This document summarizes a research conference on Housing First programs for the homeless with mental illness. It discusses the At Home/Chez Soi project, the largest Housing First study in the world conducted across 5 Canadian cities. Interim results found Housing First reduced health system costs and increased housing stability. Efforts were made to promote sustainability after funding ended through negotiations. Current priorities are the project transition and disseminating findings to scale up Housing First nationally through toolkits and partnerships. Housing First is now a major policy shift in Canada with renewed homelessness funding and the Mental Health Commission's advisory role on implementation.

1. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
After Identifying that Housing First
Works in Canada, What’s Next?
Cameron Keller, Vice President, Programs and Priorities,
Mental Health Commission of Canada
Paula Goering, RN, PhD, National Research Lead,
At Home/Chez Soi (regrets)

2. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
At Home/Chez Soi Project Overview
 In 2008 the Federal government allocated $110million
At Home/Chez Soi is:
 the largest study of its kind in the world
 providing evidence about what services and systems best
help people experiencing serious mental health issues and
homelessness
 Housing First model
 implemented in: Vancouver, Winnipeg, Toronto, Montreal,
Moncton
 Funding – 85% services / 15% research

3. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Research Demonstration
Objectives
 Policy shift – Evidence-informed investments in Housing
First to address chronic homelessness among people
with serious mental illness
 Opportunity to create lasting system change
 Federal/provincial/territorial/municipal collaborations
 Scalable investment opportunities for all levels of
government moving forward

4. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Integrated Knowledge Translation
Research involves exchange and linkage with decision-
makers throughout the process
Requires allegiance to both scientific and participatory
principles
“evidence of effectiveness alone is rarely enough to
ensure adoption of interventions” (Leff & Mulkern, 2002)
Science requires orderly, phased process of scientific
investigation
Participation requires that the interests and values of
various groups in public systems be reflected.

5. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Research Design
 Pragmatic, multi-site, randomized, mixed methods field trial
 Effectiveness and cost effectiveness of Housing First Model in
Canadian contexts
 Model being tested at two levels of intensity – ACT and ICM
 Randomized to Housing First (HF) or TAU + third arm
 Comparisons to care as usual in all cities
 Outcome data collected at baseline, 6, 12, 18, & 21 months
 Two fidelity assessments and formative evaluations
 Qualitative data collected on subgroup of participants at baseline
and 18 months

6. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Project Timeline
 March 2008-Funding announced
 Fall 2008-Request for Proposals posted
 March 2009-Grants and Contracts Awarded
 Fall 2009-Data collection begins
 Summer 2012-One year data collection complete
 September 2012-Interim report released
 Spring/summer 2013-One year scientific papers submitted
 March 2013-Program funding ends and data collection ends
 December 2013-Final report due
 2014-Two year scientific papers submitted

7. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Program Sustainability
What happens to demonstration projects after their initial limited time
funding ends.
Continued benefits for individuals, continued activities for programs and
continued capacity for communities.
Theoretically the stage after implementation and before dissemination
to other sites. In reality….overlapping, non-linear and continuously
evolving)
Multi-factors influence outcomes (innovation, context, capacity,
processes and interactions)
Evaluation has limited utility although perceived benefits often cited
positive influence.
Scheirer, MA 2005

8. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
A common problem
 The project “should include rigorous evaluation and
enough time after the results of the evaluation are known
to plan for the sustainability of program interventions
shown to be effective”
 “The timing of evaluation findings is often too late in the
project life cycle to be useful in promoting sustainability;
evaluation could be more useful if interim data about
outcomes would be available before the initial funding
ends.”
Scheirer, M 2005

9. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Interim report results
 Over 900 people currently housed in adequate, affordable,
suitable settings
 Stable living conditions contribute to a shift from the frequent use
of inappropriate and expensive services
• At Home/Chez Soi saved the system a net average of $9,390 for those
who had a high use of services “High Users”
 Housing First has the potential to provide system-wide cost
offsets.
 Individuals receiving Housing First saved the system a yearly average of
$2,184 per person in costs related to inpatient stays – this savings was
even greater for the “high user” sub-group
 Canada can (and is) implementing Housing First
 Benefits cross a range of sectors (health, social services,
criminal justice)

10. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Review of efforts to solve the
sustainability problem
 Comprehensive government relations efforts – January 2012
through September 2012
 Interim results presented to senior leaders in multiple briefing
sessions
 Request to federal government for two years of post project housing
 Formal request to Health Canada for transition funding from four of
five provinces – August 2012
 Interim report released in September, extensive media coverage
 Federal government response communicated to MHCC – October
2012
 Federal/provincial/MHCC negotiations – November 2012 to present

11. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Sustainability outcomes
 The federal government contributed to the housing
component for one year in all of the sites
 Manitoba, New Brunswick, BC and Quebec are
all finalizing plans to provide clinical services to
participants.
 Ontario made a public announcement outlining
ongoing funding for housing subsidies and Housing First
services and supports.
 Mixed picture re continuation or modification of Housing
First program components.

12. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Current Priorities
 Facilitation of transition in five cities
 Final data cleaning and analysis
 Formulation of policy recommendations – policy forum –
October 2013
 Final report December 2013
 Ongoing dissemination of findings through MHCC’s
Knowledge Exchange Center and ongoing publications
and local KE activities

13. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
What’s Next?
 Thinking beyond immediate sustainability:
 Rich knowledge base still under creation
 Health & social innovation potential based on evidence
 Capacity built in regions across the country to deliver Housing First
 Long term opportunity for all levels of government to invest with
confidence in a cost-effective intervention to reduce chronic
homelessness
 Opportunity to build on the investment to date, and leverage the
partnerships created to date (existing P/T & private sector)

14. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Scaling Up-Definition
“deliberate efforts to increase the impact of
successfully tested pilot, demonstration or
experimental projects to benefit more people and
to foster policy and programme development on a
lasting basis”
ExpandNet/WHO www.expandnet.net

15. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Further Scaling up Activities
 Development of a HF toolkit
 Partnership with Provincial and National Housing and
Homelessness Organizations (thinktanks, PHSI and
SHERC grant applications)
 Consultations to jurisdictions interested in implementing
or scaling-up of Housing First approaches;
 Ongoing engagement with local and national media
 Continued development of Here at Home an interactive
website in partnership with NFB.
 Applications for further funding to follow up participants
post project.

16. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
A Major Policy Shift
 Federal budget announcement of renewal of Homelessness
Partnering Secretariat funding of $600M for 5 years
 Shift towards Housing First
 Mental Health Commission of Canada a “trusted advisor” invited to
assist in shaping policy shift as well as implementation support
including training and technical assistance
What advice do you have for us regarding how to do
this i.e. tension between advisor role and advocacy?
What key considerations must we not forget?

17. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Role of Research Evidence
 One of many factors that influence decision making-
politics, personalities, financial cycles
 Interim results and experiential knowledge both influence
governments
 Strong governmental relations and communications
supports are an asset
 Pressure to release findings in timely manner creates
risks re consistency. e.g. economic results will change

18. EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Thank you!
Contact Us:
Cameron Keller: ckeller@mentalhealthcommission.ca
Paula Goering: paula.goering@camh.ca
Visit: www.mentalhealthcommission.ca
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The views represented herein solely represent the views of the presenters.
Production of this document is made possible through a financial contribution from Health Canada.