Research demonstration projects in youth homelessness
| ISRCTN | ISRCTN10505930 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN10505930 |
| Secondary identifying numbers | 1441994 |
- Submission date
- 29/05/2020
- Registration date
- 25/06/2020
- Last edited
- 08/04/2025
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
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 16-24) 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?
Young people between the ages of 17 and 24 years, experiencing homelessness or housing precarity at the time of enrolment, and who meet the site-specific criteria in each city:
1. Ottawa-site participants must be between the ages of 18 and 24 years and experiencing homelessness or housing precarity at the time of enrolment.
2. Toronto-site participants must be between the ages of 17 and 24 years, experiencing or at risk of homelessness and have been in or be transitioning out of the provincial child welfare system at the time of enrolment.
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 48 months. Additionally, a sub-sample are invited to participate in interviews during the first 12 months, 24 months, and 48 months. These data will be used to evaluate the impact of the intervention over the 4-year trial period and will be refreshed after completion of the trial in 2024 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 2024
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
Contact information
Public
Canadian Observatory on Homelessness
York University
629 Kaneff Tower
4700 Keele Street
Toronto
M3J 1P3
Canada
| Phone | +1 (0)902 830 6170 |
|---|---|
| coramac@yorku.ca |
Scientific
Canadian Observatory on Homelessness
York University
629 Kaneff Tower
4700 Keele Street
Toronto
M3J 1P3
Canada
 ORCID ID |
0000-0002-4109-5611 |
|---|---|
| Phone | +1 (0)416 736 2100 |
| sgaetz@edu.yorku.ca |
Scientific
The Canadian Observatory on Homelessness (COH)
6th Floor Kaneff Tower
York University
4700 Keele Street
Toronto
M3J 1P3
Canada
| ORCID ID |
0000-0002-5440-6423 |
|---|---|
| Phone | +1 (0)416 736 5667 |
| bonakdar@yorku.ca |
Study information
| Study design | Randomized control trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Randomised controlled trial |
| Study setting(s) | Community |
| Study type | Quality of life |
| Participant information sheet | Not available in web format, please use the contact details to request a participant information sheet |
| Scientific title | Making the Shift demonstration project: Housing First For Youth randomized controlled trial |
| Study acronym | MtS Dems: HF4Y |
| Study hypothesis | Current study hypothesis as of 30/01/2023: 1. To determine whether the HF4Y model results in better participant-level outcomes than treatment-as-usual services for young people experiencing homelessness in two urban settings (Ottawa and Toronto) with respect to: (1) housing stability; (2) health and well-being; (3) engagement in education, training, and employment; (4) social functioning and life skills, and (5) social inclusion. 2. To identify the critical components of the HF4Y model and what modifications are needed to effectively serve particular communities and sub-populations (e.g., youth exiting the child welfare system, Indigenous youth, 2SLGBTQ+ youth). 3. To identify the main pathways into youth homelessness or precarious housing situations and understand key challenges young people experience in terms of recovery, the ability to thrive, and housing precarity, so policies, practices, and program interventions can be improved to better serve the needs of youth experiencing homelessness. _____ Previous 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(s) | 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 |
| 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 |
| Primary outcome measure | Current primary outcome measure as of 30/01/2023: 1. Housing stability measured using Residential Timeline Follow-back [RTLFB] at baseline, 6, 12, 18, 24, 30, 36, 42, and 48 months. 2. Health and mental well-being measured using the 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. Complementary Supports measured using Youth Life Skills Assessment, Herth Hope Index, Resilience Scale-14, at baseline, 6, 12, 18, 24, 30, 36, 42, and 48 months _____ Previous 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 | Current secondary outcome measures as of 30/01/2023: 1. Education and employment measured using Attitudes Toward School, Vocational Timeline Follow-back at baseline, at baseline, 6, 12, 18, 24, 30, 36, 42, and 48 months 2. Social functioning measured using Multidimensional Scale of Perceived Social Support, Community Integration Scale at at baseline, 6, 12, 18, 24, 30, 36, 42, and 48 months _____ Previous 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 study start date | 01/08/2017 |
| Overall study end date | 31/03/2024 |
Eligibility
| Participant type(s) | Other |
|---|---|
| Age group | Mixed |
| Lower age limit | 17 Years |
| Upper age limit | 24 Years |
| Sex | Both |
| Target number of participants | 140 |
| Total final enrolment | 148 |
| Participant inclusion criteria | Current inclusion criteria as of 30/01/2023: In Ottawa: 1. Youth aged 18-24 years 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 17-24 years 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 _____ Previous inclusion criteria: In Ottawa: 1. Youth aged 18-24 years 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 years 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 exclusion criteria | Current exclusion criteria as of 30/01/2023: 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 48-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 24 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 _____ Previous 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
Study participating centres
Ottawa
K2B 8K2
Canada
Toronto
M1L 2T3
Canada
4700 Keele Street
Toronto
M3J 1P3
Canada
Toronto
M5S 2R4
Canada
Sponsor information
Other
720 Bathurst St
Toronto
M5S 2R4
Canada
| Phone | +1 (0)416 907 8458 |
|---|---|
| ocundangan@awayhome.ca | |
| Website | https://awayhome.ca/ |
Funders
Funder type
Government
No information available
Results and Publications
| Intention to publish date | 31/03/2026 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| 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 plan | The datasets generated during and/or analysed during the current study are/will be available upon request from Lauren Mar (ljmar@yorku.ca). |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol article | 19/09/2023 | 22/09/2023 | Yes | No |
Editorial Notes
08/04/2025: The intention to publish date was changed from 31/03/2025 to 31/03/2026.
08/07/2024: The following changes were made to the study record:
1. The total final enrolment was changed from 151 to 148.
2. The IPD sharing plan contact details were updated.
3. The intention to publish date was changed from 31/07/2024 to 31/03/2025.
27/03/2024: Contact details updated. Total final enrolment added.
22/09/2023: Publication reference added.
30/01/2023: The following changes were made to the trial record:
1. The study hypothesis was changed.
2. The primary outcome measure was changed.
3. The secondary outcome measures were changed.
4. The inclusion criteria were changed.
5. The exclusion criteria were changed.
6. The overall end date was changed from 31/07/2023 to 31/03/2024.
7. The plain English summary was updated to reflect these changes.
01/04/2022: The following changes were made to the trial record:
1. The overall end date was changed from 31/03/2021 to 31/07/2023.
2. The intention to publish date was changed from 31/03/2022 to 31/07/2024.
3. The plain English summary was updated to reflect these changes.
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.
