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A Personalized Tweak Helps Homelessness Programs Work Even Better

Over the last two decades, North American cities have been giving homeless people a place to live before any other treatment. The programs mostly work, but now researchers are seeking improvements.
(Photo: Hernán Piñera/Flickr)

(Photo: Hernán Piñera/Flickr)

It used to be that housing programs for homeless folks required people to get treated for mental illness and addiction first. The idea was that people needed to clean up before they were ready to live on their own. It turned out, however, that it was difficult for people to stick to their treatment programs—to keep taking their meds, or to stay away from drugs—while living in the streets.

So, throughout the 1990s and 2000s, cities in the United States and Canada tried reversing the formula. They ran “Housing First” programs, which gave people access to subsidized apartments right away. Since then, plenty of research has shown that Housing First generally costs cities less and helps more people succeed in treatment. Still, the programs could use improvement, as Pacific Standard reported last year: Namely, they could be better tailored for specific populations. Chronically homeless people may need something different than people who recently became homeless because they lost their jobs, for example. Now, a new study shows one tailored program's preliminary success.

The study, published in the Journal of the American Medical Association, analyzes a program researchers ran in Montreal, Toronto, Vancouver, and Winnipeg. The program, called At Home/Chez Soi, was geared to a specific population—people who have repeated trouble with homelessness and have some mental illness that doesn't require intense care, such as depression.

Plenty of research has shown Housing First generally costs cities less and helps more people succeed in treatment. Still, the programs could use improvement.

At Home combined Housing First with moderate mental-health support. Case managers helped participants find apartments scattered throughout the city, which participants paid for using a combination of their own income and subsidies of up to 480 U.S. dollars. Participants also had to check in weekly with their case managers, but they didn’t have a team of specialists working with them, the way participants in a more intense program called Assertive Community Treatment do.

To check whether At Home worked, a team of researchers from several Canadian institutes followed nearly 1,200 chronically homeless people in Montreal, Toronto, Vancouver, and Winnipeg. A little more than half of them enrolled in At Home. The rest used whatever services were available in their cities.

Over the course of two years, At Home participants stayed in stable housing for more days than other study participants, the research team found. Overall, At Home cost less than Assertive Community Treatment, about $11,000 per person, per year, compared to about $18,000 per person, per year. In surveys, however, the At Home participants didn’t report that their quality of life was significantly different from participants in other programs.

“The first [step] is to be able to work with policymakers to make sure that housing policy in this country is informed by our findings,” Vicky Stergiopoulos, a psychiatrist with St. Michael’s Hospital in Toronto who led the study, said in an interview with the Journal of the American Medical Association. Stergiopoulos also wanted to improve Housing First further, and to follow her study participants longer, to see how they fare in the years to come.

Quick Studies is an award-winning series that sheds light on new research and discoveries that change the way we look at the world.