Economic analyses
A cost analysis was performed to evaluate the impact of the HF programs, considering all costs incurred by participants. On average, the intervention cost $22,482 per person per year for high need participants and $14,029 for moderate need participants. This cost is almost completely offset by savings in costs of other services, notably hospitalizations, shelters, and other types of housing. Over the two-year period following participants’ entry into the study, every $10 invested in HF services resulted in an average savings of $8.27 for high need participants and $7.19 for moderate need participants. Please consult our methods document (pdf link) to see the unit costs (costs per service, per bed-night, etc.) and their sources.
Ongoing analyses being carried out in Montreal aim to: (1) estimate costs per person of being homeless, in each of the five sites, and the personal characteristics associated with greater costs; (2) evaluate the overall cost-effectiveness of Housing First for people with high and with moderate needs, and the factors associated with greater or lesser cost-effectiveness; and (3) identify the individual-level and site-level factors associated with greater or lesser offsets in costs of resources such as shelters, psychiatric hospitalizations and court appearances.
Planning, development and implementation of the project in Montréal
The role of advocacy coalitions in a project implementation process: The example of the planning phase of the At Home/Chez Soi project dealing with homelessness in Montreal. Evaluation and Program Planning. 2014 Aug;45:42-9. doi: 10.1016/j.evalprogplan.2014.03.008.
- Marie-Josée Fleury
- Guy Grenier
- Catherine Vallée
- Roch Hurtubise
- Paul-André Lévesque
This study analyzed the planning process (summer 2008 to fall 2009) of a Montreal project that offers housing and community follow-up to homeless people with mental disorders, with or without substance abuse disorders. With the help of the Advocacy Coalition Framework (ACF), advocacy groups that were able to navigate a complex intervention implementation process were identified. In all, 25 people involved in the Montreal At Home/Chez Soi project were surveyed through interviews (n = 18) and a discussion group (n = 7). Participant observations and documentation (minutes and correspondence) were also used for the analysis. The start-up phase of the At Home/Chez may be broken down into three separate periods qualified respectively as “honeymoon;” “clash of cultures;” and “acceptance & commitment”. In each of the planning phases of the At Home/Chez Soi project in Montreal, at least two advocacy coalitions were in confrontation about their specific belief systems concerning solutions to address the recurring homelessness social problem, while a third, more moderate one contributed in rallying most key actors under specified secondary aspects. The study confirms the importance of policy brokers in achieving compromises acceptable to all advocacy coalitions.
Mapping of existing services for homeless people in Montreal
Profiles of agencies serving the homeless or those at risk of homelessness in the region of Montreal. Santé mentale au Québec. Vol 38, numéro 1, spring 2013, p. 119-141, doi : 10.7202/1019189ar
- Guy Grenier
- Marie-Josée Fleury
- Armelle Imboua
- André Ngui
This article presents a study of organizations serving people who are homeless or at risk of becoming homeless (PHRH) in Montreal, as well as the determinants of their inter-organizational relationships. The study shows that greater inter-organizational collaboration is needed, particularly within the network of health and social services (NHSS), to deal with the concomitant problems faced by PHRH. Among determinants that have an impact on the extent of inter-organizational relationships are the number of services offered, the appreciation of the relationships between organizations within the NHSS, and the ratio of Anglophones among the homeless and of individuals with gambling problems.
Narrative interviews
The impact of the Montreal At-Home project after 18 months, from the participants' point of view.
McAll, C., Lupien P-L., Gutiérrez M., Fleury A., Robert A., & Rode A. (2013). CREMIS.
A set of narrative interviews was conducted on 45 randomly selected for a qualitative interview, 18 months after study entry, in order to understand possible differences between the two groups over the course of the study. In contrast with the quantitative measures, the qualitative data suggest more substantial differences between the HF and TAU groups.
Wellbeing, defined as a sense of “peace,” “security,” and the ability to live at their own “rhythm,” is a feeling that participants in the HF groups were more likely to mention in the 18-month interviews. Experimental groups were also more likely to say in interviews that they felt less stressed (15 % of HF vs none of the TAU participants sampled). Participants from the HF group were three times as likely as those in TAU to mention in interviews that their mental health had improved over the 18 months, four times as likely to say that they had reduced their consumption of prescription medicines, five times as likely to say that they had made new friendships, and six times more likely to say they had reconnected with family members.
Four factors stand out among those to which participants attribute the success of the HF intervention: rapid access to stable housing, intensive long-term support by ACT and ICM teams, a non-judgmental attitude on the part of case managers, and regaining responsibility for decision making.
Employment
- Eric Latimer
- Robert Whitley
- Daniel Poremski
The objective of the Individual Placement and Support (IPS) sub-study was to determine the best way to help homeless people with mental health problems fulfill their career goals. The team compared the impact of the IPS approach with usual vocational rehabilitation services. The IPS program aimed to help people with mental health disorders find employment on the regular job market. While employment rates were greater in the IPS group (34% vs. 22% in the comparison group) the percentage of people who found work was lower than what could be expected from an IPS program. The short period of observation, as well as experiences of homelessness, may have contributed to this finding.
Housing
- Henri Dorvil
- Sarah Boucher Guèvremont
This sub-study is looking at how participants adapt to their new housing and at the rapport they develop with their landlords/superintendents and caretakers, as well as the perception that the latter group has of their At Home/Chez Soi tenants.
Family
This paper explores the experience of families supporting a homeless relative with mental illness. The authors investigate the types of support offered by families; they also examine the relational and personal dimensions which can support a redefining of the role and consequently a modulation of the level of support. Using qualitative research, semi-structured interviews were realized with 14 family members. The results indicate that housing and the financial support are the types of support most frequently stopped while the emotional and the social support tend to be pursued. The control in the relation, the emotionalism and the perception of future appear as important element for the initiation of a role redefining process.
Victimization and Criminal Justice System Involvement
- Anne Crocker
- Eric Latimer
- Laurence Roy
This sub-study will examine the extent of victimization and Criminal Justice System (CJS) involvement among At Home project participants and compare the profiles of their CJS/victimization experiences. The study will evaluate whether the Housing First intervention is more effective at reducing the frequency of such experiences than treatment as usual. An economic analysis component will compare the costs associated with different CJS profiles and the factors behind them.
Legal trajectories, victimization and impulsivity
- Anne Crocker
- Laurence Roy
This sub-study evaluates the extent to which the approaches of the At Home project influence participants' experiences with the legal system and degree of victimization. Participants' impulsivity is measured to determine whether this aspect affects individuals' behaviour in housing or jeopardizes their success in a Housing First-type program.
Peer participation
- Christopher McAll
- Baptise Godrie
This sub-study is assessing the integration and influence of peer support workers on decisions and perceptions of different clinical teams of the At Home/Chez Soi project.
Theatre forums
- Christopher McAll
- Pierre-Luc Lupien
With the collaboration of the Mise au jeu theatre company, theatre forums are a way to present research results to a mixed audience of users, case managers, researchers, and administrators to communicate, validate and discuss the project findings.
This type of activity promotes the participation of marginalized individuals—in this case homeless people who use mental health services — with dramatizations of key events from their experiences.