Transitioning Youth Out of Homelessness 2.5: A Co-Designed Strengths-Based Leadership Program for Young People Transitioning Out of Homelessness
Phase: NA
Conditions: Homelessness, Youth
Sponsor: Unity Health Toronto

 
 
 
 
 
 
 
 
 
Transitioning Youth Out of Homelessness 2.5: A Co-Designed Strengths-Based Leadership Program for 
Young People Transitioning Out of Homelessness  
 
NCT06425458 
 
Protocol version last approved by REB May 27, 2024 

TYOH 2.5 Study Protocol – v1.2 – May 27, 2024 
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Appendix A: Study Protocol 
 
Transitioning Youth Out of Homelessness 2.5: A Co-Designed Strengths-Based Leadership 
Program for Young People Transitioning Out of Homelessness 
 
Abstract  
Background: This project builds on our current community-based randomized clinical trial 
(Transitioning Youth Out of Homelessness 2.0) utilizing coaching and a co-designed leadership 
guide to target identity capital (purpose, control, self-efficacy, and self-esteem) for youth 
transitioning out of homelessness (all participants are also receiving rent subsidies). Based on 
preliminary feedback from study youth and coaches involved in the intervention arm, we plan to 
modify the leadership guide and pilot it in the form of an in-person, four-week leadership 
program (vs. independent learning in our current study). 
 
Objectives: The overarching objective of this mixed methods pilot project is to co-develop and 
test a strengths-based leadership program targeting identity capital for youth (16 – 24 years of 
age) transitioning out of homelessness. Specifically, the objectives are to: 
1. Modify the leadership guide being used in our current study so it can be delivered as an 
in-person leadership program. 
2. Co-develop and pilot a four-week, strengths-based leadership program for young 
people transitioning out of homelessness. 
3. Determine the feasibility and acceptability of the leadership guide when delivered as a 
four-week, in-person program (as opposed to independent learning in our current study). 
4. Examine whether self-reported measures of identity capital and knowledge of program 
material show improvement immediately post-program compared to baseline. 
5. Explore whether there are differences in outcomes by sub-groups (e.g., gender, age, 
identification as 2SLGBTQ+, child welfare involvement) and/or program participation 
levels. 
 
Methods: This study will employ a mixed method design embedded within a Community Based 
Participatory Action Research framework. Phase One (Objectives 1 & 2): An established team of 

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two coaches and four youth lived expert advisors will collaborate with a Toronto-based high 
school teacher on modifying the guide and co-developing the leadership program. Phase Two 
(Objective 2): Participants (n = 30) will be recruited from our community partner agencies. Two 
four-week leadership programs (15 youth per program) will be led by coaches from our current 
study with our youth advisors participating as paid leadership interns. Data collection will occur 
at baseline (baseline demographic questionnaire; identity capital questionnaire; knowledge 
assessment questionnaire) and immediately post-program (identity capital questionnaire; 
knowledge assessment questionnaire; program feedback questionnaire; focus group). We will 
also track program session attendance. Phase Three (Objectives 3, 4 & 5): Quantitative 
questionnaires and program attendance will be examined using descriptive statistics and non-
parametric or t-tests and Cohen’s d effect size. Qualitative focus groups (primarily centred 
around acceptability) will be explored using reflexive thematic analysis with a critical social 
theoretical lens. 
 
Significance: If this modified delivery of the leadership guide shows promise, we plan to 
incorporate it into a national scale-up alongside rent subsidies and coaching. 
 
1. Background and Rationale 
Drivers into youth homelessness are well documented and include multiple adverse childhood 
experiences, poverty, discrimination, and child welfare involvement (Abramovich, 2016; 
Centrepoint, 2022; Crandall et al., 2019; Dej, 2020; Gaetz et al., 2016; Karabanow, 2004; 
Karabanow et al., 2016; Liu et al., 2021; Morton et al., 2018; Samuels et al., 2019). The impact 
of being failed by people and systems intended to nurture and support have profound impacts on 
the health and well-being of these inequitably served youth (Abramovich, 2016; Bonakdar et al., 
2023; Brueckner et al., 2011; Crandall et al., 2019; Dej, 2020; Gaetz et al., 2016; Karabanow et 
al., 2016; Kidd et al., 2016; Kidd et al., 2021; Kozloff et al., 2016; Liu et al., 2021; Mayock et 
al., 2011; Samuels et al., 2019; Thulien et al., 2018). For example, a 2019 pan-Canadian survey 
of 1,375 young people accessing supports within the youth homelessness system (e.g., shelter 
drop-in services) reported 74% of youth were experiencing high degrees of mental health distress 
(e.g., anxiety and/or depression) and 35% had tried to commit suicide at least once (Kidd et al., 
2021). Levels of mental health distress and suicidality were the highest among younger 

