With contributions from Lesley McMillan, Program Director, A Way Home Canada
I’m excited about this week! Over the course of one week, I not only get to celebrate my birthday, but I also get to help host a group of thoughtful, passionate and determined folks that make up the National Learning Community on Youth Homelessness (LC).
The LC’s annual meeting is happening between May 10 and 12 in Toronto. This rich community is made up of leaders from across Canada, who are making the shift away from simply managing the crisis of youth homelessness to preventing and ending it. I was fortunate to come on board with Eva’s, prior to my role with A Way Home. Since then, I’ve helped grow the LC and support a refinement and expansion of the LC’s scope of work. Now, not only does AWH host the LC, but the LC is a critical founding member of the A Way Home coalition and continues to contribute to our vision to prevent and end youth homelessness.
A community of practice on youth homelessness is very important to our collective vision. Prior to the LC’s inception, service providers across the country were doing essential and often innovative work, but they were generally done in isolation. A small group of services providers, with the support of Eva’s, decided that this needed to change and founded the LC. Not only do LC members support each other in their local work, but the LC has developed tools and resources to support the homeless-youth serving sector to implement the best practices. Some acclamations include:
“Without the support, guidance and learning opportunities provided through the Learning Community, Vancouver's Broadway Youth Resource Centre would not have been able to develop its continuum of supported housing for youth. Prior to BYRC's engagement in the Learning Community in 2006, it did not have any housing for youth. Since joining the LC, the Youth Centre has opened, supported and maintained more than 50 units of supported housing -- and the number keeps growing.” – Robert Wilmot
“I've been a part of the Learning Community since 2008 and the experience has been nothing short of exceptional. There is no greater privilege than to be a part of a group of like-minded professionals who experience the same challenges and can offer a perspective to people who cannot understand. It is comforting to know that someone across the other side of the country went through the same thing you just went through, and can be reached with a phone call. It is this kind of fellowship that truly makes the Learning Community an invaluable tool to everyone involved.” – Darrell Lechman (SCYAP, Executive Director)
These comments show the LC is a space where members share their local work in an open-source environment, which enables others to replicate those programs to fit the needs of their communities. It is also a space where members can ask for support and assistance to improve their practices and policies, which would directly support young people and reduce the length of their experience of homelessness.
The LC works in partnership with A Way Home, Canadian Observatory on Homelessness, the Canadian Alliance to End Homelessness and others, to help ensure that the voices of youth with lived experience are elevated in all areas of policy, practice and resource development. One such example is the Without a Home’s report, based on the largest national survey on youth homelessness ever done in Canada. Led by Canadian Observatory on Homelessness in partnership with A Way Home, the study was supported at every turn by the LC. Service providers from the LC advised on the scope and delivery of the study, as well as ensuring that youth with lived experience in their communities were involved as well. The result is an important report that gives us insights into the causes and conditions of youth homelessness and points squarely at the need for prevention. This is invaluable as we collectively work to impact public policy and investment.
So lock down the hatches and board up the windows, because the National Learning Community on Youth Homelessness is in town!
On January 24, I gave a presentation to students at the University of Calgary as part of the Certificate in Working with Homeless Populations program. The goal of this presentation was to discuss ways students could advocate to senior orders of government for better public policy that can help end homelessness.
My PowerPoint slides from the presentation can be downloaded here: Falvo_Homelessness Advocacy WHP 3 of 3 20jan2017.
Here are 10 things to know about advocacy in Canada’s homelessness and affordable housing sectors:
- Advocacy can be defined as a collective effort to bring about changes to political priorities, funding levels, legislation, regulations or policies. It’s relevant to people working in the homeless-serving sector because, in addition to delivering services to clients on a day-to-day basis, many workers in that sector also want to see changes to public policy that would help end homelessness.
- In the homelessness and affordable housing sectors, there are at least seven approaches to advocacy. They are: grassroots advocacy; direct action; rights-based advocacy; government-to-government advocacy; advocacy within Parliament; professionalized advocacy; and policy-based advocacy. Some people and groups take part in more than one type of advocacy; also, there’s considerable overlap among the different approaches.
