Medicine, Faculty of
Non UBC
Occupational Science and Occupational Therapy, Department of
DSpace
de Pass, Timothy
Dada, Oluwagbenga
John, Joyce
Daley, Mardi
Mushquash, Chris
Abramovich, Alex
Barbic, Skye
Frederick, Tyler
Kozloff, Nicole
McKenzie, Kwame
Stergiopoulos, Vicky
Vitopoulos, Nina
Kidd, Sean A.
Youth homelessness represents a persistent and significant challenge for service sectors with limited best practice guidance. Housing supports, in particular, are widely deployed, with the practice-oriented literature providing little detail regarding service design beyond broad domains such as employment support and life skills coaching. The present multiple case study investigation was designed to develop a preliminary understanding of the guiding principles that attend the development of interventions that support youth exiting homelessness in the Canadian context. These case studies were conducted with a diverse group of five organizations recognized as sector leaders, with findings considered in light of practice standards from the better-established adult housing literature. Key findings with respect to service models included the strategies used to provide flexible, culturally responsive, tailored services with an emphasis on specialist support. Implementation factors included the navigation of strategic partnerships, the use of data in capacity-building, and the benefits and drawbacks of larger, centralized service environments versus smaller, dispersed environments. Youth-specific considerations in housing stabilization models are highlighted. This work contributes to a growing body of literature that seeks to articulate best practices in the effort to address and prevent youth homelessness.
Citation: de Pass, T.; Dada, O.; John,J.; Daley, M.; Mushquash, C.;Abramovich, A.; Barbic, S.; Frederick,T.; Kozloff, N.; McKenzie, K.; et al.More than a Roof and a Key Required:Exploration of Guiding Principles forStabilizing the Housing Trajectories ofYouth Who Have ExperiencedHomelessness. Youth 2024, 4, 931–949.https://doi.org/10.3390/youth4020059Academic Editors: Pamela Nilanand Diego Gomez-BayaReceived: 23 November 2023Revised: 6 June 2024Accepted: 12 June 2024Published: 17 June 2024Copyright: © 2024 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).ArticleMore than a Roof and a Key Required: Exploration of GuidingPrinciples for Stabilizing the Housing Trajectories of Youth WhoHave Experienced HomelessnessTimothy de Pass 1,*, Oluwagbenga Dada 2, Joyce John 1, Mardi Daley 1, Chris Mushquash 3, Alex Abramovich 1,4,5 ,Skye Barbic 6, Tyler Frederick 7, Nicole Kozloff 1,4 , Kwame McKenzie 1,4,8, Vicky Stergiopoulos 1,4,Nina Vitopoulos 1 and Sean A. Kidd 1,41 Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; joycerjohn@gmail.com (J.J.);mardi.daley@camh.ca (M.D.); alex.abramovich@camh.ca (A.A.); nicole.kozloff@camh.ca (N.K.);kwame@wellesleyinstitute.com (K.M.); vicky.stergiopoulos@camh.ca (V.S.); nina.vitopoulos@camh.ca (N.V.);sean.kidd@camh.ca (S.A.K.)2 MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada;oluwagbenga.dada@unityhealth.to3 Department of Psychology and NOSM, Lakehead University, Thunder Bay, ON P7B 5E1, Canada;cjmushqu@lakeheadu.ca4 Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada5 Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada6 Department of Occupational Science and Occupational Therapy, University of British Columbia,Vancouver, BC V6T 1Z4, Canada; skye.barbic@ubc.ca7 Criminology and Justice, Ontario Tech University, Oshawa, ON L1G 0C5, Canada;tyler.frederick@ontariotechu.ca8 Wellesley Institute, Toronto, ON M5S 1A1, Canada* Correspondence: depasstim@gmail.comAbstract: Youth homelessness represents a persistent and significant challenge for service sectorswith limited best practice guidance. Housing supports, in particular, are widely deployed, with thepractice-oriented literature providing little detail regarding service design beyond broad domainssuch as employment support and life skills coaching. The present multiple case study investigationwas designed to develop a preliminary understanding of the guiding principles that attend thedevelopment of interventions that support youth exiting homelessness in the Canadian context. Thesecase studies were conducted with a diverse group of five organizations recognized as sector leaders,with findings considered in light of practice standards from the better-established adult housingliterature. Key findings with respect to service models included the strategies used to provide flexible,culturally responsive, tailored services with an emphasis on specialist support. Implementationfactors included the navigation of strategic partnerships, the use of data in capacity-building, andthe benefits and drawbacks of larger, centralized service environments versus smaller, dispersedenvironments. Youth-specific considerations in housing stabilization models are highlighted. Thiswork contributes to a growing body of literature that seeks to articulate best practices in the effort toaddress and prevent youth homelessness.Keywords: homeless youth; housing; stabilization; youth homelessness prevention1. IntroductionYouth homelessness is a persistent problem globally in both high- and low-incomecontexts. In Canada, at least 35,000 to 40,000 youth experience homelessness annually [1].In the United States, 4.3% of households with 13–17-year-olds and 12.5% of householdswith 18–25-year-olds were comprised of a youth or youths who have experienced homeless-ness [2]. The populations of youth experiencing homelessness are diverse, with an arrayof intersecting risks associated with pathways into homelessness. Risk domains includeYouth 2024, 4, 931–949. https://doi.org/10.3390/youth4020059 https://www.mdpi.com/journal/youthYouth 2024, 4 932(i) youth characteristics with Black, Indigenous, 2SLGBTQ+ identities having pronouncedand unique risk implications, (ii) social context risks such as family instability and exposureto violence and neglect, and (iii) contact with child protection and juvenile justice sys-tems [3]. Mental health and addiction challenges are common, with depression and traumaparticularly prevalent [4]. Mortality rates, primarily due to overdose and suicide, are manytimes those of comparable general populations [5]. These risks occur in parallel with arange of coping activities, efforts to survive and cultivate resilience, and activist and artis-tic engagement, which have been extensively documented [6]. Service systems accessedby youth at risk of and experiencing homelessness have largely taken the form of crisisresponse through interventions such as drop-ins and shelters. However, the field is seeingan increasing emphasis on housing stabilization, which involves assisting individuals whohave experienced homelessness and housing precarity with the necessary supports to exitas quickly as possible and ensure they do not cycle back into homelessness [7]. In additionto providing housing units, housing stabilization aims to improve outcomes in areas ofhealth, employment, education, and social inclusion. One approach is through supportivehousing, which combines housing or rental assistance along with individualized, flexible,and voluntary support services. The Housing First model is one such example. HousingFirst prioritizes the rapid placement into scattered-site housing of individuals experiencinghomelessness and mental health and addiction challenges. Housing First combines severalelements, including a low-barrier process for housing placement, the provision of a unit,and integrated supports. Youth data from a trial of Housing First in Canada demonstratedpromising effects with respect to housing stability for youth with poorer outcomes in otherdomains such as employment [8,9]. Another promising housing stabilization approach foryouth is seen in “Family Reconnect”, which emphasizes shelter diversion and mediation,as supports in this instance are wrapped around youth residing with a parent or otherfamily member.Other work has focused on critical time interventions, as there is evidence emergingthat intensive, comprehensive support at the time of transitions into housing may improveoutcomes [10,11]. One of the most consistent observations in this literature is that housingis necessary but not sufficient, in and of itself, to stabilize the housing trajectories of youthand support flourishing in major life domains [10,12]. In particular, articulation of thespecific components of wraparound supports that attend housing for youth remain unclearin this field—which some have characterized as being in its infancy [12]. A recent scopingreview of housing stabilization