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. Read the first blog here.
At times I feel a bit dismayed when reading another descriptive research article on people experiencing homelessness. Perhaps another article on rates of mental illness among shelter occupants, maybe one on the unmet support needs of homeless families, maybe it’s the correlation between intimate partner violence and women experiencing homelessness. The ones that are the hardest to see are those on life expectancy, average age of death, or survival rates of those experiencing chronic homelessness. We know the numbers will be bad, so do we need another description of these numbers? Or do we need more intervention research that helps people find home?
Because, ultimately, homelessness is a palliative condition unless treated with housing.
This is illustrated in a recent article by Amanda Stafford and Lisa Wood out of Perth, Western Australia. The article opens with the same discouraging statistics that we see worldwide on high morbidity, barriers to health care, high use of emergency services, and poor life expectancy. At the same time, Stafford and Wood confront and contest the natural response to these statistics: provide people experiencing homelessness with more healthcare services. They query that perhaps this medical model approach is too short-sighted and downstream?
To answer the question, then, of how to respond to the poor health outcomes of people experiencing homelessness, they present three in-depth case histories of two men and one woman accessing primary care and housing support. The case histories include not just detailed health and social histories, but also service utilization and cost estimates. All three individuals scored a 14 on the VI-SPDAT (a high acuity score on this measure of acuity) and utilized an average of $100,000 of health care services.
Three clear lessons are presented through these cases:
- There is a low degree of effectiveness in treating the health needs of people experiencing homelessness then simply sending them back to the conditions that compromise their health.
- While current health services are a valuable use of money in terms of preserving life, a more comprehensive approach would involve funding better access to housing with appropriate supports, thus mitigating downstream costs of homelessness and providing enhanced quality of life.
- The personal stories of experiences of homelessness demonstrate how social policy and social conditions create risks of homelessness, at times in contrast to public perceptions of homelessness being simply an individual experience.
While the case study methodology involves an intentionally small sample, the story is very clear. Medicine is an insufficient response to the health needs of homelessness and must go hand in hand with enhanced public policy and social programs to ensure access to affordable housing with adequate supports. This is the treatment needed to reverse the palliative nature of homelessness.
In 2017, we were proud to launch the “Making the Shift Youth Homelessness Social Innovation Lab” project with funding support from the Government of Canada’s Youth Employment Strategy. Though Making the Shift is led by a partnership between A Way Home Canada and the Canadian Observatory on Homelessness, our community partners are key. It was a dynamic year of co-creating solutions to youth homelessness alongside youth-serving organizations in ten Canadian communities. Year One of MtS has come to a close, and we’re pleased to share our newly released “Making the Shift Year One Report.” At the same time, we want to showcase a key deliverable for Phase One of Making the Shift, which is an important piece of work led by our friends at MaRS Centre for Impact Investing. “Funding Services for Homeless Youth in Canada: Review and Recommendations” takes a critical look at how we currently fund youth homelessness interventions and then makes some recommendations for how we might do it differently and more effectively.
Phase One of MtS (2017-2019) involves the implementation of three demonstration projects at twelve sites across Ontario and Alberta. These large-scale demonstration projects seek to build practical knowledge and an evidence base for the following interventions focused on prevention and sustained exits from homelessness.
- Housing First for Youth (Ottawa, Toronto), Housing First for Indigenous Youth, Indigenous led (Hamilton)
- Enhancing Family and Natural Supports (Calgary, Edmonton, Fort McMurray, Grande Prairie, Lethbridge, Medicine Hat, Red Deer, Toronto)
- Youth Reconnect (Hamilton)
Most importantly, these demonstration projects provide critical services that will help ensure the best possible outcomes for young people and their families. All three interventions are designed to enhance housing stability, well-being and social inclusion, and thereby increase the engagement of young people in education, training and/or employment. As we build an evidence base on the effectiveness of these interventions, we must also think about the sustainability and scaling of this work, which requires us to ask some key questions of the role and approach of funders (government and philanthropy).
I’ve invited Duncan Farthing-Nichol from MaRS to share some of the key recommendations from the “Funding Services for Homeless Youth in Canada” report.