- People engaged in “grassroots advocacy” have often been directly affected by homelessness. Also, their effort likely has a very small budget. This often involves informal working relationships, as well as a strong volunteer component. Examples of grassroots advocacy in Canada’s homelessness and affordable housing sectors include: Calgary’s Client Action Committee; Vancouver’s Carnegie Community Action Project; Housing Action Now (in Toronto); Montreal’s Front d’action populaire en réaménagement urbain(FRAPRU); and Montreal’s Réseau d’aide aux personnes seules et itinérantes de Montréal (RAPSIM).
- People who engage in “direct action” are very willing to be disruptive (i.e. sit-ins, protest, civil disobedience). Little effort is made to charm or cajole the audience (e.g., observers, media, etc.). Direct action often receives a considerable amount of media attention. Examples of groups who engage in direct action include CLAC-Montréal and the Ontario Coalition Against Poverty.
- The underlying argument of “rights-based advocacy” is that individuals should receive a social benefit because it’s their legal right to have it. This often means challenging interpretations of the Canadian Charter of Rights and Freedoms and invoking “economic, social and cultural rights.” Rights-based advocacy is heavily dominated by people in the legal community. Examples of organizations that take this approach include Canada Without Poverty and the Right to Housing Coalition (organized by the Advocacy Centre for Tenants Ontario). An example of a Calgary-based approach to rights-based advocacy is the Homeless Charter of Rights project.
- Government-to-government advocacy, as well as advocacy within a legislature or parliament, has obvious importance. Examples of organizations that engage in the former approach include the Federation of Canadian Municipalities and the Assembly of First Nations. Examples of advocacy that take place within a legislature or parliament include Question Period, committee work and the legislative process.
- “Professionalized advocacy” is often well-resourced and tries to positively reinforce what it sees as ‘good behaviour’ by government. This approach typically involves frequent meetings with elected officials—sometimes elected officials even seek out the group in question for their opinion and for background information. Such groups typically have multiple paid staff and sufficient resources to plan large events (e.g., conferences), hire consultants, commission research and produce web-based resources. Such organizations often provide services to their members (e.g. webinars, trainings). They also place emphasis on positive messaging with government (i.e. praising good behaviour, positive reinforcement). Canadian groups in the homelessness and affordable housing sector that engage in this approach include the Canadian Alliance to End Homelessness, the Canadian Housing and Renewal Association, Housing Partnership Canada and the National Housing Collaborative.
- “Policy-based advocacy” is an approach whereby a specific policy or funding pitch is used to galvanize attention and lobby government. Examples include the Alternative Federal Budget, the One Percent Solution and “ending homelessness.” (As a self-proclaimed policy wonk myself, I like this approach very much.)
- In the past decade, there’s been a change in tone in Canadian homelessness advocacy. Beginning in the mid-2000s, many homelessness advocates began making their cases to senior orders of government in Canada in new ways. Advocates started to emphasize what the non-profit sector could do differently, rather than how much more money senior orders of government needed to spend on social welfare programs. Increasingly, advocates also began using economic arguments in favour of action (by emphasizing the economic cost of homelessness to society) rather than a moral argument. This approach was especially popular among those practicing the professionalized approach; it has notbeen as popular within the direct action movement. I’ve previously blogged about this phenomenon here.
- There’s a role for all of these approaches. There’s no inherent reason why all of these approaches can’t co-exist. Not only do they not need to compete; they can actually complement and reinforce each other. I would argue, for example, that direct action approaches ‘create space’ for professionalized approaches. What’s more, some people and groups may choose to practice a variety of approaches.
The author wishes to thank the following individuals for invaluable assistance with this blog post: Cathy Crowe, Katie-Sue Derejko, Louise Gallagher, Kara Layher, Allan Moscovitch, Emily Paradis, Steve Pomeroy, Kaitlin Schwan and Greg Suttor. Any errors lie with the author.
This blog post has been republished with permission from the Calgary Homeless Foundation website.
By Melanie Redman, Executive Director, A Way Home Canada and Dr. Stephen Gaetz, Director, Canadian Observatory on Homelessness and Professor at York University
In the midst of so much happening at federal, provincial/territorial and municipal levels concerning housing and homelessness, it’s important that we don’t lose sight of some of the most vulnerable people in Canada: youth experiencing homelessness.
