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Housing program provides improved stability for mentally ill Canadian youth
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The “Housing First” program provided improved housing stability relative to usual treatment for Canadian homeless youth with mental illness, according to an analysis published in Pediatrics.
“Homeless youth have rates of mental disorders at least twice those of housed youth,” Nicole Kozloff, MD, a clinician scientist in the psychiatry department at the University of Toronto, and colleagues wrote. “On average, homeless youth with mental illness report having been homeless for over 2 years, a substantial portion of their young lives. The chronic stress and deprivation associated with homelessness may have lasting effects on cognitive and academic functioning, financial stability and physical and mental health.”
Housing First, a program for homeless adults developed in New York in the 1990s, demonstrates “housing as a human right, harm reduction, consumer choice, and recovery, provides immediate access to permanent independent housing in the community” and has increased housing stability in homeless adults with mental illness.
In 2008, the Canadian government invested $110 million in a clinical trial of Housing First through the Mental Health Commission of Canada called At Home/Chez Soi. Kozloff and colleagues conducted At Home/Chez Soi with homeless youth, aged 18 to 24 years, with mental illness in Vancouver, Toronto, Winnipeg, Montreal and Moncton during a 2-year period. They evaluated the program’s efficacy for improving housing stability for homeless young adults compared with its effect on adults. The trial included 156 participants randomly assigned to receive either Housing First combined with assertive community treatment or intensive case management (n = 87) or treatment as usual (n = 69).
Adjusted analysis of self-reports where data were available showed that participants who received Housing First were stably housed for an average of 437 of 645 (65%) days compared with those who received usual care and were stably housed an average of 189 of 582 (31%) days, or a mean difference of 34% (95% CI, 24-45). A comparison with outcomes for adults aged older than 24 years displayed no significant differences; however, participants in the youth subgroup were more likely to have a drug or learning disorder, be in an ethnoracial minority and have been arrested recently.
The results of the study suggest “that Housing First is a viable intervention to promote housing stability in homeless youth with mental illness and is as effective for young people as it is for adults in general,” the investigators said. “However … we suggest considering modifications of Housing First to maintain fidelity to core principles while better meeting the needs of the youth.
“This may include attention to issues such as peer/family relationships, sexual health, education and job skills, culture, life skills, substance use and crime avoidance, and should engage youth in all stages of implementation and evaluation.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
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