approaches for youth identified a small and diverse liter-ature comprised primarily of case studies with very limited trial data [13]. These papershighlighted factors such as the need for supportive housing provided over longer periodswith a range of wraparound supports. Alongside limited detail regarding program compo-nents, specifics regarding how these supports were developed, integrated, and sustainedwere particularly lacking in the reviewed papers. More nuanced commentary in this areacan be found in a recent paper by Slesnick and colleagues [12]. Along with describingapproaches to address basic needs (e.g., negotiating the payment of landlords and bills),they emphasize the need for a flexible approach by support workers in terms of intensityof support and indexing to variable degrees of client engagement. Guidance is also givenin the context of Housing First for youth [14] in areas such as assessment and admissionprocesses, emphasizing youth choice and community integration. However, validation ofthese domains through research and greater specificity in their application remains a gaparea. In particular, considering the large amount of diversity across varying urban contextswhere youth homelessness occurs, very little is known about how housing supports maydiffer—having been optimized for city and population-specific requirements. This knowl-edge gap can hamper implementation without a clear understanding of more universalbest practices and which elements need to adapt to site-specific considerations. Workingtoward the articulation and validation of youth-specific supports might lead to advances inimproving access to effective housing services. Such work would draw on the precedent ofYouth 2024, 4 933how the clear articulation of the Housing First model for broader adult populations has ledto its garnering a large body of trial evidence and wide implementation internationally.The present multiple case study investigation was undertaken as an early effort todevelop guidance on establishing effective housing stabilization interventions for youthdrawing upon diverse, established practice settings. This study presents an opportunity toprovide further detail on model components, their implementation, and which componentsmay be cross-cutting and which might differ as a function of factors such as the size of thecity. This research also provides an opportunity to compare and contrast observations withthe more established adult literature—bridging both implementation and practice modelconsiderations. It is hoped that this work might inform future studies that can establishand validate clear practice standards for the youth housing sector.2. MethodsTo articulate promising practices in the delivery of housing stabilization interventionsfor youth, an intrinsic case study approach was employed. As described by Stake [15,16],this involved site selections based on their own merits and uniqueness to better understanda particular case. Approaching the research question with this case study method appearedthe best aligned with both the need to address the diverse contexts and populationsinvolved and the early/limited state of evidence. For this study, sites considered leaders inthe sector were studied to better understand their approaches to youth housing stabilization.Triangulation was used to enhance the rigor of the design. We examined and compared datacollected from a range of organizations (considering geographic location and organizationsize), different participant groups (i.e., service providers of various programs, serviceleadership, and service recipients), and data sources (interviews and archival documents).Additionally, detailed case study reports were sent to organization leadership for reviewand all feedback and comments were incorporated into the final draft. The case studieswere intended to provide a “thick description” that would help in fully understanding andexperiencing each case study site contributing to the trustworthiness of the findings [16].Ethics approval (#004/2020) was granted by the Centre for Addiction and Mental HealthResearch Ethics Board.2.1. Site selection and SamplingTo identify housing stabilization study sites, key informants from service, policy, andresearch sectors were engaged to recommend what they considered to be effective andinnovative service settings. This process led to the engagement of the National LearningCommunity on Youth Homelessness—a community of practice made up of executiveleaders of Canadian services in the youth homelessness sector that are national practiceleaders. The National Learning Community membership process is invitation only, drawingup organizations that have won national awards and organizations nominated by peers assector leaders and innovators. The full network was invited to consider participation, beingprovided with information about the project by email. The intent had been to conduct5 case studies and a total of 5 sites volunteered to take part (no sites were rejected). Theoriginal intent to sample diversity amongst organizations recognized as providing high-quality services was challenged due to pandemic pressures, as discussed later in the paper.However, while sampling was opportunistic and, as such, posed a study limitation, adiverse group of organizations were found as a function of organization size and regionwith some geographic limitations (no representation from Eastern Canada or the Prairies).Another parallel study is underway, employing the same methods, concentrating onorganizations with an Indigenous focus broadly and in smaller, northern, urban centers.Within organizations, all senior leaders were interviewed with leaders engaging all staff atthe organization working in housing stabilization services with invitations to participate.Service staff, in turn, described the study to individuals and groups of youth residing intheir housing services who were subsequently engaged by research staff.Youth 2024, 4 9342.2. Data CollectionQualitative data were collected between March 2021 and March 2022 using in-depthinterviews. Individual interviews were conducted using a mix of virtual and in-personinterviews with service leaders, direct-service staff, and service users, utilizing separatesemi-structured interview guides for each group. Domains of inquiry included a detailedhistory of the trajectory of services developed and offered over time, components andintegration of the service models, how resources are generated and leveraged, and positionwithin the local systems. The perceived “theories of action” of the participants regardinghow their activities lead to outcomes were also examined. The interview questions werederived through discussions with service leaders in the sector with respect to importantdomains and knowledge gaps. Being mindful of the small number of participants perorganization and potential confidentiality concerns, limited demographic information wascollected and reported. The duration of the interviews ranged from 40 to 60 min. Interviewswere conducted and recorded, then transcribed verbatim by T.d., O.D., and J.J. In additionto these semi-structured interviews, archival documents from each organization wererequested and reviewed (e.g., annual reports).2.3. Data AnalysisData were analyzed jointly by S.K., O.D., T.d., and J.J. using NVivo 14 software.We used the circular approach to analysis as described by Crabtree and Miller [17]. Alltranscripts were read to develop an overall sense of the data collected. The main objective ofthe analysis was to synthesize the various key informant interviews (including the servicerecipient (youth) and service providers (staff)) and secondary data to produce a narrativeaccount of the diverse housing stabilization support models in Canada. This included adescription of what made them practical, detailed information about the services theseprograms provide, how they operate, and how they were implemented and sustained.The analysis employed a constant comparative analysis [18] entailing a sequence of opencoding to identify and apply provisional codes to similar portions of transcribed data thatre-occurred or appeared to be emerging as significant; thematic/focused coding to establishcategories of responses, grouping them into emerging themes; and theoretical coding toidentify how various themes inter-relate.For quality check and inter-coder reliability, all transcripts independently coded byT.d. and O.D. were later reviewed for accuracy by researchers T.d., O.D., J.J., and S.K.Preliminary themes were discussed with the research team and then regularly reviewedin an ongoing analysis. For the coding of documents, a