AT HOME/CHEZ SOI
Housing First: Working towards an evidence based solution for people
who are homeless and have mental health issues
Evidence Synthesis: Volume 1
April 14, 2011
Prepared on behalf of the “At Home/Chez Soi” Toronto Site team by the Centre for Research on
Inner City Health, St. Michael’s Hospital and adapted from their draft backgrounder “At
Home/Chez Soi Beyond 2013 An Evidence Based homelessness solution for Ontario”
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
1
Background on At Home/Chez Soi
At Home/Chez Soi is a 4-year national research demonstration project exploring ways to help the
growing number of homeless people who have a mental health issues. It builds on existing evidence and
knowledge and applies it in cities across Canada to provide more evidence about what service and
system interventions can best help which people across Canada who are living with mental health issues
and are homeless. The At Home/Chez Soi project, funded by the Mental Health Commission of Canada,
is happening in five cities across Canada (Moncton, Montreal, Toronto, Winnipeg, and Vancouver).
 In 2008 the Canadian federal government allocated $110 million to the Mental Health Commission of
Canada to undertake At Home/Chez Soi
• At Home/Chez Soi provides housing and services to people experiencing serious mental health issues
and homelessness and is researching those services at the same time
• It is the largest study of its kind in the world and will provide policy relevant evidence about what
housing-related service and system interventions best support recovery
• Compares a Housing First approach (based on evaluated programs including Pathways in New York
City and Streets to Homes in Toronto where housing is seen as the first step, client choice is central
and treatment is not required before receiving housing); with housing and service approaches
currently available in the 5 sites
• Persons with lived experience (PWLE) are involved throughout the project and are members on
national and local committees including the National Consumer Panel an advisory committee made
up entirely of PWLE; PWLE are also employed on the project as peer support workers and peer
researchers. For example at the Toronto Site, PWLE formed an advisory Caucus and its members
advise the project team at all levels
The Need: Homelessness and Mental Health in Canada
Canada does not have accurate estimates of homelessness however, a government report suggests
there are 150,000 homeless people in Canada and some reports suggest it is as high as 300,000.2 It has
been estimated that homelessness costs Canadians $1.4B per year.4
People who are homeless more commonly experience serious mental health issues, substance abuse
and challenges with stress, coping and suicidal behaviour than the general population.1 Mortality among
homeless people in Canada is much higher than among the general Canadian population and many
unexpected deaths are related to mental illness and suicides.10
The face of homelessness in Canada is diverse, nearly one in seven users of shelters are children; almost
one third of the homeless population is youth aged 16-24; increasing numbers of homeless are seniors;
aboriginal people are overrepresented in homeless counts across the country; and one quarter of all
new Canadians were paying more than 50% of their income on rent.39
People who are homeless and living with mental health issues often face barriers to access services and
end up using emergency room and inpatient hospitalizations for their care.13 A study in British Columbia
found that costs for health, criminal and social services are 33% higher for people who are homeless
than for people with housing.5 Existing mental health services often lack the resources or are unable to
combine the basket of services and supports needed to address their needs, especially at higher levels
of care.3 Service fragmentation and lack of options for consumer choice often make it difficult to
engage those with the most complex needs.
Research in Canada and elsewhere has shown that people with serious mental illness prefer to live
independently in community settings, and that consumer choice is an important predictor of clients’
success in retaining housing and engaging in treatment.14-16
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
2
Evidence Synthesis: What We Know About the Strengths of the Housing First Model
At Home/Chez Soi is the largest study of the Housing First model in the world, aiming to study its
effectiveness and cost effectiveness in our Canadian context. It will add to evidence from comparable
cities in North America demonstrating its impact on housing stability and public service use. Interim
results will be available at 12 month intervals over a two year period in 2012 and 2013.
The studies cited below offer promising evidence that Housing First models provide a variety of positive
outcomes for clients. Many important questions, however, remain, as many of the studies have
methodological limitations or are based on the experiences of U.S. programs. Given the differences in
health care and social policies between the U.S. and Canada, it is vital that evidence about the Housing
First approach be grounded in the Canadian context. In addition, the rigorous, multi-site, experimental
research design of the At Home/Chez Soi project will help us identify exactly what works, at what cost,
for whom and in which environments. It will also allow us to compare Housing First with alternative
approaches in each of the five cities. It includes for the first time in a trial, a standardized definition of
Housing First and the use of fidelity assessments to document the implementation process. The
inclusion of recovery, employment and social functioning outcomes will add new knowledge to the
evidence base, as will the broadened definition of the target population to include those with moderate
mental illness and disabllity.
