Recently, the International Journal of Homelessness Research published an article that I co-wrote with Mary-Anne Martin, the postdoctoral fellow at the Research for Social Change Lab (RSCL). The article is titled, “The Implementation of Coordinated Access to End Homelessness in Ontario, Canada,” and you can read it here.
In this blog post, I explain how we came to do the research for this article, what we did to gather and analyze our data, and offer a few key findings. I also share the community actions resulting from this research and explain the practical significance of conducting such applied local research.
What is Coordinated Access and how does it work in Ontario?
Coordinated Access is Canada’s version of Coordinated Entry – which has been supported by the U.S. Department of Housing and Urban Development (HUD) since 2012. In Canada, all designated communities (i.e., communities receiving federal funding) must implement a Coordinated Access system as defined by Reaching Home.
Coordinated Access systems are defined by the following steps, which align with the four central elements of Coordinate Entry (access, assessment, prioritization, and referral):
- Access: the point of engagement for the individual or family experiencing a housing crisis. This may include emergency shelters, mobile outreach teams, day centres, other community-based organizations, and hotlines.
- Assessment: the process of gathering information about an individual or family accessing the crisis system.
- Prioritization: the process of determining the individual’s or family’s priority for housing based on information gathered through the assessment.
- Matching and referral: the process whereby the individual or family is matched to and offered housing based on needs, preferences, and project-specific eligibility (Infrastructure Canada, 2023).
Municipal homelessness service managers in Ontario are also required to maintain a By-Name List of people experiencing homelessness. The By-Name List is a source of real-time data that municipal service managers use to accomplish the prioritization, matching, and referral processes. It is a repository of all individuals experiencing homelessness within a municipal service manager’s area, “including names, contact details and information collected,” as well as “specific population and demographic information” (Government of Ontario, 2022, np).
The By-Name List is maintained by municipal service managers and is meant to be updated monthly, so that it enables the identification of “hotspots for unsheltered homelessness.” It also identifies the “movement of people, time on the list, and households on the list in receipt of homelessness prevention program (HPP) funding” (Government of Ontario, 2022, np).
How did this project begin?
In 2021, a new lived experience research team (the Building from Experience Super Crew) at the RSCL came together to design a project on the housing and homelessness system in our community. We received a request from a local community-based organization to create a guidebook that outlined how a person would use our shelter system and other local resources to get access to housing. We also identified key values that would underpin our work together, such as the idea that housing is a fundamental human right and that we can’t police our way out of poverty and homelessness.
What were our research activities?
We spent about five hours a week for 6 months getting to know one another, doing research training, finalizing our project design, and engaging in an expressive arts process facilitated by a local artist/researcher.
After this, we undertook several months of desk research and fact-checking to produce our first zine, which explains how a person would use our local housing and homelessness resources to get access to housing. You can check it out here.
Based on the diverse experiences of our teammates, we also knew that the system we described in our guidebook would work differently for actual people in our community. For example, frontline shelter workers have different insights into how the system operates compared to those seeking emergency shelter services. Similarly, based on our team’s experiences, it was clear that a disabled, non-binary Indigenous person new to the system and with a strong support network, experienced it differently than a white trans-woman with a criminal record and a longer history of service use but a less strong support network. We wanted to talk to those who use the homelessness system and those who work in it and/or manage it, in order to understand how it’s working from their perspectives.
Fortunately, in 2022, our local Reaching Home Community Advisory Body (CAB) funded us to do just that. Specifically, the CAB was interested in learning more about how people were experiencing the implementation of Coordinated Access – the service-coordination and structured decision-making process that the Government of Canada requires every Reaching Home community to implement.
So, we interviewed 42 social service professionals and municipal government employees, as well as 48 people who are or have been using municipal housing and homeless services (e.g., emergency shelters, mobile healthcare, outreach services, transitional housing).
For people using homelessness services, interviews focused on the process of seeking and receiving services. We used open-ended questions like: “Can you please walk me through the process you followed to get help, step by step?” Interviews with service providers followed a similar script, maintaining our focus on the local service delivery workflow. We asked questions like: “What is the process for qualifying for services from your agency?” We also used focused prompts to bring specific aspects of the system into view (e.g., remembering to ask about the By-Name List when talking about access and eligibility; inviting people to explain how they use the common assessment tool). The aim was to understand how service delivery processes work from the perspectives of those seeking support to resolve their homelessness, as well as those delivering, managing, or governing these services. We also wanted to understand people's experiences with the Coordinated Access process and the various homeless-serving organizations that the process is meant to coordinate.
What did we learn?
There is a mismatch between the magnitude of the housing and homelessness crisis and the positioning of Coordinated Access as a viable solution to this crisis. Coordinated Access rests on the assumption that the central problem in homelessness-serving sectors is a lack of structured decision-making and coordination of services, rather than a lack of appropriate housing and social and healthcare support for individuals and families in need.
We also learned that several specific things undermine the efficacy of this process in our community.
- Common community access points (i.e., shelters) are not accessible to everyone in housing need. At the time of this research, a growing number of people were choosing not to use the shelter system or had received service restrictions and could not access it. Thus, the most common community access point for Coordinated Access was not serving about half of those in our community experiencing homelessness.
