In this bi-weekly blog series, I explore recent research on homelessness, and what it means for the provision of services to prevent or end homelessness.
Financial supports for low-income Canadians are much more comprehensive for older adults than for those supported through general social assistance. In Ontario, for example, between OAS, GIS, GAINS, CPP, the GST/HST credit, and the Ontario Trillium Benefit, less than 5% of seniors live below the Low Income Cut Off (LICO). However, in spite of these more comprehensive income supports, older adults are still at risk of experiencing housing loss.
Victoria Burns and Tamara Sussman sought to understand pathways into homelessness for older adults in Montreal, Quebec. They interviewed 15 men and women currently residing in emergency shelters. Through a grounded theory analysis, they discovered two distinct pathways into homelessness for older adults: Gradual versus Rapid.
A gradual pathway into homelessness involved decades or a lifetime of financial, social, health, and/or housing precarity. These individuals had often accessed many services for many years, including frequently living on poverty-level social assistance rates. Many had complex and traumatic life histories including activities meant to assist in maintaining housing. For these individuals, entering emergency shelter was often considered a relief, as they entered a system of support and momentarily left behind a lifetime of stressors related to maintaining housing.
A rapid pathway into homelessness involved multiple, rapidly-occurring catastrophic events such as relationship-breakdown, financial crisis, health crises, or deaths. For these individuals, entering emergency shelter was often perceived as a shock and a failure. These individuals often minimized their use of services, feeling ashamed of reaching out for support.
While these unique pathways into homelessness for older adults are interesting, and should lead those providing emergency shelter to reflect on the very divergent experiences of those they support, the conclusions of the authors sound all too familiar. “We recommend an influx on affordable, quality housing with varying types and levels of support.” Neither those who experience gradual or rapid losses should have to end up in shelter if better housing with supports were available.
However, the authors offer an additional and potentially promising practice: Those who add themselves to the social housing waitlists should automatically be connected with an intake worker to be assessed for potential case management support. This could be a preventative intervention for a group who is self-identifying as being in housing need.
Canada’s Federal Homeless strategy was initiated eighteen years ago with a three year commitment of funding for communities across Canada. Since that time it has never been transformed into a permanent program, having been continuously renewed for periods of one to five years often accompanied by reductions in funding. As part of the new National Housing Strategy, the Government of Canada has done something bold: it has committed to a ten year investment in a new homelessness strategy (which it describes as Phase One), with a doubling of the previous funding level. The questions we have been waiting to have answered are, what will the new program look like? What will be the government’s priorities? The release of two reports that are the outcome of national consultations over the past year “Advisory Committee on Homelessness – Final Report” and “Homelessness Partnering Strategy Engagement – What We Heard Report 2018” may offer some insights into the direction the government is heading.
I had the privilege of being appointed to the Advisory Committee on Homelessness, and participating in it’s deliberations. The Committeeis made up of a diversity of individuals with different kinds of knowledge from across Canada that include: key communities, representatives from national organizations, researchers, Indigenous leaders, and people with lived experience of homelessness. Our mandate was to consult with experts and stakeholders throughout Canada and provide next steps to redesign the new national homelessness strategy, and the results of this work led by Parliamentary Secretary Adam Vaughan, including 12 recommendations, was presented to the Honourable Jean-Yves Duclos, Minister of Families, Children and Social Development. As the government announces details of the new program in the coming months, in light of these recommendations, I want to highlight several important themes from the report that suggest the federal government may be ready to move in a bold direction.
1. Adopt a national definition of homelessness to break barriers
The Government of Canada has never adopted an official definition of homelessness, meaning there is often confusion as to what problem we are trying to solve. Does homelessness only describe people sleeping rough or in emergency shelters? What about the hidden homeless? Or those at risk of homelessness? The Committee recommends adopting a broad, inclusive, and consistent definition of homelessness. The Canadian Definition of Homelessness describes a range of accommodations that make up the continuum of homelessness – unsheltered, emergency sheltered, provisionally accommodated, and at risk of homelessness. By adopting this widely used definition, HPS will be able to expand its scope, thereby improving access to funding for groups less likely to qualify as ‘chronically homeless’ (as measured through shelter use), such as Indigenous People’s, youth, LGBTQ2S-identified people, and women. Employing a comprehensive definition will shed a light on hidden homelessness and increase transparency, regarding the scale and impact of homelessness in Canada.