1. HOUSING FIRST CREATES COST OFF-SETS WHEN COMPARED TO EXISTING APPROACHES
Housing First typically reduces costs associated with health care and justice system use. Multiple
economic analyses have shown that the resulting cost savings in these areas can significantly offset the
cost of a Housing First program.11-16
A recent study in Seattle of 95 homeless individuals with serious alcohol use disorders found significant
cost savings for Housing First participants after the first 6 months, with increased costs savings over the
first year. Comparing the monthly costs of participants in Eastlake HF program to wait-list controls, the
study showed that HF clients accumulated 53% less costs.17 A US study of 460 veterans with psychiatric
and/or substance abuse disorders found that providing clients with supported housing and ACT carried
societal costs of approximately $2,067(USD) per person.16 In New York, a study of 4,679 homeless
people with SMI found that the net cost of supportive housing with case management was about
$995(USD) per person per year; the study estimated that those placed in supportive housing reduced
service use by $16,202 USD per year per unit.12
An observational study of 363 homeless people with serious mental illness in California found that
reductions in inpatient and emergency service costs associated with participation in Housing First offset
82% of the program’s outpatient and housing costs, with a net cost per person per year of
approximately $2,780(USD).13
A study conducted in Denver found that savings for a group of chronically homeless individuals with
mental health issues totaled $600,000 in the 24 months they participated in a housing first program.
After factoring in the investment costs, the net cost savings per person per year was $4,745.15 A
multisite collaborative initiative in Housing First found that there was a 51% total quarterly reduction in
treatment costs per person over the first year of treatment.14
Research from Toronto’s Streets to Homes Post-Occupancy study of a convenience sample of 88
participants also suggests savings from the reduction in emergency service use once an individual is
housed. The study estimated that the four highest service users they surveyed used an average of at
least $36,000 in emergency and health services in the last year they were homeless.11
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
3
2. HOUSING FIRST INCREASES LONG-TERM HOUSING STABILITY
Studies from the US and Canada show that Housing First, and programs that share operational and
philosophical similarities, have been successful in improving residential stability for people with serious
mental health issues – increasing the number of days in stable housing, and decreasing the number of
days spent homeless.10,12,16,18-24 A US study of 1,842 homeless people with psychiatric disabilities found
that 5 years after program entry, 88% of the clients housed in the Housing First program were still
housed, compared to 47% of people housed through a “step by step” treatment approach in which
housing was the final goal.23
In Toronto, the City of Toronto introduced in 2005 a program for homeless people based on Housing
First called “Streets to Homes”. By the end of 2010, the program had housed 3,000 homeless people
directly from the street, and more than 80% of the clients remained in their homes.25 The Streets to
Homes program differs from the At Home/Chez Soi project in several ways. It serves a wide range of
people who are street homeless, including, but not limited, to those who have severe or moderate
mental illness and it does not provide dedicated funding for housing costs. As well the At Home/Chez Soi
project has a strong emphasis on client choice of the type of housing (e.g., private apartments) and the
geographic location of the housing and provides as well it provides Assertive Community Treatment and
Intensive Case Management services alongside the housing.
3. HOUSING FIRST CAN REDUCE EMERGENCY VISITS AND HOSPITALIZATIONS
Chronically homeless adults with serious mental health issues are heavy users of high-cost inpatient and
emergency psychiatric services, cycling through emergency departments, inpatient and crisis facilities,
jails and mental health and substance use programs.26 A study of state hospital patients living in Chicago
found that when poor persons with mental illness seek psychiatric hospitalization, they often do so
more as a short-term housing arrangement than for psychiatric reasons.27
Housing First significantly reduces use of hospital services among homeless people with mental health
issues. An observational study of homeless people with serious mental health issues in California found
that Housing First reduced clients’ use of inpatient services by 14% and emergency services by 32%.
