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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Health Services Research 1/2014

Housing First: exploring participants’ early support needs

BMC Health Services Research > Ausgabe 1/2014
Vicky Stergiopoulos, Agnes Gozdzik, Patricia O’Campo, Alixandra R Holtby, Jeyagobi Jeyaratnam, Sam Tsemberis
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-14-167) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

VS conceived of the study, interpreted results, contributed to the drafting of the manuscript and read and revised all drafts of the manuscript. AG developed the analysis plan, analyzed the quantitative data, interpreted the findings and drafted the manuscript. PO helped interpret the results and contributed to drafting of the manuscript. AH analyzed the qualitative data and contributed to the drafting of the manuscript. JJ analyzed the qualitative data and contributed to the drafting of the manuscript. ST interpreted the results and contributed to drafting of the manuscript. All authors read and approved the final manuscript.



Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants’ early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrolment in a Canadian field trial of Housing First.


The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis.


The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrolment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support.


Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs.

Trial registration

Current Controlled Trials ISRCTN42520374
Additional file 1: Table S1: Means (standard errors) for each of the domains at both baseline and 6 months, in addition to the mean change from baseline to 6 months1. (DOC 32 KB)
Additional file 2: Table S2: Mean change from baseline to 6-months in outcome domains by length of time to housing and housing status at 6 months1,2. (DOC 35 KB)
Additional file 3: Table S3: Correlation coefficients between changes from baseline to 6-months for each outcome domain and time to housing and the participant-reported Working Alliance total score1. (DOCX 18 KB)
Authors’ original file for figure 1
Authors’ original file for figure 2
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