Wilfrid Laurier University
Wilfrid Laurier University
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Theses and Dissertations (Comprehensive)
2020
A Housing First Model for Youth and its Relation to Social
A Housing First Model for Youth and its Relation to Social
Integration
Integration
Alexandra Amiri
amir4350@mylaurier.ca
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and Dissertations (Comprehensive). 2251.
https://scholars.wlu.ca/etd/2251
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Running Head: SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
A Housing First Model for Youth and its Relation to Social Integration
by
Alexandra Amiri
Honours BA Psychology, York University, 2015
THESIS
Submitted to the Department of Psychology in partial fulfillment of the requirements for Master
of Arts in Community Psychology
Wilfrid Laurier University
2019
Alexandra Amiri 2019 ©
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
2
Abstract
The present study explored how a Housing First for Youth intervention, working from an
empowerment theory approach, influences the social integration of youth experiencing
homelessness. This was done by contrasting between groups of individuals who either did or did
not receive the intervention. The sample consisted of 86 youth in the city of Ottawa between the
ages of 17-24 who were randomized into the intervention (n=44) or treatment as usual group
(n=42). Quantitative data from baseline and 6-month follow-up were analyzed using the
Community Integration Scale (CIS) and Multidimensional Scale of Perceived Social Support
(MSPSS). Repeated measures ANOVA revealed an effect for time but not by study group in the
MSPSS subscales and the CIS psychological subscale, but this effect disappeared when
controlling for the country of birth variable. Baseline narrative interviews (n=20), which
occurred during the first 13.5 months of the program, were analyzed for emergent themes related
to social integration. Findings from narrative interviews demonstrated the complex ways youth
exiting homelessness experience social integration including the importance of social support
and feelings of membership, and a lack of knowledge of resources in the community to support
physical integration. By using a mixed-methods approach, study findings revealed that a greater
emphasis on social support and addressing knowledge gaps on how to integrate physically into
the community may be beneficial for the first year after youth exit homelessness due to the
tendency for feelings of isolation and loneliness to occur during this time period. Future
implications for the study include following the effects of the intervention on social integration
over the 2-year mark due to the nature of social integration, which is not a rapid or linear
process.
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
3
Acknowledgements
I would like to first acknowledge the dedication and mentorship of my supervisor Dr.
Maritt Kirst, without which the completion of this project would not be possible. Dr. Kirst’s
guidance and support during all moments of my graduate career have been instrumental in my
learning and growing both as a researcher and personally.
Secondly, I would like to thank all the participants at the MtS project in the city of
Ottawa who consented to being in the study and took time out of their day to carefully and
considerably share their story. I would also like to especially thank the research team at both
Ottawa and Toronto who have supported me in this process and have been very gracious and
understanding during my final months as a masters student, particularly Lauren Kimura and Cora
Macdonald who step-by-step worked with me and aided me in getting me what I needed for the
completion of this project.
Next, I would like to thank my internal committee, Manuel Riemer and Todd Coleman
for their guidance and detailed feedback and support. I would also like to extend my gratitude to
my cohort who have been in my shoes and vice-versa every step of the way during this graduate
school process. Their support was at times crucial and always welcome these past two years.
Lastly, I would like to thank my family, friends and my partner for being understanding
during stressful times, supportive at all times, and active listeners throughout the whole graduate
process. Your love and support was crucial and instrumental in this final phase of my thesis.
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
4
Table of Contents
Abstract………………………………………………………………………………………………………………… 2
Acknowledgements …………………………………………………………………………………………………. 3
Tables & Figures
……………………………………………………………………………………………………. 6
Note to the Reader ………………………………………………………………………………………………….. 7
A Housing First Model for Youth and its Relation to Social Integration
…………………………… 8
Introduction
………………………………………………………………………………………………………………….8
Social Integration…………………………………………………………………………………………………………..9
Social integration and well-being ……………………………………………………………………………………
10
Social integration and Youth Experiencing Homelessness ………………………………………………….
15
Housing First Model and At Home/Chez Soi ……………………………………………………………………
18
Housing First and Social Integration ………………………………………………………………………………
20
HF4Y …………………………………………………………………………………………………………………………
22
An Operationalized Framework of Social Integration ……………………………………………………….
25
Empowerment Theory, HF4Y & Social Integration
…………………………………………………………..
