A new Canadian study lends backing for a commonsense approach to moving people off the street that has been used in the District and other U.S. cities since the 1990s: Ensure that the homeless receive permanent shelter first, and their chances of achieving stability will increase.
Known as the “housing first” approach, the program offers social support as well. But it emphasizes finding secure shelter in the community first, in contrast to homeless programs that insist on preconditions such as sobriety or psychiatric care and moving through transitional housing.
The study, carried out by researchers at the Centre for Research on Inner City Health of St. Michael’s Hospital in Toronto, found that giving mentally ill homeless people financial help to secure free-market rental housing and mental health support services enhanced their chances of achieving stability.
Over a 24-month period, those with both supports had stable housing nearly 63 to 77 percent of the time, compared with about 24 to 39 percent of those who received “usual care” or even “housing first” programs that also require more assertive social service help.
“Housing first is not housing only. It is housing with support,” lead author Vicky Stergiopoulos, who is psychiatrist in chief at St. Michael’s, said in a telephone interview late Tuesday. “And a lot of the individuals, or most of them, would not be able to keep their housing without support.”
The study appeared Tuesday in the Journal of the American Medical Association (JAMA).
The study involved about 2,000 people enrolled in a program called At Home/Chez Soi, a research program that takes a “housing first” approach in five Canadian cities. (The study drew data involving people recruited to the program between October 2009 and July 2011 in four cities: Vancouver, Winnipeg, Toronto and Montreal.)
Participants were randomly assigned to one group where they received independent rental housing that cost up to 30 percent of their income. A rental supplement of up to $600 was also provided. The participants had some choice over the neighborhood and type of housing they desired. Participants also were required to meet once a week or more with a case manager. The case managers could help them locate employment, mend family relationships, seek medical care or plan for other goals.
Those in the group who received “usual care” were not without assistance, but it was less intensive, Stergiopoulos said. They received no financial help to find adequate housing in the community, and their housing and social services care were not coordinated.
“They didn’t have rent supplements. They couldn’t access housing in the community,” she said, adding that as a result they had fewer housing options.
Other studies have demonstrated the benefit of the “housing first” approach, she said. But this study also shows that the program is effective even when the social services offered are less intense than those in similar programs. Those more intensive programs – what the authors call Assertive Community Treatment – involve an interdisciplinary team that includes a psychiatrist and others, and small caseloads.
The approach taken by Chez Soi is also less expensive than the more intensive approach, costing about $14,177 per participant per year, compared with $22,257.
“Our findings thus highlight that scattered-site housing with intensive case management is effective in reducing homelessness among a broader spectrum of the homeless population who may have a severe mental illness but do not require Assertive Community Treatment support, best reserved for a smaller group of homeless adults with high needs for mental health and other support services,” the study says.
There are about 150,000 homeless people in Canada and about 1.5 million in the United States.