CANADIANCCPA CENTRE FOR POLICY ALTERNATIVES MANITOBA
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg By Matthew Stock
JANUARY 2016 Ending Homelessness? About the Author: A Critical Examination of Housing First in Canada and Winnipeg Matthew Stock is a recent graduate of the School of Policy Studies at Queen’s University. His research isbn 978-1-77125-259-1 interests are non-profit policy and homelessness policy. He currently works as a research associate at JANUARY 2016 the University of Ottawa.
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Unit 205 – 765 Main St., Winnipeg, MB R2W 3N5 tel 204-927-3200 fax 204-927-3201 email [email protected] Abstract
The Housing First model is an increasingly popular First programs to participants with unique needs, approach to housing homeless Canadians. Many as well as problems the Housing First model faces studies have examined the benefits of Housing First, when operating in rural communities and areas arguing that it is more effective than traditional experiencing a shortage of affordable and/or so- methods of addressing homelessness. Far less at- cial housing. It contends that to understand the tention has been paid to the challenges involved strengths and limitations of Housing First more in operating Housing First programs, particularly high quality research needs to take place. Further, it in the Canadian context. This paper attempts to argues that to be effective Housing First programs fill this research gap. To do this it discusses the need to adapt to the unique circumstances that limitations of the Housing First model, examining they operate in, and need to be a part of a wider, the difficulties associated with providing Housing comprehensive homelessness strategy.
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 1 Introduction
Homelessness is a major problem in Canada. the literature by examining several of the major Each night approximately 35,000 Canadians challenges HF faces in the Canadian context, experience visible homelessness, while as many including the shortage of affordable and social as 50,000 live in hidden homelessness (Gaetz et housing, the lack of tertiary services available in al. 2014: 5). Homelessness also presents a chal- rural communities, the difficulty of addressing lenge in Winnipeg, the October 2015 Street Cen- the needs of the homeless population1 as a whole sus found 475 people absolutely homeless, and and the complexities associated with serving 1,252 provisionally accommodated people (So- women, youth and Aboriginal peoples. Further, cial Planning Council 2015). The Housing First it will consider the experiences of communities (HF) model, which focuses on getting partici- across Canada, focusing particularly on Winni- pants housed as quickly as possible, regardless peg. Overall, the aim of this paper is not to argue of perceived readiness, is an increasingly popu- that HF is ineffective or that it is not a reasonable lar approach to addressing homelessness. Stud- method for addressing homelessness. Instead, it ies have found that the HF model is far more ef- seeks to highlight: more research needs to take fective than traditional approaches at keeping place to broaden our understanding of homeless- homeless people housed and improving their ness and HF; the HF model is not a silver bul- health. Yet research has only briefly touched on let answer (by itself it will not be enough to end the difficulties associated with implementing HF homelessness); and a one-size-fits-all approach programs. This paper attempts to fill this gap in to HF is not viable.
1 This paper makes reference to “homelessness” and Canada’s “homeless population” throughout. I acknowledge that this is a simplification, and do not intend to imply that Canadians experiencing homelessness are a homogenous group.
2 canadian centre for policy alternatives — MANITOBA Homelessness in Canada
The way that homelessness has been defined out of doors, people living in temporary insti- has evolved over time. Hulchanski and his col- tutional accommodations and people staying in leagues have argued that, before the mid-1980s, emergency shelters. Stephen Gaetz and his col- homelessness as we currently understand it did leagues at the Homeless Hub at York University not exist because Canada had an ample stock of estimate that at any given time there are 35,000 affordable housing and a social safety net strong visibly homeless Canadians, and that each year enough to ensure that everyone had a place to 235,000 Canadians experience visible homeless- live. Instead, they suggest that traditionally peo- ness (Gaetz et al. 2014: 5). Of this population, the ple were considered to be “homeless” if they had majority are transitionally homeless, meaning a house, but not a stable, loving home (Hulchan- that they are homeless only for a short period ski et al. 2009:1-4). For example, individuals who of time and generally manage to find permanent were transient, had no family support network accommodation on their own. Yet between 5 and and lived in low-income housing were labelled 15 percent of visibly homeless Canadians experi- homeless. ence more extreme forms of homelessness, in- The definition of homelessness began to shift cluding episodic homelessness (when individuals during the 1980s as the decline of the welfare continuously move in and out of homelessness) state, social housing cutbacks and an overall and chronic homelessness (when individuals ex- reduction in the availability of affordable hous- perience long-lasting periods of homelessness) ing resulted in many people finding themselves (Aubry et al. 2013: 910). without any form of stable accommodation, let In recent years, researchers have attempted alone a home. A typical definition during this era to broaden the interpretation of homelessness to considered homelessness to be characterised by include people who are relatively homeless. For “not having customary and regular access to a example, in 2012 the Canadian Homelessness conventional dwelling” (Rossi 1989: 10). Today, Research Network (CHRN) defined homeless- homeless individuals who fall within this defi- ness as, “the situation of an individual or family nition are considered visibly homeless. Visibly without stable, permanent, appropriate housing, homeless populations include people who sleep or the immediate prospect, means and ability of
