"I want purpose in my life": A qualitative exploration of how homeless youth envision their futures.

Preparing for the future is a major developmental task during adolescence and early adulthood. However, youth experiencing homelessness face additional challenges relating to economic instability, housing insecurity, and a lack of social support. Semi-structured interviews were conducted with 38 youth, from Ottawa and Toronto, who were experiencing homelessness and participating in a randomized controlled trial of Housing First for Youth (HF4Y). This qualitative study explores youths' visions for the future, including their goals, aspirations, plans, and barriers to achieving them. Overall, findings demonstrated that youth had positive visions of the future and strove to reach developmentally appropriate goals and responsibilities. Compared to youth receiving HF4Y, the future expectations of those receiving treatment as usual (TAU) were characterized by uncertainty and lacked clear direction. Additionally, they emphasized self-reliance and autonomy, while HF4Y prioritized forming relationships and reconnection. Findings highlight the importance of stable housing intervention, and social, community, and financial support in planning for the future and transitioning out of homelessness. Implications for intervention, directions for future research, and limitations are provided.

Evaluating the Effectiveness of the Housing First for Youth Intervention for Youth Experiencing Homelessness in Canada: Protocol for a Multisite, Mixed Methods Randomized Controlled Trial.

BACKGROUND: Emerging evidence at the international level suggests that the Housing First approach could improve the housing stability of young people experiencing homelessness. However, there is a dearth of literature in Canada on whether the Housing First intervention for young people experiencing homelessness can improve outcomes including housing stability, health and well-being, and access to complementary supports. Adapted from the original Housing First model, Housing First for Youth (HF4Y) was developed in Canada as a rights-based approach tailored specifically for young people aged 16 to 24 years who are experiencing or are at risk of homelessness. OBJECTIVE: The Making the Shift Youth Homelessness Social Innovation Lab is testing the effectiveness of the HF4Y intervention in Canada. The objective of this study is to determine whether the HF4Y model results in better participant-level outcomes than treatment-as-usual services for young people experiencing homelessness in 2 urban settings: Ottawa and Toronto, Ontario. Primary outcomes include housing stability, health and well-being, and complementary supports, and secondary outcomes include employment and educational attainment and social inclusion. METHODS: The HF4Y study used a multisite, mixed methods, randomized controlled trial research approach for data collection and analysis. Eligible participants included young people aged 16 to 24 years who were experiencing homelessness or housing precarity. The participants were randomly assigned to either the treatment-as-usual group or the housing first intervention group. Survey and interview data in Ottawa and Toronto, Ontario are being collected at multiple time points (3-6 months) over 4 years to capture a range of outcomes. Analytic strategies for quantitative data will include mixed-effects modeling for repeated measures and logistic models. A thematic analysis will be used to analyze qualitative data based on participants' narratives and life journeys through homelessness. Furthermore, program fidelity evaluations are conducted within each HF4Y program. These evaluations assess how well the intervention aligns with the HF4Y model and identify any areas that may require adjustments or additional support. RESULTS: The HF4Y study has received human participant research ethics approval from the Office of Research Ethics at York University. Recruitment was conducted between February 2018 and March 2020. Data collection is expected to be completed at both sites by March 2024. A preliminary analysis of the quantitative and qualitative data collected between baseline and 24 months is underway. CONCLUSIONS: This pilot randomized controlled trial is the first to test the effectiveness of the HF4Y intervention in Canada. The findings of this study will enhance our understanding of how to effectively deliver and scale up the HF4Y intervention, with the aim of continually improving the HF4Y model to promote better outcomes for youth. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) ISRCTN10505930; https://www.isrctn.com/ISRCTN10505930. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46690.

Workplace trauma and chronic stressor exposure among direct service providers working with people experiencing homelessness.

