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

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.