Discussion
ACEs
This is the first analysis of women’s outcomes in an RCT of Housing First. Prior studies and trials on housing interventions for people who experience homelessness often included very small numbers of women or few variables reflecting women’s unique needs and experiences that have precluded documentation of the heterogeneity of experiences and in-depth understanding of this population.In this Canadian multi-site study, the largest longitudinal sample of women experiencing homelessness to date, the intervention group experienced housing stability for 75% of the 24-month follow-up, as compared to 38% for women in the TAU group, a finding similar to previously published reports of At Home/Chez Soi participants, the majority of whom were men [While ED visits declined in a similar fashion for HF and TAU over the 24-month follow-up, an unanticipated finding was a significant reduction in ED visits of 0.5 visits at 18 months for the TAU group over the HF group. For this rare count outcome, the dip in ED visits for TAU at 18 months could be a chance improvement as both groups had similar levels of ED visits by 24 months. Analyses of the full At Home/Chez Soi trial data did not show differences for this outcome [Since improvements in outcomes over the 24-month period were similar for both the HF and TAU groups, we moved beyond the intention-to-treat analysis and examined baseline predictors for our outcomes across the full sample. We focused on baseline suicidality, ACEs, and parental responsibilities as predictors- variables rarely examined in past studies of supported housing or Housing First [Contrary to what we might have anticipated on the importance of ACEs in predicting multiple study outcomes given past research [Although the At Home/Chez Soi support services were important for intervention participants to remain stably housed and make gains in health and social standing, these supports and services were not designed in this Housing First program to be tailored to women’s unique needs. Psychological housing stability which includes considerations of safety, security and feelings of home, is particularly important for women while the At Home/Chez Soi focused predominantly on material housing stability [The lack of greater improvements in the HF arm in this analysis might have been due to the intensive follow-up schedule that could have led to a Hawthorne effect among the TAU group, and higher loss to follow-up in the TAU group might have contributed to smaller differences between groups at 24 months. Despite our sample of homeless women being relatively large, it may not have been sufficient to detect small effects. The At Home/Chez Soi study did not capture gender-sensitive outcomes specific to women experiencing homelessness and therefore we may have missed important changes, such as those associated with positive social support, increased safety from crime and victimization, or strengthening of relationships with children, family or friends [Our study adds to the growing yet sparse literature on the characteristics and needs of women experiencing homelessness and the effectiveness of interventions to eliminate homelessness. Given that women make up more than one third of the homeless population, and their needs differ from that of men [