BACKGROUND: Service providers working with people experiencing homelessness can be directly and indirectly exposed to trauma and other chronic stressors in their work. The types of individuals that are most at-risk of problematic outcomes from traumatic event exposure are unknown. AIM: This study examined exposure to and effects of workplace traumas and stressors among service providers working with people experiencing homelessness in Canada. METHODS: A cross-sectional survey was completed by 701 direct service providers working in the homeless service, supportive housing, and harm reduction sectors. Descriptive statistics, hierarchical multiple regression, and double moderation models were used in the analysis. RESULTS: Employment in homeless service settings, service provision to single adults, and more time in direct contact with service users were each positively associated with the frequency of exposure to critical events and chronic stressors. Younger age, lived experience of behavioural health problems, more frequent exposure to chronic stressors, and less social support from coworkers were significantly correlated with post-traumatic stress and general psychological distress. Emotional support from supervision moderated the relationship between direct exposure to workplace critical events and post-traumatic stress. CONCLUSIONS: More trauma-informed psychosocial supports tailored to the needs of direct service providers working with people experiencing homelessness are needed.

Shelter Bans Among People Experiencing Homelessness: an Exploratory Study of Predictors in Two Large Canadian Datasets.

Emergency shelters are a core component of homeless service systems that address immediate basic needs. Service bans, which refer to temporary or permanent disallowances from a program or organization, are an underresearched phenomenon that can leave people experiencing homelessness without needed supports. This exploratory study examined the factors associated with shelter bans among people experiencing homelessness using secondary data from two Canadian studies: (1) a multisite randomized controlled trial of Housing First (At Home/Chez Soi Demonstration Project) and (2) a cross-sectional survey of youth experiencing homelessness across Canada (2019 Without a Home-National Youth Homelessness Survey). The two datasets were analyzed separately using logistic regression models with similar predictors to maximize the comparability of the results. Participants who experienced homelessness at an earlier age and had recent criminal justice system involvement were more likely to have shelter bans in both datasets. Impaired impulse control, more chronic medical conditions and living in Toronto were associated with increased likelihood of shelter bans in the At Home/Chez Soi dataset, whereas more adverse childhood experiences, physical violence victimization, engagement in survival sex behaviours and longer current episodes of homelessness were significant predictors of bans in the Without A Home dataset. Overall, the findings suggest that victimization and criminalization during homelessness may increase the risk of shelter loss from bans and further exclusion. The observed regional differences also highlight the potential limits of individual-level predictors. Further research is needed on shelter ban outcomes, as well as how capacity limits and organizational policies affect banning decisions.

Mental Health and Wellness of Service Providers Working with People Experiencing Homelessness in Canada: A National Survey from the Second Wave of the COVID-19 Pandemic.

OBJECTIVE: This study examined the scope of common mental health problems and perceived impacts of the COVID-19 pandemic among direct service providers working with people experiencing homelessness in Canada. METHOD: This cross-sectional study used an online survey that was disseminated to homeless service, supportive housing, and harm reduction organizations and networks. Data were collected on depression, anxiety, stress, post-traumatic stress, compassion satisfaction and fatigue, and substance use problems as well as pandemic-related changes in mental health and wellness. A total of 701 service providers completed the survey and were included in data analysis. Descriptive statistics were used to examine the primary research questions, with hierarchical multiple regression models also being fit to explore mental health and wellness differences by occupational service setting. RESULTS: Most direct service providers (79.5%) working with people experiencing homelessness reported a decline in their mental health during the pandemic. There were high rates of common mental health problems within the sample that are largely consistent with those found among health-care workers during the pandemic. Occupational service settings were not associated with the severity of mental health problems, indicating pervasive issues across the workforce, though providers who were younger and spent more time in direct service roles were at greater risk. CONCLUSIONS: The common mental health problems and negative impacts of the pandemic among service providers working with people experiencing homelessness highlight a highly vulnerable workforce that could benefit from improved access to supports. Given the similarities between our findings and other studies examining essential workforces, it is recommended that initiatives that provide accessible mental health care to the health-care workforce during the pandemic be expanded to include homeless and social service providers.

Climate Change, Weather, Housing Precarity, and Homelessness: A Systematic Review of Reviews.