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 3 acquiring it” (CHRN 2012: 1). This includes people lation 2,324) and 100 Mile House (population who have access to shelter that lacks security or 1,885), reported homeless populations of over quality and people who are at risk of losing their thirty people (Greenburg 2007a). Second, while housing due to financial difficulties. It also- in the most prominent demographic among home- cludes hidden homelessness: where individuals less Canadians is single adult males between the live, or temporarily couch surf, with friends or ages of 25 and 55, who make up 47.5 percent of relatives because they cannot afford their own the homeless population (Gaetz et al. 2014: 40), housing. There are an estimated 50,000 Cana- the homeless population is comprised of people dians experiencing hidden homelessness at any from all backgrounds, including families, women given time (Gaetz et al. 2013b: 6). Overall, when and youth. Third, a disproportionate number of considering homelessness, it is important to note homeless Canadians come from vulnerable pop- that the categories of visibly homeless and rela- ulations, including people have who previously tively homeless are not mutually exclusive, and experienced abuse, people facing addictions and instead many homeless Canadians transition be- mental health challenges, members of sexual mi- tween the two. For example, an individual may norities and members of racial minorities, most spend one week living on the street and the next notably individuals from an Aboriginal back- sleeping on a friend’s couch. The flexible nature ground. In Winnipeg, while approximately 10 of homelessness is highlighted by the 2011 Win- percent of the general population is Aboriginal, nipeg Street Health Report, which interviewed studies have suggested that between 55 and 70 three hundred homeless individuals, finding that percent of the homeless population is Aborigi- in the previous month: nal (Gessler and Maes 2011: 10). • 84% stayed in an emergency shelter There are a number of factors that can lead someone toward homelessness. Many individ- • 31.6% stayed outside uals find themselves homeless after experienc- • 29.6% stayed with friends or relatives ing a traumatic event. For example, a fire may • 8.6% stayed in a treatment program burn down a family’s apartment building or an • 6.3% rented a room in a hotel economic downturn may cause an individual to lose their job, making it impossible for them to • 6.0% stayed in a rooming house afford housing. An individual may also become • 5.6% were in a hospital homeless if they leave home to escape a domestic • 2.3% were in jail dispute and/or abuse. This reality is especially • 2.3% slept in a car common among homeless women and youth. In many cases people become homeless because • 1.7% stayed in an abandoned building support or care systems fail. For example, when • 1.7% found shelter in a business. people are discharged from child welfare, hospi- (Gessler and Maes 2011: 14) tals, addictions facilities, psychiatric institutes or When discussing the demographics of Cana- correctional facilities without receiving proper dian homelessness, there are several points to planning or support, their chance of becoming keep in mind. First, while homelessness is largely homeless increases exponentially (Gaetz et al. an urban problem, it is also prevalent in many 2013b: 13). rural areas and in small communities. For ex- The overrepresentation of individuals expe- ample, in the case of a recent housing project riencing mental illness and/or addictions among in British Columbia, several communities of the homeless population indicates that these char- under 2,500 people, including Lillooet (popu- acteristics are a significant obstacle when peo-
4 canadian centre for policy alternatives — MANITOBA ple are attempting to find housing. Similarly, the Another factor that disadvantages renters is overrepresentation of ethnic and sexual minori- that, in many Canadian communities, there is a ties suggests that discrimination can be a major shortage of rental housing available. It is generally influence leading individuals toward homeless- accepted that in a healthy rental environment, ness. This can be seen in the 2011 Winnipeg Street vacancy rates will stand around 3 percent (three Health Report, in which many survey respond- of every one hundred rental units are empty and ents claimed that before becoming homeless they ready for occupation). Recent figures from the had been discriminated against by their land- CMHC suggest that Canada’s thirty-five largest lords. Among survey respondents, 40.9 percent centres fall slightly below this mark at 2.8 per- thought that they were discriminated against due cent. A number of Canada’s largest cities are far to their drug use and/or mental illness, 31.8 per- below the 3 percent target, with Vancouver ex- cent because of their source of income, 21.1 per- periencing vacancy rates of 1 percent, Calgary cent because of their ethnicity, 20.4 percent due recording rates of 1.4 percent and Toronto re- to their gender, 9 percent because of a physical cording rates of 1.6 percent (CMHC 2014: 1). In disability and 6.4 percent because of their sexual recent years Winnipeg has experienced an in- orientation. Overall, 30 percent of surveyed in- crease in rental vacancies, but with a vacancy dividuals claimed that they were evicted or had rate of 2.5 percent, the city still falls well short lost their homes after a conflict with their land- of 3 percent. Overall, this is significant because lord (Gessler and Maes 2011: 11, 13). if renters are unable to easily find housing, they While the causes of homelessness are diverse, are put at great risk of becoming homeless. difficulty finding and maintaining housing is- of Housing shortages are an especially relevant ten the most significant factor. An oft-quoted line challenge for low-income renters because since the among homelessness stakeholders is that: “Home- 1980s there has been a reduction in the amount lessness may not be only a housing problem, but of affordable housing available on the private it is always a housing problem” (Dolbeare 1996: market. In large part this is because there is lit- 34). This is especially relevant in Canada, as gov- tle financial incentive for profit-driven compa- ernment policy has largely failed to address the nies to build affordable rental housing, which housing needs of vulnerable groups. According generally produces a smaller return on invest- to the Canada Mortgage and Housing Corpora- ment than homes or condominiums targeted at tion (CMHC), housing is considered unaffordable middle- and upper-income demographics (Hul- if it consumes over 30 percent of a household’s chanski 2007: 3). Hulchanski and his colleagues income. It has been estimated that 20 percent have argued that Canada’s shortage of affordable of Canadian households live in housing that is housing is a major problem, and one that can be unaffordable according to this definition (Con- directly linked to the rise of homelessness (Hul- ference Board of Canada 2010: 4). The vast ma- chanski et al. 2009: 4–6). jority of these households are renting their pri- Low income Canadians also receive less than mary residence. Yet, despite the fact that many adequate support in the way of non-market social renters are experiencing housing vulnerability housing. According to Hulchanski, Canada has and the fact that the average Canadian home- the smallest social housing sector (which, under owner earns over twice as much as the average his definition, includes government-owned pub- renter ($91,122 per annum as opposed to $43,794 lic housing, non-profit housing and non-profit per annum), a 2010 study found that homeown- housing cooperatives) of any western nation out- ers received 92.6 percent of federal housing sub- side of the United States, with only 5 percent of sidies (Clayton 2010: i, ii). Canadian households living in social housing