TYOH 2.5 Study Protocol – v1.2 – May 27, 2024 
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respondents, those with an earlier age of first homelessness, and those who identified as a 
woman/girl, Indigenous, and/or two-spirit, lesbian, gay, bisexual, transgender, or queer 
(2SLGBTQ+; Kidd et al., 2021). A notable 61% reported involvement with child protective 
services, with just under half (48%) reporting that they did not receive any help regarding a 
suitable plan for where they could go or how they could support themselves after exiting the 
child welfare system (Bonakdar et al., 2023). 
 
The problem of no suitable plan for long-term, equitable social and economic inclusion (i.e., 
supports beyond housing and welfare payments) is emerging as a critical societal issue for young 
people attempting to transition away from homelessness. Research from the small but growing 
body of longitudinal studies on post-homelessness experiences highlights that, despite the 
attainment of relative housing stability and irrespective of the type of housing acquired (market 
rent with limited or no social service supports vs. subsidized with social services supports), too 
many youth are surviving, not thriving – struggling with poverty-level incomes, feelings of 
purposelessness, loneliness, “outsiderness”, meaninglessness, hopelessness, and a sense of being 
stuck (Brueckner et al., 2011; Karabanow et al., 2016; Kidd et al., 2016; Kozloff et al., 2016; 
Mayock et al., 2011; Thulien et al., 2018, p. 6). Moreover, there is an extremely limited evidence 
base regarding effective and rigorous interventions for this population (Morton et al., 2020), 
especially when it comes to inclusion health – an emergent approach that aims to address 
extreme health and social inequities (Luchenski et al., 2018). 
 
This project builds on our 2.5-year community-based pilot mixed method randomized clinical 
trial of rent subsidies and mentorship for youth exiting homelessness (Transitioning Youth Out 
of Homelessness 1.0; Thulien et al., 2019). While we were unable to prove that youth receiving 
rent subsidies and mentorship had significantly better socioeconomic inclusion outcomes 
compared to the group who received rent subsidies only, there were signals from our quantitative 
and qualitative data that connecting with informal mentors – people outside the study who played 
“coach-like” roles (e.g., asking powerful, future-oriented questions vs. simply providing advice) 
– was key to fostering socioeconomic inclusion (proxy indicators of socioeconomic inclusion 
encompassed measures such as community integration, self-esteem, and engagement in 
education, employment, and training; Thulien et al., 2022; Thulien et al., 2023). 

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Drawing on 71 in-depth interviews conducted by Dr. Naomi Thulien over the 2.5-year study 
period, the study also highlighted the crucial role of identity capital – a sense of purpose, control, 
self-efficacy, and self-esteem – as an important mediator of socioeconomic inclusion (Thulien et 
al., 2023). When people with limited identity capital encounter challenges, they are more likely 
to give up and take the path of least resistance (Côté, 2016). For study participants, this 
inequitable fostering of identity capital meant living in the legacy of their past (e.g., a sense of 
powerlessness over their futures) and becoming trapped in the “fog” of exclusion (Thulien et al., 
2023, p. 5). 
 
Building on these findings, our team of youth with lived expertise, community partners, and 
researchers, developed Transitioning Youth Out of Homelessness (TYOH) 2.0 – a pilot mixed 
method randomized clinical trial of rent subsidies and coaching along with a co-designed 
leadership guide for youth exiting homelessness (ClinicalTrials.gov, 2023). Briefly, all 
participants (n = 40) receive rent subsidies and half are randomly assigned a solution-focused 
coach and a leadership guide which was co-designed with youth who have experienced 
homelessness (including several youth from the TYOH 1.0 study). Young people in the 
intervention group are expected to engage one-on-one with their coach, and independently with 
the leadership guide for one year. We are trying to understand if this more deliberate targeting of 
identity capital (alongside rent subsidies) will show promise as a way to improve socioeconomic 
inclusion outcomes. Our goal is to use these findings to conduct a larger national study.  
 