This systematic review of reviews was conducted to examine housing precarity and homelessness in relation to climate change and weather extremes internationally. In a thematic analysis of 15 reviews (5 systematic and 10 non-systematic), the following themes emerged: risk factors for homelessness/housing precarity, temperature extremes, health concerns, structural factors, natural disasters, and housing. First, an increased risk of homelessness has been found for people who are vulnerably housed and populations in lower socio-economic positions due to energy insecurity and climate change-induced natural hazards. Second, homeless/vulnerably-housed populations are disproportionately exposed to climatic events (temperature extremes and natural disasters). Third, the physical and mental health of homeless/vulnerably-housed populations is projected to be impacted by weather extremes and climate change. Fourth, while green infrastructure may have positive effects for homeless/vulnerably-housed populations, housing remains a major concern in urban environments. Finally, structural changes must be implemented. Recommendations for addressing the impact of climate change on homelessness and housing precarity were generated, including interventions focusing on homelessness/housing precarity and reducing the effects of weather extremes, improved housing and urban planning, and further research on homelessness/housing precarity and climate change. To further enhance the impact of these initiatives, we suggest employing the Human Rights-Based Approach (HRBA).

The Second National Canadian Homeless Youth Survey: Mental Health and Addiction Findings: La Deuxième Enquête Nationale Auprès des Jeunes Sans Abri : Résultats en Matière De Santé Mentale et de Toxicomanie.

OBJECTIVE: Youth experiencing homelessness represent a major social problem in Canada and, as demonstrated in the first national survey of this population conducted in 2015, are experiencing significant mental health challenges. The present study examines the findings of a second national survey completed in 2019. These findings afford the opportunity to examine the reliability of the findings of the first study with another large, representative sample and to attempt to articulate the unique characteristics of youth experiencing the greatest distress among this at-risk population. METHODS: This study analyzed the mental-health-related data from the 2019 Without a Home-National Youth Homelessness Survey that was administered through convenience sampling at 98 agencies serving homeless youth in 49 communities across Canada. The survey was cross-sectional and self-administered, assessing a range of demographic information, pre- and post-homelessness variables, and mental health indicators. Multinomial logistic regression and linear regression were implemented to evaluate associations with distress level. RESULTS: Survey data were obtained from 1,375 youth accessing Canadian homeless services in 9 provinces. Thirty-five percent reported at least 1 suicide attempt, and 33.1% reported a drug overdose requiring hospitalization. The findings of this survey replicated most of the key findings from the 2015 survey. The current findings emphasized, for this high-risk population, the heightened adversity faced by young women, Lesbian, Gay, Bisexual, Transgender, Queer, Two-Spirit (LGBTQ2S), and Indigenous subpopulations, as well as the centrality of violence exposure in determining risk and distress. Sexual violence, in particular, emerged as a key factor in the identification of youth experiencing the greatest distress with risk buffered by contact with family. CONCLUSIONS: These findings can inform prevention and intervention policies and services and reinforce the importance of attending to violence exposure and trauma as central to the mental health trajectories of youth who have experienced homelessness.

Turning Off the Tap: A Typology for Homelessness Prevention.

As states move beyond simply managing their homelessness crises to looking for ways to reduce and ultimately end homelessness, broad-scale efforts to prevent homelessness are lacking. Experiences of homelessness are often harmful, traumatic, and costly, making a compelling case for why homelessness prevention should be prioritized. In recent years, countries such as Australia, Finland, and Wales have shifted their focus to prevention, but there remains a conceptual and systematic gap in our collective knowledge about what precisely homelessness prevention is, what policies, programs, and interventions are captured in a homelessness prevention strategy, and how to build a framework for orienting our response to homelessness towards prevention. This article begins to fill that gap by providing a definition and typology of homelessness prevention (THP). Our definition offers a schema to clarify the nature of homelessness prevention and to develop a collective response between various policies and practices that can and should be framed as homelessness prevention. Building off of the public health model of prevention and pre-existing homelessness prevention classification systems, our THP complements the definition by specifying the pragmatic nature of prevention initiatives and the range of sectors, stakeholders, and levels of government required to respond to the causes of homelessness. Our typology is made up of five interrelated elements: structural, systems, early intervention, evictions prevention, and housing stabilization. Each of these elements contains actionable strategies that cut across primary, secondary, and tertiary prevention to ensure that people at various levels of risk have access to the tools and resources necessary to find and maintain safe, appropriate, and suitable housing. Together the definition and THP are useful tools to envision a new way forward in how we respond to homelessness.

Evolving an evidence-based model for homelessness prevention.

