Efficacité de l’approche « logement d’abord » : une revue systématique

Abstract

Les personnes itinérantes aux prises avec des problèmes de santé mentale et de toxicomanie qui souhaitent obtenir un logement se butent à des programmes dans lesquels l’abstinence et les traitements psychiatriques sont obligatoires. Ce type de programmes se base sur l’approche « traitement d’abord » selon laquelle ces personnes doivent d’abord être traitées avant de pouvoir aller en logement.Cette approche est remise en question et un changement de paradigme s’opère à la suite de l’implantation aux États-Unis du modèle Pathways to Housing. Ce modèle est fondé sur le principe qu’une personne doit être logée avant de pouvoir se concentrer sur ses autres besoins. Les logements privés sont privilégiés dans ce modèle et ceux-ci sont offerts conjointement avec un soutien d’intensité variable ou un suivi intensif dans la communauté.Le modèle Pathways to Housing a influencé la création de plusieurs programmes hybrides basés sur l’approche « logement d’abord » combinée à une offre de services et de logements diversifiés. Cette approche est basée sur la même philosophie d’obligation minimale que le modèle original, voulant que les personnes n’aient pas à être abstinentes ou à suivre un traitement psychiatrique pour accéder à un logement.Au Canada, le gouvernement envisage de subventionner principalement les programmes basés sur cette approche. Cette annonce a mené à un soulèvement au Québec, notamment en raison des logements sociaux qui y sont actuellement priorisés.Cet article présente les résultats d’une revue systématique de la littérature réalisée afin de statuer sur l’efficacité des programmes basés sur l’approche « logement d’abord ».Les résultats de cette revue nous permettent de conclure que la mise en place au Québec de programmes basés sur cette approche devrait être favorisée. Les modalités et interventions offertes dans ces programmes auraient également avantage à être diversifiées.Homeless people diagnosed with substance abuse and mental illnesses often encounter problems in their quest to find housing since sobriety and psychiatric treatments are frequently required to qualify for a housing program. These programs are based on the “treatment first” approach, meaning individuals must first be treated before being admitted in a housing program.The relevancy of this approach is being questioned and change is occurring due to the implantation, in the United States, of the Housing First approach initiated by the Pathways to Housing organisation. The general premise of this model is that homeless people must first be housed before their other needs are taken care of. Private independent apartments are the preferred model of housing while intensive case management (ICM) or assertive community treatment (ACT) constitute the possible interventions.Pathways to Housing model influenced the cr...

What treatment and services are effective for people who are homeless and use drugs? A systematic ‘review of reviews’

“…Included reviews were published between 2004 and 2020, and consisted of: four grey literature reports [39,[52][53][54]; 18 systematic reviews [2,31,46,50,[55][56][57][58][59][60][61][62][63][64][65][66][67][68], two of which also included a meta-analysis [2,65]; and three non-systematic reviews [69][70][71]. Thirteen reviews included quantitative studies only, 11 included any study type/mixed designs, including one realist synthesis [62], two systematic review of reviews [52,60], one 'state of the art' review [61], and one review was a meta-ethnography of qualitative studies [31].…”

“…For example, Pleace and Quilgars [54] reported no significant difference between HF participants and a control group in terms of either alcohol or drug use at 24-or 48-months post intervention in one of their included studies, with small but statistically significant improvements in alcohol and drug use over 24-months in another. Both Baxter et al [2] and Beaudoin [55] found that HF produced no clear differences in substance use when compared with treatment as usual (TAU) which consisted of diverse alternative homeless services and interventions. Beaudoin [55] found no differences between those involved in HF interventions and those accessing traditional psychosocial interventions.…”

The Impact of Housing First on Criminal Justice Outcomes among Homeless People with Mental Illness: A Systematic Review

“…Housing First (HF) provides immediate access to subsidised housing along with support services to homeless people, including those with mental illness. Because it increases residential stability [1][2][3][4][5][6] and results in significant cost offsets, 7 it is put forward by policy makers as an important component of a pragmatic plan to end homelessness. 8 It has been hypothesized that the benefits of HF include a reduction in criminal justice involvement (CJI).…”

‘It maybe doesn’t seem much, but to me it’s my kingdom’: staff and client experiences of Housing First in Scotland

“…Pleace & Quilgars, 2013;Padgett et al, 2006). Similary, both Baxter et al (2019) and Beaudoin (2016) found that HF resulted in no clear differences in substance use when compared with treatment as usual. Qualitative research from a Norwegian HF program suggested that trusting relationships can contribute to clients talking openly about substance use and/or mental health problems (Andvig et al, 2018).…”