Outpatient visits increased substantially.13 In Seattle, a quasi-experimental study showed a substantial
decrease in the use of crisis-oriented health services for those in a Housing First program.17 Similarly, in
Denver individuals involved with a Housing First program over a period of 24 months had a decrease in
psychiatric and inpatient service use.15
Another study examining the effects of placement in Housing First programs on health care utilization
found that persons with serious mental illness who were in supportive housing had significant
reductions in number and length of hospitalizations, as compared to matched-controls.12 These findings
were replicated in New York, where participants who were randomly assigned to the Pathways Housing
First program spent fewer days hospitalized than participants in the comparison groups, receiving a
Continuum of Care approach to services.28 Moreover, from enrollment in the Pathways Programs to the
2-year follow-up point, Housing First participants spent a significantly smaller proportion of time in
psychiatric institutions.29
A post-occupancy study of the Streets to Homes program in Toronto also found that after enrollment,
clients used fewer emergency and inpatient services: There was a 38% reduction in ambulance use, 40%
decrease in emergency room use, and 25% reduction in individuals requiring a hospital stay.11
This decrease in use of emergency and inpatient services is accompanied by increases in use of
outpatient services that are better able to meet client needs and prevent unnecessary or lengthy
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
4
hospitalizations.
4. HOUSING FIRST CLIENTS HAVE BETTER HEALTH AND ADDICTIONS OUTCOMES
Health improvements associated with stable housing also contribute to reduced service use. The
Streets to Homes study found that clients’ mental and physical health improved dramatically postenrollment: 70% of clients reported improvements in physical health, and 57% of all clients and 68% of
long-term homeless clients said their mental health had improved. Alcohol and drug use was also
reduced: of those who said they used alcohol, 17% said they had quit drinking since moving into
housing, and 32% said they were drinking less. Of those who said they used drugs, 31% said they had
quit using drugs completely, and 42% had decreased their use.11
In a Seattle study, homeless persons with alcohol abuse disorders considerably reduced their use of
alcohol when participating in a Housing First program, in spite of the fact that there were no
requirements to change drinking behavior in order to get or maintain housing; furthermore, they
showed a steady 2% decrease per month in daily alcohol usage over the time they were housed. The
median number of drinks per day dropped from 15.7 drinks in the year prior to housing to 10.6 daily
drinks following 12 months in supportive housing. The study also found that for housed individuals,
there was a significant decrease in the number of days they were intoxicated. 17
Housing first initiatives also have a positive impact on psychiatric symptoms. 14,15,30 In a sample of 734
people in a multi-site study of Housing First in the United States, the study found that individuals had
improvements in overall mental health functioning, in addition to a 16% decline in psychological
distress. 14
Participants in New York's Pathways Housing First program experienced a decrease in psychiatric
symptoms over the 36 month period following enrollment. The study found that the improvement in
psychiatric symptoms is related to greater perceived choice with respect to their housing, treatment,
and daily living in this consumer-driven program. The authors suggest that programs that increase
consumer choice also enhance mastery, or personal control, which is connected to overall-well being in
psychiatric patients.30
Likewise, a Denver study examining the impact of a Housing First initiative for chronically homeless and
disabled individuals found that 50% of participants had improvements in overall health status, with 43%
citing an improvement in mental health status. Furthermore, there was a 15% decrease in substance use
over the 24month period clients were involved with the study.15
5. HOUSING FIRST REDUCES CLIENTS' INVOLVEMENT WITH POLICE AND THE CRIMINAL JUSTICE SYSTEM
A New York study found that homeless and mentally ill clients spent less time in jail, and were
incarcerated less frequently when they were provided with supportive housing and case management.
