Research Matters Blog
When you speak with people across Canada who work with young people who are homeless, a common question is, “In what ways can Housing First be used to address the needs of young people?” Is this just another example of taking a model for addressing adult homelessness, and by changing the age mandate, creating a “homelessness junior” version? Or is there real promise here?
These are all good questions, and there is actually an urgency to begin to figure these things out. For those looking for solutions to homelessness, Housing First is seemingly everywhere. The Government of Canada has made it a central feature of its five year renewal of the Homelessness Partnering Strategy. The At Home/Chez Soi project, the world’s largest study of the process, outcomes and impact of Housing First, has provided impressive results as demonstrated in the final report released several weeks ago. In a nutshell, At Home/Chez Soi has demonstrated what should perhaps seem obvious – that if you take someone who is homeless, provide them with the housing and supports they need, they generally stay housed and for chronically homeless persons, the recovery begins.
So can we just apply this approach in a straightforward way for youth? For 16-year-olds as well as 23-year-olds? The research on youth in Housing First programs is not extensive. The best known example, the Infinity Project (run by the Boys and Girls Clubs of Calgary) shows impressive results, with 95% of the young people in the program retaining their housing after a year. Other research by Cheryl Forchuk suggests that the transitions to independence for young people can be more complicated, and that many youth prefer to address some of their personal issues before they take on the responsibility of a lease.
The uncertainty about the effectiveness of this program model for youth is creating nervousness in many communities, where funders are now expecting a shift in focus to Housing First with a prioritization of chronically homeless – and mostly adult – persons for the program. The questions regarding whether Housing First can actually meet the needs of young people, how it works with other existing program models and approaches, and what this will mean for communities struggling to address youth homelessness need to be addressed.
The new report released today by the Homeless Hub A Safe and Decent Place to Live: Towards a Housing First Framework for Youth seeks to answer some of these questions and concerns. The key theme of this report is that Housing First can indeed work for youth – it actually can work for anybody – but that the program delivery model must be designed and implemented in a way that takes into account the needs of the developing adolescent and young adult. Youth homelessness is distinct from adult homelessness both in terms of its causes and conditions, and therefore so must be the remedies.
The core principles of Housing First for youth are therefore modified from the version found in the Framework for Housing First that the Homeless Hub published last year, to address the special needs of young people. Also important to note here is that the models of accommodation are broadened to include, for instance, the possibility of returning home (through family reconnection) and transitional housing. While the latter has fallen out of favour in some quarters based on the success of Housing First, it is argued here that many young people prefer congregate living models with higher levels of supports in early years, before they are ready to go out on their own. Many fear the isolation and risks that go with that. Others, of course, are ready for independent living in a scattered site model. The key here is that if choice is at the centre of Housing First, there need to be a range of housing options available.
The supports that young people may require also have to reflect their needs as they transition to adulthood. Many young people will have little or no experience running a household and may be in the throws of adolescent development, meaning they have special challenges regarding decision-making, managing relationships and juggling complex responsibilities. Young people who want to return to school should be supported to do this. The supports young people need should be in place for as long as they need them – not just for one year. The point is that in developing a model of Housing First for youth, we should base it on what any young person needs, which is the necessary supports required to move into adulthood and the time allowed to do it. What is good for me, for my children, is also good for young people who experience homelessness.
So, Housing First can work for young people, if done properly and built around their needs. Young people who experience homelessness will do better if they are provided with housing and supports designed to help them transition to adulthood.
A couple of important things to consider with this approach:
As communities rush to implement Housing First for youth, it is crucial that there is fidelity to the model presented here. That is, we cannot take a half-baked program that simply drops young people into housing without providing necessary and appropriate supports. We need to ensure that appropriate accommodation AND supports (and the funding to ensure these are delivered properly) are in place.
Finally, we need to always remember that Housing First is an important intervention for homeless youth, but not the only one. There will continue to be the need for a focus on prevention, for shelter diversion programs, for emergency services and alternative models of housing and supports.
Housing First can work for young people, but lets make sure we get it right.
Transitional housing refers to a supportive – yet temporary – type of accommodation that is meant to bridge the gap from homelessness to permanent housing by offering structure, supervision, support (for addictions and mental health, for instance), life skills, and in some cases, education and training.
“Transitional housing is conceptualized as an intermediate step between emergency crisis shelter and permanent housing. It is more long-term, service-intensive and private than emergency shelters, yet remains time-limited to stays of three months to three years. It is meant to provide a safe, supportive environment where residents can overcome trauma, begin to address the issues that led to homelessness or kept them homeless, and begin to rebuild their support network.”
Historically, transitional housing programs were situated within dedicated, building-specific environments, where there was more common space and less private space than might be the case in permanent housing environments. However, as the concept of transitional housing has evolved, new approaches that incorporate scattered-site housing are now being adopted. In such cases, some of the transitional ‘supports’ are considered portable.
