A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats

PLoS One. 2017 Jan 11;12(1):e0168745. doi: 10.1371/journal.pone.0168745. eCollection 2017.


Objective: No previous experimental trials have investigated Housing First (HF) in both scattered site (SHF) and congregate (CHF) formats. We hypothesized that CHF and SHF would be associated with a greater percentage of time stably housed as well as superior health and psychosocial outcomes over 24 months compared to treatment as usual (TAU).

Methods: Inclusion criteria were homelessness, mental illness, and high need for support. Participants were randomised to SHF, CHF, or TAU. SHF consisted of market rental apartments with support provided by Assertive Community Treatment (ACT). CHF consisted of a single building with supports equivalent to ACT. TAU included existing services and supports.

Results: Of 800 people screened, 297 were randomly assigned to CHF (107), SHF (90), or TAU (100). The percentage of time in stable housing over 24 months was 26.3% in TAU (reference; 95% confidence interval (CI) = 20.5, 32.0), compared to 74.3% in CHF (95% CI = 69.3, 79.3, p<0.001) and 74.5% in SHF (95% CI = 69.2, 79.7, p<0.001). Secondary outcomes favoured CHF but not SHF compared to TAU.

Conclusion: HF in scattered and congregate formats is capable of achieving housing stability among people experiencing major mental illness and chronic homelessness. Only CHF was associated with improvement on select secondary outcomes.

Registration: Current Controlled Trials: ISRCTN57595077.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Female
  • Housing*
  • Humans
  • Ill-Housed Persons / psychology*
  • Intellectual Disability / psychology*
  • Male
  • Middle Aged

Grants and funding

This work was supported by Grant #: 2009s0124 from Mental Health Commission of Canada, http://www.mentalhealthcommission.ca; Recipient: JMS. The funder required the use of an experimental design in the Call for Proposals. The funder played no role in the remainder of the research design, collection of data, decision to publish, of preparation of the manuscript.