26
An Operationalized Framework of Empowerment ……………………………………………………………
29
Research Objectives
………………………………………………………………………………………………. 31
Research Questions ………………………………………………………………………………………………. 31
Methodology ……………………………………………………………………………………………………….. 32
Research Paradigm
………………………………………………………………………………………………………
32
Personal Reflexivity ……………………………………………………………………………………………………..
33
Method ………………………………………………………………………………………………………………………
33
Research Context. …………………………………………………………………………………………………………………………….
33
Participants. …………………………………………………………………………………………………………………………………….
36
Data Collection. ………………………………………………………………………………………………………………………………..
39
Analyzing the Data. …………………………………………………………………………………………………………………………..
42
Establishing the Quality of the Data. ………………………………………………………………………………
43
Quantitative Results ……………………………………………………………………………………………… 46
Qualitative Results ……………………………………………………………………………………………….. 53
Social Integration…………………………………………………………………………………………………………
53
Physical Integration ……………………………………………………………………………………………………..
57
Psychological Integration
………………………………………………………………………………………………
59
Other Themes ……………………………………………………………………………………………………………..
62
Discussion
…………………………………………………………………………………………………………… 64
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
5
Findings ……………………………………………………………………………………………………………………..
64
Implications for Service Providers ………………………………………………………………………………….
69
Limitations of the Current Study
……………………………………………………………………………………
71
Summary and Future directions …………………………………………………………………………………….
73
Knowledge Translation
…………………………………………………………………………………………………
74
Conclusion ………………………………………………………………………………………………………….. 74
References ………………………………………………………………………………………………………….. 76
Appendix A: Community Integration Interview Guide ………………………………………………… 84
Appendix B: Community Integration Scale (CIS) ………………………………………………………. 87
Appendix C: Multidimensional Screener of Perceived Social Support Scale (MSPSS) ………. 89
Appendix D: Informed Consent Form ……………………………………………………………………… 92
CONSENT TO PARTICIPATE
…………………………………………………………………………………………………………………
97
Appendix E: Visual Timeline of Qualitative Data Collection ………………………………………… 98
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
6
Tables & Figures
Figure 1: Theory of Change: A Conceptual Diagram of Social Integration through a HF4Y
intervention for youth experiencing homelessness………………………………………………28
Figure 2: The Empowerment Process Model…………………………………………………29, 70
Table 1: Demographic characteristics of participants at baseline (N=86)………………………47
Table 2: Baseline characteristics of participants who have not completed the survey (N=22) and
those who have (N=64) at 6-months……………………………………………………………..48
Table 3: Post hoc power analysis…………………………………………………………….48-49
Table 4: Comparison of community integration and social support between baseline and 6
months using a Paired Samples T-test…..……………………………………………………….50
Table 5: Comparison of community integration and social support between baseline and 6
months by study group using a Repeated Measures ANOVA ………………………………..50-51
Table 6: Comparison of community integration and social support between baseline and 6
months by study group using a Repeated Measures ANOVA*……………………………….51-52
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
7
Note to the Reader
In this thesis manuscript, the terms ‘homeless youth’ and ‘youth homelessness’ are used
interchangeably with ‘youth experiencing homelessness’. All terms are in no way meant to
impose a label or identity; the intent is for ease of reading.
Social integration is used as an umbrella term to represent 3 dimensions of integration: physical,
psychological and social. Both social and community integration are used interchangeably in
research with youth experiencing homelessness. This study has chosen to use the former term as
it captures the three dimensions of integration and the complex ways in which people’s lives are
influenced by their social environment.
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
8
A Housing First Model for Youth and its Relation to Social Integration
Introduction
Young adulthood is a developmentally sensitive time wherein youth require extensive
supports to develop the skills they need to navigate adulthood. Youth experiencing homelessness
require even greater supports tailored to their needs (Gaetz, 2017). The Canadian Observatory on
Homelessness (COH) defines youth homelessness as “the situation and experience of young
people between the ages of 13 and 24 who are living independently of parents and/or caregivers,
but do not have the means or ability to acquire a stable, safe or consistent residence” (Gaetz,
O’Grady, Kidd & Schwan, 2016, p. 27). In Canada, there are up to 40,000 youth between the
ages of 13 to 24 experiencing homelessness in a given year (Gaetz et al., 2016), making up
approximately 20% of the homeless population in the country (Gaetz, Gulliver & Richter, 2014).