The Committee also recommends that HPS review the Indigenous Definition on Homelessness in Canada as the program is designed and delivered. The definition reflects Indigenous Peoples’ experiences of homelessness as more than houselessness, but as a loss of All my Relations. Historical and ongoing colonization practices and discrimination have led to the over-representation of Indigenous Peoples among those experiencing homelessness. Applying the Indigenous definition will provide opportunities for HPS to better listen to and support Indigenous communities to provide the programs and services they identify as crucial to ending Indigenous homelessness.
2. Taking a rights-based approach to homelessness and housing
Leilani Farha, the UN Special Rapporteur on the Right to Adequate Housing, has argued that “Homelessness is the most egregious violation of the right to housing and other human rights.”1 The Advisory Committee has asked that the Government of Canada place “Realizing the right to housing for Canadians experiencing homelessness” as central to the government’s strategy. This is important, because even when the National Housing Strategy leads to an expansion of supply of affordable housing, this will not on its own guarantee a reduction in homelessness, because of the pent up demand within the rest of society. In framing housing as a human right, this means going beyond simply a rights-based approach. The government will need to explicitly acknowledge its obligations to international treaties and progressively work towards implementing this right fully within a reasonable amount of time. The right to housing means that governments will be obligated to support those in greatest need such as people experiencing homelessness to get access to housing that is safe, appropriate and affordable, and that this right is judiciable (meaning if a person’s rights are violated, they will have legal recourse to public hearings, adjudication and remedies to ensure the government meets its obligations). Ensuring that the obligations to the right to housing is honoured, will mean that the integration and linkage between the National Housing Strategy and the new national homelessness strategy is made clear, ensuring that the goal of ending homelessness is truly possible.
3. Work towards solutions guided by the Truth and Reconciliation Commission
One of the consequences of our history of colonization in Canada is that Indigenous peoples are overrepresented amongst homeless populations, whether we are talking about adults or youth. We believe we cannot discuss homelessness in Canada without acknowledging and addressing this challenge through collaboration and meaningful engagement with Indigenous peoples. The Committee positioned its recommendations within the Calls to Action of the Truth and Reconciliation Commission. The HPS renewal must advance meaningful reconciliation, which includes supporting Indigenous-led solutions to homelessness. The Committee recommends increased funding for the Indigenous stream of HPS, particularly the addition of new funding for the Territories, with the knowledge that Northern Indigenous communities have unique challenges that require community-led solutions. Not only must we work towards better and more inclusive outcomes for Indigenous people, but Indigenous ways of knowing should be informing how we work with all people at risk of, or who experience homelessness.
4. Shift to prevention
The Committee also recommends that HPS prioritize homelessness prevention and this is a bold and overdue move. In North America, unlike elsewhere in the world, we have been very reluctant to embrace the importance of prevention as part of the strategy to address homelessness. The argument that as a crisis response, we need to focus only on those in greatest need – in this case chronically homeless persons – before we can focus on prevention is not justifiable. We would never accept building our entire health care system around the emergency room, waithing for people to be extremely sick or close to death before we help them.
In keeping with the recommendations found within Leading the Way: Reimagining Federal Leadership on Preventing Homelessness,the Committee calls for HPS to work upstream and reduce the in-flow into homelessness. In 2014, the HPS renewal centered around investing in Housing First, where large communities were directed to use 65% of their funding towards Housing First initiatives. This same policy shift now needs to take place with prevention. By adopting the definition of homelessness prevention found in the COH’s Prevention Framework, HPS can take another bold and resolute step forward, with emphasis on progressive policy, systems-based approaches, early intervention and housing retention. We should never design a system where people are only offered help after the experience of homelessness has been sufficiently damaging to a person’s health and well-being. People should not have to wait until things get really bad to get help. So while the advisory committee has recommended the government continue to prioritize chronic homelessness (and those with high acuity), it is worth pointing out once again that all orders of government and communities are allowed to have more than one priority. It is my belief that we can never end homelessness until we figure out how to prevent it from happening in the first place.
5. Prioritize and invest in strategic youth-focused programs and services
The causes and conditions of youth homelessness, compared with adults are unique, and therefore so must be the solutions. When the 2014 HPS renewal prioritized chronically and episodically homeless populations, concerns from sector stakeholders emerged that the current investment requirements create barriers for communities to support other vulnerable populations, such as youth. The Advisory Committee has flagged the importance of addressing youth homelessness to meet the federal government’s mandate of reducing chronic and episodic homelessness by 50%. Addressing youth homelessness now will prevent chronic homelessness in the future.