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 5 Figure 1 Federal Operating Agreement Spending
$1,800
$1,600
$1,400
$1,200
$1,000
$800
$600 Annual Spending ($) Millions $400
$200
$0 $0 1 1 5 3 3 3 7 7 7 6 8 4 4 01 1 03 03 03 03 03 03 00 6 00 0 1997 2015 2013 2017 202 2012 1998 1999 2016 2018 2019 2014 20 25 202 2010 2001 2032 202 2022 202 20 29 2030 200 2026 2005 /2 200 2024 2002 2020 200 9 200 8 /2 200 / / / / / / / / /2 /2 /2 / / / /2 /2 / /2 / /2 7/ 5/ 8/ 7/ 3/ 9/ 4/ 3/ 2011/ 1997 2010 2017 1996 2012/ 2016 2015 1998 2014/ 2018 2031/ 2013 2030 2032 2021/ 2036 2035 2020 2034 202 2033 2022/ 2019/ 2026 202 202 2024/ 1999 2001/ 202 202 2009/ 2000 200 2002/ 2006 2005 200 200 2008
DATA source: Pomeroy 2014
(Hulchanski 2007: 1). Traditionally, the federal for existing social housing and social housing government has been the primary funder of social construction was transferred to the provinces. housing in Canada. This began after the Second Despite this reassignment, the federal govern- World War when, as part of the newly formed ment has continued to provide over $1.3 billion welfare state, investments were made to provide annually to finance existing social housing units, social housing for Canadians in need. But in 1984, but, as Figure 1 highlights, this funding is in the facing a challenging economic environment, the process of expiring and by 2037 federal transfers government began fiscal cutbacks to social hous- will cease almost entirely (Pomeroy 2014). Re- ing programs, and in the mid-1990s, as a part of searchers have expressed concern that, as fund- deficit cutting measures, funding diminished ing diminishes, social housing providers will not further. In 1993, the federal government ceased be able to afford operating and repair costs. This all spending on the construction of new public may lead to social housing projects being shut housing, and in 1997 managerial responsibility down or rents being increased (Ward 2011: 2).
6 canadian centre for policy alternatives — MANITOBA Responses to Homelessness in Canada
In recent decades a comprehensive system has reliance on emergency services, supporting been developed to support Canada’s growing homeless Canadians has become increasingly homeless population. Typically reactive emer- expensive, with current estimates putting the gency services such as shelters, meal programs cost (including expenses related to health care, and hospital emergency departments have been social services and justice) at $7 billion per year used to address the immediate needs of the home- (Goering et al. 2014: 6). Furthermore, while meal less. Moving out of homelessness has tradition- programs and emergency shelters are valuable ally been approached using the Continuum of tools for addressing the daily needs of homeless Care (CoC), or staircase model, where individu- individuals, they are reactive and do not pre- als transition toward having a home by moving vent people from becoming homeless in the first through a series of steps (Peters and Craig 2012; place. The CoC model has also had questionable Johnsen and Teixeira 2010). For example, people success in moving participants out of homeless- move from the streets, to shelters, to transition- ness. This is highlighted by the results of the At al housing and finally to permanent housing. As Home/Chez Soi (AH/CS) project, conducted they progress, participants are introduced to a by the Mental Health Commission of Canada, wider range of support programs and services, which found that in the final six months of the preparing them to move to the next stage. In this project only 31 percent of participants receiv- model, transitioning from one step to the next ing support under the CoC model were housed is generally reliant on the individual being per- all of the time, with 23 percent housed some of ceived as “housing ready.” This means that they the time and 46 percent never housed (Goering have to demonstrate sobriety or behavioural et al. 2014: 5). control before they are provided with support Due to the problems associated with the CoC to access their own home. If they are unable to approach, many organizations have begun to ad- do so, they do not progress or are removed from dress homelessness in a new way, using the HF the process entirely. model. The fundamental perspective of HF is In recent years, this approach has been criti- that access to suitable housing is a basic human cized for a number of reasons. First, due to its right and that housing is the first step towards
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 7 recovery for homeless individuals (Tsemberis depth investigation into the effectiveness of HF, and Eisenberg 2000: 488). In general, HF pro- establishing pilot studies in five Canadian cit- grams target the homeless populations that are ies, including Winnipeg (Goering et al. 2013). In seen to have the highest needs, particularly in- 2014 the federal government also renewed its dividuals suffering from mental illnesses and/ Homelessness Partnering Strategy with an ad- or addictions and those who are chronically or ditional emphasis on HF principles (Government episodically homeless. of Canada 2014). This has led to a large shift in Programs providing HF services generally funding toward HF projects and away from tra- adhere to several basic principles. First, partici- ditional approaches to addressing homelessness. pants are re-housed as quickly as possible, re- According to the current Homelessness Partner- gardless of whether or not they are perceived as ing Strategy framework, large Canadian cities “housing ready.” Second, HF programs attempt must spend at least 65 percent of the funding to provide housing with few strings attached: to they receive on HF projects, medium-sized cities receive housing, people do not have to be sober must spend 40 percent of their funding on HF and do not need to seek further treatment or and small communities, while no targets have support. Often the only requirement is that, in been set, have been encouraged to adopt the HF the short term, the individual stays in contact approach (Foran and Guibert 2013: 7). with a worker from the HF organization. Third, In large part HF has become popular because within the limits of affordability and availabil- it has proven to be an effective and cost efficient ity, HF organizations give participants choices way to keep homeless people housed. This can be regarding the type of housing they will receive. seen in a number of international and domestic For example, participants may be given a choice cases. For example, New York City’s Pathways between living in a privately rented apartment to Housing has reported a steady housing reten- or in government-subsidized social housing. HF tion rate of 85 to 90 percent among HF program programs also attempt to provide participants participants during its twenty-two years of op- with choice regarding where their housing will eration (PTH 2013: 2). Further, in 2015 Medicine be located and whether or not they will have a Hat became the first city in Canada to eliminate roommate. Finally, once an individual has become chronic homelessness, in large part thanks to the housed, further services are optionally provided, use of HF techniques (CBC 2015). particularly in the areas of community reinte- The AH/CS report has also highlighted the gration, substance abuse, physical and mental success of the HF model, specifically regarding health, education and employment (Tsemberis participants experiencing mental illness. The re- and Eisenberg 2000: 488–489). port found that HF programs reduced partici- Pathways to Housing (PTH), a housing or- pants’ stays in psychiatric, general and emergency ganization founded in New York City in 1992, is hospitals, in addition to reducing incarcerations generally credited with having developed and and emergency shelter use. Considering this, HF popularized the model discussed above (Go- was estimated to cost $14,177 a year for moder- ering et al. 2013: 10). In Canada, the first large- ate-needs individuals, with a savings of $3.42 scale HF project, Toronto’s Streets to Homes for every $10 spent, and $22,257 a year for high- program, was launched in 2005 and in recent needs participants, with a savings of $9.60 for years many other communities have launched every $10 spent. The greatest financial rewards their own HF initiatives. Between 2009 and 2013 were seen in the 10 percent of participants with the Canadian federal government financed the the highest needs, with savings of $21.72 for every AH/CS project, the world’s largest and most in- $10 spent (Goering et al. 2014: 23–26).
8 canadian centre for policy alternatives — MANITOBA The AH/CS report also found that the HF final six months of the project, compared to 29 model was more successful in reducing home- percent of participants who received treatment lessness than the traditional CoC model. Dur- using the CoC model (Distasio 2014: 5). These ing the final six months of the study, 62 percent figures suggest that in Winnipeg HF was more of HF recipients were housed all of the time, 22 effective than the CoC approach, but also that percent were housed some of the time and 16 HF in Winnipeg was less effective than at other percent were never housed. This success rate test sites. In part the lower housing rates expe- is far higher than that experienced by people rienced in Winnipeg can be explained by the housed using the CoC model (which had hous- city’s low housing vacancy rates and the unique ing rates of 31 percent, 23 percent and 46 percent, challenges of working with Aboriginal clients. respectively) (Goering et al. 2014: 5). In the Win- These issues, as well as other challenges facing nipeg portion of AH/CS, 45 percent of HF par- the HF model, will be discussed in detail in the ticipants were housed all of the time during the following section.
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 9 Identifying Weaknesses and Looking for Solutions
Despite the fact that many studies have conclud- outcomes. Waegemakers Schiff and Rook (2012) ed that HF is an effective way to address chronic also found that HF research was generally not and episodic homelessness, HF is not without very diverse. Before 2008 the majority of stud- weaknesses. The following section will examine ies looking at HF outcomes were written by Sam some of the research gaps that exist regarding Tsemberis, founder of Pathways to Housing, and HF. It will then look at several factors that can focused on that organization in particular. Also, reduce the effectiveness of HF projects. Finally, while there was a great deal of research looking it will provide suggestions as to how these bar- at the outcomes of the urban homeless popula- riers can be overcome. tion and individuals with mental illness and/or substance abuse issues, few studies looked at the outcomes of other subpopulations. In particular, Research Gaps Waegemakers Schiff and Rook (2012) found that While research has generally supported the rural homeless, youth, families, ethnic minori- effectiveness of the HF, a number of the stud- ties and women had received less attention in the ies that have looked at the model have been of HF literature. Overall, while they concluded that questionable quality and/or have only looked at evidence supported the effectiveness of HF, par- small subgroups of the homeless population. In ticularly for single adults with substance abuse their HF literature review, Waegemakers Schiff issues and mental illnesses in urban areas with and Rook (2012) found that many studies lacked adequate rental stock, they questioned whether methodological rigour. For example, a number it should be considered a “best practice” without of them were done internally by the organiza- further high-quality research. tion running the program, with a small number A strong first step toward improving the qual- of participants, over a relatively short period of ity and scope of HF literature has been taken time and at a single site. Many studies also lacked by the AH/CS final report (Goering et al. 2014), a control group for comparison, while others which was published in 2014, after Waegemak- lacked quantitative data, instead using less precise ers Schiff and Rook’s literature review. AH/CS qualitative tools such as interviews to examine was conducted using a control group in addition
