***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Recent studies in North American context s have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness . In the context of the highly generous French national health and social care system , which is easily accessible and does not require out-of-pocket payment , the French Health Ministry insists on rigorous techniques , including r and omized protocol s , to evaluate the impact of Housing First approaches in France . Method and design A prospect i ve r and omized trial was design ed to assess the impact of a Housing First intervention on health outcomes and costs over a period of 24 months on homeless people with severe mental illness , compared to  Treatment-As-Usual . The study is being conducted in four cities in France : Lille , Marseille , Paris and Toulouse . The inclusion criteria are as follows : over 18 years of age , absolutely homeless or in precarious housing , and possessing a ‘ high ’ level of need : diagnosis of schizophrenia or bipolar disorder and moderate to severe disability according to the Multnomah Community Ability Scale ( score ≤ 62 ) and at least one of the following three criteria : 1 ) having been hospitalized for mental illness two or more times in any one year during the preceding five years ; 2 ) co-morbid alcohol or substance use ; and 3 ) having been recently arrested or incarcerated . Participants will be r and omized to receiving the Housing First intervention or Treatment-As-Usual . The Housing First intervention provides immediate access to independent housing and community care . The primary outcome criterion is the use of high-cost health services ( that is , , number of hospital admissions and number of emergency department visits ) during the 24-month follow-up period . Secondary outcome measures include health outcomes , social functioning , housing stability and contact with police services . An evaluation of the cost-effectiveness and cost-utility of Housing First will also be conducted . A total of 300 individuals per group will be included . Discussion This is the first study to examine the impact of a Housing First intervention compared to Treatment-As-Usual in France . It should provide key information to policymakers concerning the cost-effectiveness and health outcomes of the Housing First model in the French context .Trial registration The current clinical trial number is BACKGROUND Homelessness is associated with increased risks of mortality but it has not previously been possible to distinguish whether this is typical of other socio-economically deprived population s , the result of a higher prevalence of morbidity or an independent risk of homelessness itself . The aim of this study was to describe mortality among a cohort of homeless adults and adjust for the effects of morbidity and socio-economic deprivation . METHODS Retrospective 5-year study of two fixed cohorts , homeless adults and an age- and sex-matched r and om sample of the local non-homeless population in Greater Glasgow National Health Service Board area for comparison . RESULTS Over 5 years of observation , 1.7 % ( 209/12 451 ) of the general population and 7.2 % ( 457/6323 ) of the homeless cohort died . The hazard ratio of all-cause mortality in homeless compared with non-homeless cohorts was 4.4 ( 95 % CI : 3.8 - 5.2 ) . After adjustment for age , sex and previous hospitalization , homelessness was associated with an all-cause mortality hazard ratio of 1.6 ( 95 % CI : 1.3 - 1.9 ) . Homelessness had differential effects on cause-specific mortality . Among patients who had been hospitalized for drug-related conditions , the homeless cohort experienced a 7-fold increase in risk of death from drugs compared with the general population . CONCLUSIONS Homelessness is an independent risk factor for deaths from specific causes . Preventive programmes might be most effectively targeted at the homeless with these conditions OBJECTIVE Housing First with assertive community treatment ( ACT ) is a promising approach to assist people with serious mental illness to exit homelessness . The article presents two-year findings from a multisite trial on the effectiveness of Housing First with ACT . METHODS The study design was a r and omized controlled trial conducted in five Canadian cities . A sample of 950 participants with serious mental illness who were absolutely homeless or precariously housed were r and omly assigned to receive either Housing First with ACT ( N=469 ) or treatment as usual ( N=481 ) . RESULTS Housing First participants spent more time in stable housing than participants in treatment as usual ( 71 % versus 29 % , adjusted absolute difference [AAD]=42 % , p<.01 ) . Compared with treatment-as-usual participants , Housing First participants who entered housing did so more quickly ( 73 versus 220 days , AAD=146.4 , p<.001 ) , had longer housing tenures at the study end-point ( 281 versus 115 days , AAD=161.8 , p<.01 ) , and rated the quality of their housing more positively ( adjusted st and ardized mean difference [ASMD]=.17 , p<.01 ) . Housing First participants reported higher quality of life ( ASMD=.15 , p<.01 ) and were assessed as having better community functioning ( ASMD=.18 , p<.01 ) over the two-year period . Housing First participants showed significantly greater gains in community functioning and quality of life in the first year ; however , differences between the two groups were attenuated by the end of the second year . CONCLUSIONS Housing First with ACT is an effective approach in various context s for assisting individuals with serious mental illness to rapidly exit homelessness Objective No previous experimental trials have investigated Housing First ( HF ) in both scattered site ( SHF ) and congregate ( CHF ) formats . We hypothesized that CHF and SHF would be associated with a greater percentage of time stably housed as well as superior health and psychosocial outcomes over 24 months compared to treatment as usual ( TAU ) . Methods Inclusion criteria were homelessness , mental illness , and high need for support . Participants were r and omised to SHF , CHF , or TAU . SHF consisted of market rental apartments with support provided by Assertive Community Treatment ( ACT ) . CHF consisted of a single building with supports equivalent to ACT . TAU included existing services and supports . Results Of 800 people screened , 297 were r and omly assigned to CHF ( 107 ) , SHF ( 90 ) , or TAU ( 100 ) . The percentage of time in stable housing over 24 months was 26.3 % in TAU ( reference ; 95 % confidence interval ( CI ) = 20.5 , 32.0 ) , compared to 74.3 % in CHF ( 95 % CI = 69.3 , 79.3 , p<0.001 ) and 74.5 % in SHF ( 95 % CI = 69.2 , 79.7 , p<0.001 ) . Secondary outcomes favoured CHF but not SHF compared to TAU . Conclusion HF in scattered and