Yesterday, along with MP Adam Vaughan, A Way Home Canada announced the launch of the “Making the Shift: Reimagining the Response to Youth Homelessness Through Social Innovation” project at an event hosted by York University. With this federal investment, we are going to ensure we have a strong proof of concept and evidence base on models of prevention and Housing First for Youth. We will then take these models to scale, in order to ensure better outcomes for more than 1,300 young people and their families over the next two years during phase one.
The Making the Shift project will provide prevention and Housing First for Youth interventions to young people who are homeless or at risk of homelessness in 10 communities in two provinces -- Alberta and Ontario-- where there are existing or emerging provincial strategies to end youth homelessness.
The main purpose of this project is to support communities and all levels of government to make the shift away from a reliance on emergency response, to a more strategic investment in the prevention and ending of youth homelessness. This means developing a comprehensive knowledge base on prevention and support programs that result in lasting positive changes for homeless youth or youth at risk of homelessness. We’ve chosen to focus on models of family reunification (Family First), Youth Reconnect and Housing First for Youth because there is an existing knowledge base that we can build upon, through a series of demonstration projects that lay the groundwork for scaling these models nationally. (Note: We will be supporting the efforts of Coalition founding member Raising the Roof concerning the scale of a shelter diversion model known as Host Homes.)
When young people become homeless, they typically become part of the “Not Engaged in Education or Training” population, a group that hasn’t had an education and employment focus placed on them. The proposed interventions in Making the Shift will ensure that these young people achieve housing stability and have natural supports, such as family, that are essential as they receive support to stay in school or access training and employment. And by serving these young people, we will also build an evidence base to inform sound public policy and investment. This will, in turn, stabilize and increase their employment and education participation and success.
The Making the Shift project is a partnership of A Way Home Canada, the Canadian Observatory on Homelessness, MaRS Centre for Impact Investing, two provinces, and dozens of community partners. Supporting the work of the “Making the Shift” demonstration projects will be the Youth Homelessness Social Innovation Lab (YHSIL) led by the Canadian Observatory on Homelessness. Its role is to identify and imagine policy and practice innovations that have a high potential of contributing to effective solutions. The YHSIL will also be responsible for the research and evaluation necessary to establish “proof of concept”, as well as the knowledge development components necessary to enable taking such intervention models to scale.
The value of the research and evaluation component of our demonstration projects cannot be overstressed. We know that the successful “At Home/Chez Soi” project has been highly influential in shaping government policy in Canada. The evidence base for youth homelessness interventions, including Housing First for Youth, is currently not as strong. These demonstration projects, if successful, are poised to provide a key evidence base for all levels of government interested in prioritizing youth homelessness.
We will be taking prevention models with an evidence base elsewhere in the world, as well as the key innovation of Housing First for Youth (co-developed by the Canadian Observatory on Homelessness, youth with lived experience, the Hamilton Street Youth Planning Collaborative and the National Learning Community on Youth Homelessness), and providing proof of concept and ‘facts on the ground’ in Canada. All of the knowledge developed through evaluation will contribute to knowledge development and dissemination, including toolkit development. And through our evaluation work and research, we will focus on developing clear outcomes measures that demonstrate positive impacts on young people, including housing stability, health and wellness, educational engagement and achievement, and labour force participation. We want more for young Canadians than just housing stability -- we want them to have access to what any of us want for our own children.
Beyond the life of the Making the Shift project, the YHSIL will continue to identify, demonstrate, evaluate, disseminate, mobilize and scale innovations in policy and practice across the full spectrum – this will prevent young people from becoming homeless, and if they do, preventing them from ever becoming homeless again.
A Way Home was launched as a coalition in order to have maximum impact on the issue and the time has come for us to ramp up our collective efforts to ensure the job is done.
The time for innovation is now, because we can truly end youth homelessness, if we want to.
We gratefully acknowledge the support of the Government of Canada. The project is funded through Employment and Social Development Canada and Skills Link.
Over two hundred years ago, Benjamin Franklin said, “An ounce of prevention is worth a pound of cure”. Since that time, most people have come to understand the importance of prevention in dealing with major social, economic, and health problems. For instance, it is better to prevent cancer, measles, the flu, or other illnesses than have to deal with the consequences. This kind of thinking has influenced how we approach crime, road safety, and many other problems.