The total number of days incarcerated fell 39.8% after the housing placements.12
The Streets to Homes study in Toronto also found that after enrollment, there was a 75% decrease in
the number of individuals using police detox (‘drunk tank’), a 56% decrease in the number of individuals
arrested, and a 68% reduction in those using jail detention.11
Similarly, a study in California found that the probability of using justice system services among Housing
First clients declined by 20%, and actual justice service used was reduced by 17%.13 A review of a
Housing First initiative in Denver cited a 76% reduction in the number of days participants were
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
5
incarcerated throughout their participation in the program.15
6. QUALITY OF LIFE
Housing First has a significant positive effect on individual’s quality of life. 11,13-15 A California study found
that homeless clients with severe mental illness participating in a Housing First program reported a
much greater quality of life than non-Housing First participants. Among the 161 clients in the Housing
First group, scores in all domains of quality of life were significantly higher than the scores of those
receiving out-patient services. Not surprisingly, satisfaction in the living situation was the domain that
showed largest difference between groups. Other domains with the large group differences were legal
and safety issues, satisfaction with daily activities and health, as well as general life satisfaction.13
The Toronto Streets to Homes post-occupancy report also demonstrated a higher quality of life in
several domains for housed participants. After enrollment, 72% of participants reported an
improvement in personal security, 69% stated an increase in length and quality of sleep, 63% reported
higher food quantity and quality, and 60% of participants indicated reductions in their stress levels.11
A study of a multisite Housing First initiative across the United States found that participants had
improvements in their overall subjective quality of life, as well as an increased sense of community
integration. 14 In Denver as well, participants in a Housing First plus ACT program reported a 64%
increase in their overall quality of life. 15
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
6
Evidence Synthesis: PRIORITY POPULATIONS
VETERANS
A U.S. study that followed 460 veterans with psychiatric and/or substance abuse disorders over 3 years
found that clients in supported housing with ACT spent 25% more days in stable housing than the
standard care group, and 16.9% more days housed than clients who received ACT only. Veterans in
supported housing with ACT had larger social networks overall (numbers of people they felt close to)
and were more satisfied with their family relationships, compared to clients who received only ACT, and
clients in the standard care group.16
PEOPLE WITH CONCURRENT DISORDERS
Individuals with a concurrent diagnosis of a serious mental illness and a substance use disorder are at an
increased risk for losing tenancy as compared to clients with a single diagnosis; nonetheless, current
research has demonstrated the benefits of a Housing First approach for this population.10,12,17,23,31,32
In New York, several follow-up studies found that dually diagnosed participants in the Pathways to
Housing program had a significantly higher rate of housing stability than those in the Treatment First
program.23,32 Congruous results were found in a Seattle study assessing the efficacy of the Housing First
approach for homeless individuals with severe alcohol problems; moreover, participants in the Housing
First program had reductions in—the amount of alcohol consumed, the number of days intoxicated, and
the frequency of using crisis-oriented services, such as hospitals and jails.17
Consistent with this literature, an evaluation report of frequent healthcare users in California found that
homeless individuals connected with stable supportive housing had greater reductions in their number
of emergency visits and hospital charges as compared to those not connected to housing. The report
also found that inpatient charges decreased 27% for those in stable housing, in comparison to a 49%
increase for individuals who were not connected to housing.31
PEOPLE WITH FORENSIC INVOLVEMENT
Being homeless increases the likelihood of ending up in jail.33 In a 2010 report by the John Howard
Society of Toronto, it was found that 19% of individuals recruited from Toronto area jails were
absolutely homeless when incarcerated. The number of homeless prisoners in Toronto area jails is
growing quickly; between 2001 and 2004 the numbers increased by 64%.34 An increasing number of
homeless men are trapped in a revolving door between jails and shelters. There is a marked pattern of
recidivism for homeless individuals in jail– 40% of the admissions in a single year were returnees.35
Prisoner re-entry to the community is a risk factor for homelessness and recidivism, and housing is
considered the 'lynchpin' that holds the reintegration process together”.36
Individuals with mental illness are grossly overrepresented in the criminal justice system, with a
prevalence of 14% among offenders; thus, the risk of incarceration for homeless individuals with a
severe mental illness is extremely high.37 Forensic adaptations of ACT programs (FACT) can reduce
recidivism and improve criminal justice outcomes for this population. In 2010, a randomized clinical trial
in California found that participants receiving FACT had fewer jail bookings, and a higher probability of
avoiding jail as compared to treatment as usual groups.38 Other studies have found that FACT is
primarily effective for individuals for whom there is a direct link between their symptoms of mental
illness and their criminal behaviour. The study indicates that for the rest of this population, FACT is not
sufficient, and suggests that improving general risk factors, such as poverty, could lead to a reduced rate
of recidivism.37 One way to achieve this is through providing housing and supports.