congregate formats is capable of achieving housing stability among people experiencing major mental illness and chronic homelessness . Only CHF was associated with improvement on select secondary outcomes . Registration Current Controlled Trials : IS RCT N57595077 IMPORTANCE Scattered-site housing with Intensive Case Management ( ICM ) may be an appropriate and less-costly option for homeless adults with mental illness who do not require the treatment intensity of Assertive Community Treatment . OBJECTIVE To examine the effect of scattered-site housing with ICM services on housing stability and generic quality of life among homeless adults with mental illness and moderate support needs for mental health services . DESIGN , SETTING , AND PARTICIPANTS The At Home/Chez Soi project was an unblinded , r and omized trial . From October 2009 to July 2011 , participants ( N = 1198 ) were recruited in 4 Canadian cities ( Vancouver , Winnipeg , Toronto , and Montreal ) , r and omized to the intervention group ( n = 689 ) or usual care group ( n = 509 ) , and followed up for 24 months . INTERVENTIONS The intervention consisted of scattered-site housing ( using rent supplements ) and off-site ICM services . The usual care group had access to existing housing and support services in their communities . MAIN OUTCOMES AND MEASURES The primary outcome was the percentage of days stably housed during the 24-month period following r and omization . The secondary outcome was generic quality of life , assessed by a EuroQoL 5 Dimensions ( EQ-5D ) health question naire . RESULTS During the 24 months after r and omization , the adjusted percentage of days stably housed was higher among the intervention group than the usual care group , although adjusted mean differences varied across sites . [ table : see text ] The mean change in EQ-5D score from baseline to 24 months among the intervention group was not statistically different from the usual care group ( 60.5 [ 95%CI , 58.6 to 62.5 ] at baseline and 67.2 [ 95%CI , 65.2 to 69.1 ] at 24 months for the intervention group vs 62.1 [ 95 % CI , 59.9 to 64.4 ] at baseline and 68.6 [ 95%CI , 66.3 to 71.0 ] at 24 months for the usual care group , difference in mean changes , 0.10 [ 95%CI , −2.92 to 3.13 ] , P=.95 ) . CONCLUSIONS AND RELEVANCE Among homeless adults with mental illness in 4 Canadian cities , scattered site housing with ICM services compared with usual access to existing housing and community services result ed in increased housing stability over 24 months , but did not improve generic quality of life . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N42520374 OBJECTIVES We examined the longitudinal effects of a Housing First program for homeless , mentally ill individuals ' on those individuals ' consumer choice , housing stability , substance use , treatment utilization , and psychiatric symptoms . METHODS Two hundred twenty-five participants were r and omly assigned to receive housing contingent on treatment and sobriety ( control ) or to receive immediate housing without treatment prerequisites ( experimental ) . Interviews were conducted every 6 months for 24 months . RESULTS The experimental group obtained housing earlier , remained stably housed , and reported higher perceived choice . Utilization of substance abuse treatment was significantly higher for the control group , but no differences were found in substance use or psychiatric symptoms . CONCLUSIONS Participants in the Housing First program  were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms CONTEXT Homeless adults , especially those with chronic medical illnesses , are frequent users of costly medical services , especially emergency department and hospital services . OBJECTIVE To assess the effectiveness of a case management and housing program in reducing use of urgent medical services among homeless adults with chronic medical illnesses . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted at a public teaching hospital and a private , nonprofit hospital in Chicago , Illinois . Participants were 407 social worker-referred homeless adults with chronic medical illnesses ( 89 % of referrals ) from September 2003 until May 2006 , with follow-up through December 2007 . Analysis was by intention-to-treat . INTERVENTION Housing offered as transitional housing after hospitalization discharge , followed by placement in long-term housing ; case management offered on-site at primary study sites , transitional housing , and stable housing sites . Usual care participants received st and ard discharge planning from hospital social workers . MAIN OUTCOME MEASURES Hospitalizations , hospital days , and emergency department visits measured using electronic surveillance , medical records , and interviews . Models were adjusted for baseline differences in demographics , insurance status , prior hospitalization or emergency department visit , human immunodeficiency virus infection , current use of alcohol or other drugs , mental health symptoms , and other factors . RESULTS The analytic sample ( n = 405 [ n = 201 for the intervention group , n = 204 for the usual care group ] ) was 78 % men and 78 % African American , with a median duration of homelessness of 30 months . After 18 months , 73 % of participants had at least 1 hospitalization or emergency department visit . Compared with the usual care group , the intervention group had unadjusted annualized mean reductions of 0.5 hospitalizations ( 95 % confidence interval [ CI ] , -1.2 to 0.2 ) , 2.7 fewer hospital days ( 95 % CI , -5.6 to 0.2 ) , and 1.2 fewer emergency department visits ( 95 % CI , -2.4 to 0.03 ) . Adjusting for baseline covariates , compared with the usual care group , the intervention group had a relative reduction of 29 % in hospitalizations ( 95 % CI , 10 % to 44 % ) , 29 % in hospital days ( 95 % CI , 8 % to 45 % ) , and 24 % in emergency department visits ( 95 % CI , 3 % to 40 % ) . CONCLUSION After adjustment , offering housing and case management to a population of homeless adults with chronic medical illnesses result ed in fewer hospital days and emergency department visits , compared with usual care . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00490581 BACKGROUND AND OBJECTIVES : " Housing First " has been shown to improve housing stability in homeless individuals with mental illness , but had not been empirically tested in homeless youth . We aim ed to evaluate the effect of " Housing First " on housing stability in homeless youth aged 18 to 24 years particip 
    Output:
    
No clear difference in substance use was seen .
HF approaches successfully improve housing stability and may improve some aspects of health .
Implementation of HF would likely reduce homelessness and non-routine health service use without an increase in problematic substance use .