Despite these numbers, there is an insufficient number of programs in Canada developed to serve
youth experiencing homelessness and provide them with the supports they require to exit
homelessness and transition to adulthood (Gaetz, 2014).
While housing is assumed to have a large impact on the extent to which youth
experiencing homelessness are socially integrated into their communities (Quilgars & Pleace,
2016), without providing these youth with developmentally appropriate supports alongside
residential stability, successful social integration is unlikely to occur and re-entry into
homelessness becomes a likely outcome (Gaetz, 2017; Thulien, Gastaldo, Hwang & McCay,
2018). Developmentally appropriate supports are an essential component in social integration,
improved well-being and prevention of re-entry into homelessness for youth experiencing
homelessness (Roy et al., 2016; Gaetz, 2017).
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
9
This thesis explores if, and to what degree, youth experiencing homelessness are socially
integrated after receiving permanent housing alongside age-appropriate supports. The following
sections will outline and provide an overview of the following: connections between social
integration and well-being, and their importance for youth experiencing homelessness; the youth
most impacted by homelessness and their intersections; the type and nature of needed supports; a
program model designed to support successful social integration and the role that empowerment
plays in this process.
Social Integration
The term ‘social integration’ is complex with no one agreed upon definition (Quilgars &
Pleace, 2016) and is oftentimes defined with terms such as ‘community integration’, ‘social
inclusion’, ‘mainstream society’ or just ‘reintegration’. Only a handful of studies have looked at
the transition of formerly homeless youth into mainstream society after obtaining stable housing
(Kidd, Karabanow, Hughes & Frederick, 2013; Karabanow & Naylor, 2013; Kidd et al., 2016;
Thulien et al., 2018; Thulien, Gastaldo, McCay & Hwang, 2019); however there is no consistent
definition of social integration between these studies. For the purposes of this study, I have used
the Quilgars and Pleace (2016) definition of social integration, broadly defined as “the extent to
which formerly homeless people are able to live, work, learn and participate in their communities
to the extent that they wish to, and with as many opportunities as other community members”
(p.5). This definition is in keeping with an empowerment theory framework used in this study
that also considers the context of an individual’s environment.
Zimmerman and Eisman (2017) conceptualize empowerment theory using three levels of
analysis – individual, organizational and community. This study has chosen to define
empowerment through the individual lens of analysis due to its focus on person-environment fit,
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
10
consideration of context, and influence from other levels of analysis (Keys, McConnell, Motley,
Lynn Lao & McAuliff, 2017). Influence from other levels of analysis is especially important to
consider since empowerment, and subsequently social integration, do not occur in a vacuum and
are heavily influenced by community contexts and other, often larger, social systems.
This individual level of analysis is referred to as psychological empowerment (PE)
(Zimmerman & Eisman, 2017). PE includes three components: an intrapersonal component
referring to how an individual thinks about themselves and their sense of control (e.g. self-
efficacy); an interactional component referring to how individuals can critically analyze their
environment to determine what resources are needed to achieve their goals; and a behavioural
component referring to “actions taken to achieve goals and influence outcomes” (Zimmerman &
Eisman, 2017, p.174). All three components influence the outcome of social integration.
Social integration and well-being
Social integration, housing and well-being are interconnected concepts. Securing housing
is the first step towards successful integration into mainstream society (Nolan, 2009) and social
integration in turn improves well-being by reducing reactivity to stress, providing a sense of
competency and control, and opening up pathways to wellness (Gracia & Herrero, 2004).
Despite its importance, social integration is a relatively under-researched concept in the areas of
youth and adult homelessness (Thulien et al., 2019; Wong & Solomon, 2002). Limited research
is available on the factors that facilitate social integration for formerly homeless individuals who
have secured permanent housing – particularly for youth (Thulien et al., 2018). Social integration
has, however, been linked to well-being and self-esteem among different populations of youth,
including students. In fact, the “interrelation of social integration, self-esteem, and health might
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
11
play an important role especially in adolescence” (p.3); however, few studies have explored their
connections (Schwager et al., 2019).
The link between social integration and well-being is also not extensively researched with
youth exiting homelessness, and there are few studies that have reported on this. Thulien et al.
