Housing First is an effective intervention to stably house and alter service use patterns in a large proportion of homeless people with mental illness. However, it is unknown whether there are differences in the patterns of service use over time among those who do or do not become stably housed and what effect, if any, Housing First has on these differing service use patterns. This study explored changes in the service use of people with mental illness who received Housing First compared to standard care, and how patterns of use differed among people who did and did not become stably housed. The study design was a multi-site randomized controlled trial of Housing First, a supported housing intervention. 2039 participants (Housing First: n = 1131; standard care: n = 908) were included in this study. Outcome variables include nine types of self-reported service use over 24 months. Linear mixed models examined what effects the intervention and housing stability had on service use. Participants who achieved housing stability, across the two groups, had decreased use of inpatient psychiatric hospitals and increased use of food banks. Within the Housing First group, unstably housed participants spent more time in prison over the study period. The Housing First and standard care groups both had decreased use of emergency departments and homeless shelters. The temporal service use changes that occurred as homeless people with mental illness became stably housed are similar for those receiving Housing First or standard care, with the exception of time in prison. Service use patterns, particularly with regard to psychiatric hospitalizations and time in prison, may signify persons who are at-risk of recurrent homelessness. Housing support teams should be alert to the impacts of stay-based services, such as hospitalizations and incarcerations, on housing stability and offer an increased level of support to tenants during critical periods, such as discharges. ISRCTN. ISRCTN42520374 . Registered 18 August 2009.

Between 5 and 25% of people experiencing homelessness have pets. Pet ownership can have a range of impacts in the lives of people experiencing homelessness, which may mitigate or further complicate the many adversities they face. However, there is a need to better understand the benefits and challenges associated with pet ownership to determine how this group can be best supported. Accordingly, a scoping review was conducted using PubMed, PsycINFO, and Google Scholar to address the question: What are the effects of pet ownership on people experiencing homelessness? All of the 18 reviewed studies used either qualitative or cross-sectional research designs. Three domains have been principally examined in relation to pet ownership and homelessness: (1) psychological health and purpose; (2) social support and connection; and (3) access to housing, employment, and service use. Physical health, violence, and crime were less frequently studied. Although the findings offer further support that there are both benefits and liabilities to pet ownership for people experiencing homelessness, there is a critical need for more rigorous research, including longitudinal and intervention studies. Recommendations for developing more pet-friendly services and using a strengths-based approach that considers animal companionship when working with people experiencing housing instability are also discussed.