Preliminary qualitative feedback from TYOH 2.0 coaches and study participants is that, while 
the co-designed leadership guide is a tremendous resource, it is hard for youth to independently 
engage with the material (e.g., showing up to one-on-one coaching sessions with minimal/no 
engagement with the leadership guide beforehand). We have also had enthusiastic feedback from 
teachers in the Ontario Education and Community Partnership Program (ECPP) – a program 
designed to reach youth not engaged in traditional school settings (e.g., shelter-based schools) – 
that the guide has tremendous potential for use in an ECPP setting (e.g., high school credits for 
guide completion). Given our plan to incorporate the leadership guide into a TYOH 2.0 national 
scale-up (alongside rent subsidies and coaching), we plan to collaborate with our established 
youth advisors on modifying the leadership guide and make it more engaging, align it with the 

TYOH 2.5 Study Protocol – v1.2 – May 27, 2024 
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Ontario Ministry of Education core high school learning competencies, and pilot it in the form of 
an in-person, four-week leadership program with youth who are transitioning out of 
homelessness. 
 
1.1. Objectives  
The overarching objective of this mixed methods pilot project is to co-develop and test a 
strengths-based leadership program targeting identity capital for youth (16 – 24 years old) 
transitioning out of homelessness. Specifically, the objectives are to: 
1. Modify the leadership guide currently being used in TYOH 2.0 so it can be delivered 
as an in-person leadership program. 
2. Co-develop and pilot a four-week, strengths-based leadership program for young 
people transitioning out of homelessness. 
3. Determine the feasibility and acceptability of the leadership guide when delivered as a 
four-week, in-person program (as opposed to independent learning in the TYOH 2.0 
study). 
4. Examine whether self-reported measures of identity capital and knowledge of program 
material show improvement immediately post-program compared to baseline. 
5. Explore whether there are differences in outcomes by sub-groups (e.g., gender, age, 
identification as 2SLGBTQ+, child welfare involvement) and/or program participation 
levels. 
 
2. Methodology and Methods 
This study and the past five years of collaborative work in this area is grounded in a commitment 
to centring voices of youth with lived expertise as well as responding to priorities defined by 
community partners. The overall study draws on key principles of community-based 
participatory action research (CBPAR) and the qualitative component is framed with a critical 
social theoretical lens (Israel et al., 2018; Kirkham & Anderson, 2010; Moosa-Mitha, 2015; 
Strega, 2015): 
• Research participants are viewed as experts in their own lives. 

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• Focus on highlighting how inequitable social structures of power – including the 
intersection of factors such as race, class, and gender – play out in the lives of 
participants. 
• Search for examples of resilience and agency despite socio-structural inequities. 
• Concerted effort to acknowledge and reduce power imbalances between researchers and 
the community. 
• Equal value placed on academic knowledge and experiential knowledge. 
• Commitment to co-producing practical, actionable data to build community capacity and 
improve the lives of research participants. 
• Duty to remain invested with the community beyond the life of the research project. 
 
2.1. Trial Design 
This pilot study will employ a mixed methods design embedded within a CBPAR framework. 
The study will be conducted collaboratively with three long-term community partners who serve 
youth who are experiencing or have experienced homelessness: 1) Covenant House Toronto 
(Toronto, ON); 2) The RAFT (St. Catharines, ON); and 3) StepStones for Youth (Toronto, ON). 
We will prospectively register this trial on Clinicaltrials.gov once we receive Unity Health 
Toronto Research Ethics Board approval.  
 
2.2. Eligibility Criteria 
Eligible young people aged 16 – 24 years who have transitioned out of homelessness (e.g., no 
longer living in a shelter or couch surfing), defined as 3 consecutive months within the past 12 
months, will be identified by our community partners (note: for the purpose of this study, youth 
living in foster care will be considered homeless). This age mandate was chosen because this is 
the age group served by our community partners. We have chosen to target the first year of 
exiting homelessness because our collective experience has shown that this can be a particularly 
precarious time for youth in terms of mental health challenges and risk of (re)experiencing 
homelessness (even if youth have attempted exits in the past).  
 
In addition to the above age and housing inclusion criteria, study participants must: 
• Be able to provide free and informed consent.  

