Condition category
Not Applicable
Date applied
29/05/2020
Date assigned
25/06/2020
Last edited
25/08/2020
Prospective/Retrospective
Retrospectively registered
Overall trial status
Ongoing
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
Housing First (HF) is a complex housing and support intervention for homeless individuals that is becoming well-known internationally and that has been implemented in some Canadian cities with positive outcomes. Programs – including the Pathways model and the At Home/Chez Soi project – have shown notable success in addressing the needs of adults who experience homelessness by specifically prioritizing chronically homeless persons with significant mental health and addiction issues. However, the results are less certain when it comes to young people.
Available evidence suggests that the experience of youth homelessness is distinct from adult homelessness, both in terms of its causes and conditions, as well as the solutions. An effective response must focus on positive outcomes for young people across a range of life domains including: housing stability, health and well-being, social connections to peers, family and meaningful adults, connections to communities, and school and work aspirations. Based on this understanding, it is believed that with the appropriate adaptations, HF will also be effective for the population of young people who experience homelessness.
Together with community agencies delivering interventions, young people themselves, and the broader network of service providers, the Housing First for Youth (HF4Y) Demonstration Project is evaluating the impact of a HF model adapted specifically to the context of youth homelessness in two Canadian cities: Toronto and Ottawa. This study will test whether a complex housing and support intervention for young adults (aged 13–24) who experience homelessness, or who are at risk of becoming homeless, works under real-life conditions. This study will also investigate what modifications are needed to effectively serve particular sub-populations of young people (exiting the child welfare system, LGBQT2S+, ethnic groups, Indigenous).

Who can participate?
Up to 180 participants will be recruited through local agencies and providers who are in contact with young people experiencing or at risk of becoming homeless in each city. Participants must be between the ages of 17 and 24 years old, have experienced homelessness in the past year and/or are at imminent risk of becoming homeless at the time of enrollment, and require a moderate level of support.

What does the study involve?
Participants from each site will be randomly allocated to either Housing First for Youth (HF4Y); or Treatment As Usual (TAU). Participants allocated to the HF4Y group receive housing and support in accordance with the Housing First for Youth model framework, including the provision of a housing subsidy, for the duration of the program. They are offered a range of housing options with no treatment pre-conditions (crisis, transitional, supportive, or scatter-site with mobile support), and are provided with an array of support options related to housing retention, well-being, income and employment, education, social inclusion, and complementary supports. Intensive Case Management (ICM) provides support via a case manager working a standard work week and carrying a case load of roughly 10 clients. ICM provides limited direct care and otherwise aims to engage clients with relevant health and social services as indicated (i.e., a brokerage model). Participants randomly allocated to TAU will have access to support and to regular housing available in each community for young people, including available income support, drop-ins, health/mental health clinics, emergency shelters, transitional housing and longer-term housing. Participants in this group will be provided with an information package about both housing and supports, and are invited to use the field office and/or participating service agency as a resource. A general logic model is guiding service delivery at both project sites, project activities and intervention components will vary accordingly. Participants in both groups are asked to complete interviews every 3 months for 24 months. Additionally, a sub-sample are invited to participate in interviews during the first 12 months and 24 months. These data will be used to evaluate the impact of the intervention over the 2-year trial period and will be refreshed after completion of the trial in 2021 in order to assess the long-term welfare of study participants.

What are the possible benefits and risks of participating?
Participating in the study will provide benefits in that successful results will increase the chances that HF4Y will be made available more widely across Canada. As mentioned, the study is part of a wider initiative that will create knowledge products and strategies for implementing the approach more widely, both nationally and internationally, and will contribute important data to the nascent body of knowledge on HF4Y. The participants in the HF4Y group will receive the benefit of being provided housing and support that is over and above the usual care offered in the community, for the duration of the study and possibly beyond, if funds for sustainability are secured. Participants in both groups have the opportunity to be listened to and remunerated to tell the researchers about their experiences.
In both parts of the study participants are asked about their histories of trauma and abuse and/or asked questions that may cause youth to reflect on experiences related to their lives before being homeless, or to the experience of being homeless that may be traumatic. The research team will fully inform research participants about potential risks related to arising distress, and will discuss with the participant in advance of the interview the steps available for support needs. Before each interview the research team will alert the service team to the possibility of the need for their support. Research interviews generally take place on the premises of agencies with staff who can provide immediate support if distress occurs. Should the research take place off the premises of such agencies, participants will be informed of the options for obtaining support, and provided with the means to access it from the appropriate place.

