title: Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial.
abstract: Housing First (HF) is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM) among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU) in Toronto (Canada), and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS) and mental (CSI, GAIN-SS) health, social functioning (MCAS), quality of life (QoLI20), and health service use. Two-thirds of the sample (63%) was from racialized groups and half (50%) were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively). Similarly, community functioning (MCAS) improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30). There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99) relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044). Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96) and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96) from baseline to 24 months. Secondary analyses found a significant reduction in the number of days experiencing problems due to alcohol use among foreign-born (vs. Canadian-born) HF participants at 24 months (ratio of rate ratios = 0.19 95% 0.04 to 0.88), relative to baseline. Compared to usual care, HF with ICM can improve housing stability and community functioning and reduce the days of alcohol related problems in an ethnically diverse sample of homeless adults with mental illness within 2-years.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN42520374.
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Agnes
authors.initials: A
authors.lastname: Gozdzik
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Vachan
authors.initials: V
authors.lastname: Misir
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Skosireva
authors.affiliation: Toronto North Support Services, Toronto, Ontario, Canada.
authors.forename: Jo
authors.initials: J
authors.lastname: Connelly
authors.affiliation: Across Boundaries, Toronto, Ontario, Canada.
authors.forename: Aseefa
authors.initials: A
authors.lastname: Sarang
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Whisler
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Health Services and Health Equity Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Kwame
authors.initials: K
authors.lastname: McKenzie
mesh_terms: D000328:Adult; D019090:Case Management; D002947:Cities / Q000706:statistics & numerical data; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology*; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D066107:Social Skills