Research Matters Blog
“If we want to stop people dying on roads, we invest money in seatbelts, not in the emergency department. In the same way in regards to homelessness, why would we wait to intervene with a young person when they’re in crisis, when we can intervene early and keep them at home, and in school and engaged?” – Peter Jacobson, manager, youth services, BCYF, Australia
Ending homelessness means investing in homelessness prevention – that is, stopping people from becoming homeless to begin with. This involves a change in the way we think about homelessness. Rather than managing the problem through emergency services, such as soup kitchens and shelters, it makes more sense to intervene before the loss of housing occurs, or if someone does experience homelessness, to get them stably housed as quickly as possible. This requires several sectors, like the health, education, justice, child, and housing systems to work together to implement policies and interventions that lower the risks of homelessness.
The Public Health Model of Homelessness Prevention
The public health model of prevention is helpful in altering the way we can respond to homelessness. This model was developed in the 1940s by Leavell and Clark and, was initially used to reduce the risks and harms associated with disease, illnesses, and injuries; that includes smoking, diabetes, strokes, and car accidents. This model was eventually adapted to address societal issues, like crime.
Risk Factors of Homelessness
To decide where prevention legislation, policy, and practices must be implemented, it is important to identify the causes of homelessness. Though these causes are organized into three intersectional categories, we need to keep in mind that the causes of homelessness are complex and involve a number of interacting factors that may play out in different ways from individual to individual.
- Structural factors are economic and societal issues that limit opportunities and reduce resiliency for the general population.
- Systems failures are inadequate policies and service delivery.
Examples: barriers to accessing public systems, such as health, social services and legal supports, and failed transitions from publicly funded institutions and systems, such as child welfare and corrections
- Individual and relational factors are personal circumstances that increase the risk of homelessness.
Similar to knowing potential causes of diseases, illnesses and injuries, we can put systems and interventions in place to reduce the likelihood that someone will experience homelessness when we know the potential causes of homelessness. The public health model of prevention contains a variety of prevention measures that should operate at the same time. In addition, all these areas play a unique and essential role in homelessness prevention.
Primary prevention of homelessness looks a lot like disease initiatives in the form of risk reduction. This involves altering the behaviours and exposures that can lead to a disease or by enhancing resistance to the disease, such as getting vaccination. When thinking about homelessness, primary prevention aims to reduce the risk of homelessness for the entire population by addressing broad structural factors that contribute to this risk and by building protective factors. Primary prevention takes the form of universal interventions aimed at entire communities as well as targeted interventions for at-risk communities.
Primary prevention breaks down into three categories targeted at different populations:
- Universal prevention – programs available to the entire population and helps to create greater equality.
- Selected prevention – programs aimed at people who may be at risk of homelessness because they belong to a particular group, such as individuals facing inequality and discrimination, particularly Indigenous Peoples.
Examples: school-based programs and anti-oppression strategies, and support for people facing discrimination to access public and private services
- Indicated prevention – programs aimed at people at higher risk of homelessness due to individual characteristics.
Secondary prevention of homelessness further resembles preventing a disease once a person has been exposed to it, such as quick early detection via screening procedures. For homelessness prevention, secondary prevention involves identifying and addressing homelessness at an early stage by directing interventions to individuals either at imminent risk of homelessness, or who have recently experienced homelessness. The goal is to avoid or exit homelessness quickly by either retaining their housing or using rapid rehousing strategies to ensure people move into permanent and stable accommodation that is affordable, safe, and appropriate with the supports they need.
For diseases, tertiary prevention involves softening the impact caused by the disease on a patient’s function, longevity, and quality of life. Tertiary prevention of homelessness supports to ensure that those who have experienced homelessness never experience it again. It provides housing stability and other supports to those experiencing chronic homelessness to find and maintain housing.
Importantly, Housing First is a type of tertiary prevention because it provides no-barrier housing and the wrap-around supports needed to keep people stably housed.
It is important to note that primary, secondary, and tertiary prevention do not represent separate categories. They are interrelated and must occur simultaneously.
“We would never build our health care system around the emergency department only” – A New Direction: A Framework for Homelessness Prevention
The public health model of prevention is important because it helps us realize that we need to intervene at different levels at all times. It’s not enough to focus in on just one of the areas. We need to reach the general population, those at imminent risk of homelessness, and those who have experienced homelessness. To end homelessness, we need to address all three areas of prevention.
This blog is the second instalment of a four-part series on homelessness prevention. You can read the first blog article here.
