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?
Who is the main contact?
Dr Paula Goering
Dr Paula Goering
33 Russell Street
+1 (0)416 979 6844
Dr Carol Adair
Departments of Psychiatry and Community Health Sciences
The University of Calgary
Faculty of Medicine
1215 – 39 Ave SW
Multi-site pragmatic randomised controlled field trial of Housing First versus treatment as usual in mental health and homelessness
What is the effectiveness, cost/benefit, and cost/effectiveness of Housing First in comparison to care as usual for homeless adults?
Centre for Addiction and Mental Health Research Ethics Board, 21/09/2009, ref: 252/2009
Multi-method multi-site unblinded randomised controlled field trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Homelessness and serious mental illness
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: 2 years.
Primary outcome measures
Housing stability, measured using the Tsemberis Residential Timeline Follow-back Inventory at 6, 12, 18 and 24 months
Secondary outcome measures
Quality of life, measured using the EQ-5D at 6, 12, 18 and 24 months
Overall trial start date
Overall trial end date
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
Target number of participants
Participant exclusion criteria
Does not meet inclusion criteria
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Centre for Addiction and Mental Health
Trial participating centre
Centre for Research on Inner City Health
St. Michael's Hospital
Health Canada (Canada)
Funding Body Type
Funding Body Subtype
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
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
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
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/26418677
2016 results in: http://www.ncbi.nlm.nih.gov/pubmed/27619826
2016 results in: http://www.ncbi.nlm.nih.gov/pubmed/27769226
2018 results in: http://www.ncbi.nlm.nih.gov/pubmed/29558927
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 .
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.
Woodhall-Melnik J, Misir V, Kaufman-Shriqui V, O'Campo P, Stergiopoulos V, Hwang S, The Impact of a 24 Month Housing First Intervention on Participants' Body Mass Index and Waist Circumference: Results from the At Home / Chez Soi Toronto Site Randomized Controlled Trial, PLoS One, 2015 , 10, 9, e0137069, doi: 10.1371/journal.pone.0137069.