Condition category
Mental and Behavioural Disorders
Date applied
05/06/2009
Date assigned
18/08/2009
Last edited
06/08/2015
Prospective/Retrospective
Prospectively registered
Overall trial status
Completed
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
The Mental Health Commission of Canada is working with a national and five local research teams in Vancouver, Winnipeg, Toronto, Montreal and Moncton to conduct this study. The aims are to find out what kind of housing and support work best for people who are homeless and have mental health issues and to influence the government to create more long-term community-based housing and supports.

Who can participate?
Homeless or precariously housed adults aged 18 and older diagnosed with a serious mental disorder.

What does the study involve?
To find out which kind of supported housing works best, we are comparing people receiving Housing First with those in usual care. This means that those who agree to participate will be assigned at random to receive either Housing First (rent supplements and mental health supports from a case manager at one of two levels, assertive community treatment or intensive case management) or usual care (existing community services). All participants will be interviewed every 3 months over a period of two years and be asked to continue in a longer-term 4 year follow-up study. We ask participants to provide us with access to information about their use of health services, income assistance and any contacts with the justice system.

What are the possible benefits and risks of participating?
All participants get a cash honorarium (payment) for each interview. We make the interview as comfortable as possible to reduce the risk of personal questions creating distress. Those in the Housing First groups get supported housing through the study and have access to a minimum level of support and additional treatment if they choose to use it. Rent stipends and case management supports will be provided for the duration of the study when we will try to make sure that their housing is maintained. If they lose the housing for any reason, we will help them find another place to live and either continue to provide services/supports or locate alternative sources in the community. There is an equal chance that participants who agree to be in the study will not receive housing through the study. For those who do not get supported housing through the study, we let them know about housing and support through other sources.

Where is the study run from?
Centre for Addiction and Mental Health (Canada).

When is the study starting and how long is it expected to run for?
September 2009 to April 2013.

Who is funding the study?
Health Canada.

Who is the main contact?
Dr Paula Goering
paula_goering@camh.net

Trial website

Contact information

Type

Scientific

Primary contact

Dr Paula Goering

ORCID ID

http://orcid.org/0000-0002-2976-2127

Contact details

33 Russell Street
Toronto
M5S 2S1
Canada
+1 (0)416 979 6844
paula_goering@camh.net

Type

Scientific

Additional contact

Dr Carol Adair

ORCID ID

http://orcid.org/0000-0001-5630-700X

Contact details

Departments of Psychiatry and Community Health Sciences
The University of Calgary
Faculty of Medicine
1215 – 39 Ave SW
Calgary
T2T 2K6
Canada
-
cadair@ucalgary.ca

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

N/A

Study information

Scientific title

Multi-site pragmatic randomised controlled field trial of Housing First versus treatment as usual in mental health and homelessness

Acronym

Study hypothesis

What is the effectiveness, cost/benefit, and cost/effectiveness of Housing First in comparison to care as usual for homeless adults?

Ethics approval

Centre for Addiction and Mental Health Research Ethics Board, 21/09/2009, ref: 252/2009

Study design

Multi-method multi-site unblinded randomised controlled field trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Other

Trial type

Treatment

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet

Condition

Homelessness and serious mental illness

Intervention

Treatment: provision of rent supplements and case management or assertive community treatment for the duration of the study
Comparison: care as usual

Duration of intervention: Data collection will be ongoing from Sept 2009 to Feb 2013 with duration of intervention from 24 to 42 months.
Duration of follow-up: two years

Intervention type

Other

Phase

Not Applicable

Drug names

Primary outcome measures

Housing Stability: Tsemberis Residential Timeline Follow-back Inventory, measured at 6, 12, 18 and 24 months.

Secondary outcome measures

Quality of Life: EQ-5D, measured at 6, 12, 18 and 24 months.

