O'Campo Patricia, Stergiopoulos Vicky, Davis Owen, Lachaud James, Nisenbaum Rosane, Dunn James R, Ahmed Naveed, Tsemberis Sam
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1T8, Canada.
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.
EClinicalMedicine. 2022 Apr 21;47:101387. doi: 10.1016/j.eclinm.2022.101387. eCollection 2022 May.
Homelessness continues to grow globally. The Housing First (HF) model offers immediate access to housing and support services without preconditions and has a growing body of evidence documenting its effectiveness at ending homelessness. HF has a robust theory of change that hypothesizes how unique program components (i.e., immediate access to housing, separation of services from housing, client choice, etc.) drive positive social and health changes over time. We advance the understanding of how HF causes client improvement by empirically testing this program's theory of change.
Using a unique longitudinal quantitative data from the large Canadian At Home/Chez Soi Housing First trial we used path analysis to test the theory of change for Quality of Life, Crisis related events or service utilization, and Recovery. Program pathways and health and social outcomes were measured at enrolment, 6-, 12- and 24-months post-enrolment.
Most hypothesized pathways were confirmed with path analysis. Confirmed pathways for two outcomes- Quality of Life (QOL) and Recovery - were similar. Health and social consultations at enrolment, health status at 6- and 12-months post enrolment, and social connectedness at 12-months were important predictors of the 24-month outcomes of Quality of Life and Recovery, but not for Crisis related events or service utilization.
This analysis directly responds to recent calls for more empirical evidence about intervention mechanisms. Ensuring linkages to health and social service consultations for clients, supporting clients' engagement with family and community, and enabling clients to improve or maintain good health will drive better longer term client outcomes within Housing First.
Funding Mental Health Commission of Canada.
全球范围内无家可归者的数量持续增加。“住房优先”（HF）模式提供无需先决条件即可立即获得住房和支持服务的机会，并且有越来越多的证据证明其在终结无家可归状态方面的有效性。HF有一个完善的变革理论，该理论假设了独特的项目组成部分（即立即获得住房、服务与住房分离、客户选择等）如何随着时间的推移推动积极的社会和健康变化。我们通过对该项目的变革理论进行实证检验，推进了对HF如何促使客户改善的理解。
利用来自加拿大大型“在家/在自己家中住房优先”试验的独特纵向定量数据，我们使用路径分析来检验生活质量、危机相关事件或服务利用以及康复方面的变革理论。在入组时、入组后6个月、12个月和24个月测量项目路径以及健康和社会结果。
大多数假设路径通过路径分析得到了证实。两个结果（生活质量和康复）的已证实路径相似。入组时的健康和社会咨询、入组后6个月和12个月的健康状况以及12个月时的社会联系是生活质量和康复24个月结果的重要预测因素，但对危机相关事件或服务利用不是如此。
该分析直接回应了近期对更多关于干预机制的实证证据的呼吁。确保客户与健康和社会服务咨询建立联系、支持客户与家庭和社区的互动，并使客户能够改善或保持良好健康状况，将在“住房优先”模式下推动客户获得更好的长期结果。
加拿大心理健康委员会资助。
