Exploring the relationship between neighbourhood quality (NQ) and housing stability among formerly homeless individuals with mental illness in housing first

We developed, tested, and operationalized a comprehensive objective measurement tool, the Observer-rated Housing Quality Scale (OHQS), to assess housing unit, building, and neighbourhood characteristics in a large trial of Housing First (HF) in 5 Canadian cities. The OHQS provided an opportunity to explore the role of neighbourhood and its contribution to housing stability among formerly homeless individuals. A subset of 423 participants who had become housed in the second year of the trial were systematically selected. The psychometric properties of the neighbourhood quality (NQ) items were assessed within the OHQS. The association between NQ and housing stability was explored using ordinal logistic regression, adjusting for group, site, demographic, housing unit and building quality variables. Inter-rater reliability and internal consistency were very good for the NQ items and subscale. Although NQ was not predictive of housing stability after considering other residence and building features in the multivariable analysis, we assert further analysis is required to explore this relationship, especially for HF programs offering clients choice in housing and neighbourhood.