(2018) researched this link and reported that the well-being of youth may not improve after
obtaining stable housing if there is a lack of social support outside of housing. The study
followed nine formerly homeless youth in their first ten months of stable housing. One
participant in the study stated that they “desired more than residential stability – they desired
pathways to a successful life” (p. 97). The study emphasized that “simply providing young
people with a home and welfare supplements is not enough” (p. 97), they require supports as
well. The study demonstrates that supports are key for improved well-being. Additionally, the
results demonstrate that either these youth need to be housed longer in order for the effects of
social integration to take place or, more importantly, that residential stability on its own is not
enough to socially integrate formerly homeless youth and prevent re-entry into homelessness.
In a study by Gracia and Herrero (2004), stressful life events, including housing
instability (the example given in this instance was moving to a worse neighbourhood), among a
sample of adult participants living in an urban area, left participants vulnerable to poorer
psychological well-being and decreased social integration. In light of such a finding, stable
housing and social integration is highlighted as a key factor for positive well-being, particularly
for youth since young age and low income are significantly associated with higher levels of
stressful life events (Gracia & Herrero, 2004). The study also found that social support is also
linked to an increase in social integration (Gracia & Herrero, 2004) and can have a particularly
positive effect for late adolescence, in the sense that receipt of social support can facilitate better
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
12
coping with emotional, familial, health, and addiction-related issues over time (Newcomb &
Keefe, 1997).
Youth Populations Experiencing or At-Risk for Homelessness
The make-up of Canada’s homeless youth population is diverse and requires a close look
at the experiences of youth identifying in such groups as: youth involved in child welfare
services; LGBTQ2S youth; Indigenous youth; and racialized communities. This is by no means
an extensive list of subpopulations and it should be noted that youth in different groups do not
experience homelessness in a vacuum, but that intersectionality of different social identities is
significant and impacts their experiences. It is important not only to develop a clear picture of the
different populations affected by youth homelessness but of the complexity of providing the
supports necessary to each group – which can be varied or different.
Links between youth involvement with the child welfare system and later experiences of
homelessness have clearly been documented in reports and empirical studies (Schelbe, 2018).
Youth experiencing homelessness have been reported to be 193 times more likely to have been
involved with the child welfare system as compared to national data which has shown “that 0.3%
of the general public receive child welfare services” (Nichols et al., 2017, p. 3; Statistics Canada,
2011). Additionally, compared to youth who do not go through the child welfare system, youth
who age out of care are more likely to have not completed school, have no family support
network, to have limited or no financial resources, require training in life skills and have
emotional scars from the trauma of childhood neglect or abuse; as a result, once they are on their
own, they are at much greater risk of becoming homeless (Tweddle, 2005).
Interventions with affordable-housing and built-in supports that address maltreatment,
mental health and substance use for youth transitioning out of care help in disrupting the cycle of
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
13
homelessness (Goldstein et al., 2012). Ongoing supportive relationships, independent living
training, access to financial support, and education, employment and training programs are also
beneficial and increase the likelihood of a successful transition to adulthood for youth leaving the
care system (Tweddle, 2005).
A population that is overrepresented in homelessness is lesbian, gay, bisexual,
transsexual, transgender, queer and two-spirit (LGBTQ2S) youth, particularly in North America
(Côté & Blais, 2019). Although they make-up only 5-10% of the general population,
approximately 25-40% of homeless youth identify as part of the LGBTQ2S community (Gaetz,
O’Grady, Buccieri, Karabanow, & Marsolais, 2013). Despite this astounding overrepresentation
they have in our homeless population, little research is available regarding utilization of
homeless agencies (Côté & Blais, 2019). Homelessness organizations and programs available to
homeless LGBTQ2S youth are not built to eliminate the heteronormative and cisnormative
biases that prevent these youth from establishing feelings of safety when accessing these
organizations (Côté & Blais, 2019).
Family conflict is one of the main causes for youth in this community leaving their home,
specifically being kicked out of the house which can be further be categorized as abuse,
homophobia or transphobia, including being forced to leave home after coming out to one’s
family (Abramovich, 2008). Youth who end up on the street prefer to stay there rather than stay
at shelters due to the prevalent homophobic and transphobic discrimination and violence that
prevent these youth from feeling safe inside shelters (Abramovich, 2017). There is still a lack of
LGBTQ2S-friendly specialized support services and shelters that homeless youth can access
(Abramovich, 2012). Research in Canada has yet to focus specifically on this population and so
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
14
there is little understanding regarding the situation of what the LGBTQ2S homeless youth
experience is (Abramovich, 2012).