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• Be able to understand English (leadership program and data collection will be conducted 
in English). 
• Have experienced homelessness (e.g., unstable housing arrangements including shelter 
stays, foster care, and couch surfing) for 3 consecutive months in the past 12 months. 
• Be able to consistently attend the four-week leadership program. 
 
Young people will be excluded from the study if they are: 
• Enrolled in a program or study with similar features to the TYOH 2.5 leadership 
program.  
 
2.3. Intervention 
An established TYOH 2.0 core team of two coaches and four youth lived expert advisors will 
collaborate with Dr. Thulien and the TYOH 2.5 research team on modifying the leadership guide 
currently being used in the TYOH 2.0 study (Appendix B: Leadership Guide) so it can be 
delivered as an in-person, four-week (two sessions/week) leadership program. They will be 
joined by a high school teacher (and former ECPP teacher at Covenant House Toronto) who will 
help align the guide with the Ontario Ministry of Education core high school learning 
competencies for potential consideration of high school credits for leadership program 
completion (note: we will unlikely be able to guarantee a high school credit at this pilot stage, 
but plan to develop the guide with this goal in mind for our planned scale-up).   
 
At the same time the leadership guide is being modified, the team will collaborate on how best to 
deliver material during the four-week, in-person program (Table 1). The leadership sessions will 
be held in a public library, last approximately three hours, and be led by coaches from our 
current study with our youth advisors participating as paid leadership interns. Participants will be 
paid $25.00/hour for attending the program and receive a certificate upon program completion.  
 
 
 
 
 

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Table 1. TYOH 2.5 Leadership Program*  
SESSION 
KEY FOCUS/ACTIVITES 
1 
(Week One) 
• Consent forms 
• Baseline questionnaires 
• Examine link between mindfulness and purpose 
2 
(Week One) 
• Explore core values 
• Create a vision board 
3 
(Week Two) 
• Examine link between core values and mood 
• Create a daily routine 
4 
(Week Two) 
• Discover strategies to develop good habits 
• Understand difference between excellence and perfection 
ONE WEEK BREAK 
5 
(Week Three) 
• Review pre-break key learnings 
• Explore link between identity and behaviour 
• Develop strategies to live in alignment with positive identity 
6 
(Week Three) 
• Examine growth mindset vs. fixed mindset 
• Explore link between purpose and connecting with others 
7 
(Week Four) 
• Explore concept of scarcity 
• Understand link between vulnerability, courage, and worthiness 
8 
(Week Four) 
• Review and share key learnings  
• Discuss next steps 
• Complete questionnaires 
• Celebration meal 
• Focus group  
*Note: A more comprehensive/detailed session-by-session agenda will be developed in 
collaboration with youth advisors during the co-design stage.  
 
2.4. Study Outcomes 
The primary outcomes for this pilot program are feasibility and acceptability (Table 2). 
Secondary outcomes include knowledge of program material and identity capital (Table 2). 

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Exploratory outcomes are differences in primary/secondary outcomes by sub-groups (e.g., 
gender, age, identification as 2SLGBTQ+, child welfare involvement) and/or program 
participation levels (Table 2).  
 
Table 2. TYOH 2.5 Key Outcome Variables and Instruments  
Key Outcome Variables 
Instruments  
Collection 
Timepoints* 
Primary Outcomes 
 
Feasibility and 
Acceptability 
Recruitment and enrollment metrics  
Session attendance 
Dropout metrics  
Focus group 
Composite program feedback 
questionnaire 
T0 
T1/T2 
T1/T2 
T2 
T2 
Secondary Outcomes  
 
Knowledge of Program 
Material 
Composite knowledge assessment 
scale 
T1/T2 
Identity Capital 
 
Multi-Measure Agentic Personal 
Scale (MAPS20; Côté, 2016) 
T1/T2 
 
Exploratory Outcomes 
 
Subgroup Differences 
Baseline Demographic 
Questionnaire 
Session attendance 
Focus group 
T1 
 
T1/T2 
T2 
*Pre-program = T0; Week One = T1; Week Four = T2 
 
The decision to incorporate the leadership program into an adequately powered definitive trial 
(alongside rent subsidies and coaching) will be based on feasibility and acceptability. We will 
not incorporate the leadership program into our planned national larger study if we find program 
attendance is less than 50%, more than 30% of participants drop out, and/or qualitative feedback 
from program participants is overwhelmingly negative.  