10 canadian centre for policy alternatives — MANITOBA to an experimental group and it recorded both resulted in a reliance on shared accommodation, qualitative and quantitative data. Also, while which was less desirable to participants and gen- the project focused primarily on people experi- erally led to worse outcomes, when compared to encing visible homelessness who suffered from individuals housed in private apartments (City mental illness and/or addictions, it captured data of Toronto 2007: 18, 34). on a large number of homeless Canadians from A shortage of housing can also impede the diverse backgrounds, having followed over two ability of organizations to provide suitable accom- thousand individuals across five cities, includ- modation within participants’ budgets. This can ing a number of ethnic minorities and women. once again be seen in the City of Toronto’s report, Still, in the wake of the AH/CS report, a which found that the average participant spent number of questions regarding HF remain un- 41 percent of their income on rent, far above the answered or inadequately answered. For exam- 30 percent considered affordable by the Canada ple, what are the long-term impacts of HF pro- Mortgage and Housing Corporation, leaving 68 jects on participants? What is the impact on the percent of respondents without enough money wider homeless population of funding being re- to live on after rent was paid. Further, the study allocated toward HF programs and away from found that many housing units lacked ameni- traditional homelessness support services? And ties. In particular, some participants found food can HF be effective for populations other than storage and preparation difficult because their single adults with substance abuse issues and apartments lacked stoves, full-sized fridges or mental illnesses in urban areas with adequate cupboard space (City of Toronto 2007: 38, 48, 100). rental stock? Overall, if these questions are go- HF programs are also heavily reliant on the ing to be answered, more high-quality research availability of tertiary and support services to on the HF model is needed. help participants reintegrate into the commu- nity (Gaetz et al. 2013a: 6). In particular, many participants require access to employment help, Housing Shortages, Support Services and health and addictions services and counselling. Small Communities Due to poverty, many HF participants also rely A significant challenge associated with the HF on food banks and public transportation on a model is that it generally relies on there being daily basis. HF participants generally receive an ample stock of affordable housing available. support from case management teams (inten- This is problematic in the Canadian context be- sive case management or assertive community cause there is a severe shortage of social housing treatment) that are responsible for connecting and affordable private-market housing in many participants to the services that they need. Yet, Canadian communities. One impact of hous- if these services are not available, it becomes in- ing shortages is that they reduce the amount of creasingly difficult to ensure that participants choice that HF agencies can offer their partici- remain healthy and housed. pants. This can be seen in the City of Toronto’s Challenges related to affordable housing and 2007 examination of the Streets to Homes pro- access to support services are especially relevant gram, which found that in Toronto’s tight hous- in small and rural communities. In their 2011 ing market 29 percent of participants reported study, Stewart and Ramage found that many having no choice in the type of housing they Northern Ontario communities had a shortage were offered, and 31 percent claimed that they of affordable housing and a lack of support ser- were given no choice in location. The study also vices such as emergency shelters, public trans- found that the low supply of affordable housing portation and mental health services (Stewart
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 11 and Ramage 2011: 5). These findings were sup- come challenges related to economies of scale is ported by Schiff and her colleagues, who argued adopting a regional model, where one HF team that there were a number of barriers to success- works with participants from a number of com- fully implementing HF programs in rural com- munities within the same region (Schiff et al. 2014: munities, including small homeless populations 33–34). Another approach that holds promise for (often exhibiting a large range of acuities), as isolated communities is utilizing the Internet well as a lack of funding, health workers and and telephones to offer long-distance counsel- housing (Schiff et al. 2014: 33). It has also been ling and mental health services. Yet, it is worth argued that in rural settings it can be difficult noting that this strategy is limited by the fact to find landlords willing to rent to HF program that many remote northern communities lack participants. This is because, due to the small reliable Internet access (Schiff et al. 2014: 34). populations of these communities, badly behaved With regard to addressing the challenge of tenants can easily gain notoriety with landlords landlords unwilling to rent to HF participants, a (Greenburg 2007b: 10). recent rural British Columbia HF project (Green- These concerns need to be addressed for HF burg 2007b) offers a possible solution. The project programs to be effective. The first and most- im found that it was very important to put meas- portant step that needs be taken is building more ures in place to protect landlord interests and to affordable housing and social housing. This strat- ensure that they did not suffer undue financial egy is already an important aspect of several HF loss as a result of participant actions. Further, programs in Canada. For example, faced with the project used housing outreach workers who increasing rents and decreasing housing avail- helped participants maintain housing, and me- ability, nine Calgary organizations involved in diated between participants and landlords when the city’s HF initiative have partnered together conflict arose. with the goal of building social housing units for three thousand vulnerable and homeless Cal- garians (Resolve Campaign 2014). Beyond this, Reactivity, Rhetoric and Challenges for the if further housing is not built, it is vital that HF Wider Homeless Population projects collaborate with other stakeholders, Another challenge HF faces is that there are some including governments, private landlords and problems it is either ill-equipped to deal with social housing providers, to ensure that there is or it fails to address altogether. One area where enough suitable housing available for program the HF model falls short is in preventing people participants. from becoming homeless in the first place. By its There are also a number of steps that can be very nature HF is a reactive approach, placing taken to ensure that necessary support services an emphasis on getting people who are already are made available to participants. One approach chronically and episodically homeless off the that has been used by many HF programs is col- streets and keeping them housed. This is sig- laborating with other stakeholders in their com- nificant because no matter how many people munity. For example, HF programs may partner are re-housed through HF programs, as long as with a local mental health organization to provide the root causes of homelessness remain unad- counselling to their participants. Further, they dressed, more Canadians will continue to find may form an agreement with the local munici- themselves without a home. pality to provide program participants with city As HF has become more popular, a problem- bus passes. In small and rural communities, an atic rhetoric has also developed around home- approach to service delivery that can help over- lessness and what it means to be homeless. Many