similar process unfolded. Docu-ments were coded within Excel 2024 software using the same coding steps and scheme asabove and then reviewed by members of the research team. These procedures, extendingto the preparation of the manuscript, sought to ensure that the quotes provided wererepresentative and divergent perspectives were brought forward when possible.3. ResultsIn total, data were collected from (1) organization service providers and leaders(n = 26); (2) service users (n = 35) with an average of 5 service providers interviewed (rangeof 4–7) and 7 service users (range of 3–12) at each site; (3) and a variety of organizationaldocuments and publicly available resources (e.g., organization websites). The most recentannual reports at the time of review from each organization, as well as a mix of programplans, fidelity reports, surveys, and strategic plans shared by sites were included in thedocuments. The quotes provided throughout the paper consisted of 17 different serviceprovider and leadership participants and 10 different service user participants with allfive case study sites being represented. Service provider and organization leadershipparticipants ranged across roles and experience. For service users, there was an effort tointerview participants across a variety of programs within each site. The five case studysites were located across British Columbia and Ontario; ranged in organizational size; anddemonstrated decades of housing stabilization services for youth (Table 1). The five caseYouth 2024, 4 935study sites had a variety of models, scale, and levels of support, providing a unique andranging perspective on stabilization models within Canada (Table 2). The findings acrosscase study sites were quite consistent, and as such, the results were presented togetherto highlight the significant themes across sites while noting specific points where themesdiverged as a function of a given site.Table 1. Organization overview.Site Location Years ofOperation AgesNumber of Staff(Approximate) Direct-Service Staff StructureCMHA (FoundryBC) 1 Kelowna, BC 20+ years 17–24 105- Case managers- Housing workers- Housing program managersThreshold Victoria, BC 30+ years 15–24 30- Case managers- Residential supervisors- Outreach workers- Youth mentorsRAFT Niagara Region ~30 years 16–24 30- Case managers- Social workers- Outreach workersYSB Ottawa 60+ years 16–24 350- Case managers- Program managers- Youth workers (shelter, drop-in, youthengagement, justice, mental health andemployment)360 Kids York Region 30+ years 16–26 180- Youth workers- Counsellors- Housing workers- Job developers- Outreach workers1 Canadian Mental Health Association—Kelowna Branch.Table 2. Housing services overview.Organization Stabilization Model Population-Specific Housing Scale Length of Stay Level of SupportCMHA(Foundry BC)Housing First for Youth;Transitional andSupportive Housing;Supportive RecoveryProgram >50 units up to age 25Ranges from 24/7support toindependent,scattered-site livingThreshold Transitional andSupportive Housing N/A >50 units Up to age 24Ranges from 24/7support toindependent livingRAFTYouth Reconnect; ShelterDiversion; FamilyReunification;Emergency ShelterN/A N/A Indefinite N/AYouth ServicesBureauHousing First for Youth;Transitional andSupportive Housing;Emergency ShelterLGBTQ+ Housing (part oftransitional andsupportive housing)>100 units Ranges from1 year—up to age 25Ranges from 24/7support toindependent living360 KidsTransitional andSupportive Housing;Shelter Diversion;Emergency, ShortTerm HousingHOPE: Human Traffickingsurvivors (part of transitionaland supportive housing);Black Youth Housing(program currentlyin development)50–100 units 1–3 yearsRanges from 24/7support toindependent,scattered-site livingThe results below represent the thematic analysis of three main areas; (1) Modelsof support—specific components and cross-cutting themes, (2) Support development,Youth 2024, 4 936integration, resourcing, and (3) Perceived challenges. This organization of results wasdesigned to facilitate a comparison with the literature on youth-specific and adult sectormodels of wraparound support as well as Housing First implementation best practices.3.1. Models of Support—Components and Cross-Cutting Principles3.1.1. Models of Support—ComponentsAcross all sites, supports designed to complement housing were provided in someform, either in a general or specialist role, in areas of mental health, education, employment,physical healthcare, life skills, and basic needs (for a detailed breakdown see Table 1). Gen-eral wraparound supports would often involve a case manager or youth worker providingdirect one-to-one support and connecting clients to community-based resources. Withinsome organizations, more specialist, or professionally specific supports were providedin the housing setting or other organization spaces. These specialized programs wereseen to reduce historical barriers that are often faced and increase access to support in keylife domains. Four of the organizations had a mental health program and/or counsellorsemployed, and two provided on-site access to primary healthcare. Service users noted thathaving an on-site mental health program was important in reducing stigmatization andincreasing accessibility.“So that having it in the building. . . You don’t feel embarrassed and then mental health.When you’re homeless, there’s a lot of mental health issues. You don’t have help. Like Ican verify for that. Like I kind of ignored it and that’s why I went down the drug path. Soto have it here and be like, ‘Hey, like I’m having a bad day’”—Service UserOther examples included having on-site employment programs or specialists on staff(three organizations). Staff spoke about how these dedicated programs may support youthto navigate barriers that have historically blocked paths to securing employment.“We’ve recently started up a youth specific employment services for youth with morebarriers. So youth who have mental health or other challenges that have historicallyprevented them from securing employment, can work with employment specialists at -) tolook forward and be supported in finding employment.”—StaffThe importance of increasing access and reducing barriers were also heavily empha-sized in the area of education. The most prominent example of this was one organizationproviding a classroom and teacher that youth could access on-site with support from aprofessional educator“- has a classroom within our building so youth can get support from a fulltime teacherthat sits in that classroom for the online pieces. Each youth is working on their own classes,but the teachers in the room to support them and then we’ll have a graduation.”—StaffAll organizations emphasize the value of these specialized supports and on-site re-sources in promoting access and gains in key life domains beyond general youth workersupport roles that touch on a number of areas.3.1.2. Cross-Cutting Principles—FlexibilityA key process factor that youth, staff, and leadership highlighted across sites was theability to deliver flexible services. The idea of flexibility occurred across many differentareas of service delivery, including length of services, varied combinations of supports, anddecision-making based on the unique needs of youth rather than rigid guidelines.One dynamic of flexibility was the duration of available supports and housing pro-grams. Both staff and youth discussed how not having a firm move-out date or being ableto maintain contacts with the organizations after they exited the program created a naturaltransition into the next stage while still maintaining a sense of security if needed.“But for me right now I think I just want to stay here for a little while longer just becauseat least here like there’s always someone I can reach out to, I’m not like—I don’t know ifYouth 2024, 4 937I’m ready to be like 100 percent independent yet. But it is nice to have those options andit’s also nice to know that I can also stay if I want to”—Service UserAdditionally, offering a variety of supports and having programming that was choice-based was described as key. Maintaining model fidelity is important for structure andeffective service delivery, yet also having opportunity for different levels and types ofsupport was described as the optimal practice. Incorporating flexibility in service offeringsis significant as it promotes individualized supports.“So I think they, they’re really good at like fitting to everyone’s needs if they needsomething. So yeah. they’re really good at that.”