Open Access Research article

Housing First: exploring participants’ early support needs

Vicky Stergiopoulos12*, Agnes Gozdzik1, Patricia O’Campo13, Alixandra R Holtby1, Jeyagobi Jeyaratnam1 and Sam Tsemberis14

Author Affiliations

1 Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada

2 Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada

3 Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada

4 Pathways to Housing, Inc, New York, NY, USA

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BMC Health Services Research 2014, 14:167  doi:10.1186/1472-6963-14-167

Published: 13 April 2014



Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants’ early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrolment in a Canadian field trial of Housing First.


The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis.


The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrolment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support.


Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs.

Trial registration

Current Controlled Trials ISRCTN42520374