12 canadian centre for policy alternatives — MANITOBA organizations and researchers have talked about gling to fulfill this need. For example, according HF as an approach that holds the potential to to the 2011 Winnipeg Street Health Report, over “end homelessness” (Gaetz et al. 2013a; Tsemb- 50 percent of respondents said they had trouble eris 2010). Further, many Canadian communi- accessing food at least once a week (Gessler and ties, including Winnipeg, are currently engaged Maes 2011: 17). If funding continues to be reallo- in the development and implementation of “plans cated towards HF and away from meal programs, to end homelessness,” which are based around figures like this are likely to rise even further. providing comprehensive support, including HF Another limitation of relying primarily on programs, to chronically and episodically home- the HF approach is that, because it does noth- less individuals (see CTFEH 2014). Yet, as was dis- ing to address issues surrounding the supply of cussed earlier, individuals who are chronically and demand for affordable and social housing, and episodically homeless only make up a small providing program participants with accommo- percentage of the homeless population. Instead, dation can reduce housing availability for those the majority of those at risk are transitionally not supported by HF initiatives (either because homeless or experience hidden forms of home- they are not eligible or because of a lack of pro- lessness. Given this, the rhetoric surrounding the gram space). This is especially true in a context HF model can lead to a narrow understanding where there is a severe housing shortage. This of homelessness that overlooks the needs of the can be seen in the example of the Winnipeg por- majority of people living without a home. tion of the AH/CS study. Even though a relatively The rise of HF has also presented a number small number of people were involved in this HF of challenges for the wider homeless community initiative, conversations with participants have and organizations that work with the homeless. suggested that individuals who did not receive One major challenge that organizations face is support through the program found it increas- access to funding. In recent years, many fund- ingly difficult to obtain housing, because much ing bodies have increasingly devoted resources of the affordable stock was being occupied by HF toward supporting HF programs. Further, when participants (Peters and Stock 2014). Further, HF the federal government renewed its Homeless- programs may disadvantage low-income rent- ness Partnering Strategy in 2014, it mandated ers because, as demand for affordable housing that most communities spend between 40 and increases, landlords may raise rents or become 65 percent of what they received on HF projects more selective in who they rent to (Peters and (Foran and Guibert 2013: 7). Overall, HF programs Stock 2014). are currently receiving a great deal of funding Because HF does not work to prevent home- attention, but this is often at the cost of other lessness and struggles to address the needs of the emergency response and prevention services, entire homeless population, it is important that which in many cases were already underfund- HF programs make up only a part of a compre- ed and overwhelmed. In many communities, as hensive homelessness strategy. At the centre of part of the transition toward HF, services such any such strategy there should be a focus on ad- as community meal programs and emergen- dressing the root causes of homelessness, with cy shelters have had their funding cut, leading the goal of preventing people from becoming them to scale back services or close their doors homeless in the first place. The most important (CBC 2014; Pearson 2015; Richmond 2015). This step in this direction would be a renewed focus is problematic because vulnerable Canadians of- at all levels of government on building more af- ten depend on having access to these programs fordable and social housing. Additionally, fur- on a daily basis, and programs are already strug- ther investment in programs aimed at providing
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 13 support to populations at risk of homelessness cause of these barriers, many of these populations could significantly reduce the number of people have experienced worse than average outcomes who lose their homes. It is also important that, under HF programs. For example, among par- in addition to programs focused on re-housing, a ticipants suffering from multiple mental illnesses number of safety net programs such as emergency and/or severe substance abuse issues, while HF shelters and meal programs remain in place to has been more successful than the CoC model, ease the transition of individuals from housed, to housing retention rates have been below average homeless, to being housed once again. Programs (Johnsen and Teixeira 2010: 12). When discuss- such as these are vital to the wider homeless and ing the impact of addictions, one American HF low-income community. As such, stakeholders stakeholder said: need to consider the effect that the loss of these The group that we lose in this programme, services will have before reallocating funding I would say almost all of them are because toward narrowly focused HF activities. of addiction … Because it’s independent As Canada moves toward ending chronic and apartments in the community, people with episodic homelessness using the HF model, it is severe addiction problems tend to figure out also crucial that more is learned about hidden ways to use the apartment as a commodity homelessness. To this point, the majority of re- where … they’ll get free drugs in order to allow search and homelessness policy has focused on for others to be there using. And so it becomes a the visible homeless population, with little at- lease violation, really, that triggers the attention tention being paid to individuals couch surfing of the landlords or the police or somebody, or living with friends. A strong first step toward that ends up in them losing their apartment. understanding hidden homelessness was taken by (Johnsen and Teixeira 2010: 11) Eberle and her