Housing First is a complex housing and support intervention for homeless individuals with mental health problems. It has a sufficient knowledge base and interest to warrant a test of wide-scale implementation in various settings. This protocol describes the quantitative design of a Canadian five city, $110 million demonstration project and provides the rationale for key scientific decisions.
A pragmatic, mixed methods, multi-site field trial of the effectiveness of Housing First in Vancouver, Winnipeg, Toronto, Montreal and Moncton, is randomising approximately 2500 participants, stratified by high and moderate need levels, into intervention and treatment as usual groups. Quantitative outcome measures are being collected over a 2-year period and a qualitative process evaluation is being completed. Primary outcomes are housing stability, social functioning and, for the economic analyses, quality of life. Hierarchical linear modelling is the primary data analytic strategy.
Ethics and dissemination
Research ethics board approval has been obtained from 11 institutions and a safety and adverse events committee is in place. The results of the multi-site analyses of outcomes at 12 months and 2 years will be reported in a series of core scientific journal papers. Extensive knowledge exchange activities with non-academic audiences will occur throughout the duration of the project.
Trial registration number
This study has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374.
An evaluation of the cost-effectiveness of Housing First in comparison to treatment as usual for homeless adults with mental illness in five Canadian cities with a 2-year follow-up.
Primary outcomes include housing stability, quality of life and social functioning.
The correlates of different trajectories and the critical ingredients of the intervention for sub-populations will also be investigated.
The first and largest multi-site trial of this complex housing and support intervention will provide information about implementation and outcomes.
The addition of site specific intervention arms to a core common protocol will allow investigation of innovative adaptations that are tailored to local context.
The inclusion of a broader homeless population receiving a less intensive service model will increase the policy relevance of findings.
Strengths and limitations of this study
A larger sample size (n=2500) and a wider range of outcome variables than in previous trials are strengths of this study.
This study utilises a concomitant mixed methods process evaluation that includes fidelity assessments.
Variation in sample characteristics and in treatment as usual across five cities may limit opportunities for aggregate analyses.