Women experiencing homelessness and mental illness in a Housing First multi-site trial: Looking beyond housing to social outcomes and well-being.

OBJECTIVE: There is scant research on the effectiveness of permanent supportive housing for homeless women with mental illness. This study examines the effectiveness of Housing First with an unprecedentedly large sample of homeless women from five Canadian cities, and explore baseline risk factors that predict social, health and well-being outcomes over a 24 month-period. METHODS: The At Home/Chez Soi multi-site randomized controlled Housing First trial recruited over 600 women between October 2009 and July 2011. This is a post-hoc subgroup exploratory analysis of self-identified women with at least one follow-up interview who were randomized to Housing First (HF) (n = 374) or treatment-as-usual (TAU) (n = 279) and had at least one follow-up interview. Linear mixed models and generalized estimating equations were used after multiple imputation was applied to address missing data. RESULTS: At the end of follow-up, the mean percentage of days spent stably housed was higher for women in the intervention 74.8% (95%CI = 71.7%-77.8%) compared with women in the treatment-as-usual group, 37.9% (95%CI = 34.4%-41.3%), p<0.001. With few exceptions, social and mental health outcomes were similar for both groups at 6-, 12-, 18- and 24-months post-enrollment. Suicidality was a consistent predictor of increased mental health symptoms (beta = 2.85, 95% CI 1.59-4.11, p<0.001), decreased quality of life (beta = -3.99, 95% CI -6.49 to -1.49, p<0.001), decreased community functioning (beta = -1.16, 95% CI -2.10 to -0.22, p = 0.015) and more emergency department visits (rate ratio = 1.44, 95% CI 1.10-1.87, p<0.001) over the study period. Lower education was a predictor of lower community functioning (beta = -1.32, 95% CI -2.27 to -0.37, p = 0.006) and higher substance use problems (rate ratio = 1.27, 95% CI 1.06-1.52, p = 0.009) during the study. CONCLUSIONS: Housing First interventions ensured that women experiencing homelessness are quickly and consistently stably housed. However, they did not differentially impact health and social measures compared to treatment as usual. Ensuring positive health and social outcomes may require greater supports at enrolment for subgroups such as those with low educational attainment, and additional attention to severity of baseline mental health challenges, such as suicidality. TRIAL REGISTRATION: International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374.

Drug treatment court of Vancouver: an empirical evaluation of recidivism.

BACKGROUND: Drug treatment courts (DTCs) have proliferated on the basis of their promise to reduce criminal recidivism among the burgeoning numbers of drug-related offenders. Empirical research on the effectiveness of DTCs indicates that they produce reductions in recidivism, primarily drawn from experiences in the US. There are no published outcome studies on Canadian DTCs. Canada's second DTC has operated in Vancouver's Downtown Eastside since 2001. We examine longitudinal changes in recidivism and characteristics of participants in the DTC in Vancouver (DTCV). METHODS: DTCV participants (n=180) were included in a longitudinal cohort design (intent-to-treat), and a comparison group was derived using the propensity score matching method. Matching variables represented the domains of health, offending, and socio-economic histories as well as demographics. Annualized rates of offending were compared for the two years prior to entering DTCV and two years following programme termination. RESULTS: Compared to the matched group of offenders, DTCV participants exhibited significantly greater reductions in offending, and a significant decrease in drug-related offences. The characteristics of DTCV participants differ significantly from those of the larger offender population in the DTES. CONCLUSION: Results provide empirical support for the DTCV in relation to the goal of reducing criminal recidivism. Participants in the DTCV are disadvantaged in diverse ways apart from their offence-related difficulties. These results have implications for the design of DTC programmes, as well as for future research.