This presentation provides critical insights on homelessness and mental health. Mental Health Commission of Canada

1. Research Demonstration
Projects on Homelessness
and Mental Health -
Open Forum

2. Today’s Presentation
• Mental Health Commission of Canada
• Federal Agreement
• Research strategy
• Funding
• Structure
• Progress

3. Mental Health Commission of Canada
• Standing Senate Committee on Social Affairs,
Science and Technology in November 2005
• “Out of the Shadows at Last – Transforming
Mental Health, Mental Illness and Addiction
Services in Canada” May 2006
• Mental Health Commission of Canada established
fall 2007
• Board – 11 non-government members & 6
government members

4. Mental Health Commission of Canada
8 Advisory Committees to the Board
• Children and Youth
• First Nations, Inuit, and Metis
• Workforce
• Mental Health & the Law
• Service System
• Family Caregivers
• Seniors
• Science

5. Mental Health Commission of Canada
• Primary role as a catalyst
• Four major initiatives
• Development of a national strategy
• Anti-discrimination campaign
• Establish a knowledge exchange center
• Research demonstration project on mental
health and homelessness

6. Background – Homelessness Project
• Announced on February 26, 2008 as part of the
Federal budget
• $110 m to MHCC to undertake five research
demonstration projects in mental health and
homelessness
• Project sites:
• Moncton
• Montreal
• Toronto
• Winnipeg
• Vancouver
• To occur over the next five fiscal years
• Funding Agreement signed March 30, 2008

7. Funding Agreement: Principles
• People with lived experience are central
• Development of a knowledge-base with respect to
the homeless mentally ill that will ultimately support
more effective interventions
• Build on related work to maximize scope of the
results and impact of the study
• Research ethically sound
• Support knowledge exchange

8. Funding Agreement: Principles cont.
• Work with communities to ensure lasting results and
buy-in
• Strive for long-term improvements in the quality of
life of participants
• Address fragmentation through improved system
integration.
• Plan for sustainability
• Foster collaborations and partnerships to avoid
duplication of efforts and to leverage funds

9. Project Definition
• Multi-site, four year, demonstration project aimed at
providing policy relevant research evidence about
what service and system interventions best achieve
housing stability and improved health and well being
for those who are homeless and mentally ill.
• Will include five cities, each with particular
subgroups of interest.
• Will involve various stakeholders in a collaborative,
integrated knowledge translation process.
• Funding to include research, rent subsidies,
services and system integration components.

10. Core Research Design Requirements
• One common core research design for all sites
• Tailor site-specific demonstration projects
• Function and processes of intervention are standardized, whereas
the form of the components may be tailored to local conditions
• Local studies may add sub-studies that are unique to their setting
Research design:
• Pragmatic, multi-site field trial of the effectiveness and costs of a
complex community intervention using mixed methods
• Randomizing participants into experimental and control conditions
• Definition of the target group and the nature of the experimental
condition must be common across the sites
• Comparisons to care as usual will be required in all cities

11. Research Strategy: Why multi-site?
• Opportunity to scale up quickly established best practice
approaches. i.e. “bring interventions that are proven and
effective to the public.”
• Pooling of data increases numbers and possibilities for
analysis
• Cross- site comparisons provide information about
implementation in different contexts and increases the
policy impact.
• Economy of scale for technical assistance, knowledge
exchange and network building

12. Research Strategy: Recommended
Intervention
• Housing First-combines permanent housing in scattered site
apartments with consumer choice and assertive community
treatment. Very effective with difficult to serve, long term homeless
with concurrent disorders.
• Considerable interest in current Canadian context- HRDC
partnership initiatives, Streets to Home and LEAD in Toronto,
Calgary Homeless Foundation
• Model could benefit from further enhancement (to include primary
care and vocational outcomes) and replication/adaptation in
Canadian context with broader population subgroups.
• Relative costs/benefits in comparison to alternative models will be of
interest to field and to policy makers.
• Work on Canadian version of toolkit and fidelity scales underway in
Calgary.
• Capacity for training and technical assistance available