So how about homelessness? For decades we have relied on emergency services to help those experiencing homelessness. Emergency shelters, soup kitchens, and day programs, meant to be short-term supports, have become the main response to manage homelessness. While we will always need emergency services to help those in crisis, it’s past time we move in a new direction and look for ways we can support people to avoid homelessness. Housing First points the way to helping people permanently exit homelessness. But what is and what should the role of homelessness prevention be?
The results were compelling. Eighty-nine percent agreed that it is possible to prevent homelessness in Canada; however, only 29% believed their communities have a good understanding of what homelessness prevention involves. Respondents noted that in their communities prevention was a much lower priority (31%) than housing and supports (61%) and even more so than emergency services (71%).
All of this begs the question, what do we mean by the prevention of homelessness? Today, the Canadian Observatory on Homelessness launches A New Direction: A Framework for Homelessness Prevention with the intention of beginning a national conversation about how we can prioritize homelessness prevention. The survey informed our thinking on the framework and on making the prevention of homelessness a policy and practice priority. The framework provides the language and clarity to begin that conversation. It includes a definition of the prevention of homelessness and a typology that outlines the legislation, policies, collaborative practices, and interventions that will reduce the risk of homelessness.
The international context
Although Canada hasn’t made homelessness prevention a priority, other countries have been making headway. It is important to note that there are some great local homelessness prevention programs across Canada, but none have been taken up systematically. Alternatively, Australia’s Reconnect program provides outreach and support to youth at risk of homelessness in schools. Finland developed an action plan for cross-sectoral collaboration on prevention. The US has focused on preventing veteran homelessness. Germany and the UK saw a reduction in homelessness when they began running homelessness prevention interventions.
Homelessness prevention legislation is at the center of a lot of the international success because it sets out the government’s prevention goals, lays out different government departments’ responsibilities and how they must work together, and provides the policy and funding for local communities. Wales, Ireland, and Britain have all passed legislation setting out a duty to provide information and assistance to those who are at risk of homelessness. This legislation is rooted in a human rights approach that believes everyone should have access to safe and adequate housing. Over 96% of our survey respondents agreed that housing is a human right.
Defining homelessness prevention
The COH framework creates a definition of homelessness prevention so that we can be clear on what we’re talking about. In our survey, 93% of respondents agreed with our proposed definition.
Definition of the Prevention of Homelessness
Homelessness prevention refers to policies, practices, and interventions that reduce the likelihood that someone will experience homelessness. It also means providing those who have been homeless with the necessary resources and supports to stabilize their housing, enhance integration and social inclusion, and ultimately reduce the risk of the recurrence of homelessness.
The causes of homelessness include individual and relational factors, broader population-based structural factors, and the failure of many public institutions to protect people from homelessness. This suggests that homelessness prevention must not only include interventions targeted at individuals, but broader structural reforms directed at addressing the drivers of homelessness. That not only communities but all orders of government, and most departments within have a responsibility to contribute to the prevention of homelessness is in keeping with a human rights perspective.
The definition sets out the nature and scope of homelessness prevention. Emergency services and the supports they provide, while important, are not homelessness prevention unless they are offered in the context where people have immediate access to housing. In the prevention survey, 94% of respondents, many of whom are service providers in the homelessness sector, agreed that more resources should go to homelessness prevention even if it means in the long run there will be less need for existing services and supports.
The public health model
The framework is guided by the public health model of prevention, which has been used for decades to prevent disease and more recently in crime prevention and to prevent school dropout. The public health model is broken down into three categories:
- Primary prevention – These are prevention efforts that work at the structural level to help everyone. Primary prevention can be unpacked further:
- Universal prevention – Applies to the population as a whole, such as poverty reduction strategies and having an adequate supply of affordable housing.
- Selected prevention – Interventions aimed at a particular group, such as school-based programs and anti-oppression strategies for those facing discrimination.
- Indicated prevention – Prevention strategies for individuals at greatest risk of homelessness, such as support for families experiencing violence and for individuals with mental health and/or addictions challenges.
- Secondary prevention – Programs and practices to help those at immediate risk of homelessness or who have recently become homeless. Examples include evictions prevention and family mediation.
