A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Study Design
Study Population
Study Interventions
Housing First.
Treatment as usual.
Randomization
Study Outcomes
Sample Size and Statistical Analysis
Results
Study Participants
Housing First (N=469) | Treatment as usual (N=481) | Total (N=950) | ||||
---|---|---|---|---|---|---|
Characteristic | N | % | N | % | N | % |
Age (M±SD) | 38.93±10.81 | 39.86±11.22 | 39.40±11.03 | |||
Male | 319 | 68 | 329 | 68 | 648 | 68 |
Member of racial or ethnic minority group | 95 | 20 | 103 | 21 | 198 | 21 |
Aboriginal | 91 | 19 | 90 | 19 | 181 | 19 |
Never married | 342 | 73 | 356 | 74 | 698 | 73 |
Not a high school graduate | 272 | 58 | 289 | 60 | 561 | 59 |
>24 months lifetime homelessness | 191 | 60 | 200 | 58 | 391 | 59 |
Longest period homeless >1 year | 240 | 51 | 242 | 50 | 482 | 51 |
Current psychiatric conditionb | ||||||
Major depressive episode | 204 | 42 | 208 | 44 | 412 | 43 |
Mania or hypomania episode | 78 | 16 | 75 | 16 | 153 | 16 |
Posttraumatic stress disorder | 122 | 25 | 134 | 29 | 256 | 27 |
Panic disorder | 94 | 20 | 109 | 23 | 203 | 21 |
Mood disorder with psychotic features | 94 | 20 | 100 | 21 | 194 | 20 |
Psychotic disorder | 242 | 50 | 250 | 53 | 492 | 52 |
Substance-related problems | 333 | 71 | 359 | 75 | 692 | 73 |
Chronic health conditions (M±SD) | 4.80±3.67 | 4.99±3.74 | 4.89±3.70 | |||
≥2 hospitalizations for mental illness in past 5 years | 238 | 51 | 261 | 54 | 499 | 53 |
Past-year arrest | 151 | 32 | 160 | 33 | 311 | 33 |
Victimization in past 6 months | 268 | 57 | 289 | 60 | 557 | 59 |
Primary Outcomes
Housing First (N=320–469) | Treatment as usual (N=178–481) | |||
---|---|---|---|---|
Outcome | M | SD | M | SD |
Days to moving into first housing | 72.92 | 95.99 | 219.70 | 193.32 |
Percentage of time housed in previous 3 months | ||||
Baseline | 10.78 | 27.16 | 8.64 | 25.03 |
3 months | 47.76 | 37.53 | 12.81 | 29.68 |
6 months | 76.07 | 37.98 | 22.56 | 38.07 |
9 months | 76.43 | 38.81 | 27.34 | 41.80 |
12 months | 77.23 | 37.93 | 30.69 | 43.55 |
15 months | 76.59 | 39.11 | 32.45 | 44.45 |
18 months | 74.23 | 40.81 | 37.87 | 45.88 |
21 months | 73.85 | 41.04 | 45.88 | 46.99 |
Final follow-up | 72.60 | 42.81 | 41.79 | 47.61 |
Days housed at final interview | 280.74 | 278.92 | 115.33 | 191.43 |
Perceived housing qualitya | ||||
6 months | 20.21 | 4.30 | 17.20 | 5.57 |
12 months | 20.55 | 3.97 | 17.96 | 5.05 |
18 months | 19.76 | 4.21 | 19.06 | 4.51 |
21 or 24 months | 19.97 | 4.26 | 18.99 | 4.77 |
MCAS community functioningb | ||||
Baseline | 54.43 | 7.38 | 54.21 | 7.21 |
6 months | 60.97 | 8.76 | 59.07 | 8.82 |
12 months | 62.46 | 8.66 | 60.34 | 9.09 |
18 months | 62.53 | 8.86 | 60.74 | 9.59 |
21 or 24 months | 62.53 | 9.29 | 61.04 | 9.75 |
Secondary Outcomes
Housing First (N=354–467) | Treatment as usual (N=312–481) | |||
---|---|---|---|---|
Outcome | M | SD | M | SD |
QoLI-20 quality of lifea | ||||
Baseline | 73.99 | 22.71 | 72.39 | 23.84 |
21 or 24 months | 89.38 | 22.45 | 87.16 | 22.57 |
Community Integration Scale | ||||
Physical integrationb | ||||
Baseline | 1.95 | 1.71 | 1.97 | 1.68 |
21 or 24 months | 1.81 | 1.60 | 2.00 | 1.74 |
Psychological integrationc | ||||
Baseline | 10.89 | 3.79 | 10.76 | 3.87 |
21 or 24 months | 12.85 | 3.34 | 12.75 | 3.60 |
EQ-5D health statusd | ||||
Baseline | 0.64 | .24 | 0.62 | .24 |
21 or 24 months | 0.70 | .24 | 0.72 | .24 |
CSI mental health symptomse | ||||
Baseline | 39.87 | 12.89 | 40.81 | 12.62 |
21 or 24 months | 32.57 | 11.79 | 31.49 | 12.54 |
GAIN substance use problems (symptoms)f | ||||
Baseline | 1.93 | 1.88 | 1.95 | 1.89 |
21 or 24 months | 1.47 | 1.78 | 1.31 | 1.73 |
Costs
Discussion
Conclusions
Acknowledgments
Footnotes
Supplementary Material
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