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, 14:365

First Online: 01 November 2013Received: 16 May 2013Accepted: 16 October 2013DOI: 10.1186-1745-6215-14-365

Cite this article as: Somers, J.M., Patterson, M.L., Moniruzzaman, A. et al. Trials 2013 14: 365. doi:10.1186-1745-6215-14-365


BackgroundIndividuals with mental illnesses are overrepresented among the homeless. Housing First HF has been shown to promote positive outcomes in this population. However, key questions remain unresolved, including: how to match support services to client needs, the benefits of housing in scattered sites versus single congregate building, and the effectiveness of HF with individuals actively using substances. The present study aimed to recruit two samples of homeless mentally ill participants who differed in the complexity of their needs. Study details, including recruitment, randomization, and follow-up, are presented.

MethodsEligibility was based on homeless status and current mental disorder. Participants were classified as either moderate needs MN or high needs HN. Those with MN were randomized to HF with Intensive Case Management HF-ICM or usual care. Those with HN were randomized to HF with Assertive Community Treatment HF-ACT, congregate housing with support, or usual care. Participants were interviewed every 3 months for 2 years. Separate consent was sought to access administrative data.

ResultsParticipants met eligibility for either MN n = 200 or HN n = 297 and were randomized accordingly. Both samples were primarily male and white. Compared to participants designated MN, HN participants had higher rates of hospitalization for psychiatric reasons prior to randomization, were younger at the time of recruitment, younger when first homeless, more likely to meet criteria for substance dependence, and less likely to have completed high school. Across all study arms, between 92% and 100% of participants were followed over 24 months post-randomization. Minimal significant differences were found between study arms following randomization. 438 participants 88% provided consent to access administrative data.

ConclusionThe study successfully recruited participants meeting criteria for homelessness and current mental disorder. Both MN and HN groups had high rates of substance dependence, suicidality, and physical illness. Randomization resulted in no meaningful detectable differences between study arms.

Trial registrationCurrent Controlled Trials: ISRCTN57595077 Vancouver at Home study: Housing First plus Assertive Community Treatment versus congregate housing plus supports versus treatment as usual and ISRCTN66721740 Vancouver At Home study: Housing First plus Intensive Case Management versus treatment as usual.

KeywordsHousing First Homelessness Mental illness Concurrent disorders AbbreviationsACCHealth service access items

ACEadverse childhood experiences

ACTAssertive community treatment

ANOVAAnalysis of variance

CICognitive impairment

CISCommunity integration scale

CMCComorbid conditions list

CONGCongregate housing with support

CONSORTConsolidated standards of reporting trials

CSIColorado symptom index modified

C-SSSCore service satisfaction scale

CTSConflict tactics scale

EQ-5DEuroQol 5D

FSSocial support items and food security

GAIN-SPSGlobal appraisal of individual needs, substance problem scale

GEEGeneralized estimating equation

HFHousing first

HLMHierarchical linear modeling

HNHigh needs

HSJSUhealth, social, and justice service use inventory

ICMIntensive case management

LRLandlord relations

MAPMaudsley addiction profile

MCASMultnomah community ability scale

MHMobility history

MINIMini-international neuropsychiatric interview

MNModerate needs

MoCAMontreal cognitive assessment

OHQSObserver-rated housing quality scale

PHQLPerceived housing quality

QoLI-20Quality of life index, 20-item

RAS-22Recovery assessment scale, 22-item

RCTRandomized controlled trial

RTLFBResidential time-line follow-back

SF-12SF-12 health survey

SROSingle room occupancy

TAUTreatment as usual

VAHVancouver at home

VFCFoster care history

VTLFBVocational time-line follow-back

WAIWorking alliance inventory.

Electronic supplementary materialThe online version of this article doi:10.1186-1745-6215-14-365 contains supplementary material, which is available to authorized users.

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Autor: Julian M Somers - Michelle L Patterson - Akm Moniruzzaman - Lauren Currie - Stefanie N Rezansoff - Anita Palepu - Karen 


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