Thanks, Melanie. We at the MaRS Centre for Impact Investing have learned a lot over the last year. We’ve interviewed homelessness experts and funders to find out more about how governments pay for homeless youth services today and how they might fund those services in the future. We’ve heard about empowering communities to decide their priorities while strengthening their ability to deliver. We’ve heard about gathering consistent data, emphasizing prevention, shifting dollars to focus on results and coordinating funding across government departments.
We drew a few recommendations from our research. First, federal and provincial governments that fund pilot programs should mandate strong evaluation designs to learn as much as possible about what programs work, for whom and under what conditions. For youth especially, communities often lack the detailed program evidence that allows a sophisticated response.
Second, federal and provincial governments should weigh tying a small portion of community-level homelessness funding to community-level results. A small amount paid on results could channel communities toward the federal or provincial government’s goals without micromanaging on-the-ground delivery. Any scheme to tie money to results must be made in close partnership with communities. The scheme must also adapt over time.
Third and last, federal and (especially) provincial governments should test cross-departmental funds to pay for homeless youth programs. Homelessness’ causes and consequences reach across departmental boundaries, yet departments not directly responsible for homelessness often shy away from taking part in homelessness programs. By paying for programs based on results - by paying, for example, on the number of youth who graduate from high school - a cross-departmental fund might attract interest from departments keen on those results. Paying for results clarifies how ending youth homelessness can help many departments realize their aims.
Back to you, Melanie.
MtS is providing leadership in helping communities and governments move away from band-aid solutions to youth homelessness through an investment in the development and testing of effective strategies to prevent youth homelessness and to help those who are experiencing homelessness to move out of it quickly and in a sustainable way. In partnership with MaRS Centre for Impact Investing, Making the Shift is also providing cost modelling and practical recommendations for how we can more effectively fund this important work. Over the next year we will continue to support program implementation and ongoing service delivery, as well as conducting rigorous research and evaluation and sharing findings as they emerge. For Phase Two of Making the Shift (Spring 2019 and beyond), we will build new partnerships that will contribute to the long-term sustainability of these interventions, while continuing to support our Phase One partners to provide critical services to young people and their families. We will also conduct additional research and evaluation of other interventions in the areas of prevention and sustained exits from homelessness. Our ongoing work with research, evaluation, program delivery, and cost modelling will continue to inform our policy and investment recommendations, as well as provide all Canadian communities with the practical tools (resources, training and technical assistance, etc.) they need to “Make the Shift.”
Are you working in the homelessness sector and in need of program evaluation support? We’ve got an exciting update for you!
Hub Solutions is a social enterprise nestled within the Canadian Observatory on Homelessness that provides research, evaluation and design services to organizations working to end homelessness. As part of our mandate, and recognizing that preventing and ending homelessness is a shared effort, we are looking for new ways to support the sector. This is why we are excited to announce that we are giving away a FREE evaluation consultation!
What are we talking about?
This is a unique opportunity to win a free evaluation consultation from Hub Solutions! It’s also an opportunity for us to reflect and check in with our stakeholders (you!) and the homelessness sector to learn about your needs and how we can work together to prevent and end homelessness in Canada.
Who can apply for the FREE evaluation consultation giveaway?
- Organizations based in Canada who are working to end homelessness. If you have multiple programs to submit, you can even have multiple submissions.
- Small agencies, organizations and collectives who are doing really great work, but don’t always have the time to dedicate their efforts to evaluation or sustainability.
Is this FREE evaluation consultation for you?
Is your initiative making magic happen in the community? Do you need support showing how your initiative shines for that future funding proposal, community check-in or an upcoming AGM? Do you need support figuring out your initiative’s pain points and how you can do better?
If yes, then we would say this opportunity is for you!
If I get picked, what happens next?
We’ll let you know if you’ve won by December 2018 and intend to hit the ground running by January 2019. We’ll schedule a kick off meeting with our team and your team for January, where we’ll figure out the nitty gritty of your project, schedules, timelines, and all that other fun stuff. From there, the Hub Solutions team will go and do their magic!
Ready to take the plunge? Fill out this short 15 minute application and enter to win!