—Service User“. . . a huge benefit for them is that we’re not some institutionalized thing who plans theireveryday, plans their every minute, tells them where to go, how to eat, what to eat, how todo”—StaffLastly, flexibility appeared within the leadership decision-making level. Leadershipflexibility was described as making it easy for direct-service staff to work with youthin a way that was individually tailored. Size of the organization also played a role inflexibility, as larger organizations may have more ability to create a range of housingprograms but, conversely, smaller organizations may have fewer funders to answer to indesigning services.“But I, again it does give you some flexibility, right, so the one thing is would say is beinglarger it means we do have flexibility we can do things like, we’re going to create a queerbuilding. But as a smaller organization, and I’ve worked in those too, you just, you’re sostrapped all the time, right”—Leadership“Some of the elements that really have helped [. . . ] thrive are the fact that we are able tobe so flexible to meet the needs of youth, right. It’s not an organization that likes to sayno. That being said, we do when it’s kind of like a safety risk or a youth or staff, otheryouth, that kind of thing. But for the most part, [. . . ] really has a lot of leeway to makethe decisions that they feel would be best for youth and for staff ”—Staff3.1.3. Cross-Cutting Principles—Intensive Youth EngagementA key factor in the design of relevant, inclusive, and safe housing service environmentswas the promotion of youth engagement. Through councils and committees, youth areable to organize with peers to provide input on programming design and service delivery.Additionally, incorporating youth-led roles within programs created a dynamic whereyouth can connect with peers who have shared lived experience. Youth also spoke of thesepositions as an opportunity for leadership and growth as they transition into adulthood.“I advocate for the other tenants too that live here, and so I advocate for better access toresources and better communication, stuff like that. Other things that we need. I advocatefor our need for safety, I advocate for some of our wants, some of the things that makeus uncomfortable, like the giant banners on the front of the building, that’s what we’recurrently working on trying to get rid of.”—Service User“And in exchange for free rent, they’re on site, they get trained through our peersupport program, in various helping skills, boundaries, this that the other thing andthey provide some on site monitoring and support to the individuals that are residingthere.”—Leadership3.1.4. Cross-Cutting Principles—Equity, Diversity, and InclusionAnother emphasis in the area of youth engagement centered on Equity, Diversity, andInclusion. Across sites, an EDI strategy was underway at multiple levels of organizationaldesign and service delivery. Both service users and staff discussed implementing EDIthrough areas of representation, partnerships, programming, training, and specific diversehousing settings. Rigor in this area was emphasized, given the diversity of the youthbeing supported.Youth 2024, 4 938“40% of the youth at—are younger than age 19, 23% identify as LGBTQ2S+ and23% identify as Indigenous.” [Document Source]One domain in which sites looked to improve in areas of diversity and inclusion wasthrough more representative staff and roles. Having staff and positions that reflected thosethat the organization was serving assisted understanding between staff and youth.“We also have a cultural wellness worker who works 20 h a week. And her role is toprovide an Indigenous lens to our program and work specifically with Indigenous youthor any other youth that are interested in. . . involving those practices into their recoveryjourney.”—Staff“What I feel that if—had a more diverse cultural staff team, it would be so much help-ful. . . because interpretation is not only language, it can be values, how the person israised.”—StaffFurthermore, several specific practices were implemented throughout organizationsto offer diverse cultural and identity programming. This created spaces for youth to feelconnected and understood within their housing.“And then on Fridays, we always—we usually do, if there any Indigenous workers here,we do like—what’s it called—smudging. We’ll have like a group, kind of we’ll sit aroundthe fire and do like cultural stuff.”—Service User“We also have a gender specific group for women and people who identify as female thatdoes that same sort of work and convenes regularly. And also, locally we have like thequeer youth group that meets and also an advisory committee that’s convened aroundyouth who have received service”—StaffOrganizations also looked to address diversity and inclusion through a purpose-ful redesign of programs that focused on increasing acceptance of gender-diverse andtransgender youth.“Another shift, so, a lot of shifts have happened in the last few years. So, I mentionedthat our homes used to be called the boys’ house and the girls’ house. They’re now themale identifying house, female identifying house, and there’s a gender diverse house that’s. . . intentionally kind of open and without any barriers there”—LeadershipLastly, organizations spoke to the development of trainings and frameworks to increasestaff and organizational understandings of EDI; however, assessment of the direct impactson services and outcomes was described as challenging.“We’ve done work around EDI work, the last sort of organizational push we did, was toadopt an anti-oppression framework. . . and that was a solid piece of work, but I don’t thinkit really had an impact on the experience of folks, both staff and youth in our services oron our work sites.”—LeadershipUltimately, staff and service users spoke to how better representative staff, implement-ing culturally specific programming, and promotion of acceptance of diverse identitiescontribute to culturally relevant and safe housing supports.3.2. Support Development, Integration, and Resourcing3.2.1. Data and EvaluationBudget growth and sustainability strategies were discussed extensively as they relatedto building out more robust housing stabilization services over time. In terms of building arationale for funding, themes included using evidence of impact and avoiding sympathy-inducing narratives about clients. Data generation was also seen as important to identifysystem gaps and develop innovative programming that “wouldn’t have existed withoutus.” Staff spoke to the importance of utilizing data to obtain funding by providing evidenceof proof of concept and positive impacts on other systems, such as healthcare.Youth 2024, 4 939“We had a social return on investment study that was done a few years ago on ourscattered site housing, which showed that for every dollar in, we got just under $5, back.2.50, to the you know, the emergency care system, and then another two something to theindividuals that were housed and some benefit to the, to the landlords that were leasingto us. . . We use that as a document to sell, sell, sell, to try and get resources. . . give mebasically one case manager and 20 rent supplements, and we’ll take care of 20 of thosepeople that are going to be on the streets. And we’ll do it in a way that’s cost effective,and you’re going to see a return.”—LeadershipBeyond securing funding and growing services, data generation was also useful inmeeting service users’ needs and assessing their goals. This helped with engaging youthon how they are doing in the program while also seeking out improvement areas in servicedelivery to fit their needs.“So we have a pretty extensive survey that we created last year. We created it in thespring, and we ask them, we either do the intake—or do the survey with them, some youthlike to do it on their own, . . . and we track everything.”—StaffGrowth was described as a back-and-forth process, emphasizing building the bestpossible team, generating evidence of impact, and growing from there rather than placinga sole emphasis on obtaining funds without a strategy.“Not looking at building your budget, but building the best team possible, and you know,and I found that if you do it right your budget will grow with that.”