13. Research Design
Key Elements of the Experimental Intervention:
Housing First Model
Recovery oriented culture
Based on consumer choice for all services
Only requirements: income paid directly as rent; visited at a minimum once a week for pre-determined periods of follow-up
supports
Rent supplements for clients in private market: participants pay 30% or less of their income or the shelter portion of welfare
Treatment and support services voluntary - clinicians/providers based off site
Legal rights to tenancy (no head leases)
No conditions on housing readiness
Program facilitates access to housing stock
Apartments are independent living settings primarily in scattered sites
Services individualized, including cultural adaptations
Reduce the negative consequences of substance use
Availability of furniture and possibly maintenance services
Tenancy not tied to engagement in treatment
(High Need) (Moderate Need)
Recovery-oriented ACT team Intensive case management for a minimum of one year once
housed
Client/staff ratio of 10:1 or less and includes a psychiatrist and
nurse Client/staff ratio of 20:1 or less
Program staff are closely involved in hospital admissions and Integrated efforts across multiple workers and agencies
discharges
Workers accompany clients to appointments
Teams meet daily and include at least one peer specialist as
Centralized assignment and monthly case conferences
staff
Seven day a week, 12 hours per day coverage
Seven day a week, 24 hr crisis coverage

14. Research Design
Partnerships – Building Capacity and
Sustainability
• Encourage and support collaboration and partnerships with
federal, provincial, municipal, not-for-profit and private
sectors in order to leverage funds, avoid duplication of
efforts, and build a foundation for sustainability
• Proponents should describe the in kind and direct
contributions of partner organizations and jurisdictions in
relation to both the research and service aspects of the
proposed Research Demonstration projects
• Sites are expected to aim for a minimum of 20% leveraging
of funds over the duration of the project

15. Research Design
Funds Available and Allowable Costs:
• Site coordinators can assist local teams
• Allowable costs include evaluation, rent subsidies, support
services, furniture and property management costs
• Capital expenditures above $10,000 are not allowable costs
• The services will be a minimum of 85% of the budget and will
include rent subsidies as well as a range of support services
• In Vancouver, Toronto and Montreal the maximum allowable rent
subsidy is $600 per person; in Winnipeg and Moncton, the
maximum allowable rent subsidy is $400 per person
• The maximum allowable cost for an ACT team serving 100 people
is $1.1M.
• The maximum allowable cost for ICM support system for 100
people is $0.5M.

16. Research Design
Supplemental Funding
• A complementary funding pool has been established with
CIHR’s Partners for Health Systems Improvement program
to support applied research studies that fall outside of the
research demonstration projects but with the scope of the
federal funding agreement.
• Funding for local system integration will be made available
through a supplementary process during the second year of
the project

17. Project Structure
• MHCC Project Lead – Jayne Barker
• National Research Team led by Paula Goering
• National Working Group
• Consumer advisory committee
• National training and data capacity
• 5 local research/provider teams funded through RFA process
• 5 site advisory committees
• 5 site coordinators

18. National Research Team
• Carol Adair, University of Calgary
• Tim Aubry, University of Ottawa
• Paula Goering, CAMH, University of Toronto
• Jeffrey Hoch, St. Michael’s Hospital, University of Toronto,
University of Western Ontario
• Geoff Nelson, Wilfrid Laurier University
• Myra Piat, Douglas Mental Health University Institute;
McGill University
• David Streiner, Baycrest Hospital; University of Toronto
• Sam Tsemberis, Pathways to Housing, Inc

19. Progress to Date
• Agreement with Health Canada completed
• Initial engagement at each site
• Lit scan and key informant interviews with multi-site
investigators
• Consultation re project design with Science AC
• Selection of members of the national research team
• Planning workshop-July 30, 31st
• Draft RFA-Aug 2008
• Site Coordinators hired – Aug. 2008

20. Progress to Date
• Consultation Forums in each city- Sept/Oct
2008
• Post RFA – Nov 7, 2008
• Applications due Jan 23rd, 2009
• Select site research teams from RFA –
Jan./Feb 2008