Upstream Canada is an innovative approach aimed at preventing youth homelessness and school disengagement by combining social services and schools. It is based on the idea that early intervention gives you the best chance of addressing issues before they worsen. But in order to intervene early, good screening tools are required to identify at-risk youth and refer them to services. Upstream Canada does this by means of universal screening for all students at participating schools.
Upstream Canada is already being implemented in select communities across the country, notably in Kelowna and Saint John’s The Canadian pilot program was inspired by a model developed in Geelong, Australia called the Community of Schools and Services (COSS) model, and a recent evaluation conducted in the state of New South Wales shows the positive effects such programs can have.
What Is COSS?
The Community of Schools and Services (COSS) model is about collective impact: services and schools working together to advance a common vision. Its basic principle is that, by integrating with schools, it is easier to meet youth where they are at and intervene before problems become serious. COSS has several different elements:
- Common agenda: Participating organizations have “[…] a shared vision for change including a common understanding of the problem and a joint approach to solutions […].”
- Shared measurements: Data is collected and outcomes are measured in a consistent manner across all participating organizations.
- Mutually reinforcing activities: Although they may do different things, all activities by participating organizations are coordinated through an action plan.
- Continuous communication: This builds trust, contributes to shared goals, and favours common motivation.
- Backbone support: There is staff to provide an organizational backbone, coordinating the entire collective effort.
As David Mackenzie, co-creator of the COSS model, wrote in 2018, the shift to “place-based” interventions is very promising for keeping vulnerable and disadvantaged young people connected with education. He writes, “The [COSS] model is represented as consisting of four foundations: community collaboration, early identification, the practice framework and early intervention support work with families and a robust, embedded longitudinal monitoring and measurement of outcomes.”
How Does Screening Lead to Support?
The report titled Evaluation of the Universal Screening and Support Pilot: Final Report presents data based on a COSS pilot project conducted from 2019 to 2022. The pilot ran in seven schools in two communities in New South Wales, Australia —Albury and Mount Druitt—and was called Universal Screening and Support (USS).
Students in participating schools completed a standardized screening questionnaire based on the Australian Index of Adolescent Development, and the results of the questionnaire were used to refer students to USS supports. Students could also be referred directly by school staff—about a third of students referred to USS supports went through this route. Students who were referred were interviewed, consent was obtained, and then they were assigned to a tier of support, with Tier 1 being the lowest level of need and Tier 3 being the highest. By the end of 2022, 804 students were referred to services (5-10% of those screened) and 608 accepted, for an overall engagement rate of 75%.
The engagement rate was much higher in Albury (94%) than in Mount Druitt (48%), and the drop-out rate was also much higher in Mount Druitt, with 40% of students leaving the program with 90 days of starting (compared to just 11% in Albury). As well, in Albury, only 17% of students were assessed as Tier 3 while this group was much bigger—68%—in Mount Druitt. These results speak to the higher levels of marginalization faced by students in the Mount Druitt schools more generally as well as to increased difficulties with program implementation, partly due to high staff turnover.
What Kinds of Evaluation Were Used?
The evaluation of the USS pilot had three distinct parts:
- Process evaluation: Examining the implementation of USS in both sites using interviews.
- Outcomes evaluation: Using linked data to compare outcomes for the USS pilot schools with similar schools that did not participate.
- Economic evaluation: Based on the identified outcomes, examining the cost- benefit ratio of the pilot.
What Outcomes Were Identified for the USS Pilot?
Several key outcomes were highlighted through the evaluations:
- Students who engaged with supports experienced improvements in well-being and mental health, based on the Personal Well-Being Index and a measure of psychological distress.
- In Albury, there was a statistically significant reduction (2.41%) in the likelihood that a student would present to homelessness services. The reduction was not statistically significant in Mount Druitt.
- For school disengagement, there were statistically significant improvements at both sites (2.0% in Albury and 1.2% in Mount Druitt).
As well, the report points out that although rates of homelessness and school disengagement increased in both pilot and comparison sites during the period of study (likely due to the COVID-19 pandemic), it increased by a lower rate for students who had access to USS.
Was the USS Pilot Cost Effective?
The study describes the economic impact of USS as follows: “The Net Present Value (NPV) and Benefit-Cost Ratio (BCR) reflect a positive return on investment for USS, with an NPV of $2.86 million and a BCR of 1.66. This includes benefits relating to reduced use of [homelessness services] and the increased lifetime earnings associated with greater school attendance, and costs related to the delivery of USS.”
In short, USS provides greater value for money than business as usual. This is, of course, in addition to the unquantifiable benefits of improving the lives of young people in a community.
What Are the Next Steps?
USS was a unique program in that it provided case management services to young people both in and out of school settings. Its successes show the value of collaboration between schools and services and “[…] has highlighted the utility of early intervention to identify and support students at risk of homelessness and school disengagement, especially students with lower-level needs who may ‘fly under the radar.’”
The authors of Evaluation of the Universal Screening and Support Pilot: Final Report conclude that the evidence they gathered supports expanding the pilot to more sites and continuing to study its effectiveness in different contexts. However, they do not believe the results are strong enough to support a full roll-out in the state of New South Wales in Australia. Part of the reason for this is the disruption to the programs caused by the COVID-19 pandemic, which meant that educational conditions were often changing and less than ideal.
They go on to state that any implementation in the future should involve broader community consultation, notably with Indigenous groups and organizations. They also make the case that better data on USS is required in order to make the argument for a wider implementation.
Making the Case for Early Intervention
As one of the largest and most detailed studies of the COSS model to date, the USS pilot lends support to establishing Upstream Canada in more communities. We now have evidence that universal screening and targeted supports delivered in schools with an eye on intervening early can make a significant difference in the lives of young people on a large scale.
As Jacqueline Sohn and Stephen Gaetz argue in their report on Upstream Canada, “The longer a young person remains homeless, the more difficult it becomes to help them stabilize in housing and reintegrate with mainstream society. With an early intervention approach, the goal is to prevent a young person from experiencing homelessness altogether or to intervene as quickly as possible after a young person has become street-involved to minimize the negative consequences.”
Early intervention matters. And the USS pilot study and Upstream Canada show us that partnering with schools is one of the best ways of doing it.