title: Vancouver At Home: pragmatic randomized trials investigating Housing First for homeless and mentally ill adults.
abstract: BACKGROUND
  Individuals with mental illnesses are overrepresented among the homeless. Housing First (HF) has been shown to promote positive outcomes in this population. However, key questions remain unresolved, including: how to match support services to client needs, the benefits of housing in scattered sites versus single congregate building, and the effectiveness of HF with individuals actively using substances. The present study aimed to recruit two samples of homeless mentally ill participants who differed in the complexity of their needs. Study details, including recruitment, randomization, and follow-up, are presented.
  
  
  METHODS
  Eligibility was based on homeless status and current mental disorder. Participants were classified as either moderate needs (MN) or high needs (HN). Those with MN were randomized to HF with Intensive Case Management (HF-ICM) or usual care. Those with HN were randomized to HF with Assertive Community Treatment (HF-ACT), congregate housing with support, or usual care. Participants were interviewed every 3 months for 2 years. Separate consent was sought to access administrative data.
  
  
  RESULTS
  Participants met eligibility for either MN (n = 200) or HN (n = 297) and were randomized accordingly. Both samples were primarily male and white. Compared to participants designated MN, HN participants had higher rates of hospitalization for psychiatric reasons prior to randomization, were younger at the time of recruitment, younger when first homeless, more likely to meet criteria for substance dependence, and less likely to have completed high school. Across all study arms, between 92% and 100% of participants were followed over 24 months post-randomization. Minimal significant differences were found between study arms following randomization. 438 participants (88%) provided consent to access administrative data.
  
  
  CONCLUSIONS
  The study successfully recruited participants meeting criteria for homelessness and current mental disorder. Both MN and HN groups had high rates of substance dependence, suicidality, and physical illness. Randomization resulted in no meaningful detectable differences between study arms.
  
  
  BACKGROUND
  Current Controlled Trials: ISRCTN57595077 (Vancouver at Home study: Housing First plus Assertive Community Treatment versus congregate housing plus supports versus treatment as usual) and ISRCTN66721740 (Vancouver At Home study: Housing First plus Intensive Case Management versus treatment as usual).
authors.affiliation: Somers Research Group, Faculty of Health Sciences Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada. jsomers@sfu.ca.
authors.forename: Julian M
authors.initials: JM
authors.lastname: Somers
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Patterson
authors.forename: Akm
authors.initials: A
authors.lastname: Moniruzzaman
authors.forename: Lauren
authors.initials: L
authors.lastname: Currie
authors.forename: Stefanie N
authors.initials: SN
authors.lastname: Rezansoff
authors.forename: Anita
authors.initials: A
authors.lastname: Palepu
authors.forename: Karen
authors.initials: K
authors.lastname: Fryer
mesh_terms: D000328:Adult; D001955:British Columbia; D019090:Case Management; D003156:Community Mental Health Services; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D008603:Mental Health; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D013997:Time Factors