Online Program

Housing first with intensive case management: 12 month outcomes of the at home/chez soi randomized trial

Monday, November 4, 2013 : 8:50 a.m. - 9:10 a.m.

Stephen Hwang, MD, MPH, Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON, Canada
Eric Latimer, Ph.D., Psychiatry, McGill University, Verdun, QC, Canada
Tim Aubry, Ph.D., Psychology, University of Ottawa, Ottawa, ON, Canada
Sam Tsemberis, Ph.D., Pathways to Housing, New York City, NY
Paula Goering, RN, PhD, SER, CAMH, Toronto, ON, Canada
Objective: The At Home/Chez Soi randomized controlled trial examines the effectiveness of a less resource-intensive Housing First intervention using Intensive Case Management (HF-ICM) for homeless individuals with mental illness and moderate levels of unmet mental health needs. Method: Homeless individuals with mental illness (N=1198) in four Canadian cities (Vancouver, Winnipeg, Toronto and Montreal) were randomized to HF-ICM or treatment-as-usual and assessed at 3-month intervals over a 12 month period. Intent-to-treat analysis using multilevel models with a p-value set at α≤0.01 were performed to assess changes in mental health symptomatology (CSI), overall functioning (MCAS) and quality of life (QoLI20), with time, treatment and study site as predictors. Differences in the proportion of individuals stably housed for >100 days at 12 months were assessed using chi-square tests. Results: Significant decreases in CSI scores and increases in MCAS and QoLI20 scores were observed over time; however treatment did not have a significant effect. Compared to Toronto, Vancouver had a significantly larger decrease in CSI scores while both Vancouver and Winnipeg had significant smaller increases in MCAS scores. A larger proportion of participants were stably housed for more than 100 days at 12 months in the treatment group (67%) compared to the control group (25%); the median number of days stably housed at 12 months was 251 days and 0 days in the treatment and control groups, respectively. Discussion: HF-ICM positively affects housing outcomes for homeless individuals with mental illness in a relatively short period of time.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Program planning
Provision of health care to the public
Public health or related research

Learning Objectives:
Describe the analytic approach used to examine the effectiveness of an intervention to meet the needs of homeless people with mental illness. Demonstrate the effectiveness of a Housing First intervention with intensive case management for homeless people with mental illness. Analyze the domains in which improvements are significantly greater over a 12-month time frame.

Keyword(s): Homelessness, Mental Illness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an co-investigator on multiple peer-reviewed federally-funded grants which focus on services to address the needs of homeless individuals with mental illness. Research interests include: homelessness, health care utilization and interventions research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.