- Tertiary prevention – Making sure those who have experienced homelessness never do again. The most common example is the Housing First model.
Most of the homelessness prevention programs currently running fall into secondary prevention. While these interventions are key, they will not prevent homelessness on their own. We need to focus as well on the structural and systemic causes of homelessness if we want to truly prevent homelessness.
The typology of homelessness prevention
The five elements of this typology each contain elements of primary, secondary, and tertiary prevention show the continuum of prevention models needed to prevent homelessness in Canada. Local prevention programs are supported by prevention legislation, policy, and funding. This will take coordination between multiple sectors. Prevention can’t be the responsibility of the homelessness sector alone. It needs all levels of government on board and collaboration across sectors, including: housing, employment, child protection, health care, criminal justice, and education. The typology is as follows:
- Structural prevention – Use legislation, policy, and investment to build up the protective factors that prevent homelessness. Some examples are ensuring an adequate supply of affordable housing and poverty reduction strategies, such as Ontario’s basic income pilot.
- Systems prevention – Fixing restrictive policies that limit access to benefits and supports and addressing barriers to using services, such as mobility or transportation issues, difficulty navigating the systems, cultural barriers, and citizenship status. It also highlights the need for reintegration supports for people leaving public systems, such as hospitals, correctional facilities, and child protection.
- Early intervention – Acting quickly for those at imminent risk of, or who have recently become, homeless. These include a range of supports, from client-centered case management to shelter diversion, such as Host Homes.
- Evictions prevention – Strategies to reduce the likelihood that someone will lose their housing. There are lots of different kinds of evictions prevention, such as strengthening landlord/tenant laws, emergency financial assistance, and rent supplements.
- Housing stability – Supports to help people access and maintain their housing. This is especially important for those who have previously experienced homelessness. The Housing First model is a best practice in providing housing and supports.
Given the scope of the typology, it’s clear that homelessness prevention calls for a systems integration approach. We need people across sectors at the table, ready to do their part to prevent homelessness. A key finding from the prevention survey is that we are ready to make homelessness prevention a priority. The framework is a starting place to have a conversation about prevention. Let’s start talking.
You can join us for a webinar on A New Direction: A Framework for Homelessness Prevention on May 25th at 1:00pm (ET) or post your thoughts on the framework on the Workspace!
Access to health care is a human right. In Canada, we enjoy a system of universal health insurance and yet, many Canadians are left without services other Canadians can access with relative ease. For individuals experiencing homelessness, the ability to maintain one's health can be compromised by the impact of deteriorating health and obstacles, which often prevent them from getting the critical help they need.
Health & Poverty
In Canada, our publicly funded health care service is a cornerstone of our society -- it is central to the health and well-being of the general population. According to Statistics Canada, 85.1% of Canadians have a family doctor and 59% cite their health as very good or excellent. On the other hand, for individuals experiencing extreme forms of poverty and marginalization, including homelessness, maintaining a healthy life and accessing health care services is a considerable challenge. This is a major problem as these marginalized individuals face the largest likelihood of illness.
The World Health Organization finds that poverty is the single largest determinant of health.
Poverty is correlated with illness and in turn, illness increases one’s likelihood of poverty.
A lack of income can entail inadequate access to nutritious food as well as safe and stable shelter - all working to negatively impact health. On the flip side, illness leads to poverty by reducing household savings, overall productivity, and quality of life for individuals and families.
Poverty causes serious health problems such as significantly increasing one's chance of developing diabetes and complications such as blindness and cardiovascular disease.
The increase in illness that derives from poverty bears a significant economic burden, where the cost of poverty on the Canadian health care system is approximately $7.6 billion.
Health & Homelessness
Considering the points provided above, it is obvious that poverty is strongly correlated with poor health and increased health care costs overall. What sort of impact, then, would extreme forms of poverty such as homelessness have on the health of this population? The COH defines homelessness as an extreme form of poverty characterized by the instability of housing and the inadequacy of income, health care supports and social supports. These instabilities that characterize homelessness has a profound impact on one's health that include:
The longer an individual experiences homelessness, the more their health deteriorates.