colleagues (2009) in their attempt to enumerate the hidden homeless population of The AH/CS study also experienced difficulties Vancouver through a telephone survey. Current addressing the needs of high-acuity partici- estimates of Canadian hidden homelessness are pants. The study found that, of the HF partici- derived from these data, but because the study pants who did not receive stable housing after only looked at Vancouver, it is difficult to gen- one year, participants typically had been home- eralize its results. It would be a worthwhile en- less longer, were less educated, had more con- deavour to conduct further studies across Can- nections to street culture and were more likely ada, to gain a better understanding of the true to face cognitive impairment or serious mental size of the hidden homeless population and the health issues (Goering et al. 2014: 7). challenges they face. This understanding would In its evaluation of the Streets to Homes allow organizations to work more effectively to- program, the City of Toronto (2007) found that ward ending hidden homelessness as well as vis- Aboriginal individuals reported fewer improve- ible homelessness. ments in their quality of life than the average participant, as can be seen in Figure 2. There are several explanations for why Aboriginal partici- Aboriginal, High-Acuity, Women and Youth pants have experienced worse outcomes. In the Participants study in question, Aboriginal participants tend- A final challenge faced by HF is that a number ed to have been homeless for longer, had experi- of homeless subpopulations, namely high-acuity enced more episodes of homelessness and were participants, Aboriginal participants, women and more likely to have substance abuse problems. youth, face unique barriers to being housed. Be- This is significant because, as is discussed above,
14 canadian centre for policy alternatives — MANITOBA table 1 Streets to Homes: Aboriginal Outcomes Aboriginal Non-Aboriginal Improved health 60% 74% Improved food 43% 73% Reduced stress 48% 65% Inproved sleeping 52% 75% Improved personal safety 52% 80% sources: Graph Source: (Favlo 2009: 28); Data Source (City of Toronto 2007: 43) high-acuity participants have tended to achieve of the hidden homeless population, as opposed worse outcomes with HF. The homeless Aborig- to the visibly homeless population generally tar- inal population also tends to be highly mobile, geted by HF programs. According to Klodawsky which runs counter to HF’s emphasis on estab- (2006: 368), when compared to men, women are lishing a home base (Peters and Robillard 2009: less likely to stay in shelters or on the streets. In- 653). Culture may also be a barrier that prevents stead they are more likely to couch surf or attach Aboriginal participants from effectively utiliz- themselves to housed men. Women are also more ing HF services. A Winnipeg study (Deane et al. likely than men to remain in precarious housing 2004: 240) found that, because of the importance situations. For example, some women exchange placed on reciprocity within the Aboriginal com- sex for housing while others may choose to stay munity, Aboriginal people tended to rely on their in abusive homes to retain custody of their chil- own social networks for support, as opposed to dren (Klassen and Spring 2015; Klodawski 2006: mainstream organizations, which were seen as 366). Overall, because of the invisible nature of practicing charity. Furthermore, the history of women’s homelessness, the HF model may strug- colonialism and racism may cause Aboriginal gle to connect with, and address the needs of, participants to feel less comfortable working homeless women. with non-Aboriginal organizations. If HF is going to equitably address the needs Youth also face a number of barriers that may of all homeless Canadians, strategies must be de- limit the success of HF programs. One major veloped to improve the outcomes of participants issue that HF programs may experience when with unique challenges. For HF to be an effective housing youth is the building of trust, especial- tool for working with homeless women, an em- ly if the young person has had bad experiences phasis needs to be placed on making programs with authority figures in the past. If housed in accessible, especially among women experiencing a private apartment or in an unfamiliar neigh- hidden homelessness. One way this can be done bourhood, youth may also experience feelings is by establishing strong lines of communication of isolation, which can be crippling given the with other organizations that homeless women importance of peer groups to a young person’s may use, such as shelters, health services, meal social development. Finally, youth may lack the programs, women-centred resource programs maturity or skill sets required to run their own and addictions centres. home and this may lead them to feel overwhelmed When working with youth, there are several (Gaetz 2014: 7). considerations that HF programs should keep With regards to women, the major challenge in mind. First, it is important for HF organi- that HF faces relates to access. This is because zations to acknowledge that youth may not be the large majority of homeless women are part prepared to live independently. As such, it may
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 15 be necessary for youth to live in communal or to how the needs of high-acuity participants transitional housing for a time, to allow them can be addressed. First, the toolkit stresses the to build the skills required for independent liv- importance of creativity and flexibility among ing. In other cases, the best approach may be to program staff. These characteristics are impor- re-establish connection with the youth’s family, tant considering that in many cases high-acuity allowing them to move back home when ready participants can be unpredictable and difficult (Gaetz 2014: 19–22). Second, an emphasis needs to work with. Second, the toolkit emphasizes to be placed on building trust. Trust building is the need for communication and collabora- often a long and difficult process. Considering tion. In particular, it argues that when working this, existing organizations with pre-established to address the challenges posed by high-needs relationships with youth should generally be the participants, HF projects should be prepared to ones implementing HF. Further, when connect- work with landlords and with experts in fields ing with youth, organizations should look to such as mental health, trauma and addictions provide low-barrier and low-commitment sup- (Polvere 2014: 82, 97). ports, such as drop-in programs, to build trust When working with Aboriginal participants, and transition them into HF programs. Finally, culturally safe and appropriate service is vital. to prevent feelings of