Overall trial start date

01/09/2009

Overall trial end date

01/04/2013

Reason abandoned

Eligibility

Participant inclusion criteria

1. Legal adult status
2. Absolute homelessness or precariously housed
3. Presence of a serious mental disorder
4. Aged 18 years and older, either sex

Participant type

Patient

Age group

Adult

Gender

Both

Target number of participants

2,225

Participant exclusion criteria

Does not meet inclusion criteria

Recruitment start date

01/10/2009

Recruitment end date

01/07/2011

Locations

Countries of recruitment

Canada

Trial participating centre

Centre for Addiction and Mental Health
Toronto
M5S 2S1
Canada

Trial participating centre

Centre for Research on Inner City Health
St. Michael's Hospital
Toronto
-
Canada

Sponsor information

Organisation

Mental Health Commission of Canada (Canada)

Sponsor details

10301 Southport Lane SW
Calgary
T2W 1S7
Canada
-
awatson@mentalhealthcommission.ca

Sponsor type

Government

Website

http://www.mentalhealthcommissio.ca

Funders

Funder type

Government

Funder name

Health Canada (Canada)

Alternative name(s)

Santé Canada

Funding Body Type

government organisation

Funding Body Subtype

Federal/National Government

Location

Canada

Results and Publications

Publication and dissemination plan

A publications policy and plan, developed by a committee representing the project stakeholders, defined a set of core papers that will be written using the data from all sites. These include a paper describing the study methods as well as papers on how the Housing First programs were implemented and how well they worked at each level at one and two years. A process for coordinating author-initiated papers on a number of related topics is also in place. In addition, each site has a specific publication plan for their local papers.

Reports for policy and public audiences created throughout the project can be accessed at
http://mentalhealthcommission.ca/English/initiatives-and-projects/home

A National Film Board interactive documentary is at http://athome.nfb.ca/#/athome

Post project dissemination has included an interactive toolkit found at http://housingfirsttoolkit.ca

Data is stored at St. Michael's Hospital in Toronto and is available to external investigators who sign a Data Sharing and Use Agreement that stipulates the responsibilities associated with transfer of datasets. Dr. Carol Adair is the data access coordinator.

Intention to publish date

Participant level data

Stored in repository

Results - basic reporting

Publication summary

2011 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/22102645
2012 results in: http://www.ncbi.nlm.nih.gov/pubmed/23031406
2012 childhood learning disability results in: http://www.ncbi.nlm.nih.gov/pubmed/23175737
2013 initial implementation in: http://www.tandfonline.com/eprint/fhuDFnhjMDuD4Zbz798X/full
2013 results in: http://www.ncbi.nlm.nih.gov/pubmed/23750762
2013 results in: http://www.ncbi.nlm.nih.gov/pubmed/22965695
2014 cumulative childhood adversity results in: http://www.ncbi.nlm.nih.gov/pubmed/24726046
2014 discrimination results in: http://www.ncbi.nlm.nih.gov/pubmed/25196184
2014 results in: http://www.ncbi.nlm.nih.gov/pubmed/24725374
2014 results in: http://usj.sagepub.com/content/early/2014/09/09/0042098014548138.abstract
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/25734732
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/25465295
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/25496296
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/25886157
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/26176621
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/25639993

Publication citations

  1. Results

    Stergiopoulos V, O'Campo P, Gozdzik A, Jeyaratnam J, Corneau S, Sarang A, Hwang SW, Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups., BMC Health Serv Res, 2012, 12, 345, doi: 10.1186/1472-6963-12-345.

  2. Childhood learning disability results

    Patterson ML, Moniruzzaman A, Frankish CJ, Somers JM, Missed opportunities: childhood learning disabilities as early indicators of risk among homeless adults with mental illness in Vancouver, British Columbia., BMJ Open, 2012, 2, 6, doi: 10.1136/bmjopen-2012-001586.

  3. Cumulative childhood adversity results

    Patterson ML, Moniruzzaman A, Somers JM, Setting the stage for chronic health problems: cumulative childhood adversity among homeless adults with mental illness in Vancouver, British Columbia., BMC Public Health, 2014, 14, 350, doi: 10.1186/1471-2458-14-350.

  4. Discrimination results

    Skosireva A, O Campo P, Zerger S, Chambers C, Gapka S, Stergiopoulos V, Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings., BMC Health Serv Res, 2014, 14, 1, 376, doi: 10.1186/1472-6963-14-376.