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
7
The combination of supportive housing and FACT, as employed in a Housing First approach may have
the greatest impact on improving recidivism in this population. A New York study found that homeless
and mentally ill clients spent less time in jail, and were incarcerated less frequently when they were
provided with supportive housing and case management. The total number of days incarcerated fell
39.8% after the housing placements.12 The Streets to Homes study in Toronto also found that after
enrolment, there was a 75% decrease in the number of individuals using police detox (‘drunk tank’), a
56% decrease in the number of individuals arrested, and a 68% reduction in those using jail detention.11
A study conducted in Denver using a housing first approach in combination with an ACT team found that
participants reduced their number of days incarcerated by 76% over the 24month period they were
involved with the project. 15
For more information on At Home/Chez Soi or on the Mental Health Commission of Canada please go
to www.mentalhealthcommission.ca
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
8
References
1. Canadian Institute for Health Information, Improving the Health of Canadians: Mental Health and
Homelessness (Ottawa: CIHI, 2007). Available from URL
http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_910_E&cw_topic=910&cw_rel=AR_1730_E
2. Echenberg H, Jensen H. Defining and Enumerating Homelessness in Canada. Library of Parliament,
Social Affairs Division, Document PRB 08-30E. Available from URL
http://www2.parl.gc.ca/Content/LOP/ResearchPublications/prb0830-e.htm
3. Stergiopoulos V, Dewa C, Durbin J, Chau N, Svoboda T. Assessing the mental health service needs of
the homeless: a level-of-care approach. J Health Care Poor Underserved. Aug 2010;21(3):1031-1045.
4. IBI Group, 2003. Cited in Institute for the Prevention of Crime. Homelessness, Victimization and
Crime. 2008. University of Ottawa. Available from URL
http://www.socialsciences.uottawa.ca/ipc/pdf/IPC-Homelessness%20report.pdf;
5. Government of British Columbia. Homelessness Causes and Effects – Volume 3 The costs of
Homelessness in British Columbia. Available from URL
http://www.housing.gov.bc.ca/housing/docs/Vol3.pdf
6. Hwang SW, Wilkins R, Tjepkema M, O'Campo PJ, Dunn JR. Mortality among residents of shelters,
rooming houses, and hotels in Canada: 11 year follow-up study. Bmj. 2009;339:b4036.
7. Canadian Institutes of Health Research. Reducing Health Disparities & Promoting Equity for
Vulnerable Populations. 2002; http://www.cihr-irsc.gc.ca/e/4335.html.
8. Fakhoury WK, Murray A, Shepherd G, Priebe S. Research in supported housing. Soc Psychiatry
Psychiatr Epidemiol. Jul 2002;37(7):301-315.
9. Piat M, Lesage A, Boyer R, et al. Housing for Persons With Serious Mental Illness: Consumer and
Service Provider Preferences. Psychiatr Serv. September 1, 2008 2008;59(9):1011-1017.
10. Tsemberis S, Gulcur L, Nakae M. Housing First, consumer choice, and harm reduction for homeless
individuals with a dual diagnosis. Am J Public Health. Apr 2004;94(4):651-656.
11. City of Toronto. What Housing First Means for People: Results of Streets to Homes 2007 PostOccupancy Research. Toronto: Shelter, Support and Housing Administration; 2007.
12. Culhane DP, Metraux S, Hadley T. Public Service Reductions Associated with Placement of Homeless
Persons with Severe Mental Illness in Supportive Housing. Housing Policy Debates. 2002;13(1):107163. http://repository.upenn.edu/spp_papers/65.
13. Gilmer TP, Stefancic A, Ettner SL, Manning WG, Tsemberis S. Effect of full-service partnerships on
homelessness, use and costs of mental health services, and quality of life among adults with serious
mental illness. Arch Gen Psychiatry. Jun 2010;67(6):645-652.
14. Mares AS, Rosenheck RA. Twelve-month client outcomes and service use in a multisite project for
chronically homelessness adults. J Behav Health Serv Res. Apr 2010;37(2):167-183.
15. Perlman J, Parvensky J. Denver Housing First Collaborative: Cost Benefit Analysis and Program
Outcomes Report. Denver: Colorado Coalition for the Homeless; 2006.
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
9
16. Rosenheck R, Kasprow W, Frisman L, Liu-Mares W. Cost-effectiveness of supported housing for
homeless persons with mental illness. Arch Gen Psychiatry. Sep 2003;60(9):940-951.
17. Larimer ME, Malone DK, Garner MD, et al. Health care and public service use and costs before and
after provision of housing for chronically homeless persons with severe alcohol problems. Jama. Apr
1 2009;301(13):1349-1357.
18. Mares AS, Rosenheck R. HUD/HHS/VA Collaborative Initiative to Help End Chronic Homelessness:
National Performance Outcomes Assessment Preliminary Client Outcomes Report. West Haven, CT:
Northeast Program Evaluation Centre; 2007.
19. Metraux S, Marcus SC, Culhane DP. The New York-New York housing initiative and use of public
shelters by persons with severe mental illness. Psychiatric services. Jan 2003;54(1):67-71.