It has been demonstrated that both indigenous and racialized youth are over-represented
in the child welfare system, with indigenous youth making up about half of the children in care
in Canada (Nichols et al., 2017). The over-representation of this sub-population is mirrored in
the youth homelessness population as well (Nichols et al., 2017). As with other populations,
including LGBTQ2S youth, available statistics do not demonstrate the extent of the problem,
however the research available reports that indigenous youth have higher rates of multiple
experiences of homelessness, with 80.4% reporting more than one experience of homelessness in
their lifetime (Gaetz et al., 2016). The lack of research coincides with the fact that indigenous
youth are the fastest growing group in Canada (Hick, 2007) which asserts the necessity of more
research and also demonstrates the rising need for more services that meet the needs of this
population.
Similar to LGBTQ2S and indigenous youth, racialized youth are over-represented in the
youth homelessness population in Canada (Nichols et al., 2017). In the Canadian National Youth
Homelessness Survey published in 2016, 17.4% of the sample identified as a member of a
racialized community (Gaetz et al.). It is important to note that indigenous youth experience
racialized forms of discrimination, which is why a greater percentage of the survey sample
(28.2%) identified as a member of a racialized community if we include indigenous youth who
identify as racialized (Gaetz et al., 2016). Accounting for these differences and experiences is
important if the appropriate supports are to be made available to racialized and/or indigenous
identifying youth. Supports around mental health are especially important for these youth and
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
15
need to be both culturally relevant and account for experiences of systemic discrimination (Gaetz
et al., 2016).
The intersecting experiences of youth homelessness from all identifying groups should
not be overlooked. Some of the groups reviewed here may have more difficulty socially
integrating due to stigma, discrimination, family violence, and similar experiences. Many of
these experiences are more prevalent in specific groups (i.e. the many experiences of
discrimination towards indigenous youth who experience homelessness); however, it is
important to once again recognize the intersections of these experiences. Youth who identify
with multiple groups could in fact be experiencing more than one level of discrimination. For
example, indigenous who identify as being racialized and members of the LGBTQ2S community
can experience both racialized and homophobic forms of discrimination and violence.
Social integration and Youth Experiencing Homelessness
Away Home Canada and the COH have been leading the research on youth homelessness
in Canada and are advocates of the right to basic housing, safety, education and supports for
youth (Gaetz et al., 2016). They completed the first national survey on youth homelessness
(Gaetz et al., 2016) and published yearly reports on the subject (Homeless Hub, n.d.) when there
was little research being published on the topic. While there is now increasingly more literature
on youth homelessness than there was a decade ago, few effective interventions and solutions
exist for this population. More research is needed on the factors that are instrumental in
sustaining long-term exits out of homelessness for youth and integrating them into the complex
youth culture of today (Thulien et al., 2019). In addition, while it is easier to find literature on the
drivers of youth homelessness, there is currently very little empirical evidence on youth who
have secured permanent and stable housing and the extent to which they have been able to
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
16
integrate into society (Thulien et al., 2019). Social integration is a crucial factor for youth exiting
homelessness (Kidd et al., 2016) because of the positive impact of social integration on both
well-being (Gracia & Herrero, 2004) and prevention of re-entry into homelessness (Gaetz, 2017).
Social integration among youth experiencing homelessness is a construct that is often
overlooked (Thulien et al., 2019). A systematic review of interventions in high-income countries
that focused on the re-integration or harm reduction of street-involved youth found that no
studies measured re-integration of youth into their communities as a primary outcome (Coren,
Hossain, Pardo Pardo & Bakker, 2016). This review defines re-integration as a residential or
educational environment that can provide youth with “elements of physical safety, medical care,
nutrition, counselling, education, inclusion in social and economic opportunities and room for
recreation and personal and spiritual growth that may impact positively on longer-term life
chances” (Coren et al., 2016, p.11). The interventions reviewed proved no more effective for
social integration than shelters or drop-ins that youth already had available to them (Coren et al.,
2016). This finding demonstrates that current interventions do not promote the social integration
of youth (i.e. access to education, training, employment opportunities and participation and
inclusion) as effectively as they should (Coren et al., 2016). Interventions in this review that met
the criteria for inclusion did not measure access to literacy, education and employment (Coren et
al., 2016), all important factors in social integration. In fact, in accordance with the Quilgars and
Pleace (2016) definition, these factors are fundamental to social integration.