  5. Results

    Stergiopoulos V, Gozdzik A, O'Campo P, Holtby AR, Jeyaratnam J, Tsemberis S, Housing First: exploring participants' early support needs, BMC Health Serv Res, 2014 , 14, 167, doi: 10.1186/1472-6963-14-167.

  6. Results

    Stergiopoulos V, Hwang SW, Gozdzik A, Nisenbaum R, Latimer E, Rabouin D, Adair CE, Bourque J, Connelly J, Frankish J, Katz LY, Mason K, Misir V, O'Brien K, Sareen J, Schütz CG, Singer A, Streiner DL, Vasiliadis HM, Goering PN; for the At Home/Chez Soi Investigators, Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness: A Randomized Trial, JAMA, 2015, 313, 9, 905-915, doi: 10.1001/jama.2015.1163.

  7. Results

    Goering PN, Streiner DL, Adair C, Aubry T, Barker J, Distasio J, Hwang SW, Komaroff J, Latimer E, Somers J, Zabkiewicz DM, The At Home/Chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities, BMJ Open, 2011, 1, 2, e000323, doi: 10.1136/bmjopen-2011-000323.

  8. Results

    Kirst M, Zerger S, Misir V, Hwang S, Stergiopoulos V, The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness, Drug Alcohol Depend, 2015 , 146, 24-29, doi: 10.1016/j.drugalcdep.2014.

  9. Results

    Zerger S, Bacon S, Corneau S, Skosireva A, McKenzie K, Gapka S, O'Campo P, Sarang A, Stergiopoulos V, Differential experiences of discrimination among ethnoracially diverse persons experiencing mental illness and homelessness, BMC Psychiatry, 2014 , 14, 1, 353, doi: 10.1186/s12888-014-0353-1.

  10. Results

    Gozdzik A, Salehi R, O'Campo P, Stergiopoulos V, Hwang SW, Cardiovascular risk factors and 30-year cardiovascular risk in homeless adults with mental illness, BMC Public Health, 2015 , 15, 165, doi: 10.1186/s12889-015-1472-4.

  11. Results

    Stergiopoulos V, Gozdzik A, Misir V, Skosireva A, Connelly J, Sarang A, Whisler A, Hwang SW, O'Campo P, McKenzie K, Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial, PLoS One, 2015 , 10, 7, e0130281, doi: 10.1371/journal.pone.0130281.

  12. Results

    C Keller, P Goering, C Hume, E Macnaughton, P O'Campo, A Sarang, M Thomson, C Vallée, A Watson & S Tsemberis, Initial Implementation of Housing First in Five Canadian Cities: How Do You Make the Shoe Fit, When One Size Does Not Fit All?, Am J Psychiatr Rehab, 2013, 16, 4, doi: 10.1080/15487768.2013.847761.

  13. Results

    Polvere L, Macnaughton E, Piat M, Participant perspectives on housing first and recovery: early findings from the At Home/Chez Soi project, Psychiatr Rehabil J, 2013 , 36, 2, 110-112, doi: 10.1037/h0094979.

  14. Results

    Nelson G, Macnaughton E, Goering P, Dudley M, O'Campo P, Patterson M, Piat M, Prévost N, Strehlau V, Vallée C, Planning a multi-site, complex intervention for homeless people with mental illness: the relationships between the national team and local sites in Canada's At Home/Chez Soi project, Am J Community Psychol, 2013 , 51, 3-4, 347-358, doi: 10.1007/s10464-012-9554-2.

  15. Results

    Piat M, Polvere L, Kirst M, Voronka J, Zabkiewicz D, Plante M-C, Isaak C, Nolin D, Nelson G, Goering P, Pathways into homelessness: Understanding how both individual and structural factors contribute to and sustain homelessness in Canada , Urban Stud, 2014, doi: 10.1177/0042098014548138 .

  16. Results

    Aubry T, Tsemberis S, Adair CE, Veldhuizen S, Streiner D, Latimer E, Sareen J, Patterson M, McGarvey K, Kopp B, Hume C, Goering P, One-year outcomes of a randomized controlled trial of housing first with ACT in five Canadian cities, Psychiatr Serv, 2015, 66, 5, 463-469, doi: 10.1176/appi.ps.201400167.

Additional files

Editorial Notes