20. O'Connell MJ, Kasprow W, Rosenheck RA. Rates and risk factors for homelessness after successful
housing in a sample of formerly homeless veterans. Psychiatric services. Mar 2008;59(3):268-275.
21. Pearson C, Locke G, Montgomery A, Buron L. The Applicability of Housing First Models to Homeless
Persons with Serious Mental Illness. Washington, DC: US Department of Housing and Urban
Development; 2007.
22. Shern DL, Felton CJ, Hough RL, et al. Housing outcomes for homeless adults with mental illness:
results from the second-round McKinney program. Psychiatric services. Feb 1997;48(2):239-241.
23. Tsemberis S, Eisenberg RF. Pathways to housing: supported housing for street-dwelling homeless
individuals with psychiatric disabilities. Psychiatric services. Apr 2000;51(4):487-493.
24. Tsemberis SJ, Moran L, Shinn M, Asmussen SM, Shern DL. Consumer preference programs for
individuals who are homeless and have psychiatric disabilities: a drop-in center and a supported
housing program. Am J Community Psychol. Dec 2003;32(3-4):305-317.
25. City of Toronto: Shelter Support and Housing Administration Division.
26. National Alliance to End Homelessness. Chronic Homelessness 2007;
http://www.endhomelessness.org/section/issues/chronic_homelessness.
27. Lewis D, Lurigio AJ. The State Mental Patient and Urban Life: Moving in and Out of the Institution.
Springfield, IL: Charles C Thomas; 1994.
28. Gulcur L, Stefancic A, Shinn S, Tsemberis S, Fischer SN. Housing, Hospitalization, and Cost Outcomes
for Homeless Individuals With Psychiatric Disabilities Participating in Continuum of Care and Housing
First Programmes Journal of Community & Applied Social Psychology; Special Issue: Homelessness:
Integrating International Perspectives. 2003;13(2):171-186.
29. NREPP SAMHSA National Registry of Evidence Based Programs. Pathway's Housing First Program.
2007. http://www.nrepp.samhsa.gov/programfulldetails.asp?PROGRAM_ID=195. Accessed June 28,
2010.
30. Greenwood RM, Schaefer-McDaniel NJ, Winkel G, Tsemberis SJ. Decreasing psychiatric symptoms by
increasing choice in services for adults with histories of homelessness. Am J Community Psychol. Dec
2005;36(3-4):223-238.
31. Linkins K, Byra J, Chandler D. Frequent Users of Health Services Initiative: Final Evaluation Report:
The California Endowment and the California Health Care Foundation;2008.
32. Padgett D, Gulcer L, Tsemberis S. Housing First Services for People Who Are Homeless With CoOccurring Serious Mental Illness and Substance Abuse Research on Social Work Practice.
2006;16(1):74-83.
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
1
0
33. Metraux S, Culhane DP. Recent Incarceration History Among a Sheltered omeless Population. Crime
and Delinquency. 2006;52(3):504-517.
34. Howard Johnson Society of Toronto. Homeless and Jailed: Jailed and Homeless. Toronto: Howard
Johnson Society of Toronto;2010.
35. Gaetz S, O'Grady B. The Missing Link: Discharge Planning, Incarceration and Homelessness. Toronto:
Howard Johnson Society of Toronto;2006.
36. Bradley K, Michael Oliver RB, Richardson NC, Slayter EM. No Place Like Home: Housing and the Exprisoner. Community Resources For Justice: Crime and Justice Institute. 2001.
37. Skeem JL, Manchak S, Peterson JK. Correctional Policy for Offenders with Mental Illness: Creating a
New Paradigm for Recidivism Reduction. Law Hum Behav. Apr 14 2010.
38. Cusack KJ, Morrissey JP, Cuddeback GS, Prins A, Williams DM. Criminal justice involvement,
behavioral health service use, and costs of forensic assertive community treatment: a randomized
trial. Community Ment Health J. Aug 2010;46(4):356-363.
39. Laird, G. SHELTER Homelessness in a growth economy: Canada’s 21st century paradox A Report for
the Sheldon Chumir Foundation for Ethics in Leadership. 2007.
http://www.chumirethicsfoundation.ca/files/pdf/SHELTER.pdf
Adapted from “AT HOME”/”CHEZ SOI” BEYOND 2013
An evidence based homelessness solution for Ontario
1
1