title: Housing First: exploring participants' early support needs.
abstract: BACKGROUND
  Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants' early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrollment in a Canadian field trial of Housing First.
  
  
  METHODS
  The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis.
  
  
  RESULTS
  The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrollment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support.
  
  
  CONCLUSIONS
  Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN42520374.
authors.affiliation: Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St, Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. StergiopoulosV@smh.ca.
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
authors.forename: Agnes
authors.initials: A
authors.lastname: Gozdzik
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.forename: Alixandra R
authors.initials: AR
authors.lastname: Holtby
authors.forename: Jeyagobi
authors.initials: J
authors.lastname: Jeyaratnam
authors.forename: Sam
authors.initials: S
authors.lastname: Tsemberis
mesh_terms: D000328:Adult; D005260:Female; D017144:Focus Groups; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D020380:Needs Assessment; D009864:Ontario / Q000453:epidemiology; D009937:Organizational Objectives; D011788:Quality of Life; D012307:Risk Factors; D012940:Social Problems
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