—LeadershipFunders were described as being very responsive to this type of approach—building amodel, validating, and then providing more funding to build further based upon successesto date.3.2.2. Balancing Multiple Funding Sources and Resource AllocationOrganizations described obtaining funding from a range of sources, including phi-lanthropy and all levels of government. Data and relationship-building were describedas essential in identifying and cultivating funders—with a rigorous strategy necessary inthis highly competitive space. Related to housing stabilization specifically, approachesinclude securing housing from one source, subsidies from another, and staff supports fromothers. Tracking and being responsive to such a broad range of funders was, however,described as challenging. More broadly, obtaining and sustaining an adequate amount offunding for an optimal suite of support services was described as a persistent challenge.This challenge, which is very common in the not-for-profit sphere, was compounded forthese organizations given the breadth of housing supports provided.“And the challenge always with funding is that they’re very specific, everybody wantsvery specific things, and often those specific things don’t include administration, so you’reexpected to put all your money towards a project but you need those backend supports tomanage them. And we need a very sophisticated finance director to keep track of fundingfor—we’ve got 25-plus programs, not necessarily 25 different funders for each, but withineach you have—some of them—a huge mix. Like with our housing programs, there is ahuge mix from government to private, and they all have a little sliver.”—LeadershipAt one case study site, a Youth Reconnect and shelter diversion approach were deliv-ered. The organization’s successes in keeping youth within their community of origin andout of the shelter system created a reduction in the organization’s shelter use. Althougha positive outcome, it was a trade-off where the shelter needed fewer resources and, as aconsequence, could secure less funding. This was a challenging negotiation, ensuring thatresource reduction in the shelter context was balanced by securing increased resources foryouth reconnect programming.Achieving the right balance of service-related investments and growth, while meetingthe requirements of an array of funders and shifts in funding amounts and sources overtime, was described as very difficult and risky to the organization if done wrong. GettingYouth 2024, 4 940this balance right, in contrast, facilitated growth and sustained funding while being effectiveand staying true to the mission of the organization and ethical practice. Some service leadersdescribed the utility of hiring consultants to assist in developing growth plans given thecomplexities involved.3.2.3. CollaborationAcross all sites, collaboration with other agencies, partners, and different communitysystems were key in generating resources and providing a wide range of support types.Collaboration assisted organizations in creating programs, delivering effective interventions,managing referrals, and enhancing access to supports and culturally responsive programming.Partnerships with the school system were seen as effective levers to build and imple-ment services. Working with schools, organizations were able to identify and implementearly intervention approaches for youth who may be at risk of homelessness. For oneorganization, this helps to both provide youth with timely services and keep them closeto home where known supports can be leveraged to maintain their attachment to theirhome community.“. . . I talked to my teacher at school and they had told me about this program, and theneventually when I did end up leaving when I was 16, my principal immediately got me incontact with a worker from the—so I could start to try and get the ball rolling in order tofind myself sustainable housing”—Service User“So, first, we’re going to stabilize your housing, and then, second, we’re going to lookat your attachment to school. Are you still in school? Have you dropped out of school?Have you finished high school? All of those types of things. We also find those schoolquestions help determine what their home community might be, if they’ve already beenmoving around or not. Ideally, we’re getting to them before they’ve ever had to leave theirhome community or home school, because a lot of those more natural supports are alreadythere, and we don’t want to lose those.”—StaffIn creating new programs, one organization highlighted the significance of leveraginglocal developers with existing builds to secure housing units. With the affordable housingshortage, utilizing unique housing streams has been key in building programs.“We started talking about the issue of housing and youth housing and what couldpotentially happen there. And a [local developer] indicated to me that he had a propertylike a piece of land that he was looking to develop. . . So they’re like 300, square feet, andhe had this property, he was looking to do a five-story building, all with studio units. . . So,this led to an ongoing conversation about what we might do and resulted in an agreementthat we would,—lease one floor of that building with 18 studio units of housing specificallyfor youth, and we would get that at a reduced rate basically”—LeadershipAdditionally, organizations looked to leverage partnerships with provincial housingto implement youth-specific programming in an already existing project. Taking advantageof existing programs provided an opportunity to expand housing services and demonstrategood outcomes, building a rationale for further funding.“But in the absence of other resources, it’s basically we’ve built 35 units in the last yearof youth housing versus waiting for the ideal scenario to come along where a piece ofland falls out of the sky, the provincial government says, OK, we’ll give you enoughmoney to do this. We, we had to make a go of it with the idea that as we can demonstratethat this works, and there’s a specific need, we want to leverage this into a standaloneexperience.”—LeadershipThrough the development of relationships and building trust with housing partners,organizations leveraged existing units into new youth housing programs to work aroundresource availability barriers. From there, organizations can establish evidence of need andeffectiveness to leverage into further resources for future projects.Youth 2024, 4 941As described earlier in the supports section, the most frequent way collaboration wasdescribed through case study sites was to utilize partners to expand supports and provideaccess to specialists. These partnerships were implemented to bring supports on-site or, ifoffered at other organizations, service access is facilitated through strategic partnerships.Staff members spoke to the significance of utilizing community partners to meet clientneeds in key domain areas beyond what they were able to offer in-house.“We looked to stabilize housing, and then brokerage service. So, we’re not offering anykind of clinical support, we’re not offering any kind of addiction, we’re strictly housingsupports. It’s a wrap around. So, although we are looking after the housing, we’re also thebroker. So, if the youth indicates that they want additional services—clinical, or whateverit may be—then we work with our partners to find the service to best address how they’reexpressing their needs, and then we link them to that service. So that’s kind of our brokerrole.”—Leadership“I’m working with -. So, the worker comes to our building, meets with the client in theunit, and works on different life skills or support in attending appointments.”—StaffMany staff discussed programs and partnerships that had been created to supportdiversity. Such partnerships expanded culturally-relevant resources and increased servicesspecifically for racialized and Indigenous youth as they are over-represented in theirservice contexts.“So right now I’m trying to work on a partnership. . . they’re a Community Health clinic,but specifically for Black folks. So what can we do—what can we partner with to bringyou to do some services specifically with our kids who are, you know maybe looking forthat support.”—Staff“Our last practicum student created an Indigenous resource database for us, and it’sincredible. And so she went to every youth in our organization right now and askedthem, what band they were from. And she went and put links to all the websites for thosebands.”—StaffGiven that youth housing programs and services end at a certain age, the transition toindependent living afterward can be challenging due to housing costs and availability. Oneservice user highlighted how leveraging partnerships can assist in securing finances forpermanent housing, which is an important factor in long-term housing stability.“. . . they’re going to help me get my subsidy approved from the city. And they’re going totalk to the people about how we can make a plan for last month’s rent because it’s hard.And they helped me with moving vans and getting me boxes—it’s so helpful and it takesa lot of the stress off.”