If you’re still not sure, check out more information here. You can always shoot John Ecker (our Director of Research & Evaluation) a message with your questions as well, and we’d be happy to answer them!
Need a hand today? The Hub Solutions team is still around to meet your evaluation needs! Contact us today!
As Talley and Timmer eloquently put it, “If we intend to address homelessness, we must not allow ourselves to mistake another problem – the creation of a dependent and controlled client population in the shelter system – for the solution.” According to the literature on homelessness, the current response to homelessness heavily relies on the provision of emergency services, such as shelters, day programs, and soup kitchens. In recent years, however, there has been a shift towards thinking about the prevention of homelessness.
Homelessness prevention is not only humane, it is also cost-effective. Studies have found that individuals who are experiencing homelessness typically have higher levels of healthcare usage, and consequently incur higher healthcare costs. Additionally, approximately $350,000 can be saved within the criminal justice system each time an individual is prevented from being homeless.
Evidence undoubtedly exists to support the argument for preventing rather than responding to homelessness. However, is academic evidence enough to promote this widespread shift towards prevention? In an attempt to answer this question, I turn to shelter staff – those directly working in shelters and operating on the opposite end of the prevention spectrum – to understand their views on shelters and its role in addressing homelessness.
At this year’s CAEH conference, I will present the results of this qualitative research project, which explores frontline shelter staff’s perspectives on the use of shelters – an emergency response – as a strategy in addressing homelessness. This qualitative study was conducted with 13 frontline shelter staff working in adult shelters across Toronto, Canada.
This session will be of most interest to the frontline staff, as well as other professionals in the homelessness sector who are working to prevent homelessness. This research illustrates that the efforts to prevent homelessness does not exclude those working in emergency response roles. Overall, findings from this study will inform homelessness prevention stakeholders on the steps needed to promote a cross-sectoral shift towards prevention.
To learn more about this study, please attend this session within the COH stream. I am very excited to be taking part in this conference for the first time as both an attendee and a presenter, and I look forward to seeing everyone there!
With limited resources at their disposal, System Planners—such as the Calgary Homeless Foundation (CHF)—like to know how long various subgroups of persons experiencing homelessness will likely require various forms of housing support. With this in mind, Ali Jadidzadeh and I have co-authored a study that appears in Housing Studies—a leading housing journal. Titled Patterns of exits from housing in a homelessness system of care: The case of Calgary, Alberta, the study looks at the case of CHF-funded Housing First programs.
Here are 10 things to know:
- The study uses survival analysis and hazard models. To quote from the study: “[S]urvival analysis tells us when we can expect new housing units to become available for new tenants, and which programme types will have available units more quickly… [while] hazard analysis can tell us which tenants will be most likely to graduate, based on the individual characteristics of those tenants” (p. 7).
- The data in the study comes from Calgary’s Homelessness Management Information System (HMIS). Gathered between 1 April, 2012 and 31 March, 2015, the data pertain to people residing in Housing First programs funded by CHF. Thousands of people were involved in this data collection effort, including: persons living in Housing First programs who signed release of information forms; staff in Calgary’s Homeless-Serving System of Care who inputted the data; CHF staff who provided training and support to community on how to use HMIS; as well as CHF staff who then cleaned the data. The data in question were gathered on each person residing in Housing First every three months. An intake form was first completed by a case manager at intake into the program; then, another assessment form got completed every three months. There was also a form completed at exit from the program. These forms ask basic demographic information, as well as information about education, income, employment, history of family violence, use of health services and involvement in corrections. Most of the data gathered is based on self-reporting by an experienced case manager who receives accreditation. Blank copies of these forms can be accessed here.
- Key to the study is a concept known as graduation. Alberta’s provincial government provides homelessness funding to System Planners (such as CHF). To quote directly from the study: “In line with provincial programme guidelines in place during the period under consideration in the present study, a client is said to graduate from CHF-funded housing when they no longer require ‘housing support’ (i.e. case management). And in the case of temporary housing funded by CHF, a client is said to graduate once they complete programme requirements and move into a more permanent form of housing—either subsidized or unsubsidized…” (p. 3). [Note: subsequent to the period of study, the definition of graduation has changed for Calgary.] For a recent academic consideration of graduation, see this 2018 article.