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2.5 Participant Timeline 
We anticipate recruiting participants from June 3rd – 21st, 2024, with a planned program start 
date of June 24th, 2024 (see Table 3). There will be two sessions/week for four weeks, with a 
one-week break at the end of Week Two (see Table 1).  
 
Table 3. Schedule of Enrolment, Intervention, and Assessments 
STUDY PERIOD 
 
Enrolment 
Post-enrolment 
TIMEPOINT 
T0 
T1 
(Week 1) 
T2 
(Week 2) 
T3 
(Week 3) 
T4 
(Week 4) 
ENROLMENT: 
 
Eligibility screening 
X 
 
 
 
 
Informed consent 
 
X 
 
 
 
INTERVENTION: 
 
Leadership program 
 
 
 
 
 
ASSESSMENTS: 
 
Baseline demographic 
questionnaire 
 
X 
 
 
 
Knowledge of program 
material 
 
X 
 
 
X 
Identity capital 
 
X 
 
 
 
Focus group 
 
 
 
 
X 
Program feedback 
questionnaire 
 
 
 
 
X 
 
2.6 Sample Size 
This pilot feasibility and acceptability study was designed with the intention of generating data 
and hypotheses to inform a national scale-up alongside rent subsidies and coaching. The sample 
size was pragmatic, based on manageable class sizes and financial resources. No formal sample 
size calculation was performed.  
 

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We plan to enroll 30 youth: 15 from Toronto and 15 from St. Catharines. In addition to 
purposively recruiting youth (16 – 24 years of age) who have experienced homelessness within 
the past 12 months, we will target youth who are younger (16 – 18 years of age), identify as 
girls/women, have a history of being in foster care, and identify as 2SLGBTQ+ given the 
additional challenges faced by this demographic (see 1. Background and Rationale).  
 
2.7. Recruitment 
Study participants will be collaboratively recruited with our long-standing community partners: 
RAFT (St. Catharines); Covenant House (Toronto); StepStones for Youth (Toronto). RAFT and 
Covenant House work with young people who are experiencing or have experienced 
homelessness, and StepStones for Youth works with young people who are in or transitioning 
out of foster care. Youth will be invited to attend one of two four-week leadership programs – 
one in St. Catharines and one in Toronto. 
 
Initial introduction to the study will be facilitated by our community partners, and interested 
participants directed to call or email the study research coordinator (Appendix C: Email and 
Phone Script). Community partners will utilize the study poster (Appendix D: Study Poster) and 
consent form (Appendix E: Consent Form) to help guide their initial discussions with potential 
participants. Screening for eligibility (Table 4) will be done over the phone or via a Zoom call by 
the research coordinator (Appendix F: Eligibility Screening Script). The eligibility screening 
checklist will be used verbally for all interested individuals. Notes will only be taken for the 
purpose of collecting broad, anonymous information about why a potential participant could not 
meet the eligibility criteria of being able to consistently attend the four-week leadership program, 
in order to inform our scale-up study (Appendix G: Screening Log). Our team will also record 
the number of young people deemed ineligible for the study. 
 
 
 
 
 
 

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Table 4. Eligibility Screening 
 
Yes 
No 
16 – 24 years of age (at baseline) 
 
 
Have experienced homelessness (e.g., unstable housing arrangements including 
shelter stays, couch surfing, and foster care) for 3 consecutive months in the 
past 12 months 
 
 
Able to provide free and informed consent 
 
 
Able to speak and read English well enough to give consent and participate in 
the intervention and data collection 
 
 
Left homelessness within the past 12 months 
 
 
Be able to participate in the four-week, in-person leadership program (attend at 
least 6/8 sessions) 
 
 
NOT enrolled in a program or study with similar features to TYOH 2.5  
 
 
MUST SAY “YES” TO ALL TO BE ELIGIBLE FOR ENROLLMENT 
 
After eligibility screening, participants will be informed immediately over the phone whether 
they are eligible or ineligible for the study. If there is any confusion regarding eligibility and/or 
capacity to consent, the team member will reach out to Dr. Thulien for guidance. In addition to 
being the study principal investigator, Dr. Thulien is a nurse practitioner with over a decade of 
experience working exclusively with young people who are experiencing or have experienced 
homelessness. 
 