isolation and loneliness, HF To achieve this, it is important that support is organizations should provide youth with oppor- provided for Aboriginal-led housing organiza- tunities for community engagement (Gaetz 2014: tions, that partnerships are encouraged between 13). For example, this can involve supporting and Aboriginal and non-Aboriginal organizations encouraging youth to join community organiza- and that cultural training is provided to non- tions, volunteer, return to school or find a job. Aboriginal organizations (Peters and Craig 2014: With regards to working with high-acuity 5). In the Winnipeg portion of AH/CS, 71 per- participants, lessons can be taken from the ex- cent of participants were of Aboriginal descent, periences of the Vancouver AH/CS program. As and because of this a great emphasis was placed part of the city’s HF initiative many high-needs upon providing culturally appropriate services. individuals were placed in a congregate hous- To accomplish this, the city’s approach to HF ing setting. In this environment clients were was adapted to consider Aboriginal values and given their own room and bathroom, but would lessons, which were taken from a number of come together for daily meals and social activi- sources including the Medicine Wheel and the ties such as crafts and sports. Clients were also Seven Teachings. In addition, existing Aborigi- given onsite access to social and health supports nal organizations — the Ma Mawi Wi Chi Itata and were able to speak with program employees Centre and the Aboriginal Health and Wellness at a reception desk that was staffed twenty-four Centre of Winnipeg — were contracted to pro- hours a day. Overall, the congregate housing vide HF services to Aboriginal clients. The Win- model was found to be very effective at support- nipeg AH/CS site also worked to educate its staff ing high-acuity clients. This is highlighted by the about Aboriginal culture and history. This was fact that over 60 percent of congregate housing done by organizing talks by Aboriginal teachers participants were stably housed for the entire six and elders, and by having staff engage in tradi- months preceding the writing of the project’s fi- tional Aboriginal ceremonies (Distasio 2014: 10). nal report. (Currie et al. 2014: 11–12, 17) The final report of the Winnipeg site of AH/ Canada’s Housing First Toolkit, which builds CS indicates that these measures were moder- on the lessons learned during the AH/CS pro- ately successful at supporting Aboriginal clients. ject, also makes several suggestions with regards The report found that approximately 25 percent
16 canadian centre for policy alternatives — MANITOBA of Aboriginal clients who received support us- HF support from the Wiisocaotatiwin service ing the CoC model were stably housed during team, 40 percent were housed for the entirety the final six months of the study. In contrast, 50 of the projects final six months (Distasio 2014: percent of Aboriginal participants who worked 18). Two central trends can be identified in this with the Aboriginal Health and Wellness Centre data. First, when working with homeless Abo- of Winnipeg’s HF program were stably housed riginal peoples, HF appears to be more success- for the duration of the study. For Aboriginal ful than the CoC model. Second, HF outcomes clients working with the Ma Mawi Wi Chi Itata for Aboriginal peoples appear to be much less Centre, this figure was 34 percent. Interestingly, impressive than those seen among non-Aborig- among non-Aboriginal HF participants served inal participant. Overall, this suggests that HF by the Ma Mawi Wi Chi Itata Centre, 63 per- can be adapted to effectively work with Aborig- cent were able to achieve stable housing. Finally, inal populations, but also that the unique chal- among participants (some Aboriginal and some lenges faced by Aboriginal participants can be with other cultural backgrounds) who received difficult to address.
Ending Homelessness? A Critical Examination of Housing First in Canada and Winnipeg 17 Conclusion
The positive portrayal of the HF model in research, Finally, this paper has argued that HF is not a and its rapid adoption around the world, are tes- silver bullet answer to homelessness. One reason taments to the effectiveness of HF at housing in- for this is that it fails to address many of the core dividuals and keeping them housed. Yet, it is im- causes of homelessness, in particular the shortage portant to realize that there are still a number of of affordable and social housing in Canada. Fur- gaps that exist in our understanding of HF, par- ther, the HF model is generally reliant on other ticularly with regards to its long-term effectiveness programs (meal programs, counselling centres, and its effectiveness when working with subpopu- emergency shelters, health and mental health lations including women, youth and those experi- services and employment, income and educa- encing homelessness in a rural location. Further, tion programs) to support participants in their there are still aspects of homelessness that are not recovery and as they transition out of homeless- fully understood. Specifically, little research has ness — programs that may disappear as funding been conducted about Canada’s hidden homeless is reallocated to HF. Finally, the HF approach population. Because of this, it is vital that further may not be fully effective for all homeless indi- research on HF and homelessness is completed. viduals. Instead, some homeless subpopulations, Another conclusion that can be drawn from such as people with an Aboriginal background this paper is that a one-size-fits-all approach to and high-acuity participants, have experienced HF is not viable. Instead, HF programs need to below average outcomes using the model. Over- represent the unique needs of the participants all, because of these factors, HF should not be and communities they are serving. In rural ar- seen as the approach that will “end homeless- eas, this may involve using a regional services ness.” Instead, it should be seen as playing a role model to achieve economies of scale. When in a wider, comprehensive homelessness strategy working with youth, this may involve additional that includes a renewed investment in social and supports to provide individuals with the skills affordable housing, programs targeted at popu- they need to live independently. When working lations at risk of becoming homeless, emergen- with Aboriginal participants, this may involve cy support services and poverty reduction ini- engaging with Aboriginal service providers and tiatives to support the sustainable transition to using culturally appropriate measures of success. being stably housed.
18 canadian centre for policy alternatives — MANITOBA References
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