Since we launched the A Way Home Canada coalition in 2015, communities, provinces and even countries around the world have adopted the A Way Home name as a way to attach themselves to this growing international movement for change. What we seek is a fundamental shift in how we respond to youth homelessness, from a predominantly crisis response to one that focuses on prevention and sustained exits from homelessness. To make this shift happen, we must work across the systems that drive young people into homelessness to ensure they are part of the solutions. Over the upcoming months, I’ll continue to showcase efforts to do just that; and this month, our spotlight shifts to Kelowna, B.C. We’ve worked for years with amazing partners across B.C., and have supported Kelowna in various ways to get here, but the majority of the credit goes to the dedication and commitment of the community to take collective action.
I reached out to Belinda Jackson, the project coordinator for A Way Home Kelowna with some questions about Kelowna’s vision and approach for developing a targeted youth strategy embedded in the community’s homelessness strategy writ large. Kelowna is home to a population of 127,380 (based on 2016 Census) and is located in the beautiful Okanagan Valley in B.C. The convenor of this project is the Canadian Mental Health Association - Kelowna branch and Belinda’s work is guided by a steering committee. This steering committee consists of representatives from the Bridge Youth and Family Services, Okanagan Boys and Girls Club, United Way, Central Okanagan Foundation, Canadian Mental Health Association – Kelowna branch, Westbank First Nations, Ministry of Child and Family Development and the City of Kelowna. The steering committee is led by two co-chairs: Mike Gawliuk (a long time member of the National Learning Community on Youth Homelessness), Canadian Mental Health Association – Kelowna branch and Diane Entwistle, Okanagan Boys and Girls Club.
Here is my Q & A with Belinda Jackson:
Why did Kelowna decide to launch AWH Kelowna?
Youth service providers in Kelowna have been collaborating on key issues in the area for years. A workshop in 2016 with a number of community partners identified youth homelessness as a key priority for service providers. Funding was then secured from an anonymous donor to bring together the required resources to undertake the process for developing an A Way Home Kelowna initiative to address youth homelessness.
There are a limited number of options for youth seeking housing options in our community with a handful of organisations offering youth specific housing services. In a community with a 0.2% vacancy rate and rents averaging $1,043 per month (CMHC 2017), finding suitable, safe, and affordable housing is a major challenge. In addition, for young people struggling with substance use concerns, there are no local residential treatment options available. The current opioid crisis in the province of B.C. underscores the urgency to act and meet the needs of young people struggling in this area.
While a decision had been made to develop a local A Way Home Kelowna community plan, the City of Kelowna had identified addressing homelessness as a key priority area. This resulted in a Social Development Manager to undertake this work. This is also the city representative on the A Way Home Kelowna Steering Committee. The timing of the City and the youth service providers could not have been more perfect. This presented an opportunity to truly embed A Way Home Kelowna into a broader strategy to address homelessness in our community.
Kelowna’s last Point-in-Time (PiT) count (which was conducted in February 2016) identified that 15% (n=15) of the total homeless population (n=233) were under the age of 24, slightly lower than the Canadian average of 20%. However the Canadian Observatory on Homelessness highlights that PiT counts often underestimate the true number of young people that are experiencing or at-risk of homelessness, as they are more likely than adults to make up the “hidden homeless,” with many couchsurfing or in other forms of temporary, unstable, or unsafe housing.
What's the vision guiding your work?
The vision of Journey Home is to have a clear place to go for support if someone has lost or is about to lose their home. This means taking on a “no wrong door” approach, meaning any agency can connect an individual with the services they need. A Way Home Kelowna adopts that vision with a specific focus on youth and ensuring a fully integrated system of care to meet their diverse needs.
What do you hope to achieve?
While we are hoping to achieve functional zero for youth homelessness and homelessness generally in our community, there are four key actions that we will endeavor to achieve in this process:
· Enhance collaboration and partnerships in the community for systems level interventions
· Launch and implement a community strategy to address and prevent youth homelessness
· Pilot innovative practices to address youth homelessness
· Engage youth with lived experience early and often
Can you talk about the importance of aligning the dedicated youth strategy with the broader community systems plan to prevent and end homelessness?
When you consider what the ideal system of care looks like in any community, you really need to think about the necessity for care to be delivered along a continuum that is truly seamless. Aligning a dedicated youth strategy with the broader community systems plan helps address the traditional gaps in the system between the youth and adult serving sectors.
