title: One-year outcomes of a randomized controlled trial of housing first with ACT in five Canadian cities.
abstract: OBJECTIVE
  Housing First is a groundbreaking approach to ending chronic homelessness among people with mental illness. This article presents one-year findings from a multisite randomized controlled trial (RCT) comparing Housing First with treatment as usual.
  
  
  METHODS
  The study was a nonblind, parallel-group RCT conducted in five Canadian cities. A sample of 950 high-need participants with severe mental illness, who were either absolutely homeless or precariously housed, was randomly assigned to Housing First (N=469) or treatment as usual (N=481). Housing First participants received a rent supplement, assistance to find housing, and assertive community treatment. Treatment-as-usual participants had access to all other existing programs.
  
  
  RESULTS
  At one-year follow-up, 73% of Housing First participants and 31% of treatment-as-usual participants resided in stable housing (p<.001, odds ratio=6.35, covariate adjusted difference=42%, 95% confidence interval [CI]=36%-48%). Improvement in overall quality of life was significantly greater among Housing First participants compared with treatment-as-usual participants (p<.001, d=.31, CI=.16-.46). Housing First participants also showed greater improvements in community functioning compared with treatment-as-usual participants (p=.003, d=.25, CI=.09-.41).
  
  
  CONCLUSIONS
  Compared with treatment as usual, Housing First produced greater improvements in housing stability, quality of life, and community functioning after one year of enrollment. The study provides support for adopting Housing First as an approach for ending chronic homelessness among persons with severe mental illness, even if they are actively symptomatic or using substances.
authors: Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario, Canada (e-mail: taubry@uottawa.ca ). Dr. Tsemberis is with Pathways to Housing, Inc., New York. Dr. Adair is with the Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Mr. Veldhuizen and Dr. Goering are with the Centre for Addiction and Mental Health, Toronto, Ontario. Dr. Goering is also with the Department of Psychiatry, University of Toronto, Toronto, where Dr. Streiner is also affiliated. Dr. Streiner is also with the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. Dr. Latimer is with the Department of Psychiatry, McGill University, Montreal, Quebec, Canada. Dr. Sareen is with the Department of Psychiatry and the Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada. Dr. McGarvey is with the Department of Psychiatry, University of British Columbia, Vancouver. Ms. Kopp and Ms. Hume are with the Mental Health Commission of Canada, Calgary.
authors: Tim
authors: T
authors: Aubry
authors: Sam
authors: S
authors: Tsemberis
authors: Carol E
authors: CE
authors: Adair
authors: Scott
authors: S
authors: Veldhuizen
authors: David
authors: D
authors: Streiner
authors: Eric
authors: E
authors: Latimer
authors: Jitender
authors: J
authors: Sareen
authors: Michelle
authors: M
authors: Patterson
authors: Kathleen
authors: K
authors: McGarvey
authors: Brianna
authors: B
authors: Kopp
authors: Catharine
authors: C
authors: Hume
authors: Paula
authors: P
authors: Goering
mesh_terms: D000328:Adult; D002170:Canada; D003156:Community Mental Health Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D012424:Rural Population / Q000706:statistics & numerical data*