Where is the study run from?
The study is run from two sites: Ottawa and Toronto. Youth Services Bureau in Ottawa is administering the program, while Woodgreen Community Services is providing the program in Toronto.

When is the study starting and how long is it expected to run for?
August 2017 to March 2021

Who is funding the study?
Employment and Social Development Canada, Youth Employment Strategy - Skills Link (Canada)

Who is the main contact?
Cora MacDonald
coramac@yorku.ca

Trial website

https://www.homelesshub.ca/MtSDEMS

Contact information

Type

Public

Primary contact

Ms Cora MacDonald

ORCID ID

Contact details

Canadian Observatory on Homelessness
York University
629 Kaneff Tower
4700 Keele Street
Toronto
M3J 1P3
Canada
+1 (0)902 830 6170
coramac@yorku.ca

Type

Scientific

Additional contact

Dr Stephen Gaetz

ORCID ID

http://orcid.org/0000-0002-4109-5611

Contact details

Canadian Observatory on Homelessness
York University
629 Kaneff Tower
4700 Keele Street
Toronto
M3J 1P3
Canada
+1 (0)416 736 2100
sgaetz@edu.yorku.ca

Additional identifiers

EudraCT number

Nil known

ClinicalTrials.gov number

Nil known

Protocol/serial number

1441994

Study information

Scientific title

Making the Shift demonstration project: Housing First For Youth randomized controlled trial

Acronym

MtS Dems: HF4Y

Study hypothesis

1. To determine whether Housing First for Youth (HF) results in better outcomes than treatment as usual (TAU) for young people experiencing homelessness in two urban settings with respect to: (a) housing stability; (b) health and wellbeing; (c) education and employment; (d) complementary supports; and (d) social inclusion.
2. To examine the correlates of different trajectories of interest such as housing stability, health and well-being, community integration and employment over time.
3. To identify the critical pieces of the Housing First for Youth model and what modifications are needed to effectively serve particular communities and sub-populations (e.g. youth exiting the child welfare system, Indigenous youth, LGBTQ2S youth).

Ethics approval

Approved 12/05/2017, York University Human Participants Review Committee (Office of Research Ethics, 5th Floor, York Research Tower, 4700 Keele St., Toronto, ON, Canada, M3J 1P3; +1 (0)416 736 5914; acollins@yorku.ca), REC ref: 2017 - 382

Study design

Randomized control trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Community

Trial type

Quality of life

Patient information sheet

Not available in web format, please use the contact details to request a participant information sheet

Condition

Youth homelessness

Intervention

HF4Y is based on the understanding that the causes and conditions of youth homelessness are distinct from adults, and therefore the solutions must be distinct as well. Just as Housing First addresses homelessness for adults, HF4Y addresses youth homelessness through a youth lens. HF4Y is grounded in the belief that all young people have a right to housing and that those who have experienced homelessness will do better and recover more effectively if they are first provided with housing.

To find out which kind of supported housing works best, the researchers are comparing young people receiving Housing First with those in Services As Usual in two different regions, Ottawa and Toronto. This means that those who agree to participate will be assigned at random to receive either Housing First (rent supplements and support services from a case manager).

The intervention group, known as the Housing First For Youth (HF4Y), receive programming delivered by YYouth Services Bureau (YSB [Ottawa]) and Woodgreen Community Services (WGCS [Toronto]) in accordance with the HF4Y framework, including the provision of housing subsidy, for the duration of the study (two years). They are offered housing options with no preconditions, and provided an array of support options related to housing retention, well-being, income and employment, education, social inclusion, and complementary support

The control group, known as the Services As Usual (SAU) group have access to supports and to regular housing available in each community for young people, including available income support, drop-ins, health/mental health clinics, emergency shelters, transitional housing and longer-term housing. Participants in this group are provided with an information package about both housing and supports, and invited to use the field office, and/or participating service agency as a resource. They do not receive the HF4Y model provided by the community partner agencies.

