Testing a homelessness best practice in a new context: A trial of housing first in five Canadian cities

Introduction At Home/Chez Soi is a mixed methods study of homelessness and mental illness examining the cost effectiveness of Assertive Community Treatment (ACT) for those with high needs and Intensive Case Management (ICM) for those with moderate needs. The use of a common randomized control trial protocol with 2,255 participants across five different city contexts provides a unique opportunity to learn more about a complex best practice proven to work in the U.S. but not previously tested in Canada. Methods: Baseline assessments using standardized instruments describe the study sample. Longitudinal follow-ups collected data about housing, health, service use and quality of life domains with multiple instruments. Housing First fidelity assessments were conducted by external teams using methods developed with Pathways to Housing in New York City. Results: Findings from fidelity assessments demonstrate that Housing First has been successfully implemented by the study programs, with some local tailoring to local circumstances. 12 month follow up rates are high at 94% for Housing First and 88% for the control group. The characteristics of the sample reflect a wide range of demographics and a highly vulnerable population with multiple problems and unmet needs. Stratification into two need groups has resulted in meaningful distinctions in health and housing status. Discussion Similarities and differences between our findings and those from earlier U.S. trials will be highlighted is each presentation of the study results. These global findings will have relevance for local decisions about implementing best practices for those who are homeless with a mental illness.