Transitional housing, as an approach, has long been seen as part of the housing continuum for people who are homeless, and in particular for sub-populations such as youth. However, in recent years it has become somewhat controversial, particularly in light of the success of Housing First models, which do not require ‘readiness’ for a transition. Eberle Planning and Research identified two key concerns:
- Transitional programs reward those who do well by requiring them to move on; and
- They can only be effective if affordable independent housing is available to move to afterwards.
An additional concern has to do with the time-limited nature of transitional housing. Most programs in Canada determine a maximum length of stay, which is often quite short (usually one year, but there are some examples in Canada where young people can stay eighteen months or more). Nevertheless, in spite of these criticisms an argument can be made that transitional or ‘interim’ housing is still necessary in contexts where there isn’t an adequate supply of affordable housing, and also when dealing with sub-populations such as youth.
Though there have been some broader Canadian studies on the role of transitional housing as part of a range of housing options for people experiencing homelessness, there is surprisingly little evaluative research on the effectiveness of transitional housing programs for youth in Canada. Key exceptions include the recent report Live, Learn, Grow, which surveys the literature on the Foyer model; a study of Eva’s Phoenix, a Toronto-based program that has demonstrated positive outcomes, and Peel Youth Village. However, are no longitudinal studies on the long term effectiveness of such programs for youth in Canada, or of their success in helping young people transition to stable housing afterward.
The situation is the same in the United States. In their policy briefing on youth homelessness for the 2010 Opening Doors Homelessness Strategy, the United States Interagency Council on Homelessness lamented that while there were an estimated 130 transitional housing programs in the US serving 4,000 young people annually, there was very little data in existence regarding the effectiveness of these programs. There are now a number of research projects on transitional housing underway in the United States, however.
This infographic by Food Banks Canada was part of the HungerCount report. The report states that while there was a drop of approximately 40,000 food bank users between 2012 – 2013, there were 833,000 food bank users in Canada. This is 23% more than the number of people who accessed food banks prior to the 2008 recession. PROOF’s Household Food Insecurity in Canada 2012 report, stated that approximately 1.4 Million households experience food insecurity in Canada.
Programs that offer emergency food services vary in their makeup. A large majority of those in the HungerCount study (78%) offer non-traditional services. These services include:
- Food focused programs
- Skill building programs
- Social service programs
- Referral to other services
Some of the recommendations in this report are aimed at reducing future reliance on food banks in Canada. A few of the main recommendations include:
- Expanding benefits for Employment Insurance
- Increasing Social Assistance levels
- Reforms to ‘flexible’ labour laws that privilege employers
It is important to recognize that those facing food insecurity are also likely facing insecurity in other areas such as housing and employment. Those who are at risk of losing their housing may be unable to access good food without the support of emergency food services. Affordable housing, rent supplements and rent geared to income are also important in ensuring that lower paid workers are still able to access good, nutritious and culturally relevant food. Unfortunately with recent federal changes there will be 10,500 fewer social housing units funded. The HungerCount report also notes that 1.6M families currently spend over 30% of their income on housing.
Overall, it is important that we continue to look at the connection between poverty, food security and homelessness. Policy decisions at every jurisdictional level should address the current needs while implementing preventative measures that will decrease reliance on emergency services in the future.
Those who work in the homelessness sector are well aware that individuals are often discharged from hospitals and mental health facilities into homelessness. There are two main consequences to this. First, the mental health and well-being of such individuals is likely to worsen if discharged into homelessness rather than housing, and second, staff in emergency shelters and day programs are not well-equipped to provide necessary and appropriate supports for people in such situations.
Cheryl Forchuk is a leading researcher on transitions from psychiatric wards into homelessness, in terms of understanding both the consequences for individuals who experience this, and effective intervention models that ensure successful transitions to the community through housing and supports.
According to Forchuk, emergency shelters – even well run shelters – are “not appropriate places for recovery from mental illnesses”. Many of the problems we associate with shelters – lack of privacy, low resident/staff ratios, exposure to drugs and the sex trade, real or perceived threats to safety, being around others who are ill or who have mental health problems, and in some cases overcrowding – can exacerbate problems for psychiatric survivors. Unfortunately, this happens all too often. In their study of people discharged from psychiatric wards in London – a mid-sized Canadian city - they found that 167 of 1,588 (10.5%) individuals were discharged with no fixed address in a single year. Data from local emergency shelters showed the number to be even higher – 194. Structural factors contribute to this situation, including a trend towards shorter stays in hospital as an in-patient, and a dramatic reduction in the availability of affordable housing in most Canadian cities.
