title: Housing Quality in a Randomized Controlled Trial of Housing First for Homeless Individuals with Mental Illness: Correlates and Associations with Outcomes.
abstract: Housing quality (HQ) is associated with mental health, and may mediate outcomes in housing interventions. However, studies of housing interventions rarely report HQ. The purpose of this study was to describe HQ in a multi-site randomized controlled trial of Housing First (HF) in five Canadian cities and to examine possible differences by treatment group (HF recipients and treatment-as-usual (TAU) participants who were able to find housing through other programs or on their own). We also examined the association between HQ and the primary trial outcome: housing stability. The performance of a new multi-dimensional standardized observer-rated housing quality scale (the OHQS) in a relatively large cross-site sample was also of interest. HQ was rated by trained research assistants for 204 HF participants and 228 TAU participants using the OHQS. General linear regression models were used to examine unit/building quality scores by group and site adjusting for other group differences, and as a predictor of housing stability outcomes after 24 months of follow-up. The OHQS was found to have good reliability and validity, but because most of the neighborhood subscale items were negatively correlated with the overall scale, only unit and building items were included in the total HQ score (possible scores ranging from 13.5 to 135). Unit/building HQ was significantly better for the HF group overall (91.2 (95 % CI = 89.6-92.9) vs. 88.3 (95 % CI = 86.1-90.5); p = .036), and in one site. HQ in the TAU group was much more variable than the HF group overall (W (mean) = 24.7; p < .001) and in four of five sites. Unit/building HQ scores were positively associated with housing stability: (73.4 (95 % CI 68.3-78.5) for those housed none of the time; 91.1 (95 % CI 89.2-93.0) for those housed some of the time; and 93.1 (95 % CI 91.4-94.9)) for those housed all of the time (F = 43.9 p < .001). This association held after adjusting for site, housing characteristics, participant ethnocultural status, community functioning, and social support. This study demonstrates that HQ can be as good or better, and less variable, in HF programs in Canada that systematically and predominantly source housing stock from the private sector compared to housing procured outside of an HF program. HQ is also an important predictor of housing stability outcomes.
authors.affiliation: Mental Health Commission of Canada, Ottawa, Ontario, Canada. ceadair@ucalgary.ca.|Department of Psychiatry, the University of Calgary, Calgary, Alberta, Canada. ceadair@ucalgary.ca.|Department of Community Health Sciences, the University of Calgary, Calgary, Alberta, Canada. ceadair@ucalgary.ca.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Adair
authors.affiliation: Mental Health Commission of Canada, Ottawa, Ontario, Canada.
authors.forename: Brianna
authors.initials: B
authors.lastname: Kopp
authors.affiliation: Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada.
authors.forename: Jino
authors.initials: J
authors.lastname: Distasio
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.affiliation: Department of Criminology, Wilfrid Laurier University, Brantford, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lavoie
authors.affiliation: Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Veldhuizen
authors.affiliation: Department of Humanities, Social Science and Social Justice, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jijian
authors.initials: J
authors.lastname: Voronka
authors.affiliation: Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Kaufman
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Julian M
authors.initials: JM
authors.lastname: Somers
authors.affiliation: Centre de recherche et de développement en éducation, Université de Moncton, Moncton, New Brunswick, Canada.
authors.forename: Stefanie R
authors.initials: SR
authors.lastname: LeBlanc
authors.affiliation: At Home/Chez Soi Montreal Site, Montreal, Quebec, Canada.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cote
authors.affiliation: At Home/Chez Soi Vancouver Site, Vancouver, British Columbia, Canada.
authors.forename: Sindi
authors.initials: S
authors.lastname: Addorisio
authors.affiliation: At Home/Chez Soi Montreal Site, Douglas University Institute for Mental Health, Montreal, Quebec, Canada.
authors.forename: Dominique
authors.initials: D
authors.lastname: Matte
authors.affiliation: Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Paula
authors.initials: P
authors.lastname: Goering
mesh_terms: D000328:Adult; D002170:Canada; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing / Q000592:standards*; D006801:Humans; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D011594:Psychometrics
keywords: Homelessness; Housing quality; Housing-related health research; Mental illness; Public/private housing; Standardized measures