Tenants with additional needs: when housing first does not solve homelessness.

BACKGROUND: At Home/Chez-Soi was a 24 month randomized controlled trial of Housing First (HF) conducted in five Canadian cities. AIMS: This article attempts to identify the characteristics of participants who experienced housing instability one year after entering HF. METHODS: Those defined as experiencing housing instability were housed <50% of the last 9 months of the first year, excluding time in institutions, unless they were housed 100% of the past 3 months. RESULTS: Only 13.5% of HF participants (n = 157/1162) met criteria for housing instability. Several variables were significant predictors of instability in between-group comparisons and multiple regression analyses: residence in Winnipeg, cumulative lifetime homelessness, percent of previous 3 months spent in jail, and community psychological integration; while residence in Moncton and a diagnosis of PTSD or panic disorder predicted stability. The predictive models were weak, identifying correctly only 3.8% of individuals that failed to achieve housing stability. CONCLUSIONS: It is not possible to predict confidently at baseline who will experience early housing instability in HF. There are certain individual characteristics that might be considered risk factors. Providing HF to all individuals who qualify for a HF program remains the most valid way to administer admission to housing.

Postpartum Mental Health Promotion: Perspectives from Mothers and Home Visitors.

OBJECTIVE: The object of this study was to examine the implementation of the Towards Flourishing Mental Health Promotion Strategy, a demonstration project designed to promote the mental well-being of parents and their children that was added to an existing public health home visiting program. DESIGN AND SAMPLE: Structured interviews were conducted with program stakeholders including 13 women receiving home visiting services in the postpartum period and 6 home visitors. MEASURES: Thematic analysis of individual transcripts was conducted and results were compiled according to common themes. RESULTS: The results indicate that women and home visitors perceived the integration of a mental health promotion strategy into an existing public health program as feasible, acceptable and useful. The strategy provides a mechanism for women and home visitors to dialog about mental health and appears to have early positive impacts on the women. Factors that facilitated and impeded the successful implementation of the strategy are described. CONCLUSION: These results point to promising strategies to reach women early in the postpartum period to support their mental health. They also shed light on the barriers to supporting mental health, indicating the need to address stigma related to mental health and the social determinants of health.