A study in Toronto that focused on social integration followed nine formerly homeless
youth who recently transitioned into independent (market rent) housing (Thulien et al., 2018).
Ten months of qualitative data revealed that while the youth had secured independent housing, it
was still incredibly challenging for them to move forward due to barriers such as limited
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
17
education and employment opportunities, limited social capital, unaffordable housing and low
income (Thulien et al., 2018). Over time these barriers affected their ability to make long-term
plans, which eventually led to feelings of “outsiderness” (Thulien et al., 2018). This study
showed that housing on its own is not sufficient in achieving meaningful social integration for
youth exiting homelessness, and that it is necessary to also provide these youth with supports
tailored to their needs. For example, it is important to discuss the social integration of homeless
youth within the socioeconomic context (i.e., monthly income, type of employment) and position
(i.e., social class, occupation, race, gender etc.) (Thulien et al., 2018), two concepts that are not
emphasized enough in research and discussions surrounding youth exiting homelessness. Thulien
et al. (2018) found that participant’s low socioeconomic position was not separate from the
barriers they faced that prevented them from achieving meaningful social integration.
Furthermore, these authors highlight that youth exiting homelessness require the “same supports
available to mainstream youth the same age” (p. 97) and that residential stability is simply not
enough.
Another reason why social integration is such a multidimensional concept is the complex
ways that homeless youth engage with their social environments, and that they experience their
own form of social integration in the subcultures of street life (Frederick, 2019). An analysis of
the social dynamics of homeless youth found that identity dynamics were complex and how
youth identified themselves was often connected with certain discourses or ideas that shaped
how they viewed their experiences and choices (Frederick, 2019). For example, one such
discourse that homeless youth identified with was “the value of being independent and not being
confined by mainstream employment” (Frederick, 2019, p. 1142). These discourses affect how
young people engage with their environment and emphasize the challenge facing homeless youth
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
18
who now have to navigate new spaces, discourses and ideas when transitioning into permanent
and secure housing.
Providing these youth with stable housing and support services can go a long way in
improving their mental health and facilitating social integration into society (Gaetz et al., 2013).
Kidd et al., (2016) report that youth who reside in supportive housing contexts report better
social integration than those in independent housing. This finding demonstrates that youth
require supports alongside residential stability. Youth housing programs should recognize that
supports are an integral part of socially integrating formerly homeless youth. One program
model, the Housing First (HF) model, is being examined as a long-term solution to end
homelessness and foster social integration of youth exiting homelessness by providing them with
both stable housing and specialized supports with no preconditions.
Housing First Model and At Home/Chez Soi
The reality for youth experiencing homelessness is that access to services is difficult and
most of these youth are unaware of the range of services available to them (Evenson & Barr,
2009). The services currently available to youth experiencing homelessness include emergency
shelters and day programs; however, what is required is a move away from crisis responses and
towards permanent and effective solutions to end youth homelessness (Nichols et al., 2017).
What is needed for homeless youth is best practice intervention models that provide affordable
housing alongside supports that align with the needs of emerging adults – these supports can
include access to income and education, and health and well-being supports (Gaetz, 2014). One
such best practice intervention that meets these requirements is the HF model.
HF is an intervention for adults experiencing homelessness, with an emphasis on
populations experiencing chronic homelessness, and mental illness and addiction challenges
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
19
(Goering et al., 2011). The HF model is a recovery-oriented approach to ending chronic
homelessness that involves moving individuals experiencing homelessness into independent and
permanent housing as quickly as possible with no preconditions (Goering et al., 2014). After
housing has been secured, additional services and supports are provided as needed. The HF
model is considered to be a best practice for interventions on homelessness (Gaetz, 2012) and
there is evidence-based research from Canada that demonstrates the model’s general
effectiveness when compared to “Treatment First (TF)” approaches (Goering et al., 2014).
The HF model was established by the Pathways program (Tsemberis, 2011) and
provides an alternative to the mainstream TF approaches, which offer temporary congregate
housing alongside mandatory programs for sobriety to determine “housing readiness” of the
participants, as established by case managers, before access to housing is given (Padgett,
Stanhope, Henwood & Stefancic, 2011). The Pathways model offers housing first with no set
preconditions or requirements for detoxification or sobriety (Tsemberis, 2011).