All participants will be interviewed every 3 months over a period of two years and may be asked to continue in a longer 5-year follow-up study. The data being collected includes residential movement data, vocational data, and a survey with various measures capturing data for primary and secondary outcomes analysis. Prior to the COVID-19 pandemic, most of this data was collected in-person with a mix of paper and online surveys. Due to COVID-19, research assistants strictly focus on online note-taking and survey collection.

Intervention type

Other

Phase

Drug names

Primary outcome measure

1. Housing stability measured using Residential Timeline Followback at baseline, 6, 12, 18 and 24 months
2. Complementary Supports measured using Youth Life Skills Assessment at baseline, 6, 12, 18 and 24 months

Secondary outcome measures

1. Education and employment measured using Attitudes Toward School, Vocational Timeline Followback at baseline, 6, 12, 18 and 24 months
2. Health and mental well being measured using Brief Symptom Inventory, GAIN-SS, Resilience Scale-14, World Health Organization Quality of Life-BREF, ACE Questionnaire (only administered at 6 months), at baseline, 6, 12, 18 and 24 months
3. Social Inclusion measured using Multidimensional Scale of Perceived Social Support, Community Integration Scale at baseline, 6, 12, 18 and 24 months

Overall trial start date

01/08/2017

Overall trial end date

31/03/2021

Reason abandoned (if study stopped)

Eligibility

Participant inclusion criteria

In Ottawa:
1. Youth aged 18-24
2. In need of housing and case management
3. Housing status as Unsheltered, Emergency sheltered, Provisionally accommodated or At-risk of homelessness, according to the Canadian Definition of Youth Homelessness

In Toronto:
1. Youth aged 17-21
2. Current or former Crown Ward
3. In need of housing and case management services
4. Housing status as Unsheltered, Emergency sheltered, Provisionally accommodated or At-risk of homelessness, according to the Canadian Definition of Youth Homelessness

Participant type

Other

Age group

Mixed

Gender

Both

Target number of participants

140

Participant exclusion criteria

Young people will be excluded from the study if:
1. They cannot reasonably receive case management services (e.g. impending imprisonment or relocation that is outside city limits)
2. They do not give consent to receiving intense case management service delivery over the 24-month duration of the program
3. They are enrolled in and/or are receiving housing first services delivered through agencies within the City
4. They are less than 18 years of age or older than 24 years of age at intake (Ottawa); they are less than 17 years of age or older than 21 years of age at intake (Toronto)
The above criteria for exclusion were developed in consultation with partners to align with the needs and priorities in each region

Recruitment start date

12/02/2018

Recruitment end date

15/03/2020

Locations

Countries of recruitment

Canada

Trial participating centre

Youth Services Bureau
2675 Queensview Drive
Ottawa
K2B 8K2
Canada

Trial participating centre

WoodGreen Community Services
1533 Victoria Park Avenue
Toronto
M1L 2T3
Canada

Trial participating centre

York University
629 Kaneff Tower 4700 Keele Street
Toronto
M3J 1P3
Canada

Trial participating centre

A Way Home Canada
720 Bathurst St
Toronto
M5S 2R4
Canada

Sponsor information

Organisation

A Way Home Canada

Sponsor details

720 Bathurst St
Toronto
M5S 2R4
Canada
+1 (0)416 907 8458
ocundangan@awayhome.ca

Sponsor type

Other

Website

https://awayhome.ca/

Funders

Funder type

Government

Funder name

Employment Skills Development Canada

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Results and Publications

Publication and dissemination plan

1. A manuscript protocol is in development to be published by late 2020
2. Planned publication in a peer-reviewed journal
3. Reports (baseline and 1 year) to community partners involved

IPD sharing statement
The datasets generated during and/or analysed during the current study are/will be available upon request from Aranie Vijayaratnam (avijay12@yorku.ca).

Intention to publish date

31/03/2022

Participant level data

Available on request

Basic results (scientific)

Publication list

Publication citations

Additional files

Editorial Notes

25/08/2020: The scientific title has been changed from "Making the Shift demonstration project: Housing First For Youth randomized control trial" to "Making the Shift demonstration project: Housing First For Youth randomized controlled trial". 11/06/2020: Trial's existence confirmed by York University Human Participants Review Committee.