Journey Home, the community’s broader homelessness strategy driven by an appointed group of community members and facilitated by the City of Kelowna, will embed and integrate a youth lens throughout. This provides a unique opportunity for AWH Kelowna to align with the Journey Home initiative, ensuring not only an ongoing mandate to deliver but the ability to ensure AWH Kelowna maintains a prominent profile within the umbrella of Journey Home. There are few instances in Canada where a long-term homelessness strategy will encompass a youth component in the plan development process and will ideally serve as a blueprint for the process moving forward. By incorporating youth at the get-go, it will ensure the needs of youth are prioritized as a key area of focus and that the unique responses required to address their needs are front and centre.
What's the role of youth with lived experience in your process?
Youth with lived experience are the true experts on the matter of youth homelessness. We are currently undertaking a series of youth focus groups aimed at understanding:
1. Their definition of “home”
2. Their experience with the youth system in Kelowna
3. Improvements that can be made within the current system in Kelowna
4. How they would like to be involved moving forward
This process will ensure youth with lived experience are the true change makers to our youth system in Kelowna. Whether this is in the form of a youth expert committee or action group, the ideal end result will be that youth with lived experience will lead the implementation process in our community for the youth component. Honouring youth rights and desires, we are working together to determine the best ways to move forward together.
Since AWH Kelowna is embedded into the Journey Home process, we have the opportunity to leverage the work the Journey Home team is doing with those with lived experience. A Lived Experience Circle has been convened that includes all age ranges and individuals from diverse backgrounds to help identify the challenges and priorities moving forward with the Journey Home plan.
What are some early learnings from your process to date?
Kelowna is a community that is primed for action and ready to have the tough conversations in order to make progress on key issues. I’ve truly been heartened by the enthusiasm and passion of the community and its desire to tackle this issue in a thoughtful and holistic manner. This was recently highlighted at our design labs which focused on 24 priority issues identified by the community at our community summits in January. Community participants were very eager to tackle this issue in an inclusive and respectful manner.
A key challenge to date is encouraging certain stakeholders to join the discussion to be active participants in this process. There is a process of empowerment, education and relationship building that is essential to addressing the needs of all players. Part of the empowerment and education piece is highlighting the success stories in our community and where we are currently having a positive impact.
We also have a twitter account, we encourage you to follow us as we progress on journey: @awayhomekelowna
The relationship between child welfare systems and homelessness is becoming clearer, with almost 60% of youth who experience homelessness in Canada having had contact with the child welfare system. Inadequate supports through the transition out of care can become a pathway into homelessness for youth.
However, in considering the full family network in the context of child welfare, we can see further links between homelessness and this particular system. In a recent evaluation study of a Housing First program for women that chronically experience homelessness in London, Ontario, we explored histories of trauma. The program participants we interviewed, women who experienced high rates of mental health challenges, problematic substance use, gender-based violence, and relationship breakdown, identified complex histories of trauma. Yet, the foundational trauma that women spoke to over, and over, and over was the trauma of child apprehension.
Women’s homelessness includes unique pathways and unique considerations for support. These considerations may include the importance of safety, the potential need to care for or reconnect with children, risks related to sex work, gender-based violence, barriers in accessing services related to safety, reduced visibility and a disproportionate risk for experiencing poverty in general. However, while some women-specific and mixed-gender services have applied a gender lens in preventing or ending homelessness, evidence on the particularities of these services is only beginning to grow. On identifying grief and loss related to child apprehension in the context of women’s homelessness, we searched across Canada for services supporting this particular concern and found only three.
Therefore, as we recognize International Women’s Day across the world, I would encourage us all to consider the women who are left behind when children are apprehended, and the grief and trauma this experience can cause. This is an important consideration for the homelessness sector both in regards to primary prevention, and in regards to permanent and stable exits from homelessness. Proactively supporting women both to prevent apprehension and to support women through the process should apprehension occur will reduce the likelihood of downstream experiences of homelessness. For those who are already experiencing homelessness, Housing First is a proven model of sustainable exits and includes appropriate supports. For many women, appropriate supports means addressing grief and loss related to children.
Without a doubt, homelessness is a devastating and extremely stressful experience, as basic needs like food, shelter, medical care and safety would be difficult to obtain while unhoused. According to the State of Homelessness 2016, at least 235,000 Canadians experience homelessness each year, and 27 percent of them are women. As difficult as homelessness may be for anyone, women face additional challenges that make experiencing homelessness harder.