The HF model’s premise focuses on being client-centred through a commitment to work
with the clients for as long as they require it, and emphasizes warmth, respect and compassion
for all clients (Tsemberis, 2011). Great importance is placed on the values and attitudes toward
the clients – including providing consumer choice and self-determination. The HF model also
views housing as a basic human right and highlights the separation of housing and services as a
fundamental factor (Tsemberis, 2011). These principles of HF align closely to empowerment
theory, which emphasizes working with vulnerable groups, as opposed to for, to promote their
self-determination, choice and control (Rappaport, 1987).
The evidence base for Housing First in Canada was established with the At Home/Chez
Soi study, which was a randomized controlled trial of the HF model in five Canadian cities –
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
20
Vancouver, Winnipeg, Toronto, Montreal and Moncton (Goering et al., 2011). The study
provided evidence for the effectiveness of the HF model by demonstrating increases in housing
stability and choice, and decreases in homelessness and hospitalization as compared to treatment
as usual (TAU) (Polvere et al., 2014). Rather than taking the top-down expert-driven approach,
the At Home/Chez Soi study took a hybrid approach wherein both persons with lived experience
and experts (i.e. researchers and service-providers) were consulted throughout the project
(Nelson et al., 2016). This process works to personally empower the individuals who have
experienced a lack of control in their lives and to help them reclaim power in their life (Nelson &
Prilleltensky, 2010). It allows participants to choose whether or not they want to access
additional supports or services, and the location and type of housing that they want, neither of
which is contingent upon compliance (Gaetz, Scott & Gulliver, 2013). This philosophy of the HF
model provides the foundation to allow participants to make life improvements and move toward
recovery (Tsemberis, 2011), both of which are important processes in social integration.
Housing First and Social Integration
The outcome of social integration from the HF delivery model has been inconsistent, with
limited results for both adult and youth populations experiencing homelessness due to different
definitions and measures of social integration used in HF studies (Quilgars & Pleace, 2016). The
At Home/Chez Soi study did not find significant results on the outcome of social integration for
young adults aged 18-24 (Kozloff et al., 2016). This was likely due to the fact that the
intervention was targeted towards an adult homeless population and therefore was not able to
serve the needs of youth (Kozloff et al., 2016). A review of the current services available in
Canada for youth experiencing homelessness revealed that there are very few programs in place
that are implementing the HF model tailored to align with the developmental needs of youth who
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21
are transitioning into adulthood (Gaetz, 2017). A review of studies that did use the HF model
with youth showed mixed results for the outcome of social integration (Quilgars and Pleace,
2016). This was likely due to different definitions and mechanisms of social integration and that
social integration was not a primary outcome (Quilgars and Pleace, 2016). The biggest finding
from Quilgars and Pleace’s (2016) review of HF studies was that researchers viewed the
attainment of stable housing as achieving social integration, which, as discussed previously, is
not the case (Thulien et al., 2018; Gaetz, 2017).
Available research demonstrates that the difficulty youth face in exiting homelessness is
in part due to the few resources available to support them even after they have succeeded in
finding housing (Kidd et al., 2016). This finding is emphasized by the fact that youth who reside
in supported housing contexts report better social integration, quality of life, and mental health,
as compared to those in independent housing (Kidd et al., 2016), showing that access to
independent housing is not an indicator of positive well-being (Gaetz, 2017). This finding
highlights the importance of ongoing supports that should accompany stable housing. It is clear
that for social integration to occur, extensive support – such as supports for health and well-
being, access to income and opportunities for meaningful engagement – is required after
obtaining housing.
What is required is an HF delivery model tailored to youth experiencing homelessness, as
well as a stronger conceptual and practice framework for operationalizing and supporting the
outcome of social integration. Housing First for Youth (HF4Y) seeks to provide such a model;
this program model is used in this study to look at the outcome of social integration on youth
exiting homelessness.
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22
Stephen Gaetz has spearheaded the adaptation literature for the HF4Y model in his 2017
report This is Housing First for Youth: A Program Model Guide in which he discusses isolation
and loneliness as greater concerns for young people experiencing homelessness and that
opportunities to develop positive social relationships are important for social integration.