—Service UserA final way organizations discussed collaboration was utilizing partners to enhancecommunity capacity and understanding by providing resources to and otherwise engagingand educating community groups to reduce stigma and increase acceptance and belongingin community contexts.“For the average community person, you know, the idea was we were bussing up criminalsfrom Toronto and everywhere else. And so we had to do a lot of work, a lot of communitydevelopment work, to sort of, you know, get people on side about what we were doing.I think there were a lot of people that we were able to bring on side and get involved inwhat we were doing.”—StaffThere were challenges experienced within the area of collaboration. With manypartners involved, it can create confusion as to who may be responsible for what in theservice user’s life. Other times, there may be disagreements as to what the best course ofaction is or competing interests depending on each partner’s role.“Because our caseloads are big and we’re over here now, and then something big happensand we go back and look and say oh, we thought you were doing that. No, we thought youYouth 2024, 4 942were doing that oh, we don’t do that you do that. That kind of stuff comes up, and younever get really, really serious implications, but you know, any sort of bump along theroad in somebody’s recovery from homelessness is a serious implication.”—LeadershipA final takeaway in the area of collaboration was that in order to effectively implementyouth stabilization services, collaboration needs to be developed at all levels both withinand outside of the organization. Maintaining relationships with funders, the networkof partners, and different community sectors brings different growth opportunities andchallenges. On a leadership level, collaborating can introduce new funding streams andprogram development. With direct-service delivery, effective relationships with partnerscontributed to cohesive implementation of supports for the unique needs of the youth.“First of all, it’s relationships, but it’s relationships at multiple levels of the organization.Right. And sometimes it’s the service delivery staff on the front line. They get it, theyknow, they’re there, and they’re working for the best interest of the young people, andthey work pretty well together.”—Leadership3.2.4. Agency Size and ContextWhile common themes were connected across sites, each organization had their ownunique trade-offs and implementation factors based on the context of their location, size,and program design. This area was the greatest point of divergence across sites.The context of organization location and scale created different implications for thetailoring of services to youth needs. One large organization in a large city was able tomaintain a Housing First approach while still offering a variety of unique housing andprogram options for service users within the Housing First model. This was accommodatedas a function of large numbers of units across multiple sites.“We have the ability to have different types of housing based on different types of need whilealways maintaining a capacity to move somebody out from a Housing First perspective ifthose things are required. So, it’s a two-pronged approach.”—LeadershipFor smaller organizations in mid-sized communities, a different approach was neededto maximize program offerings given fewer resources. One organization utilized smaller-sized housing sites of approximately eight units which allowed for more indexing to beflexible in designing specialized programs. This smaller-scale form of housing meant thatthe organization could split their resources in different areas and maximize their ability tomeet the unique needs of youth (e.g., an abstinence site and a harm reduction site).“There’s a lot of more anecdotal evidence just based on our history that these housesof five, six, eight, are actually quite effective if connected with the right types of re-sources”—LeadershipAlthough flexibility was highlighted as a key principle, size and contextual factorsmay impact the ability to implement flexibility within housing models. Funding challengesand small organizations may limit access to spaces to introduce and implement creative,flexible programs as they try to adapt to the limited resources at their disposal. Additionally,the increasing need for affordable housing may make it difficult to extend the duration ofsupport and housing. Furthermore, while being able to modulate program designs to meetindividual needs is valuable, there also needs to be adherence to the program model tomaintain fidelity and consistency.Ultimately, the contextual factors of city size, organizational resources, and scale ledto organizations implementing and delivering their services in unique ways that theyperceived best aligned with community needs.3.3. ChallengesAcross case study sites, service users, staff, and leadership highlighted challenges thatwere faced within organizations. The most common challenge was housing affordabilityand availability. Both staff and service users discussed long waitlists to enter housingYouth 2024, 4 943programs and hesitancy or worry leaving housing programs due to the cost of marketrent housing.“But, like I said, some of the room rentals are $800 a month now, and that’s more thantheir entire Ontario Works cheque here. So, in making sure that we’re able to find safe,affordable housing and not—I’ll use the word a sketchy rooming house or something likethat for, you know, maybe a 16-year-old girl who’s never lived on her own, like, that’sdefinitely an issue.”—Staff“Working with a younger population as well some landlords are unsure about housingclients who may be 16, 17 and even 18, maybe still in high school or in university or notin school etc. and just unsure how they were going to house them without a co-signer. Soworking with the young individuals, typically in the private market landlord to be able toget a co-signer”—StaffStaff discussed specific challenges to their position and role in the organization. Staffnoted that burnout and limited compensation had negative impacts on their well-beingand job satisfaction. This was a risk for high turnover rates at organizations, leading todisruptions in services and relationships with service users. Some organizations lookedto hire more staff and develop policies and programs to better support staff as a way tomanage turnover and high burnout rates.“Because of high caseloads and high complexities of youth, intentional 1:1 time is some-times missed or the opportunity not taking because of the level of “crisis support” or“firefighting” that can take place. Adjusting caseloads to be more manageable to allow formore intentional case management and relationship building.”—Document Source“A lot of challenges that we’re facing currently, and ongoing I would say, is the turnoverof staff because of burnout”—StaffService users described various challenges and barriers they had experienced withinthese housing programs. Although organizations had implemented extensive supports,service users still faced long waitlists when accessing external community resources. Ad-ditionally, service users discussed that when they did get connected, supports such ascounselling, employment, or medical care could be limited in effectiveness due to limitedaccess, inconsistency, turnover, and short length. One service user discussed how thisdiscouraged them from reaching out to further supports, while staff highlighted relianceon informal crisis counselling.“So you’ll have somebody you’ maybe connected with, a doctor or a counsellor and thenthe next week they’re gone. . . I mean like there’s no consistency.”—Service User“No [they didn’t help], I had to find [the job] myself. Like the stuff they offered isunderpaid”—Service UserAnother significant challenge that some service users experienced was interpersonalsafety within the buildings where they lived. Service users reported experiences of violenceand confrontations in the building, guests entering the building leading to conflict withother residents, or apartment takeovers. Service users also noted an increase in these safetyissues during off-hours and in the evenings when staff were not present. In response tothese challenges, youth proposed several solutions such as disciplinary actions, increasedsecurity/staff presence after hours, and educating residents on appropriate and safe con-duct. Although not every case study site detailed similar challenges, programs with largerbuildings and a mix of needs reported more problems in this area.