Introduction
ideation, ACEs, trauma
Homelessness in Canada is primarily experienced by men, yet data show that over one-third of the homeless people in this country are women and close to 90% of the single parents who are homeless are women [Women who are homeless have different health and social vulnerabilities compared to homeless men. They have higher rates of distress including suicidal ideation [Program planners and policy makers operate in a context of too little gender-specific data on programs and interventions and weak studies addressing the experiences of women [Currently, with some exceptions [Housing First, a supportive housing approach with demonstrated success in transitioning individuals experiencing chronic homelessness and mental illness into permanent housing, has negligible evidence on outcomes for women [The At Home/Chez Soi randomized trial conducted in five cities across Canada provides an unprecedented opportunity to examine the impact of a housing first initiative among women for several reasons. First, it is the largest randomized trial of a Housing First initiative and includes an unprecedented sample of several hundred women. This large sample size facilitates a woman only analysis to focus on variability within this subsample and factors that are relevant for women living with homelessness such as sources of trauma or parental roles. A woman only analysis, too rarely seen in studies of homelessness, ensures that the focus remains on women within the sample as gender analyses largely focus on comparing experiences with those of men. With 24 months of follow-up and novel risk variables not previously examined in a Housing First analysis we can provide unique point-in-time and longitudinal evidence not previously considered because of prior sample size and variable availability limitations.The present study employs the largest longitudinal sample of women experiencing homelessness and mental illness in a Housing First randomized controlled trial (RCT) and extends the follow up duration typically seen to 24 months. Our objectives were: (i) To compare change at the end of the study in health and social outcomes between women who received and did not receive the Housing First intervention; ii) To examine whether the Housing First intervention leads to better housing stability over 24 months, and health and social and outcomes between 6- to 24-months post enrolment; and, (iii) To explore baseline demographic, social, health measures, and ACEs as predictors of key study outcomes during the study period.