationInternational Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374, assigned August 18, 2009.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3768-4) contains supplementary material, which is available to authorized users.

A randomized controlled trial of the effectiveness of Housing First in a small Canadian City

“…This choice may contribute to HF participants living in housing and neighborhoods in which they feel at home and develop a sense of belonging. In contrast with our study, the multi-site study did not show HF participants experiencing greater improvements in psychological integration than TAU for either individuals with high needs [19] or moderate needs [45]. Previous research has shown residents living in small cities to report higher levels of a sense of belonging than residents living in larger cities [46].…”

“…On the other hand, in the same trial, HF with ICM, when compared to TAU for individuals with moderate level of needs, produced greater improvements in overall quality of life and related to living situation, safety, and leisure [45]. In our study, HF participants with a mix of moderate and high level of needs and receiving ACT reported greater improvements of quality of life than TAU over the full 24-month study.…”

Mental and substance use disorders and food insecurity among homeless adults participating in the At Home/Chez Soi study

“…In fact, the existing literature provides little evidence that the Housing First intervention improves other non-housing outcomes, such as quality of life, physical community integration, psychological community integration or mental health. [52] Homeless individuals with major depressive episode, mood disorder with psychotic features, and substance disorder were more likely to remain persistently food insecure over the study period. We also found co-occurring disorders played a major role in food insecurity trajectories.…”

Effectiveness of interventions targeting community integration among individuals with lived experiences of homelessness: A systematic review

“…The most commonly used measure was the Community Integration Scale (Aubry & Myner, 1996; n = 3; 14.3%), modified by Patterson et al. (2014) and subsequently used as modified scale in other studies (O'Campo et al., 2016; Patterson et al., 2014; Stergiopoulos et al., 2016). Other standardised scales used in full or in part to measure CI included: Lehman's Quality of Life Interview (Lehman, 1983; n = 2; 9.5%; O'Connell et al., 2017; Wood et al., 1998); Social Provisions Scale (Cutrona & Russell, 1987; n = 2; 9.5%; Pankratz et al., 2017; Stewart et al., 2009); ASR (Achenbach, 1997; n = 2; 9.5%); Multnomah Community Ability Scale (Hendryx, Dyck, McBride, & Whitbeck, 2001; n = 1; 4.8%; Aubry et al., 2016); UCLA‐LS‐R (Russell et al., 1980; n = 1; 4.8%; Stewart et al., 2009); SCS‐R (Lee et al, 2001; n = 1; 4.8%; McCay et al., 2011); MOS‐SSS (Sherbourne & Stewart, 1991; n = 1; 4.8%; Boisvert et al., 2008); and ASI (McLellan et al, 1992; n = 1; 4.8%; Devine et al., 1997).…”