Housing First Enhanced with Antiracism Practices Can Improve Housing Stability

Because of known differences in health care experiences and outcomes by race and ethnicity, researchers in Toronto tested the effectiveness of a Housing First program enhanced with antiracism and antioppression practices. The main principles of the antiracism and antioppression services delivered include empowerment, education, alliance building, language use, and advocacy. In addition, whenever possible, case managers were fluent in participants’ primary language and representative of the clients they served. Prior research on adapting Housing First for client populations explored differences in outcomes for youth versus adults.

The two-year randomized controlled trial included 237 homeless adults with moderate needs for mental health services. Participants were randomized either into the adapted Housing First program with antiracism services or into usual care. Eligible patients were ages 18 and older, were black or an ethnic minority, were “absolutely homeless” or precariously housed (i.e., have a history of absolute homelessness and currently reside in a hotel, motel, or single-room-occupancy building), and had a mental disorder with or without a coexisting substance use disorder. Data were collected during in-person interviews that were conducted every three months and during longer interviews that took place at the start of the study and then at 6, 12, 18, and 24 months. The study’s findings have key policy implications for Housing First interventions, and the authors recommend that future research compare housing outcomes in traditional and adapted Housing First interventions to identify elements that make programs successful.

Key findings

• A Housing First approach to allocating rent supplements and mental health services—when combined with antiracist and antioppressive methods—can improve housing stability for black or ethnic minority adults experiencing homelessness and moderate mental health needs. This is significant because homeless people from racial and ethnic minority groups may avoid traditional services.
• Participants in the adapted Housing First group were housed for 75 percent of the two-year period compared with 41 percent for the usual care group.
• Males and those with psychotic disorders were less likely to be housed for at least half the study period, while those with major depression or posttraumatic stress disorder were more likely to spend most of the study housed.
• Self-reported days in the hospital were not significantly different between the two groups.
• The adapted Housing First approach led to improvements in general community functioning among participants.