title: The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial.
abstract: Little is known about the effectiveness of Housing First (HF) among ethnic minority groups, despite its growing popularity for homeless adults experiencing mental illness. This randomized controlled trial tests the effectiveness of a HF program using rent supplements and intensive case management, enhanced by anti-racism and anti-oppression practices for homeless adults with mental illness from diverse ethnic minority backgrounds.
  
  
  
  This unblinded pragmatic field trial was carried out in community settings in Toronto, Canada. Participants were 237 adults from ethnic minority groups experiencing mental illness and homelessness, who met study criteria for moderate needs for mental health services. Participants were randomized to either adapted HF (n = 135) or usual care (n = 102) and followed every 3 months for 24 months. The primary study outcome was housing stability; secondary outcomes included physical and mental health, social functioning, quality of life, arrests and health service use. Intention to treat statistical analyses examined the effectiveness of the intervention compared to usual care.
  
  
  
  During the 24-month study period, HF participants were stably housed a significantly greater proportion of time compared to usual care participants, 75 % (95 % CI 70 to 81) vs. 41 % (95 % CI 35 to 48), respectively, for a difference of 34 %, 95 % CI 25 to 43. HF also led to improvements in community integration over the course of the study: the change in the mean difference between treatment groups from baseline to 24-months was significantly greater among HF participants compared to those in usual care (change in mean difference = 2.2, 95 % CI 0.06 to 4.3). Baseline diagnosis of psychosis was associated with reduced likelihood of being housed ≥ 50 % of the study period (OR = 0.37, 95 % CI 0.18 to 0.72).
  
  
  
  Housing First enhanced with anti-racism and anti-oppression practices can improve housing stability and community functioning among ethnically diverse homeless adults with mental illness.
  
  
  
  International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374 , assigned August 18, 2009.
authors: Centre for Addiction and Mental Health, Toronto, ON, Canada.|Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors: Vicky
authors: 0000-0003-3941-9434
authors: V
authors: Stergiopoulos
authors: Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.
authors: Agnes
authors: A
authors: Gozdzik
authors: Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.
authors: Vachan
authors: V
authors: Misir
authors: Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.
authors: Anna
authors: A
authors: Skosireva
authors: Across Boundaries, Toronto, ON, Canada.
authors: Aseefa
authors: A
authors: Sarang
authors: Inner City Family Health Team, Toronto, ON, Canada.
authors: Jo
authors: J
authors: Connelly
authors: Centre for Addiction and Mental Health, Toronto, ON, Canada.
authors: Adam
authors: A
authors: Whisler
authors: Centre for Addiction and Mental Health, Toronto, ON, Canada. Kwame.McKenzie@camh.ca.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Kwame.McKenzie@camh.ca.|Health Equity Office, Centre for Addiction and Mental Health, room 2010, 33 Russell Street, Toronto, ON, M5S 2G8, Canada. Kwame.McKenzie@camh.ca.
authors: Kwame
authors: K
authors: McKenzie
mesh_terms: D000328:Adult; D002170:Canada; D062309:Community Integration / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008603:Mental Health / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000458:organization & administration; D008913:Minority Groups / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012940:Social Problems
keywords: Homelessness; Housing; Mental illness ethnic minority