Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial

Housing First (HF) is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM) among ethnically diverse homeless adults in an urban setting. 378 participants were ra...

Full description

Saved in:
Bibliographic Details
Published in:PloS one 2015-07, Vol.10 (7), p.e0130281-e0130281
Main Authors: Stergiopoulos, Vicky, Gozdzik, Agnes, Misir, Vachan, Skosireva, Anna, Connelly, Jo, Sarang, Aseefa, Whisler, Adam, Hwang, Stephen W, O'Campo, Patricia, McKenzie, Kwame
Format: Article
Language:English
Subjects:
Adult
Adults
Alcohol
Alcohol abuse
Alcoholic beverages
Case Management
Cities - statistics & numerical data
Clinical trials
Communities
Disabilities
Effectiveness
Emergency medical services
Emergency services
Emigration and Immigration - statistics & numerical data
Epidemiology
Ethnic Groups - psychology
Female
Health services
Health Services - utilization
Homeless people
Homeless Persons
Homelessness
Hospitals
Housing
Humans
Inner city
Knowledge
Male
Mental disorders
Mental Disorders - ethnology
Mental health
Mental Health - statistics & numerical data
Mental health care
Middle Aged
Multiculturalism & pluralism
Native North Americans
Outcome Assessment (Health Care)
Psychiatry
Public health
Quality of Life
Randomization
Reduction
Social Skills
Stability
Studies
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Housing First (HF) is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM) among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU) in Toronto (Canada), and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS) and mental (CSI, GAIN-SS) health, social functioning (MCAS), quality of life (QoLI20), and health service use. Two-thirds of the sample (63%) was from racialized groups and half (50%) were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively). Similarly, community functioning (MCAS) improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30). There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99) relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044). Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96) and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96) from baseline to 24 months. Secondary analyses found a significant reduction in the number of days experiencing problems due to alcohol use among foreign-born (vs. Canadian-born) HF participants at 24 months (ratio of rate ratios = 0.19 95% 0.04 to 0.88), relative to baseline. Compared to usual care, HF with ICM can improve housing stability and community functioning and reduce the days of alcohol related problems in an ethnically diverse sample of homeless adults with mental illness within 2-years. Controlled-Trials.com ISRCTN42520374.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0130281