Learning to trust others and feeling safe in their environment is vital in this population,
particularly for their societal reintegration process (Kidd et al., 2016). If youth experiencing
homelessness feel emotionally protected and respected, are able to trust other adults and to feel
safe, they are more likely to utilize services and supports and participate in community
programming (Kidd et al., 2016). HF4Y has incorporated supports for well-being, housing,
income, education and social inclusion as part of their model (Gaetz, 2014). The focus of this
study is to build on the existing literature of the HF model and the long-term value of adapting
this model to youth, which has not been extensively studied (Kozloff et al., 2016), by looking at
the effect of a HF4Y program on social integration.
HF4Y
All the evidence from HF demonstrates that it is indeed a best practice intervention in
addressing adult homelessness (Gaetz, 2017), particularly as demonstrated in At Home/Chez Soi
(Goering et al., 2012); however, also demonstrated in At Home/Chez Soi is that the intervention
was not as effective for youth in outcomes other than housing stability (Kozloff et al., 2016).
HF4Y is a rights-based intervention providing both access to immediate housing and age-
appropriate supports (Gaetz, 2017). Support is ongoing for as long as the youth require it, with
the goal being to help the youth “recover, to grow and mature, to engage in school or
employment, and to become socially included” (Gaetz, 2017, p.3). This model is adapted to
respond to the different needs of youth based on age, gender, sexual orientation, family structure
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
23
and experience of marginalization with the goal of providing enough supports to enable youth to
make a successful transition to adulthood. This model recognizes that youth need basic supports
for a longer period of time during this transition into adulthood than do adult populations
experiencing homelessness (Ferguson, Kim & McCoy, 2011).
The potential benefits of HF4Y are wide-ranging and work to provide youth with choice,
self-determination, individualized supports, and social and community integration (Gaetz, 2014).
Providing youth with immediate accessing to housing with no preconditions is particularly
crucial and every effort should be made to divert them from long stays in emergency shelters
(Gaetz, 2014), as they are generally built for adult populations, can be very unsafe and are
unsuitable for youth (Jennings, Parra-Medina, Hilfinger-Messias & McLoughlin, 2006). This
model uses a strengths-based approach by building on the strengths of the youth and enhancing
protective factors (Gaetz, 2014) as opposed to the usual focus of youth-based programs on risky
behaviours. Participants in this program are also able to exercise choice on the location and type
of housing they receive, what services they receive, and when to start using these services
(Gaetz, 2014).
Ferguson et al. (2011) suggest that among homeless youth, greater ownership of the
programs that serve them contribute to increased motivation to participate in programming and
to improve their lives. As discussed previously, the HF model aligns with the theoretical
framework of empowerment theory and adapting the model to youth would provide them with
choice in determining the type of accommodations, services and supports best suited to each
individual.
SOCIAL INTEGRATION IN A HOUSING FIRST MODEL FOR YOUTH
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The core principles of HF4Y include the following: a right to housing with no
preconditions; youth choice, youth voice and self-determination; positive youth development1
and wellness orientation; individualized, client-driven supports with no time limits; and social
inclusion and community integration. For the purposes of this study and its focus on social
integration, we will explore the effectiveness of the intervention at achieving the last principle –
social inclusion and community integration.
Youth who experience homelessness can feel excluded socially, economically, politically
and culturally (Gaetz, 2017). In order for youth to fully integrate and participate in community,
in education and employment, HF4Y focuses on first providing them with housing that does not
cause isolation or stigmatization. An example of this could be offering a different range of
accommodations for youth to choose from (i.e., scattered site, independent living vs. congregate
or supportive housing vs. returning to family residence) (Gaetz, 2017). This would also keep in
mind that the housing needs of youth may change and evolve over time (Gaetz, 2017).
Opportunities for social and cultural engagement as well as meaningful engagement in activities
is also a key focus for HF4Y in helping the youth to become socially integrated. The model also
focuses on strengthening relationships with the meaningful people in the youth’s life (e.g.,
building natural supports) and connecting them to appropriate professional supports (e.g.,
therapists, social workers) if natural supports are either “strained or non-existent” (Gaetz, 2017,
p.10).
In the program overview for this model by Gaetz (2017), three organizations that have
implemented HF4Y programs were reviewed (two international, one in Canada). In two of these
reviews, lack of social inclusion and community integration were listed as an obstacle and
1Positive youth development is a philosophy wherein a strengths-based approach focuses on the youth’s assets rather
than on risk and vulnerability (Gaetz, 2017).