Eligible participants will be provided the date/time/location of the first leadership program 
session. At the beginning of the first session, a research team member will carefully review the 
consent form with the participants to ensure they have a solid understanding of the study, with 
particular attention to: 1) overall study aim; 2) study length; 3) data collection; 4) data security; 
and 5) dissemination. A concerted effort has been made to ensure the consent form is in plain 
language. Highlighted throughout the document is the fact that informed consent is an ongoing 
process and can be negotiated at any time. 
  
 

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2.8. Data Collection  
To answer Objective Three (intervention feasibility and acceptability), we will utilize 
quantitative measures consisting of recruitment/enrolment/attendance/dropout metrics (see 
Appendix H: Attendance Log) and a composite program feedback questionnaire along with 
qualitative measures consisting of focus groups (Tables 2 & 5). To answer Objective Four 
(assessing whether self-reported measures of identity capital and knowledge of program material 
show improvement immediately post-program compared to baseline), we will utilize MAPS20 
(assessment of identity capital; Côté, 2016) and a composite knowledge assessment scale (Tables 
2 & 5). To answer Objective Five (exploring whether there are differences in outcomes by sub-
group and/or program participation levels), we will examine select variables from the baseline 
demographic questionnaire and attendance/dropout metrics (Tables 2 & 5). Given the differences 
in time commitment at each data collection session, youth will be paid a data collection 
honorarium of $25 at pre-program data collection and $50 at post-program data collection 
(Appendix I: Study Budget and Justification). 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Table 5. Quantitative Instruments  
Instrument 
Psychometric Properties 
Baseline Demographic Questionnaire 
This 18-item self-report measure was 
developed for this study and explores 
domains related to: age; gender; 
race/ethnicity; sexual orientation; immigration 
status; child welfare involvement; 
homelessness entrenchment; education; social 
support; financial support; food security. 
MAPS20 (Côté, 2016) 
This 20-item validated self-report measure 
explores domains related to identity capital: 
self-esteem; purpose in life; internal locus of 
control; self-efficacy/ego strength. Score 
range: 20-120; score of less than 71 indicates 
risk/vulnerability of being overwhelmed by 
any adverse circumstances (internal 
consistency of four sub-scales α = .61-.75).  
Knowledge Assessment 
This 16-item self-report measure was 
developed for this study and explores 
domains related to self-leadership such as: 
mindfulness; core values; purpose; goal 
setting; growth mindset; identity; courage. 
Composite Program Feedback Questionnaire 
This 4-item anonymous questionnaire will be 
used to collect information about participants’ 
view of the leadership program, the impact of 
the program on them, and their view of the 
individuals running the program. 
 
2.8.1. Quantitative Methods 
Quantitative data collection (Appendix J: Quantitative Data Collection Instruments) will be 
conducted at the beginning of the first leadership program session as well as the last (Tables 3 & 

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5). T1 (Week One) data collection will consist of: baseline demographic questionnaire; MAPS20 
(Côté, 2016); and knowledge assessment. T2 (Week Four) data collection will consist of: 
MAPS20; knowledge assessment; and program feedback questionnaire. All questionnaires will 
be completed in-person and on paper.  
2.8.2. Quantitative Analysis 
Quantitative analysis will be conducted using descriptive statistics to measure feasibility and 
acceptability overall (Objective 3) and by select sub-groups (Objective 5). Non-parametric or t-
tests and Cohen’s d effect size will be used to examine pre/post leadership program differences 
in identity capital (MAPS20) and acquired knowledge (Objective 4), and by select sub-groups 
and program attendance (Objective 5). Biostatistician Dr. Rosane Nisenbaum (co-investigator) 
will provide oversight to the quantitative data analysis. 
 
2.8.3. Qualitative Methods 
Qualitative data generation (Appendix K: Focus Group Guide) will take place at the end of the 
last leadership program session. Each focus group (one in Toronto and one in St. Catharines) will 
be co-led by Mardi Daley (research team member with lived expertise of homelessness) and Dr. 
Naomi Thulien and primarily centre around leadership program acceptability (Objective 3). The 
audio-taped focus groups will last approximately 45 – 60 minutes. As we have done in previous 
studies, we will share a nutritious meal together before the focus groups begin, which typically 
lasts 30 – 45 minutes. We anticipate 15 young people in each group, divided by location (one 
group with Toronto youth and one group with St. Catharines youth).  
 
