Research Matters Blog

York University
April 14, 2014
Categories: Health

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.

Hospital photograph

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.”

In a London, Ontario pilot study, patients at risk of being discharged with ‘no fixed address’ were provided with a timely intervention. This included:

  1. Assessment and immediate response to client need (it is argued that a determination of risk of homelessness should be made early, upon admittance);
  2. Goal planning and advocacy to coordinate supports;
  3. Assistance in finding affordable housing;
  4. 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.

FROMGaetz, S. (2014). Coming of Age: Reimagining the Response to Youth Homelessness in Canada. Homeless Hub Research Report Series.

Canadian Homelessness Research Network/Homeless Hub
April 11, 2014
Categories: Housing

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.

National Final Report: Cross-Site At Home/Chez Soi Project.

  1. Figure 1. Percentage of participants housed for various periods of time last six months of the study.“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)”

  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)”

  3. Housing First is a sound investment. The economic analysis found some cost savings and cost offsets. (Chapter 5)”

  4. 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)”

  5. Figure 5 and 6. Shifts away from ER services and outpatient visits.“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)”

  6. “There are many ways in which Housing First can change lives.Figure 17. Differences between HF and TAU in life courses. 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)”

  7. “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.

Housing First Framework for Youth webinar sign-up

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 thehub@edu.yorku.ca and we will provide a research-based answer.

York University - The Homeless Hub/KMb
April 09, 2014
Categories: Housing, Reports

Cities that participated in the study

Homelessness is a serious public policy concern.

Yesterday the national final report for the cross-site At Home/Chez Soi project was released. The project’s $110M budget was funded by Health Canada. The At Home/Chez Soi project utilized the Housing First model, which draws on the ‘Pathways to Housing program’ from New York City

Housing First equals permanent housing plus support.

Housing First principles.



Tracking a group of people who received the Housing First intervention, and a group of people who didn’t, allowed for what I believe to be the largest scale tracking of a homelessness intervention in Canada. The results showed that in all of the scenarios, people who had been experiencing homelessness were more likely to remain sheltered and less likely to access emergency healthcare services. Overall, throughout the course of this trial, it has shown that Housing First is cost efficient, effective and a humane solution to homelessness in Canada. This demonstration is key in moving forward to end homelessness with evidence-based practice.  Nick Falvo previously highlighted some of the other significant points about Housing First, including that it will provide a base of raw data that will be available for years to come.  The information is bitter sweet, however, in that the federal budget for homelessness intervention is at 35% of the level it was in 1999.



The seven main messages and key findings identified in the report are as follows:

1)   Housing First works in different sized cities with different ethnoracial and cultural compositions.

2)   Housing First rapidly ends homelessness.

3)   Housing First is a sound investment.

4)   Housing First is not housing only.

5)   Having a place to live with supports can lead to positive outcomes outside of those provided in the services.

6)   Housing First can change lives in many different ways.

7)   Correctly designing Housing First programs is important to getting the best outcomes.

Images taken from the National At Home/Chez Soi Final Report produced by the Mental Health Commission of Canada.

 

Carleton University
April 07, 2014
Categories: Housing, Reports

On Tuesday, April 8, results of the Mental Health Commission of Canada‘s At Home/Chez Soi homelessness study will be released at an Ottawa press conference. The study followed more than 2,000 participants in five Canadian cities.  All were homeless when the study began. Half of them received the Housing First intervention, and half of them did not.  Data was collected from 2009 until 2013.

Here are 10 things you should know about this study.

  1. It is one of the most ambitious randomized controlled trials in Canadian history.
  2. Its $110 million budget was funded entirely by Health Canada.
  3. The decision to fund it was made by the Harper government.
  4. At least 30 separate studies will roll out of this project. More than a dozen have already been released.
  5. For years to come, many researchers will be able to access raw data from the study for further analysis.
  6. The results are being announced in a context of declining federal funding for homelessness. (After adjusting for inflation, annual federal funding for homelessness in 2014 represents just 35% of its 1999 level.)
  7. As the study is being released, use of emergency shelters in Canada’s largest city has been on the rise.
  8. The report is being released amid some evidence that Toronto shelter conditions have been worsening.
  9. Canada’s Minister of State for Social Development is scheduled to attend the release of the study’s findings.
  10. The “intervention” being studied (namely, the Housing First approach to homelessness) was explicitly endorsed in last October’s federal throne speech.