Common health problems among this population include hypertension, arthritis and other musculoskeletal disorders, obstructive lung disease, tuberculosis, respiratory tract infections, human immunodeficiency virus, hepatitis, peripheral vascular disease, digestive tract disease, poor dental health, visual impairment, exposure-related skin diseases, as well as malnutrition and traumatic injuries.
For youth experiencing homelessness, malnutrition is found to exacerbate underlying medical conditions common among this population such as tuberculosis, hepatitis B infection, HIV and other STIs.
Approximately 30% of those experiencing homelessness suffer from at least 2 medical conditions. This likelihood doubles in individuals aged 50 and over.
Women who are pregnant and experiencing homelessness often are at great risk of poor health due to a lack of access to prenatal care, poor nutrition, and exposure to violence.
One study found that women experiencing homelessness in general often face sexual victimization and may engage in sex work to earn an income, putting them at risk of contracting HIV/AIDS and other sexually transmitted diseases.
Indigenous populations disproportionately experience homelessness. One study found precarious accommodations on reserve are commonly overcrowded implying that houses will have poor ventilation, poor sanitation/waste management and unsafe water supplies - all resulting in poorer health for this population.
Hospital Emergency Care & Homelessness
The information provided above makes it clear that there is a strong link between homelessness and the exacerbation of poor health. And yet, this population faces considerable gaps in getting the help that they need. Considering a lack of access to transportation to attend healthcare appointments, missing health cards, an inability to afford prescriptions and due to the 24-hour accessibility, emergency rooms are often the primary source of care for individuals experiencing homelessness. In fact, nearly 50% of individuals experiencing homelessness do not have a family doctor.
Even in accessing emergency rooms, however, homelessness significantly impacts the ability for individuals to get the care they need. This is due to prejudice, stigma and discrimination on the part of health care providers against individuals experiencing homelessness (particularly those with addictions, who are racialized and/or LGBTQ2S), long wait times and overall negative experiences that result in an interruption of treatment plans.
Coupled with this, use of hospital emergency care is a costly expense. One study found that out of 1,190 homeless individuals surveyed between 2004 to 2005, 77.3% had utilized an emergency department with a rate of 2.1 visits per person, where each person costs $1,462. Moreover, the average monthly cost associated with housing an individual while they are homeless in a hospital bed is $10,900. Ultimately, addressing homelessness via an emergency response framework, which includes emergency room over utilization, has cost Canadians over $7 billion per year.
To curb the costly expense of emergency room utilization as the primary source of health care for individuals experiencing homelessness, a variety of innovative initiatives are making great strides in breaking down barriers, making healthcare more accessible to those who need it desperately.
For instance, there are “street medicine teams” that work to bring health care directly to the visibly homeless, rather than waiting for them to visit emergency rooms. This is a great method considering that postponing treatment is a common occurrence among this population.
In Toronto, Street Health is a non-profit agency operating around the intersection of Dundas St. and Sherbourne St., the largest concentration of homeless shelters and drop-in centres in Canada. Street Health works to remove barriers to treatment and provide client-centered, flexible and responsive care. Through this crucially needed initiative, Street Health states that on an average day, 115 clients come through their doors and they are able to assist 40,000 individuals a year.
In addition to the street health initiatives, approaching homelessness via preventative framework is the most effective way to reduce the unnecessary illnesses experienced by this population. It also cuts down the massive costs associated with poverty.
There is strong evidence demonstrating Housing First can reduce illnesses associated with homelessness through providing housing without being contingent upon “readiness” or sobriety. One study following a cohort of previously unhoused individuals placed in stable accommodations found a reduced rate of emergency room utilization, in addition to increased overall health. These findings are consistent across multiple studies, including a Toronto-based study that provided individuals with stable housing, resulting in previously homeless individuals finally able to pursue treatment, attend appointments and fully implement treatment plans. Additionally, according to 7 Cities in Alberta, from 2008 to 2012 their Housing First clients reported 64% fewer days in hospital, 60% fewer interactions with Emergency Medical Services and 60% fewer emergency room visits.
As a fundamental human right, individuals experiencing homelessness are entitled to the universal health care the general population of Canada is able to obtain. And considering the health and monetary benefits associated with Housing First, a preventative approach to ending homelessness just makes sense.
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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.