CCPA Ending Homelessness? - A Critical Examination of Housing First in Canada and Winnipeg By Matthew Stock - Canadian Centre for Policy Alternatives
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CCPA
CANADIAN CENTRE FOR POLICY ALTERNATIVES
MANITOBA
Ending
Homelessness?
A Critical Examination
of Housing First in Canada
and Winnipeg
By Matthew Stock
JANUARY
2016Ending 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.
This report is available free of charge from the CCPA Acknowledgements
website at www.policyalternatives.ca. Printed
copies may be ordered through the Manitoba Office Thank you to Dr. Evelyn Peters, Canada Research
for a $10 fee. Chair in Inner-City Issues, Community Learning, and
Engagement at the University of Winnipeg for her
input and guidance during the writing of this paper.
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em ail ccpamb@policyalternatives.caAbstract 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 Ex amination 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 Th
is 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 c anadian centre for polic y alternatives —
M ANITOBAHomelessness 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 Ex amination of Housing First in Canada and Winnipeg 3acquiring 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 c anadian centre for polic y alternatives —
M ANITOBAple 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 Ex amination of Housing First in Canada and Winnipeg 5Figure 1 Federal Operating Agreement Spending
$1,800
$1,600
$1,400
Annual Spending ($) Millions
$1,200
$1,000
$800
$600
$400
$200
$0
2031/2032
2029/2030
1996/1997
1997/1998
1998/1999
1999/2000
2000/2001
2001/2002
2002/2003
2003/2004
2004/2005
2005/2006
2006/2007
2007/2008
2008/2009
2009/2010
2010/2011
2011/2012
2012/2013
2013/2014
2014/2015
2015/2016
2016/2017
2017/2018
2018/2019
2019/2020
2020/2021
2021/2022
2022/2023
2023/2024
2024/2025
2025/2026
2026/2027
2027/2028
2028/2029
2030/2031
2032/2033
2033/2034
2034/2035
2035/2036
2036/2037
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 c anadian centre for polic y alternatives —
M ANITOBAResponses 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 Ex amination of Housing First in Canada and Winnipeg 7recovery 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 c anadian centre for polic y alternatives —
M ANITOBAThe 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 Ex amination 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 c anadian centre for polic y alternatives —
M ANITOBAto 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 Ex amination of Housing First in Canada and Winnipeg 11and 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 c anadian centre for polic y alternatives —
M ANITOBAorganizations 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 Ex amination of Housing First in Canada and Winnipeg 13support 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 c anadian centre for polic y alternatives —
M ANITOBAtable 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 Ex amination of Housing First in Canada and Winnipeg 15be 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 c anadian centre for polic y alternatives —
M ANITOBAof 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 Ex amination 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 c anadian centre for polic y alternatives —
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Ending Homelessness? A Critical Ex amination of Housing First in Canada and Winnipeg 19You can also read