Reprinted with permission from The Progressive Economics Forum.

Canadian Homelessness Research Network/Homeless Hub
April 04, 2014

Last Wednesday we published a blog highlighting an infographic from the Canadian Centre for Policy Alternatives (CCPA) looking at poverty rates amongst indigenous children. The map used wasn’t a normal picture of Canada. It was missing all three territories as well as the four Atlantic provinces.

From Bad to Worse: Children Poverty Rates in Canada

On Twitter Jayde O'Rielly asked, “Are there no statistics on the Maritimes?”

Answer:

The easy answer from the CCPA is that the data sets were too small and therefore the numbers aren’t statistically viable enough for comparisons. But it raises some bigger questions. When we were pulling together researchers who studied Aboriginal Homelessness we were challenged to find people in the Atlantic Region studying that issue (we found a researcher based in Labrador studying Aboriginal Homelessness in the North for example and an Aboriginal community agency – Canadian Aboriginal AIDS Network – based in Halifax but looking at national issues).

There are a few reasons why these communities aren’t studied as much:

1)   Population

Statistics Canada data from 2013 shows that the total population of Canada is 35,158,300.  The four Atlantic Provinces (Newfoundland/Labrador, Prince Edward Island, Nova Scotia and New Brunswick) have a combined population of 2,368,800 or 6.8% of the total. The northern territories (Yukon, Northwest Territories and Nunavut) have combined population of 115,800, or .3%.  By comparison, Alberta, British Columbia, Ontario and Quebec all have more people than these seven provinces and territories combined. In the case of Ontario, at nearly 40% of the country’s population, it is about 5.5 times greater.

A smaller population tends to mean less money, less people to do the research and less focus. Unfortunately, especially in the North, this leads to even more discrimination and marginalization.

2)   Lack of Research Institutions

Much of the research in Canada on these types of issues is done by the faculty and students of Canadian universities. Social Planning Councils, Policy Institutes and community agencies also conduct research, often in coordination with a research institution.

There are no universities in the three territories and only 16 in the Atlantic Provinces (4 in New Brunswick, 10 in Nova Scotia and one each in PEI and Newfoundland and Labrador).  Ontario by contrast has 32 and Quebec has 19. Many of the universities in these 7 provinces and territories are quite small with a low number of students (especially graduate students) and faculty. This means fewer research dollars and human resources are available in this area.

You can find some area-specific research on our website by typing in the name of the city or province/territory you’re interested in.

But, this doesn’t mean that the problem doesn’t exist nor that there aren’t groups in these areas working on the issues.

A report “Household Food Insecurity in Canada: 2012” released by PROOF showed that food insecurity is a big issue across the country - 1 in 8 households experience food insecurity. This was particularly true in the Maritimes and the North. In Newfoundland and Labrador the rate was slightly less than Quebec (13.4% vs 13.5%) although it had the lowest rate in the country for children living in food insecure households at 15.1%. In Nunavut, for example, 45.2% of households were food insecure and 62.2% of children live in food insecure households.

Our Community Profiles section of the Homeless Hub highlights the statistics and research for each of the 61 designated communities across the country. This term refers to the communities that receive funding under the Homelessness Partnering Strategy (HPS) which is a unique, community-based federal program designed to help prevent and reduce homelessness in Canada. 12 of the 61 designated communities are in these 7 provinces and territories. While research and information varies for each community we can look at Halifax, Nova Scotia, for example, and learn that 1,973 individuals used shelters in 2012 and 17,465 households were in core housing need (paying more than 30% of their income on rent). At the same time, research shows that a single person only receives $538/month for income assistance but the average cost of a 1 bedroom is $773/month.  Research is also available for Halifax including the Halifax Report Card on Homelessness 2012 from the Nova Scotia Housing and Homelessness Network and the 2011-2014 Community Plan

There are many groups, organizations and researchers looking at these issues as well. Our Researcher Database is a great place to start (if you’re a researcher who wants to be added to this please email us at thehub@edu.yorku.ca). In most communities you can also dial 2-1-1 to find out about services and groups that are involved in these issues.

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

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