The Committee has strongly recommended that communities implement comprehensive and data driven systems plans to respond to homelessness, and that targeted strategies to end youth homelessness must be visibly and robustly embedded in those plans. Communities should be supported to implement innovative programs and interventions that, based on the needs of developing adolescents and young adults, focus on prevention and supporting rapid exits from homelessness for youth. Given what we are learning about how to address youth homelessness through prevention, a strong investment in this area can help the government realize its goal of helping communities shift to prevention. The Committee also raises the overrepresentation of LGBTQ2S youth among people experiencing homelessness and the need for proactive policies, programs, and practices to address their specific needs.
This is what moving forward looks like
Should the government mobilize our recommendations, we are excited by the future before us. Big changes lay ahead; with the federal government taking a leadership position, it’s time to do things differently. Communities are ready – let’s move forward, together.
In June 2017, the Honourable Jean-Yves Duclos, Minister of Families, Children and Social Development took a bold and important step. The step signaled that the Federal Government was prepared to listen, shift its course and prioritize particular issues within the Canadian context in relation to the redesign of the Homelessness Partnering Strategy. The most important role of any government is to listen to community and its stakeholders and respond accordingly. To help them listen, a 13-member Advisory Committee on Homelessness (the Committee) was assembled. Roundtables, hosted by the Committee, were held in eight regions (along with a roundtable focused on veterans homelessness, a meeting with Community Entities and Community Advisory Board representatives at CAEH17) where additional insight and priorities were captured. The result was a breadth of content, research and feedback from the public consultation process that shaped the Committee’s final report (insert link) with recommendations to the Minister.
Does the report signal a new direction for the Homelessness Partnering Strategy? We think it does and here are 5 reasons why:
- The lives of young people matter: We must transform the way we respond to youth homelessness and the Committee’s report clearly articulates the “how”. By moving from managing the crisis and putting young people at great risk, to an approach that focuses on the health and well-being of young people and assisting them to transition to adulthood in a safe and planned manner. The Without a Home study (Gaetz, O’Grady, Kidd & Schwan, 2016) which is the largest research project on youth homelessness ever conducted in Canada (led by the Canadian Observatory on Homelessness and A Way Home Canada), found that a large percentage of young people had their first experience of homelessness before they were 16 years of age. These young people had much worse childhood experiences (ex. exposure to physical, sexual and emotional abuse as well as bullying), greater housing instability (including multiple episodes of homelessness), and more acute mental health challenges. Retained investments in Housing First and other community supports should be a priority given the foundation HPS has established across Canada. This must be accompanied by a dedicated investment in, and prioritization, of youth homelessness.
- Prevention can be its own priority: The importance of prevention is highlighted throughout the report and this is coupled with recommendations focusing on funding for demonstration projects. The suggestion that the government should have a clear definition of prevention, pursue opportunities for partnerships with others orders of government or government departments should be seen as something we can all organize around. Provinces and Territories are looking for opportunities to align and harmonize their efforts. We feel this opens up a specific opportunity for the Federal government to work with provincial, territorial, and indigenous governments to make Canada a world leader in helping young people successfully transition from care in a way that is safe, planned, and supported.
- Community Planning is changing: Communities across the country are engaging in processes to plan and implement youth homelessness strategies, and many more have indicated a readiness to do so. In addition, we are seeing communities embedding the issue of youth homelessness and the necessary responses within broader community plans to address homelessness. The Committee’s report focuses on coordinated local homelessness systems and the need for communities to ensure these systems are data-driven. This kind of coordination and emphasis, which should include data focusing on the Canadian definition of youth homelessness along with measurable targets, can bring us closer to local systems that prevent and reduce homelessness, with the hope of ending it.
- Innovation should be rewarded: As demonstrated by the Making the Shift Youth Homelessness Social Innovation Lab, it is clear that the Federal government wants the evidence and foundation necessary to transform the homeless serving system. While the current Innovative Solutions to Homelessness funding stream through HPS was criticized, the recommendations mold a new and transformative process for communities to innovate. At its core, the innovation stream should provide the flexibility to launch, research and evaluate demonstration projects so the right tools and resources can be developed to support other communities. This knowledge mobilization will ensure models of prevention can take root at the policy and practice levels.
