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Housing First (HF) is an intervention designed to provide permanent housing without prerequisites for abstinence or treatment, and access to supportive health services to people experiencing homelessness and serious mental health issues. This approach contrasts with more traditional supportive housing models that require sobriety and engagement in mental health treatment before clients are deemed “housing ready.” Operating from a harm reduction philosophy, the HF approach posits that providing housing to homeless individuals with mental illness first provides the foundation, stability and safety necessary to support movement towards recovery. The "At Home/Chez Soi" randomized controlled trial was the largest evaluation study of the Housing First model to be conducted, and was implemented in five Canadian cities: Vancouver, Winnipeg, Toronto, Montreal and Moncton.
We are currently examining the role of social integration on housing stability, mental health and substance use outcomes in the At Home/Chez Soi study. Social integration, involving community integration and a variety of social supports, can be protective resources for the physical and mental health of homeless individuals. To examine the qualitative and quantitative data collected from homeless individuals experiencing serious mental health issues participating in the At Home/Chez Soi randomized control trial, we ask the following research questions:
- To what types of social supports do homeless individuals have access? To what extent do participants feel socially integrated in their communities?
- How does social integration change over time (from baseline, six, 12 to 24 months) among participants in the At Home/Chez Soi intervention and treatment as usual groups?
- How do changes in social integration affect changes in housing stability, mental health and substance use outcomes over time, by study arm?
Relevant Publications
- Urbanoski, K., Veldhuizen, S., Krausz, M., Schutz, C., Somers, J., Kirst, M.J., Fleury, M.J., Stergiopoulos, V., Patterson, M., Strehlau, V., Goering, P. (2018). Effects of comorbid substance use disorders on outcomes in a Housing First intervention for homeless people with mental illness. Addiction. 113(1), 137-145.
- Kirst, M.J., Zerger, S., Misir, V., Hwang, S. & Stergiopoulos, V. (2014). The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug and Alcohol Dependence. 146, 24-29
- Kirst, M.J., Zerger, S.,Wise Harris, D., Plenert, E., & Stergiopoulos, V. (2014). The promise of recovery: Narratives of hope among homeless individuals with mental illness participating in a Housing First randomized controlled trial in Toronto, Canada. BMJ Open, 4:e004379.
RESTART is an adaptation of the Housing First for Youth (HF4Y) model, combined with an integrated mental health and addictions model (IMHA), that is designed to address the needs of developing youth and young adults (aged 13-24) at risk of or experiencing homelessness, through providing them with immediate access to housing that is safe, affordable and appropriate, and the necessary supports that focus on wellness and social inclusion designed to help them successfully transition to adulthood. This study is assessing the effectiveness of an integrated intervention tailored to better meet the housing, mental health and addiction service needs of youth experiencing homelessness and concurrent disorders (CDs).
- Early Findings from the Restart Project: 12 Month Knowledge Brief July 2025
This project is funded by the Making the Shift Social Innovation Lab.
Public opinion is an important part of the health equity policy agenda. We surveyed 2,006 adult Ontarians through a telephone survey and assessed current public opinion on health equity and understanding of the Social Determinants of Health (SDOH), as well as support for various health equity solutions.
Findings indicate that the Ontario public is more supportive of targeted health equity interventions, but that attributions of inequities and political affiliation are important predictors of support. Not all Ontarians have a full understanding of SDOH, or attribute health inequities to larger social structures that place people experiencing poverty at a disadvantage with respect to health (i.e., ‘plight of the poor’). The Ontario public may be accepting of messaging around health inequities and the SDOH depending on how the message is framed (e.g., plight of the poor vs. privilege of the rich).
Currently, we are studying narrative styles and Canadian media in order to create a series of health equity messages representing these various styles. The messages will be tested in a future Ontario-based, experimental study to determine the optimal way to inform Ontarians on health inequities, with the goal of increasing political will to act on the SDOH.
Relevant Publications
- Kirst, M.J., Shankardass, K., Singhal, S., Lofters, A., Muntaner, C. & Quiñonez, C. (2017). Addressing health inequities in Ontario, Canada: What solutions do the public support? BMC Public Health, 17(7).
- Lofters, A., Slater, M., Kirst, M.J., Shankardass, K. & Quiñonez, C. (2014). How do people attribute income-related inequalities in health? A cross-sectional study in Ontario, Canada. PLOS One, 9(1), e85286.
- Shankardass, K., Lofters, A., Kirst, M.J. & Quiñonez, C. (2012). Public awareness of health disparities by income in Ontario, Canada. International Journal of Equity in Health, 11(26), 1-10.
Contact Us:
Maritt Kirst, Research Group Director