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A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness
Abstract
OBJECTIVE: Housing First with assertive community treatment (ACT) is a promising approach to assist people with serious mental illness to exit homelessness. The article presents two-year findings from a multisite trial on the effectiveness of Housing First with ACT. METHODS: The study design was a randomized controlled trial conducted in five Canadian cities. A sample of 950 participants with serious mental illness who were absolutely homeless or precariously housed were randomly assigned to receive either Housing First with ACT (N=469) or treatment as usual (N=481). RESULTS: Housing First participants spent more time in stable housing than participants in treatment as usual (71% versus 29%, adjusted absolute difference [AAD]=42%, p<.01). Compared with treatment-as-usual participants, Housing First participants who entered housing did so more quickly (73 versus 220 days, AAD=146.4, p<.001), had longer housing tenures at the study end-point (281 versus 115 days, AAD=161.8, p<.01), and rated the quality of their housing more positively (adjusted standardized mean difference [ASMD]=.17, p<.01). Housing First participants reported higher quality of life (ASMD=.15, p<.01) and were assessed as having better community functioning (ASMD=.18, p<.01) over the two-year period. Housing First participants showed significantly greater gains in community functioning and quality of life in the first year; however, differences between the two groups were attenuated by the end of the second year. CONCLUSIONS: Housing First with ACT is an effective approach in various contexts for assisting individuals with serious mental illness to rapidly exit homelessness.
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“The findings from the sole randomized controlled trial (At Home/Chez Soi), which examined an intervention with high fidelity to the Pathways Housing First model in five Canadian cities, did not find differences in substance-related problems over time between Housing First and treatment as usual (up to 6 years post-randomization; Aubry et al., 2016; Stergiopoulos et al., 2015, 2019a).”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Aubry et al., 2016
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“Both the HF and TAU groups had improvements in substance-related problems over 24 months”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Aubry et al. (2016)
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Metadata
- Authors
- Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., Latimer, E., Stergiopoulos, V., Somers, J., Streiner, D. L., & Tsemberis, S.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- ORCID
- Venue
- Psychiatric Services
- Published
- 2016-03-01
- Volume
- 67
- Issue
- 3
- Pages
- 275-281
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2187246823
- Semantic Scholar
- 24328f6e5c25c734576fe27e0ac5d2f4958a9c20
- Cited by
- 220
- References
- 47
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 21 · 2023: 19 · 2022: 30 · 2021: 34 · 2020: 25 · 2019: 17 · 2018: 17 · 2017: 18 · 2016: 9
- FWCI
- 28.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Homelessness and Social Issues
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- Housing First, assertive community treatment, homelessness, severe mental illness, housing stability, housing tenure, quality of life, community functioning, Canadian cities
- MeSH terms
- Adult, Mental Disorders, Canada, Community Mental Health Services, Female, Ill-Housed Persons, Housing, Humans, Male, Middle Aged, Quality of Life, Linear Models, Case Management
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