Research from Canada and the United States suggests that necessary reforms and interventions can dramatically reduce the risk of homelessness for those discharged from mental health facilities, with a resultant improvement in mental health and well-being. A randomized control trial by Herman and colleagues from 2011 demonstrates that Critical Time Interventions (CTI) upon discharge are designed to:
“prevent recurrent homelessness and other adverse outcomes following discharge in two ways: by strengthening the individual's long-term ties to services, family, and friends; and by providing emotional and practical support during the critical time of transition. An important aspect of CTI is that post-discharge services are delivered by a worker who has established a relationship with the client before discharge.”
- Assessment and immediate response to client need (it is argued that a determination of risk of homelessness should be made early, upon admittance);
- Goal planning and advocacy to coordinate supports;
- Assistance in finding affordable housing;
- A streamlined process (including fast tracking) so that individuals could receive government benefits to pay for first and last month’s rent.
The results of this study and others clearly demonstrate that targeted and relatively brief support has a substantial and lasting impact on the risk of becoming homeless for those discharged from mental health facilities.
In Alberta, the province is also piloting similar policies and protocols to reduce the likelihood that people are discharged from in-patient mental health care into homelessness. This work demonstrates that it is possible to implement more effective interventions that can contribute to thoughtful, respectful and effective responses to homelessness and the needs of mental health consumer survivors.
FROM: Gaetz, S. (2014). Coming of Age: Reimagining the Response to Youth Homelessness in Canada. Homeless Hub Research Report Series.
The Mental Health Commission of Canada just released the Final Report following their At Home/Chez Soi project. This multi-year demonstration project has shown some fabulous results and answers many of the questions we’ve had about Housing First.
Funded with $110 million by the Government of Canada, this research demonstration project encompassed four years and five cities. Each city also had a specific focus or sub-population. They were:
- Vancouver (people also experiencing problematic substance use),
- Winnipeg (urban Aboriginal population),
- Toronto (ethno-racialized populations, including new immigrants who do not speak English),
- Montréal (includes a vocational study),
- Moncton (services in small communities).
As the “Best Practice” in Housing First (HF), the report’s “Key Findings” section answers the question “Does Housing First Work?” with a resounding “YES!” We’re reproducing the key findings here with links to some other research that supports them. Be sure to read the full MHCC report for all the important details.
- “Housing First can be effectively implemented in Canadian cities of different size and different ethnoracial and cultural composition. Across all the five cities, HF programs were operated in a manner that was consistent with the HF model standards, but were tailored to best fit the local contexts. The HF approach was successfully adapted to serve Aboriginal, immigrant, and other ethnoracial groups in a culturally sensitive manner. (Chapter 2)”
- “Housing First rapidly ends homelessness. Across all cities, HF participants in At Home/Chez Soi rapidly obtained housing and retained their housing at a much higher rate than the treatment as usual (TAU) group. (Chapter 4)”
- “Housing First is a sound investment. The economic analysis found some cost savings and cost offsets. (Chapter 5)”
- “It is Housing First, but not Housing Only. The support and treatment services offered by the HF programs contributed to appropriate shifts away from many types of crisis, acute, and institutional services towards more consistent community and outreach-based services. This shift supports and encourages more appropriate use of health and shelter services. (Chapter 5)”
- “Having a place to live and the right supports can lead to other positive outcomes above and beyond those provided by existing services. HF participants also demonstrated somewhat better quality of life and community functioning outcomes than those receiving existing housing and health services in each city. (Chapter 6)”
- “There are many ways in which Housing First can change lives. The HF groups, on average, improved more and described fewer negative experiences that TAU (Chapter 6). Understanding the reasons for differences of this kind will help to tailor future approaches, including understanding the small group for whom HF did not result in stable housing. (Chapter 4)”
- “Getting Housing First right is essential to optimizing outcomes. Housing stability, quality of life, and community functioning outcomes were all more positive for programs that operated most closely to Pathways HF standards. (Chapter 6)”
Overall, it was found that Housing First is good for a variety of populations, in a variety of places and can be used in programs of different sizes. Most importantly, this report provides detailed evidence that Housing First works.
For more on Housing First check out the Homeless Hub’s book “Housing First in Canada: Supporting Communities to End Homelessness”. Also, on April 22nd we will be launching our newest report “A Safe and Decent Place to Live: Towards a Housing First Framework for Youth” which examines how communities can implement a youth-specific HF approach. Author, Dr. Stephen Gaetz will introduce the report in a free webinar on April 22nd at 12PM (EDT). Everyone is welcome to participate. Sign up for the event.
Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., Nelson, G., MacNaughton, E., Streiner, D., Aubry, T. (2014). National At Home/Chez Soi Final Report. Calgary, AB: Mental Health Commission of Canada. Retrieved from http://www.mentalhealthcommission.ca
This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at firstname.lastname@example.org and we will provide a research-based answer.
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