Housing First for Adults with Problematic Substance Use

ABSTRACT

Objectives: This study explores the two-year housing- and non–housing-related outcomes for adults who are homeless with problematic substance use who received scattered-site housing and intensive case management services from a Housing First program in Ottawa, Canada, in comparison with a group of adults who are homeless with problematic substance use who had access to standard care in the community. Methods: Housing First clients (n = 89) and members of a comparison group (n = 89) completed structured interviews at baseline and were followed for two years. Results: Housing First clients moved into housing more quickly, reported a greater proportion of time housed, were more likely to spend the final six months housed, and had longer housing tenure at 24 months. There was a group by time interaction on problematic alcohol use with more rapid improvement for the comparison group; however, both groups improved over time. The comparison group had a greater decrease on problematic drug use by 24 months. There was no change in physical health and only the comparison group had improvements in mental health by 24 months. The groups had similar improvement on community functioning by 24 months. The comparison group had a greater increase in total quality of life. More specifically, the comparison group had an increase in the family relations–related quality of life, whereas the clients did not. There was a significant interaction for safety-related quality of life, but both groups experienced improvements over time and had comparable levels of satisfaction with safety at each time point. The Housing First clients reported higher levels of satisfaction with living conditions than the comparison group at baseline and 12 months, but not at 24 months. There was significant improvement over time and no main effect of group for finances, leisure, and social relations. Conclusions: Adults who are homeless with problematic substance use can successfully be housed using a Housing First approach. However, further targeted services might be required to address other areas of functioning, such as health, substance use, and quality of life.

KEYWORDS:

• Housing First
• homelessness
• substance use
• housing

Acknowledgments

We thank the participants of the study for their involvement in the research. We acknowledge the staff and the managers of CMHA Ottawa and the Oasis program at Sandy Hill Community Health Centre for their assistance. We also thank the Mental Health Commission of Canada for providing the research protocol of the At Home/Chez Soi Demonstration Project. The results of the paper were presented at the Canadian Alliance to End Homelessness, Montreal, Canada, November 2–4, 2015, and at the Second International Housing First Conference, Castletroy, Ireland, July 7–9, 2016.

Disclosures

The authors report no financial relationships with commercial interests. Donna Pettey and Rob Boyd are employees of the agencies that delivered the program. The postdoctoral fellowship of Rebecca Cherner was funded by the project funding received from the Canadian Mental Health Association, Ottawa Branch.

Funding

The research was funded by the Canadian Mental Health Association, Ottawa Branch.