These are some of the unique challenges faced by women when experiencing homelessness:
Most women and transgender men experiencing homelessness have to deal with periods—a monthly financial burden men don’t have to worry about. Feminine hygiene products, which are necessary purchases, become a splurge for those who are unhoused. Some are forced to choose between pads/tampons and food. In a 2016 report describing how women experiencing homelessness in the U.K. manage their periods, some participants said resorting to toilet paper from public washrooms instead of pads, and another woman reported using an old t-shirt. Homemade alternatives and prolonged use of the same cloth, along with limited access to a washer and dryer, is unsanitary and can cause health issues.
Symptoms that accompany periods are additional challenges women and transgender men face, and unfortunately, homelessness worsens these issues. Limited access to showers, for example, magnifies the “dirty” feeling women get during menstruation. Furthermore, these period symptoms like changes in mood , tiredness and sore muscles can make managing homelessness more difficult. Because of the physical demands of homelessness, with people requiring to move from place to place, accessing different needs like food and shelter—often by foot—becomes challenging when they’re cramping or feeling tired.
Shelters, drop-ins, food banks and multi-service centres provide menstruation products, but there isn't enough to supply demand, and having to constantly ask for or track them down can be frustrating and degrading. Some women from the U.K. study said to be too embarrassed to even ask for them. Homelessness combined with the stigma surrounding menstruation transforms a completely natural and inevitable human process into a dreaded impediment.
Vulnerability and Sexual Abuse
Although anyone experiencing homelessness is vulnerable to violence and danger, women—particularly Indigenous women—and transgender women are more prone to victimization, especially when it comes to sexual abuse and assault. According to a report from Statistics Canada, 22 out of 1,000 Canadians over the age of 15 reported being sexually assaulted in 2014. Victims were more likely to be women, young, Indigenous, homosexual or bisexual, with poorer mental health. Experiencing homelessness also put Canadians at a higher risk. Similarly, a 2011 study based in Vancouver found female youth sex workers were more likely to be Indigenous and experiencing homelessness.
The dangers of survival sex work pose a greater threat to LGBTQ2S women experiencing homelessness. According to a 2015 report, LGBTQ youth in New York are seven times more likely than heterosexual youth to trade sex for accommodation and transgender youth in New York are eight times more likely than non-transgender youth to trade sex for a safe place to stay. In the U.S. as a whole, nearly half of transgender people reported engaging in survival sex while experiencing homelessness.
In a study describing the homelessness experiences of young women in Melbourne, Australia, some participants said to be involved in intimate relationships for personal safety and protection. One woman stayed with her partner because “Melbourne was this really bad place for women. You couldn’t go anywhere on your own because you’d get raped.” If women don’t have the protection a stable intimate relationship can provide, they’re often targets for sexual abuse. One woman said she was no longer allowed to stay in a room rental once her soon-to-be roommate found out she had a boyfriend. Another claimed to have been abused and sexually assaulted 15 times within her first month of homelessness because she didn’t know when men offered her a lift or a place to stay, they weren’t just being nice; they wanted to sleep with her.
Refusing sexual advances severely threatens women’s safety, as the participant earlier described. Another woman from the Melbourne study said she participated in survival sex because she didn’t want to be sexually assaulted. Although she claims she was willing, she only participated when she was threatened with violence, which is still assault. Not only is survival sex dangerous, but being taken advantage of when they’re most vulnerable is downright degrading.
Poor Provision of Sexual Healthcare
According to the experiences of eight young women and transgender women experiencing homelessness in Toronto, healthcare providers often undermine the women’s authority, which makes accessing sexual care difficult. And because of the “slut-shaming” discourse in our society, the women felt ashamed and embarrassed discussing their sexual history, making access to care even harder. Many of the participants described encounters with service providers who were infantilizing and judgmental. For example, one woman described feeling intense pain during sex, but all the doctor did was recommend using more lubricant, even after the woman insisted that wasn’t the issue. Another participant was given a pap smear because they didn’t believe she was a virgin.
LGBTQ2S women’s access to care is possibly more unpleasant. The lesbian-identifying participants in the same study spoke of problematic doctors who supported heteronormativity, or who were ignorant to the specific sexual health needs of LGBTQ2S youth. Because the experiences of LGBTQ2S community are rarely represented in most sex education, they are probably the most in need of advice or support when it comes to safe sex, but unfortunately, the stigma associated with them creates more barriers.
Limited Resources While Pregnant
Poor access to healthcare is even more worrying considering women experiencing homelessness risk an additional consequence of unprotected sex. Apart from risking sexually transmitted diseases, women and transgender men also risk unintended pregnancies. A survey from the Society of Obstetricians and Gynecologists in Canada (SOGC) found 61% of Canadian women have unintended pregnancies. Even more troubling, young women experiencing homelessness are almost five times more likely to become pregnant and more likely to have multiple pregnancies than young women in housing.
