title: A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats.
abstract: OBJECTIVE
  No previous experimental trials have investigated Housing First (HF) in both scattered site (SHF) and congregate (CHF) formats. We hypothesized that CHF and SHF would be associated with a greater percentage of time stably housed as well as superior health and psychosocial outcomes over 24 months compared to treatment as usual (TAU).
  
  
  METHODS
  Inclusion criteria were homelessness, mental illness, and high need for support. Participants were randomised to SHF, CHF, or TAU. SHF consisted of market rental apartments with support provided by Assertive Community Treatment (ACT). CHF consisted of a single building with supports equivalent to ACT. TAU included existing services and supports.
  
  
  RESULTS
  Of 800 people screened, 297 were randomly assigned to CHF (107), SHF (90), or TAU (100). The percentage of time in stable housing over 24 months was 26.3% in TAU (reference; 95% confidence interval (CI) = 20.5, 32.0), compared to 74.3% in CHF (95% CI = 69.3, 79.3, p<0.001) and 74.5% in SHF (95% CI = 69.2, 79.7, p<0.001). Secondary outcomes favoured CHF but not SHF compared to TAU.
  
  
  CONCLUSIONS
  HF in scattered and congregate formats is capable of achieving housing stability among people experiencing major mental illness and chronic homelessness. Only CHF was associated with improvement on select secondary outcomes.
  
  
  BACKGROUND
  Current Controlled Trials: ISRCTN57595077.
authors.affiliation: Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada.
authors.forename: Julian M
authors.initials: JM
authors.lastname: Somers
authors.affiliation: Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada.
authors.forename: Akm
authors.initials: A
authors.lastname: Moniruzzaman
authors.affiliation: Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Patterson
authors.affiliation: Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Currie
authors.affiliation: Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada.
authors.forename: Stefanie N
authors.initials: SN
authors.lastname: Rezansoff
authors.affiliation: School of Population and Public Health University of British Columbia Vancouver, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Palepu
authors.affiliation: Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Fryer
mesh_terms: D000328:Adult; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology*; D008297:Male; D008875:Middle Aged