- One of the study’s findings is that single adults without dependents require housing support longest, and families for the least amount of time. Put differently: single adults without dependents who have recently been homeless require social work (also referred to 'case management') support longer than other groups. I suspect a few factors may be at play here. First, single adults without dependents sometimes don’t have dependents because their children have been taken into child protection (possibly stemming from the parent’s challenges with mental health and/or substance use). It’s therefore intuitive that a person with such challenges would require social work support for a longer period of time. Also, in Alberta, singles without dependents receive less income assistance than other groups, making it more challenging to live independently (I encourage people to read the poverty chapter in this year’s Alberta Alternative Budget, which argues that the poverty gap for singles without dependents is much larger than for other groups).
- Women require social work support for longer periods than men (even when we control for employment and income). In fact, the study finds that men are 32% more likely to graduate than women. As noted in the study: “One possible reason for this is that women experiencing homelessness often find themselves in relationships with people who in turn jeopardize their housing stability…” (p. 20).
- Having a history of addictions does not appear to affect a client’s graduation rate. This is consistent with findings from the At Home/Chez Soi study, which found that formerly-homeless persons who consume large amounts drugs and/or alcohol maintain housing about as well as other formerly-homeless persons. This reaffirms the importance of the Housing First approach, which holds that a person should not have to go to a drug or alcohol treatment program as a precondition to receiving permanent housing.
- Older clients have lower graduation rates (meaning that it takes longer for them to move on to independence). Put differently: older people who have recently been homeless require social work support longer than other groups. The study notes: “Older clients having lower graduation rates should also not be surprising to many readers, as the health outcomes of seniors are poorer than those of younger clients” (p. 21). This is an especially important finding for System Planners across Canada, as older adults are making up an increasingly large share of the homeless population. In Calgary’s homeless shelter system, adults aged 55 and over, in 2017, accounted for 19% of bed spaces on any given night; in 2008, they accounted for just 9% of all bed spaces. These figures apply to single adults without dependents. This trend will likely continue for at least another decade or two.
- Findings pertaining to Indigenous peoples have already had ramifications on the ground. Indeed, the study finds that Indigenous peoples in the study needed support longer than non-Indigenous peoples. This holds even after controlling for income, education, and a history of family violence. Future research is needed that looks at factors that inhibit success among Indigenous peoples in Housing First [Note: Some research has already been undertaken on this in Edmonton. Check out this 2011 report and this 23-minute video]. These findings have also informed CHF’s engagement strategies with Indigenous peoples, including CHF”s hiring of an Indigenous advisor (since promoted to Director), a business case for two supportive housing buildings for Indigenous peoples (not yet funded) and future Indigenous-focused research.
- The study finds that having a source of income is positively correlated with graduation rates (i.e., it speeds up the move toward independence)—and this has already led to several changes in Calgary’s Homeless-Serving System of Care. This finding has helped inform an effort by CHF to identify, in collaboration with community partners, specific individuals in CHF-funded Housing First programs who, with some additional (short term) financial support, could likely graduate. This particular effort has been taking place for roughly one year; thus far, it has involved approximately 170 individuals with considerable success. The additional financial assistance provided varies by individual and is not intended to be permanent.
- In Calgary’s family homelessness sector, the study’s finding pertaining to income has led to the development of a new Adaptive Case Management (ACM) approach. ACM has a strong focus on providing short-term financial assistance to households in need (and it is discussed in detail in our Family System Planning Framework).
In Sum. This study finds that some groups move on from Housing First programs more quickly than others, and that some factors (such as a source of income) appear to accelerate graduation from Housing First. Because CHF embeds research into its day-to-day operations, we were well-positioned to start acting on findings well before the research was published.
For assistance with this blog post, I wish to thank Tim Aubry, Carla Babiuk, Victoria Ballance, Candice Giammarino, Ali Jadidzadeh (who also spent many hours cleaning this data so that if can be used for analysis by several stakeholders), Stephen Metraux, Shane Rempel and one anonymous source. Any errors are mine.
For a full copy of the article, please email me.
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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.