Homelessness is already an extremely difficult experience for one person alone. Having to provide for another will undoubtedly endanger both the baby and mother’s life further. Already competing priorities like access to food, accommodation, safety, proper hygiene or physical and mental health support—all crucial aspects of survival—become more complicated with a child, especially on top of additional priorities like maternal care and parenting support. A 2011 study based in the U.S. found mothers experiencing homelessness were less likely to initiate or continue breastfeeding, and they had less prenatal care and check-ups. Their babies on the other hand had “lower birth weights, a longer hospital stay, and were more likely to receive neonatal intensive care” (a care unit specializing in ill or premature babies). In another American study in 2012, some mothers with custody of their children showed signs of various mental illnesses such as a major depressive episode, lifetime posttraumatic stress disorder and lifetime drug abuse. Half showed signs for lifetime antisocial personality disorder.
It’s important to recognize women have additional challenges when experiencing homelessness. A one-size-fits-all approach to helping those without housing is inadequate, as these challenges significantly shape and impact women’s experience of homelessness. Instead, we need customized policies and strategies that address their unique needs.
Last week’s federal budget, while not as transformative as last year’s, had important new initiatives related to housing and homelessness.
Here are five things to know:
- New housing investments were announced for First Nations, Inuit and Métis people. Specifically, last year’s budget announced $600 million over three years for on-reserve housing; $400 million over 10 years for housing in the Inuit regions of Nunavik, Nunatsiavut, and Inuvialuit; and $500 million over 10 years for housing for Métis people. In each case, this targeting funding is intended to accompany the respective federal housing strategies for each group, none of which have been released. From an urban perspective – it’s important to remember that, while Indigenous peoples make up just 3% of Calgary’s general population, they make up 20% of Calgary’s homeless population. Several other funding announcements were made for Indigenous peoples, valued at $5 billion over five years. This includes funding for child welfare services, employment and skills training, nursing services in designated First Nations communities, addictions treatment and prevention in First Nations communities, and funding to build administrative and fiscal capacity in First Nations communities.
- This budget announced the further expansion and rebranding of the Working Income Tax Benefit (WITB). This is a wage supplement for workers who have a fragile toehold in the labour force. Some readers will recall that the federal government provided a $250 million enhancement to the program in 2016 (to take effect in 2019) in an effort to offset CPP expansion. In the 2017 Fall Economic Statement, the Trudeau government further announced the enhancement of WITB by an additional $500 million annually. This week’s budget announced that, beginning in 2019, this benefit will be known as the Canada Workers Benefit; it will also be more generous. For some workers, this will mean up to an additional $500 annually.
- The budget announced an increase in loans provided via the Rental Constructive Financing Initiative. Over the new three years, the amount of loans available will increase from $2.5 billion to $3.75 billion. According to the budget: “This new funding is intended to support projects that address the needs of modest- and middle-income households struggling in expensive housing markets” (p. 40). The impact of this initiative on homelessness will be indirect at best.
- Canada’s official unemployment rate is now the lowest it’s been in decades. Since November 2015, it’s gone from 7.1% to 5.9%. This strong labour market performance is good for the respective bottom lines of federal, provincial, territorial and municipal governments—not only does it mean more tax revenue each year, it also means some social programs (e.g., social assistance) can be drawn on less.
- Canada’s federal debt-to-GDP ratio remains (by far) the lowest of all G7 countries. While our federal government is projecting annual federal deficits in the $10-$20 billion range for at least the next five years, our federal debt-to-GDP ratio remains by far the lowest of all G7 countries. What’s more, our federal government is projecting a further reduction in our federal debt-to-GDP from 30.4% (2017-18) to 28.4% by 2022-23. This favourable macroeconomic context makes it easier for the federal government to invest in important social programs.
In Sum. From the vantage point of Canada’s affordable housing and homelessness sectors, the good news in this budget is its important new funding announcements for First Nations, Inuit and Métis people. This investment was announced in a context of low unemployment and an improving macroeconomic context overall. Going forward, I look forward to seeing further details pertaining to the many important initiatives announced in last fall’s National Housing Strategy.
Nick Falvo is Director of Research and Data at the Calgary Homeless Foundation. His area of research is social policy, with a focus on poverty, housing, homelessness and social assistance. Nick has a PhD in public policy from Carleton University. Fluently bilingual, he is a member of the editorial board of the Canadian Review of Social Policy / Revue canadienne de politique sociale.
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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.