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Psychiatr Serv. 2016 Mar;67(3):275-81. doi: 10.1176/ Epub 2015 Dec 1.

A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness.

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Dr. Aubry is with the Centre for Research on Educational and Community Services and the School of Psychology, University of Ottawa, Ottawa, Ontario, Canada (e-mail: ). Dr. Goering and Mr. Veldhuizen are with the Centre for Addiction and Mental Health, Toronto, Ontario. Dr. Goering is also with the Department of Psychiatry, University of Toronto, where Dr. Streiner is affiliated. Dr. Streiner is also with the Department of Psychiatry, McMaster University, Hamilton, Ontario, Canada. Dr. Adair is with the Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Dr. Bourque is with the Department of Education, Université de Moncton, Moncton, New Brunswick, Canada. Dr. Distasio is with the Department of Geography, University of Winnipeg, Winnipeg, Manitoba, Canada. Dr. Latimer is with the Department of Psychiatry, McGill University, Montreal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Somers is with the Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Tsemberis is with Pathways to Housing, Inc., New York City.



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.


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).


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.


Housing First with ACT is an effective approach in various contexts for assisting individuals with serious mental illness to rapidly exit homelessness.

[Indexed for MEDLINE]

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