- The Coordinated Access process itself is not understood by most of the people we interviewed who were unhoused. Some people knew they had completed the standardized assessment, but they had never heard of the By-Name List; others knew about the By-Name List, but they had not heard of the assessment; others knew about both parts, but not the requirement that they update their housing status to stay active on the By-Name List; and others had no idea about any aspect of the process. Service providers reported similar concerns.
- High turnover in frontline staff has led to variation in the implementation of standardized assessment tools (SPDAT or VI-SPDAT), producing unreliable results. This undermines their utility for the prioritization and matching processes. The people we interviewed also expressed a concern that the standardized tool is not trauma-informed. It can be distressing for those who receive it and those who administer it to others.
- We were struck by another mismatch between the solution on offer and known drivers of homelessness. For example, the focus on standardized assessment in Coordinated Access implies that service provider decision-making (framed as service provider advocacy) undermines the efficacy and fairness of a functioning housing and homelessness system. However, we have found no evidence that the increase in homelessness across Canada is the result of service providers’ inability to objectively assess people's interrelated vulnerabilities. Rather, research consistently identifies poverty, housing availability and affordability as the primary drivers of homelessness across the global North (Fitzpatrick et al., 2021).
- The prioritization process is undermined by the reliability of the vulnerability assessment results and a lack of suitable housing options. Unfortunately, problems with the standardized assessment tool undermine the efficacy of both the vulnerability assessment and the prioritization processes —and continued housing resource scarcity means that even if a person is assessed to be within a priority group, they may wait a long time to get a housing unit.
- The matching and referral process is undermined by a lack of suitable housing resources. Coordinated Access is framed as an evidence-led process for ensuring people without housing are matched with housing resources that suit their needs. However, our research found that there are far fewer housing resources for people experiencing multiple barriers to housing stability (people described as "high acuity" in relation to their SPDAT score) than are needed in our community. There are also far fewer affordable housing units than there are people in core housing need, placing people at risk of episodic homelessness and increasing the risk of chronic homelessness for anyone who becomes homeless in this rental market.
Our research identified structural challenges that undermine the efficacy of Coordinated Access as the main tool for solving homelessness endorsed by the Government of Canada. Findings explain why, and despite being an early adopter of the Coordinated Access process, fewer than 5% of those people on the By-Name List who were housed through Coordinated Access in 2022 in our community.
Why should people care about this research?
In our research, we learned that the human-centred aspects of social service work remain essential to enabling stable tenancies. As anyone currently engaged in the provision of housing support knows, matching and referral is not simply a technical process, enabled by the use of standardized assessment tools. It is a highly relational process requiring a commitment to flexibility, communication, and self-determination (from people in housing need).
Indeed, the best practice for Coordinated Entry (the US system upon which Coordinated Access has been modeled) continues to include a case conferencing model for moving people off the By-Name List and into suitable housing (Brown et al., 2023). Case Conferencing is not without its potential pitfalls (e.g., those who advocate more effectively can be more effective at getting their clients into housing), but it also acknowledges that service providers have relationships with service users and service users have relationships with one another – all of which may impact a person's capacity to retain their tenancy (Brown, et al., 2023).
Although Coordinated Access and Coordinated Entry assume that homelessness can be addressed by improving structured decision-making among service providers and addressing service coordination, our research suggests that the problem of increasing homelessness is not the result of poor service delivery practices in the homeless serving sector. Rather, poverty, housing availability, and housing affordability are the primary causes of homelessness across the global North (Fitzpatrick et al., 2021). Coordinated Access does not address any of the known causes of homelessness.
Furthermore, there is increasing evidence that Canada’s contemporary housing crisis is the result of changing political-economic policy in Canada and globally, characterized by a shift in housing policy toward home ownership and deregulation of the housing market. Today, Canada has one of the least affordable housing markets among OECD nations. The financialization of housing, disinvestment in social welfare spending, and downloading of economic and administrative responsibility to municipal governments are important drivers of the affordability crisis.
Directing Canadian communities to implement Coordinated Access – a process for streamlining access to the homeless-serving system – in the current context of increasing inequality and housing unaffordability sets the process up to fail. Without continued federal and provincial/territorial investments in a deeply affordable housing infrastructure (some of which must be coupled with health and social care support), communities will not be able to mobilize the economic investments required for Coordinated Access to advance local efforts to realize the right to housing.
In other words, for Coordinated Access to be useful, sufficient investments need to be made in deeply affordable housing, including housing-led health and social care interventions for those who require them.
What did our community do with these findings?
First, we gathered in May 2023 for a half-day community symposium to share our findings and prioritize local actions. We diversified our local emergency housing options to include several initiatives that better meet the needs of people who cannot or choose not to use the shelter system. To learn more about these efforts and how our community put them into play, check out this podcast.
Second, we got together again for a two-day community symposium in February, 2024. This time, the event was an opportunity for people to exchange knowledge with one another (rather than for people to simply engage with our own research findings) and to put this new knowledge into action. You can listen to all of the audio-recorded sessions here.
The results of all this work have been synthesized in a local roadmap for change, which will be available on the RSCL website by mid-July.
By participating in this research, our community had a chance to reconsider our efforts, reflect on what is working well, and what can be improved. We haven’t solved homelessness, but ending homelessness is not something cities can do on their own without significant policy and economic investments from the provincial, territorial and federal governments. However, I am confident we have diversified our response, such that we are better able to meet people’s needs, treat people with the dignity we all deserve, and continue to build community resilience.