“OK, so a typical example, would be a young person who’s vulnerable. So they’ve beenexploited in the past or trauma. They have PTSD, or what have you multiple concurrentdisorders. So they get housed. So they have apartment, and then they feel bad for theirfriends who are homeless. So they have them, yeah, you couldn’t come crash at my place.And then they let them in. And then next thing there’s a takeover. It could be—we don’tYouth 2024, 4 944have tactile proof, but it’s pretty obvious that sometimes it’s gangs. And they do humantrafficking.”—Staff“So, it’s pretty often here that we have someone banging and screaming on doors andfights in the hallway. There’s a lot of scary, sketchy things that happen, especially lateat night and that concerns a lot of people, and it makes a lot of us feel pretty unsafe.”—Service UserWorking relationships between staff and clients were also difficult at times. Serviceusers that perceived staff to treat their role simply as a job or as not having similar livedexperiences spoke of difficulties with relationship building. Some staff also detailed a lackof diversity amongst service providers as impacting their ability to engage diverse clients.Furthermore, service users’ relationships with each other was also a common challenge.Conflict between service users with differing needs and expectations could yield negativeexits and experiences in programs.“. . . everyone here just kind of feels like they’re punching the clock or just got out ofuniversity or whatever. I don’t know it’s just—the other guy that I talked to, he’s likefrom the streets and been to the lower east end, and I used to live on the lower east end sowe have kind of like a bit of a connection.”—Service UserIssues with building maintenance and appearance were also a challenge. Damage tounits was not uncommon with repairs being a significant expense for agencies. Fundingchallenges affected both building maintenance and overall quality—with implications foryouth experiences.“It’s kind of like stigmatizing, people drive up to the apartment building and like what isthis . . . like a hospital or something—no it’s just an apartment building . . . ”—Service User“And so, the cost of turning the units between tenants was also really, really growing.And so, it became pretty apparent that our facility management when it comes to non-profit buildings, was pretty weak. . . Because young folks, I mean the buildings weren’tattractive, they weren’t welcoming, they weren’t nice spaces to be in and looked fairlyneglected.”—LeadershipA final challenge that was experienced by organizations was community pushback.When programs were first being developed, there could be discrimination against indi-viduals who have experienced homelessness or used drugs and organizations would faceattempts to shut down the program.“But the community in -, where—is located really pushed back against that model. Andwe ended up with like a petition of 14,000 signatures from residents saying we don’t wantthis here. And that was really hard. Like, I went to the open house at the communitycenter and it was just full of really upset, angry folks who did not want to see thisbuilding.”—Staff4. DiscussionThis multiple case study project was designed considering extensive evidence thathousing alone is necessary but not sufficient to support youth in permanently exitinghomelessness and flourishing in major life domains [12,19]. Furthermore, this study helpsto address a gap in the literature where housing stabilization and wraparound supportsare often thinly described both in terms of program components and implementation withminimal consideration of how support models index as a function of city and populationcharacteristics [12,13].At a high level, these case studies suggested a good alignment with the core valuesof supportive housing models such as Housing First for youth and adult populations.Specifically, there was an emphasis on tailoring services to youth choice and individualizedneeds, positive development in key life domains, social connectedness, and communityintegration [14,20]. The components of these models of support in the form of case man-agement, health and social service connections, employment and education supports,Youth 2024, 4 945independent living supports, and connections to community are all likewise consistentwith supportive housing best practices [14,20] and elements identified in the broader youthhousing literature [13].Several of the findings of the present study, going beyond more generic descriptionsof values and practices, might speak to both youth-specific considerations and optimizedservice effectiveness. These findings speak to organizations engaging education, employ-ment, and health specialists to provide on-site services as much as possible. The strongemphasis on education is less evident in the adult supportive housing literature and, nodoubt, reflects the unique needs of youth populations. Future work may generate evidencebehind the strength of specialist, embedded supports (vs. generic case management andexternal referrals) and resonates with other complex intervention evidence bases suchas Assertive Community Treatment for adults with mental illness [21]. Additionally, theFamily Reconnect emphasis in these case studies represents another youth-specific supportcomponent, with family conflict being a primary driver of homelessness for youth [22].The strong emphasis on the flexibility of service types, intensity, and duration alignwith supportive housing best practices [14,20]. The theme of this flexibility extending tothe approach of organization leadership, in maximizing staff autonomy and their ability toindividualize supports, was not commented on substantively in the supportive housingliterature. The utility of flexible leadership is, however, addressed in the broader healthcareliterature with a particular focus on complex and dynamic care contexts [23]. Similarly,the youth engagement and equity domains identified here align with supportive housingbest practices. The intensity of focus on these areas (e.g., extending well beyond simplyhaving advisories, working toward whole organization anti-oppression frameworks) maybe another signal of a best practice area warranting further study. Indeed, highly intensiveyouth engagement is increasingly being emphasized as a best practice cornerstone in arange of service contexts [24,25]. Also, previous work in the area of youth homelessness hashighlighted how fundamental and essential the depth of approach to equity considerationsis in this field (e.g., 2SLGBTQ+ youth) [26].The themes generated in these case studies in the implementation frame are largely inline with implementation guidance in the Housing First literature [27]. It was evident inboth coverage of strategies and challenges, that cultivating supportive team environmentswith extensive opportunities for training and mentorship is a priority. A priority andalso an area of difficulty is an underfunded sector engaged in very stressful work whereretaining a healthy workforce is difficult [28]. Furthermore, at the program leadershiplevel in our case study sites, work had been conducted to establish clear objectives andwell-articulated practice models which were continuously evaluated and iterated upon.Leaders seemed highly engaged and supportive of staff. At the system level, interagencypartnerships were clearly present. All of these characteristics are present in descriptions ofHousing First implementation standards [27].Where the present findings make a unique contribution is, again, on emphasis andnuance. For example, although collaboration with complementary organizations is a sup-portive housing practice standard and has received some comment in the youth homelessliterature (primarily grey literature; [29]), the emphasis on a wide range of collaborationsfor multiple purposes was striking. Functions of these collaborations included an enhancedability to provide access to specialist supports on-site and off, providing culturally relevantservices, the creation of housing units working with developers and government, foster-ing community engagement to reduce stigma, and creating opportunities for preventionthrough collaborations with schools. In resource-constrained contexts and in the interest ofmeeting the needs of a very diverse population of youth, collaborations had implicationsfor organization growth and viability, sustaining a focus on a core mission, and improvingthe quality and breadth of services. These efforts resonate with the literature on the meansto work against community resistance to the presence of these types of services and creatingopportunities for inclusion [30].Youth 2024, 4 946The other