While some progress has been made in addressing chronic homelessness through supportive models, a comprehensive solution for housing loss must include prevention. The purpose of this article is twofold: to conduct a review of the literature on the domains of the Framework for Homelessness Prevention; and to use literature on the concept of quaternary prevention, preventing the harms of service provision, to theorise an additional domain. The Framework for Homelessness Prevention draws upon theory from public health exploring primary, secondary and tertiary prevention, and also integrates primordial prevention. This leads to a typology of homelessness prevention that incorporates the following five domains: (a) Structural prevention; (b) Systems prevention; (c) Early intervention; (d) Eviction prevention; and (e) Housing stability. By systematically reviewing the literature we build out the evidence-base supporting these domains. The team used research databases, internet searches and retrospective reference list reviews to identify high-quality journal articles on prevention, which were then sorted by level of prevention. Through this process, we evolved our thinking on the Framework in considering that quaternary prevention was not initially included. Therefore, we explored the literature related to quaternary prevention in the context of homelessness and offer a sixth domain for the Framework: Empowerment. Ultimately, a comprehensive Framework for Homelessness Prevention will support communities and governments to more effectively prevent homelessness through upstream approaches.

Quality of Life and Mental Well-Being: A Gendered Analysis of Persons Experiencing Homelessness in Canada.

Homelessness has negative implications for mental well-being and quality of life. This paper identifies the quality of life variables that contribute to positive or negative wellbeing, reporting on a regression analysis from 343 individuals experiencing homelessness in Canada. Results indicate that a lack of sleep duration and quality reduced mental well-being for both genders, not having access to food and/or hygiene facilities decreased men's well-being, and engaging in illegal subsistence strategies, such as selling drugs, negatively impacted women's mental well-being. For persons experiencing homelessness, mental well-being and quality-of-life are gendered outcomes of their limited access to social determinants of health.

Youth homelessness and housing stability: What outcomes should we be looking for?

In North America, the key performance indicator of success in community strategies to address homelessness is whether a homeless person is housed or not. In this article, we argue that for young people experiencing homelessness, we need to advance a broader consideration of outcomes to include a range of well-being indicators designed to understand the needs of developing adolescents and young adults and contribute to housing stability. We articulate that the positive outcomes of young people across life domains that include housing stability as well as their safety and security, health and well-being, social connections to peers, family and meaningful adults, connections to groups/neighbourhoods/communities, interests and recreation and leisure, and school and career/work aspirations and goals must be at the centre of these efforts. The Making the Shift project is designed to test this outcomes framework in order to enhance service and measurement capacity and ultimately improve outcomes for youth.

Commentary: Harm reduction, managed alcohol programs and doing the right thing.

In this commentary to the special issue on managed alcohol programs, the necessity of working from a harm reduction orientation when supporting people who experience homelessness is explored. While not all people who experience homelessness have substance use disorders, many respond to experiences of trauma and exclusion through the use of substances, and in many cases this leads to problematic use. In a context where people who are homeless regularly experience the control and regulation of their lives through emergency services, harm reduction approaches provide a welcomed alternative through humane, respectful, effective and client centred approaches to addressing substance use disorders. The articles in this volume demonstrate the value of managed alcohol programs to support people whose consumption of alcohol is problematic. The emerging evidence base for managed alcohol programs has important implications for policy and practice.

The 2015 National Canadian Homeless Youth Survey: Mental Health and Addiction Findings.

OBJECTIVE: This study was designed to provide a representative description of the mental health of youth accessing homelessness services in Canada. It is the most extensive survey in this area to date and is intended to inform the development of mental health and addiction service and policy for this marginalized population. METHODS: This study reports mental health-related data from the 2015 "Leaving Home" national youth homelessness survey, which was administered through 57 agencies serving homeless youth in 42 communities across the country. This self-reported, point-in-time survey assessed a broad range of demographic information, pre-homelessness and homelessness variables, and mental health indicators. RESULTS: Survey data were obtained from 1103 youth accessing Canadian homelessness services in the Nunavut territory and all Canadian provinces except for Prince Edward Island. Forty-two per cent of participants reported 1 or more suicide attempts, 85.4% fell in a high range of psychological distress, and key indicators of risk included an earlier age of the first episode of homelessness, female gender, and identifying as a sexual and/or gender minority (lesbian, gay, bisexual, transgender, queer, and 2 spirit [LGBTQ2S]). CONCLUSIONS: This study provides clear and compelling evidence of a need for mental health support for these youth, particularly LGBTQ2S youth and female youth. The mental health concerns observed here, however, must be considered in the light of the tremendous adversity in all social determinants faced by these youth, with population-level interventions best leveraged in prevention and rapid response.