- Federal, Provincial and Territorial Leadership is needed: Moving away from siloed policy work has always been a priority for governments. Many would suggest that the policy landscape that surrounds the issue of youth homelessness is extremely challenging. We would view those challenges as unique opportunities. Provinces and Territories have dedicated child intervention systems, justice systems, education systems and health and mental health care systems that all have a role in responding to youth homelessness. The Committee is recommending a Federal, Provincial and Territorial Committee on youth homelessness be created to allow for greater alignment of policy, funding and share best practices. Tasked with the responsibility of developing a pan-Canadian youth homelessness strategy, this would allow government and community stakeholders to come together to support and enable community-driven responses and client-centered approaches to addressing youth homelessness.
Here at A Way Home Canada we are very pleased with the alignment of the recommendations in our 2017 federal policy brief, “Opportunity Knocks,” with the recommendations in the Advisory Committee’s final report. The boldness of this government to undertake an open, transparent and community focused approach to the redesign of the Homelessness Partnering Strategy should be commended. The commitment, focus and tireless pursuit of changing the status quo by the Committee’s Chair, Adam Vaughan should be celebrated. When we see change and recommendations are accepted, we sincerely hope that those who contributed to the process feel validated and heard. We will continue to work with our government and community partners to make this report matter.
LGBTQ2S (lesbian, gay, bisexual, transgender, transgender, queer, questioning, two spirit) youth experiencing homelessness are in a particularly vulnerable state when it comes to managing their sexual and reproductive health. In addition to the obstacles they face as youth and individuals experiencing homelessness, they face discrimination as a sexual and gender minority. The risks associated with each of these factors interfere with their ability to maintain their sexual and reproductive health. Oftentimes, they have limited access to healthcare services when they experience health problems. That is, if they can access healthcare services at all.
Sexual and Reproductive Health of Individuals Experiencing Homelessness
For those experiencing homelessness, it is incredibly difficult, and at times impossible, to access healthcare services. Without a permanent address, they are unable to obtain a health card or to make a healthcare appointment. Additionally, they cannot afford items that aren’t covered by provincial medical or drug insurance plans. Often they do not receive sufficient care from providers who might discriminate against them based on their homelessness. Even if they are able to access services, they may not have a safe or appropriate space for recuperation after a hospital stay, or have someone to give them care if they are in an especially fragile state.
Additionally, for those experiencing homelessness who menstruate, there exists an additional financial need that cannot be met with their lack of funds. Not only is it a matter of hygiene and dignity, but the inability to upkeep menstrual hygiene can lead to damage to reproductive and gynecological health. Those who are forced to choose cheaper homemade menstruation products, rather than the safer store-bought products, can experience chemical irritation and yeast infections. Moreover, they are at a significantly higher risk of life threatening conditions such as toxic shock syndrome.
Furthermore, those experiencing homelessness who are also pregnant face increased reproductive health risks due in part to their inability to access prenatal programs. This lack of access can result in serious complications going unnoticed and the additional strain of being pregnant while homeless can be life threatening.
LGBTQ2S youth experiencing homelessness
It is important to consider the unique experience of LGBTQ2S youth experiencing homelessness, as rates of homelessness are disproportionately high within this population. In the United States, 40% of homeless youth identify as LGBTQ2S. In Canada, the rate ranges from 25-40%; meanwhile, only 5-10% of the total population identifies as LGBTQ2S. It is shocking to note that on average, at only 14.4 years of age, youth identifying as LGBTQ2S find themselves without a home. This is about the same age they should be starting high school. Even more troubling is that this average age drops to 13.5 years for transgender youth. As such young people, being faced with hardship so early in their lives, their sexual and reproductive health risks are compounded.
Sexual health Risks of LGBTQ2S Youth
To start, those who are low income earners are twice as likely not to use contraceptives as high income earners. Meanwhile, youth experiencing homelessness must face financial strain as well as their increased tendency to behave impulsively. At the adolescent stage of their cognitive development, they tend to be thrill seeking, meanwhile, their cognitive system to regulate these impulses is slow to mature. This finding suggests that youth are more likely to partake in risky behaviour; including risky sexual behaviour. Therefore, along with the financial burden of contraceptives, increased exposure to sexual activity, and the inability to access family planning programs, youth experiencing homelessness are even more vulnerable to STI exposure and unplanned pregnancy.