theme that has not been emphasized extensively is that of developingrigorous data infrastructures. Employing data effectively can help to focus interventions,guide decision-making about service models and expansion, and help to build a rationalefor more successful fundraising. The final point that arose in these case studies that hasreceived minimal attention in supportive housing literature is the manner in which growingand sustaining high-quality housing supports for youth is a balancing act. This themewas a major emphasis across leadership interviews and, while resonating with genericsenior management best practices in areas such as healthcare [31], resource and prioritybalancing are arguably all the more essential in youth housing stabilization—where acomplex intervention meets a diverse population with complex needs. Key points ofbalance included those of (i) keeping organization focus and cohesive teams throughgrowth periods, (ii) balancing the resourcing of prevention while reducing an emphasis onshelter-based supports, and (iii) weaving different funding sources with different supportfacets in a coherent manner. The specific city context can influence these growth and modeldetermination processes, with there being some advantages to being a large organizationwith large facilities and some advantages to being smaller (e.g., more and smaller housingsites that target specific needs such as tailoring to those using drugs and those engaged inabstinence). Awareness of the contextual factors of city size, organizational resources, andscale is key to developing a model that best fits the community’s needs.This study brought forward several implications for future directions in the field. First,this study could contribute to the development of more detailed descriptions of best practicehousing stabilization supports for youth and their implementation. More nuanced practiceguidance, and attendant tools for assessing program fidelity, could improve practicesand deepen the evidence base. Some efforts are underway in this regard, such as theMaking the Shift Housing First for Youth program of research [32]. Such work mightalso benefit from connecting with the best practice literature in areas such as supportedemployment and education [33,34]. Second, attending to the priority of providing servicesflexibly, there is a tension in navigating the maintenance of model fidelity while also beingflexible to the unique needs of youth and of the agency. Continuing to unpack whatcomponents of these models need to be more uniform as drivers of positive outcomesand what can be modified as a function of needs and agency context is a useful areafor future research. Such work might draw on research into modifications to the adultHousing First intervention for Indigenous populations [35]. Finally, the manner in whichthese interventions exist in a larger system has serious implications for the functioningof these models. Given the lack of affordable housing as well as housing processes thatoften come with barriers of discrimination for this population, youth are left with fewhousing options to exit into when they transition out of supportive housing. These issues,combined with a largely disorganized and inadequate funding environment, leave evenhigh-functioning organizations struggling to maintain an adequate amount of high-quality,safe, and sufficiently staffed housing. This resourcing problem opened up a tension in ourfindings between the intent to deliver on these housing stabilization models and the abilityto fully and consistently do so. It was intent vs. practice discrepancies, when perceived, thatwere at the heart of the challenges described in this study—particularly from direct-servicestaff and youth perspectives.This study has a number of limitations. First, it was conducted during the COVID-19pandemic. This circumstance led to fewer interviews across organizations, particularlywith service users, than would be ideal. This challenge was mitigated to some extent bythe focused nature of the inquiry and the cohesion of themes between sites, which affordedsaturation. Gaps in the depth of inquiry in certain areas, nonetheless, are present (e.g.,more nuanced information regarding the details of decision-making in the developmentof services over time could have been helpful; more detail regarding the developmentand maintenance of EDI strategies and attention to some gap areas such as services forracialized youth). The pandemic also had implications with respect to the original intentto use a rigorous Delphi method to identify organizations willing to participate givenYouth 2024, 4 947the extreme challenges this sector faced. This problem was offset to some extent by thesuccess with engaging diverse organizations and their engagement through the NationalLearning Community on Youth Homelessness. Finally, this study cannot address thespecific outcomes of these programs with our being unable to tie practice elements to effectsand assess fidelity of future work, employing pragmatic, complex intervention trial designscan assist with articulating effectiveness, including cost-effectiveness. Some work in thisarea is underway [36–38].5. ConclusionsThis study of housing stabilization models for youth exiting homelessness has showna good degree of consistency with more established adult-focused supportive housingvalues, practices, and implementation strategies [20]. Services are flexible, tailored, have apositive/recovery focus, and emphasize social and community engagement. Likely youth-specific and youth sector service quality indicators include on-site specialist engagement,degree of flexibility including leadership flexibility, and the degrees of youth engagementand attention to equity and culturally responsive supports. Points of best practice alignmentin implementation included an emphasis on staff training and support, mission and modelclarity, engaged leadership, and broader system engagement [27]. Again, potentiallyanchored to youth-specific services and quality therein, we found a marked depth ofcommunity partner engagement, the emphasis on data generation and service iteration, anda tricky balancing of resourcing, innovation, and model adherence. These characteristicsalign well with the demands of complex intervention deployment for highly diversepopulations (with youth populations having the added dimension of development in theircomplexity). This information is important in the context of a service delivery contextlacking a substantive evidence base and where platforms are emerging (e.g., A Way HomeCanada) that can help to reduce the reliance on duplicative, disconnected, and wastefultrial-and-error approaches. Such work is needed to improve the likelihood that youngpeople transitioning away from extensive histories of violence exposure and systemicadversity can take full advantage of the stability that a roof and a key provide—to heal andhave fulfilling lives after homelessness.Author Contributions: Conceptualization, all; methodology, all; formal analysis, data curation, andinvestigation, T.d.P., O.D., J.J. and S.A.K.; writing, original draft, T.d.P. and S.A.K.; writing—reviewand editing, all; supervision and project administration, S.A.K.; funding acquisition, S.A.K. Allauthors have read and agreed to the published version of the manuscript.Funding: Making the Shift—Networks Centre of Excellence.Institutional Review Board Statement: Ethics approval (#004/2020) was granted by Centre forAddiction and Mental Health Research Ethics Board.Informed Consent Statement: Written informed consent has been obtained from the patient(s) topublish this paper.Data Availability Statement: The qualitative data to support the findings of this study have not beenmade available due to their containing of information that could compromise the confidentiality andprivacy of research participants.Acknowledgments: Appreciation is extended to the National Learning Community on Youth Home-lessness and Nick Kerman.Conflicts of Interest: The authors declare no conflicts of interest regarding the publication of this paper.References1. Youth | The Homeless Hub. (n.d.). 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Article
eng
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Vancouver : University of British Columbia Library
Multidisciplinary Digital Publishing Institute
CC BY 4.0
Faculty
Researcher
homeless youth
housing
stabilization
youth homelessness prevention
More than a Roof and a Key Required: Exploration of Guiding Principles for Stabilizing the Housing Trajectories of Youth Who Have Experienced Homelessness
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