title: Trajectories of recovery among homeless adults with mental illness who participated in a randomised controlled trial of Housing First: a longitudinal, narrative analysis.
abstract: OBJECTIVE
  This study used longitudinal, narrative data to identify trajectories of recovery among homeless adults with mental illness alongside the factors that contribute to positive, negative, mixed or neutral trajectories over time. We expected that participants who received Housing First (HF) would describe more positive trajectories of recovery than those who were assigned to Treatment as Usual (TAU; no housing or support provided through the study).
  
  
  METHODS
  Narrative interview data were collected from participants at baseline and 18 months after random assignment to HF or TAU.
  
  
  METHODS
  Participants were sampled from the community in Vancouver, British Columbia.
  
  
  METHODS
  Fifty-four participants were randomly and purposively selected from the larger trial; 52 were interviewed at baseline and 43 were reinterviewed 18 months after randomisation.
  
  
  METHODS
  Semistructured interviews were conducted at both time points. For each participant, paired baseline and follow-up narratives were classified as positive, negative, mixed or neutral trajectories of recovery, and thematic analysis was used to identify the factors underlying different trajectories.
  
  
  RESULTS
  Participants assigned to HF (n=28) were generally classified as positive or mixed trajectories; those assigned to TAU (n=15) were generally classified as neutral or negative trajectories. Positive trajectories were characterised by a range of benefits associated with good-quality, stable housing (eg, reduced substance use, greater social support), positive expressions of identity and the willingness to self-reflect. Negative, neutral and mixed trajectories were characterised by hopelessness ('things will never get better') related to continued hardship (eg, eviction, substance use problems), perceived failures and loss.
  
  
  CONCLUSIONS
  HF is associated with positive trajectories of recovery among homeless adults with mental illness. Those who did not receive housing or support continued to struggle across a wide range of life domains. Findings are discussed with implications for addressing services and broader social change in order to benefit this marginalised population.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Patterson
authors.forename: Stefanie
authors.initials: S
authors.lastname: Rezansoff
authors.forename: Lauren
authors.initials: L
authors.lastname: Currie
authors.forename: Julian M
authors.initials: JM
authors.lastname: Somers
keywords: PUBLIC HEALTH; QUALITATIVE RESEARCH
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