An Examination of Charitable Meal Programs in Five Canadian cities.

While there has recently been considerable research and public investment in strategies to address homelessness in Canada, food charity remains the primary response to hunger, with little evaluation of current efforts and no initiatives to develop more effective approaches. Using data from a 2010-2011 survey of charitable food assistance in five Canadian cities, this study was undertaken to describe charitable meal provisioning in each city and to compare the relative roles of emergency programs and multi-service agencies and their capacity to meet food needs. Most meals were provided by multi-service agencies, but like emergency programs, these agencies were heavily dependent on donations and they were more likely than emergency programs to report constraints and service interruptions because demands exceeded available supplies. Our findings underscore the resource-limited and often fragile nature of charitable meal programs in Canada and highlight the need for more effective models of response to problems of hunger.

Homeless youth's overwhelming health burden: A review of the literature.

Homelessness has reached epidemic proportions in Canada. Canadian children and adolescents are the most vulnerable because youth comprise the fastest growing segment of the homeless population. A systematic literature review was undertaken using MEDLINE, Web of Science and the Homeless Hub (www.homelesshub.ca) to encompass the time frame from January 1990 to June 2009. The following terms were used as key words: 'homelessness', 'homeless youth', 'poverty', 'street youth' and 'runaway'. The present review identified an intersection among education deficits, social service insufficiencies, and poor mental and physical health in homeless youth. Health care delivery to homeless youth was often nonanticipatory, inconsistent and perceived as discriminatory. However, street youth were identified as requiring health care for pregnancy, mental health concerns, sexually transmitted illnesses, respiratory conditions, substance abuse and a myriad of other illnesses. Plenty of work is still required to reduce health inequalities and improve the daily living conditions of Canadian youth living in poverty.

An ethnographic study of meal programs for homeless and under-housed individuals in Toronto.

Over the past two decades, Canada has witnessed a proliferation of community-based initiatives providing charitable meals to homeless and under-housed individuals. The existing research has raised concerns about the ability of such initiatives to meet users' nutrient needs. As part of a study of Toronto meal programs, open-ended interviews with program coordinators and observations of 16 meal programs were conducted to provide insight into the nutritional vulnerability of program users. Analysis using ethnographic methods revealed that, although charitable meal programs began in response to concerns about unmet food needs, the planning and delivery of meals are disconnected from the dietary needs of program users. Food was often a secondary service, designed to fit within the existing operations, resources, and mandate of the host agency. This work adds to calls for a rethinking of current responses to problems of hunger and food insecurity among individuals living in poverty in Canada.

Food deprivation is integral to the 'hand to mouth' existence of homeless youths in Toronto.

OBJECTIVE: To describe homeless youths' experiences of food insecurity and examine the relation between chronic food deprivation and food acquisition practices. DESIGN: A cross-sectional survey of homeless youths was conducted in 2003 to assess their nutritional vulnerability and describe their food acquisition practices. SETTING: Toronto, Canada. SUBJECTS: Two hundred and sixty-one youths, aged 16-24 years, who had spent ten or more of the past thirty nights sleeping in a temporary shelter, public space or friend's place, because they had no place of their own. Most participant recruitment (70%) occurred outdoors, but 30% were recruited in drop-in centres. RESULTS: Over the past 30 d, 28% of males and 43% of females experienced chronic food deprivation (i.e. reduced food intake for > or =10 d), and 32% of females and 48% of males reported problems obtaining water to drink. Most youths routinely obtained meals at charitable programmes and panhandled for money for food, and many routinely stole food or ate day-old food obtained from restaurants. In contrast, eating food discarded by others and postponing debt payments were strategies of desperation, more common among youths experiencing chronic food deprivation. Additionally, for males, deliberately seeking the company of friends, relatives or acquaintances to obtain food, and for females, borrowing money or trading sex for food, were associated with chronic food deprivation. CONCLUSIONS: The pervasiveness and severity of food insecurity experienced by the youths and their desperate means of food acquisition highlight the need for more effective responses to the plight of homeless youths in Canadian cities.