Among the population of those experiencing homelessness, there is a higher incidence of HIV/ aids, when compared to the general population, due to their compromised immune systems, poor nutrition and hygiene, and frequent overcrowding at shelters. LGBTQ2S youth are at a higher risk for HIV as well. Meanwhile, the risk is even higher for LGBTQ2S youth experiencing homelessness, because they bear both the risk for those experiencing homelessness and those of the LGBTQ2S community.
Public Health Canada has found that a high proportion of street youth have reported not using condoms with both male and female partners. However, males were least likely to report using condoms with their same sex partners; though little is known about why this is the case. Regardless, it is important to understand that the risk of serious sexually transmitted illnesses is particularly high within this population.
Unfortunately, when LGBTQ2S youth do reach out for health care services, they are particularly likely to receive unfair treatment and stigmatization because they belong to a sexual or gender minority. What’s more is that Indigenous LGBTQ2S individuals face additional stigmatization and discrimination due to racism. Transgender youth are particularly at a disadvantage as they report obstacles in accessing supportive and knowledgeable health care. The healthcare needs of transgender youth differ greatly from that of others. For instance, They may choose to start hormones which require monitoring and regular blood work. Lack of supports has lead to trans youth turning to street suppliers for transition-related treatments which can cause severe health complications.
Needs for the Sexual Health of LGBTQ2S youth experiencing Homelessness
In light of these findings, LGBTQ2S youth who are experiencing homelessness have a specific set of supports that they require to protect their sexual and reproductive health; though it must be noted that this is not an exhaustive list. First, they need access to contraceptives, to protect them from STIs and pregnancy. They require access to health care services if they do become pregnant or ill, to prevent the worsening of their conditions. This healthcare must not require a health card, as it is unlikely that an individual experiencing homelessness will have the permanent address necessary to acquire such documentation.
Moreover, it is necessary that health care providers have the knowledge to support them; this is especially urgent for the supports of Transgender and Indigenous LGBTQ2s youth. Indigenous communities have healing methods that differ from the western medical model prominent in Canada. It is important to take this into consideration when discussing the health of Indigenous youth experiencing homelessness.
First and foremost, there needs to be continued progress in policy targeting the issue of homelessness. Individuals require housing and finances for the overall health and safety. This study finds that those who are housed have greater physical and mental health outcomes. Additionally, another study shows that those with HIV who are housed tend to better adhere to their prescribed medical regimes. So while short term solutions like providing contraceptives and healthcare access are important, housing is a solution that will ease the healthcare obstacles faced by those experiencing homelessness in the long term.
In this bi-weekly blog series, I explore recent research on homelessness, and what it means for the provision of services to prevent or end homelessness.
Community belonging, community integration, social support, social capital, engagement -- whatever the concept, there is a common understanding that a supportive response to both mental illness and homelessness is to actively promote citizenship. This is because both living with a mental illness and being de-housed carry the risk of marginalization, being pushed to the margins of society by other persons, by systems, or even by the services meant to support. It is not sufficient that we support recovery and re-housing. We must also support citizenship.
Allison Ponce and Michael Rowe present a framework for citizenship, building on existing theory and research including their own work with those experiencing housing loss. This work is timely as Canada recognizes CMHA Mental Health Week, with the authors providing recommendations for community psychology and psychiatry.
Ponce and Rowe provide a justification for a focus on citizenship that likely rings true for those of us who work in the homeless-serving sector: front-line workers are best prepared to provide those they assist instrumental supports and referrals to direct services, but find it more difficult to meet “affective needs of positive identity and a sense of belonging in their communities and society.” Another good fit for the sector is the social justice and equity underpinnings of their citizenship framework, that it’s not just about belonging and participation, but explicitly about “opportunities for persons of difference.”
So, how do we support citizenship in practice? Some ideas their research presented or stimulated for me include:
- Engage those with lived and living experiences into councils, committees, planning groups, etc.
- When engaged, actively avoid having services providers dominate these committees and taking on all action items.
- Educate the community about mental health and homelessness through the voices of those with lived experience directly.
- Use trained peers to assist in the intentional development of broader social networks.
- Support those who are newly independent in the community to identify an explicit community based task (ex. volunteering at an event, supporting a fundraising project, attending free library sessions, etc.), and support them in following through with this task.
- Provide free classes on the rights and responsibilities of citizens.
- If local projects or services are engaging in evaluation, train peers as community researchers to support these activities.
I conclude with their point that citizenship is not just for those who have reached some pre-determined or culturally conceived level of ‘stability,’ but is for all people.
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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.