Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial.
OBJECTIVE
Scattered-site housing with Intensive Case Management (ICM) may be an appropriate and less-costly option for homeless adults with mental illness who do not require the treatment intensity of Assertive Community Treatment.


OBJECTIVE
To examine the effect of scattered-site housing with ICM services on housing stability and generic quality of life among homeless adults with mental illness and moderate support needs for mental health services.


METHODS
The At Home/Chez Soi project was an unblinded, randomized trial. From October 2009 to July 2011, participants (N = 1198) were recruited in 4 Canadian cities (Vancouver, Winnipeg, Toronto, and Montreal), randomized to the intervention group (n = 689) or usual care group (n = 509), and followed up for 24 months.


METHODS
The intervention consisted of scattered-site housing (using rent supplements) and off-site ICM services. The usual care group had access to existing housing and support services in their communities.


METHODS
The primary outcome was the percentage of days stably housed during the 24-month period following randomization. The secondary outcome was generic quality of life, assessed by a EuroQoL 5 Dimensions (EQ-5D) health questionnaire.


RESULTS
During the 24 months after randomization, the adjusted percentage of days stably housed was higher among the intervention group than the usual care group, although adjusted mean differences varied across sites. [table: see text] The mean change in EQ-5D score from baseline to 24 months among the intervention group was not statistically different from the usual care group (60.5 [95%CI, 58.6 to 62.5] at baseline and 67.2 [95%CI, 65.2 to 69.1] at 24 months for the intervention group vs 62.1 [95% CI, 59.9 to 64.4] at baseline and 68.6 [95%CI, 66.3 to 71.0] at 24 months for the usual care group, difference in mean changes, 0.10 [95%CI, −2.92 to 3.13], P=.95).


CONCLUSIONS
Among homeless adults with mental illness in 4 Canadian cities, scattered site housing with ICM services compared with usual access to existing housing and community services resulted in increased housing stability over 24 months, but did not improve generic quality of life.


BACKGROUND
isrctn.org Identifier: ISRCTN42520374.
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Vicky
V
Stergiopoulos
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada3Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Stephen W
SW
Hwang
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Agnes
A
Gozdzik
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Rosane
R
Nisenbaum
Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
Eric
E
Latimer
Douglas Mental Health University Institute, Montreal, Quebec, Canada.
Daniel
D
Rabouin
Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Carol E
CE
Adair
Faculty of Education, Université de Moncton, Moncton, New Brunswick, Canada.
Jimmy
J
Bourque
Toronto North Support Services, Toronto, Ontario, Canada.
Jo
J
Connelly
School of Population and Public Health, University of British Columbia, Vancouver, Canada.
James
J
Frankish
Department of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Canada.
Laurence Y
LY
Katz
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Kate
K
Mason
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Vachan
V
Misir
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Kristen
K
O'Brien
Department of Psychiatry, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Jitender
J
Sareen
Institute of Mental Health, University of British Columbia, Vancouver, Canada.
Christian G
CG
Schütz
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Arielle
A
Singer
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada14Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
David L
DL
Streiner
Department of Community Health Sciences, University of Sherbrooke, Quebec, Canada.
Helen-Maria
HM
Vasiliadis
Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
Paula N
PN
Goering
D000328:Adult; D002170:Canada; D019090:Case Management / Q000191:economics; D003156:Community Mental Health Services / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D011638:Public Housing