Focus group questions will primarily centre around intervention acceptability but will also 
explore the impact of the intervention on identity capital (e.g., sense of purpose and control) and 
socioeconomic inclusion (e.g., connection to broader social networks). The focus groups will be 
audio recorded using the password-protected application Voice Record Pro on a password-
protected device. Audio recordings will be transcribed verbatim by a member of the research 
team, and the transcripts uploaded to the web-based application Dedoose (SocioCultural 
Research Consultants, LLC, 2024) for storage and retrieval. One member of the research team 
will serve as an observer/ note taker at each focus group session to document non-verbal 

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communication (e.g., eagerness or disinterest) as well as preliminary analytic insights based on 
listening to the discussion. In addition, each focus group facilitator will document field notes as 
soon as possible after the meeting to capture their own observations and reflections on the 
sessions (Luciani et al., 2019; Merriam & Tisdell, 2016).  
 
2.8.4. Qualitative Analysis 
Qualitative data analysis will be led by Mardi Daley and Dr. Naomi Thulien and conducted using 
reflexive thematic analysis (Braun & Clarke, 2021) with a critical social theoretical lens 
(Kirkham & Anderson, 2010; Moosa-Mitha, 2015; Strega, 2015). Briefly, reflexive thematic 
analysis is part of an analytic process comprised of six iterative phases (data familiarization, 
coding, initial theme generation, theme development and review, theme refining, and writing up) 
that also requires engagement with theory, reflexivity (acknowledging the role of the researcher 
in shaping the findings), and interpretation (i.e., not expecting the data to ‘speak for itself’) 
(Luchenski et al., 2018). A critical social theoretical lens will help the team use an intersectional 
approach to uncover and speak about inequitable societal factors that may disproportionately 
impact some youth (e.g., youth who identify as 2SLGBTQ+ or girls/women) while also 
highlighting participants’ individual strengths despite these inequities (Kirkham & Anderson, 
2010; Moosa-Mitha, 2015; Strega, 2015). 
 
Prior to the first qualitative data analysis session, two team members will read the two focus 
group transcripts multiple times, code data relevant to intervention acceptability and our 
assumption that identity capital is a mitigating factor in socioeconomic inclusion (and look for 
data that might disprove this assumption), and compare codes across both transcripts 
(Bhattacharya, 2017; Creswell & Creswell, 2017; Luciani et al., 2019). During the analysis 
sessions, the codes will be discussed (and revised/deleted as needed) and organized in a code 
book, clustered into categories, and eventually synthesized into key themes. Analysis will 
primarily be inductive (moving from data to conceptualizing); however, deductive reasoning 
(moving from conceptualizing to data) will be employed when we want to understand new data 
through the lens of our emerging conceptual framework. Preliminary data analysis will be 
discussed with youth advisors and their feedback will be incorporated into further analysis and 

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interpretation, collaborative knowledge mobilization, and co-planning a national scale-up 
(alongside rent subsidies and coaching).  
 
2.9. Data Monitoring 
As is common in pilot and feasibility studies, there is no interim quantitative analysis planned to 
guide a decision to stop the study early (Eldridge et al., 2016). That said, at least one member of 
our research team will attend every leadership session to monitor participant engagement. We 
will consider making adjustments to the leadership program if informal feedback from 
participants is overwhelmingly negative and/or the majority of young people stop participating. 
 
3. Limitations 
This study has limitations. First, this is a feasibility and acceptability study and thus not 
adequately powered to detect a significant difference in quantitative self-report measures; results 
must be interpreted with caution. Second, all young people will be connected to urban-based 
social service agencies in the province of Ontario; youth living in rural locations and/or outside 
of Ontario may not take up the program in the same way. Third, all of the quantitative 
instruments are based on self-reports and thus subject to social desirability bias. Finally, the 
quantitative measures we have developed/chosen are what we believe will capture knowledge of 
self-leadership and identity capital; it is plausible that these measures do not adequately capture 
these domains with this population.  
 
4. Ethics and Dissemination 
We have endeavoured to weave ethical considerations into all aspects of the study design, 
including our decision to utilize a CBPAR methodology, which foregrounds community 
(especially youth) priorities. The decision to conduct this leadership program was a direct result 
of feedback from youth in our current TYOH 2.0 study. In addition, we have fostered 
relationships with our youth advisors over the past five years, and they were actively involved in 
developing this protocol. Ethical approval for this study will be obtained by the Unity Health 
Toronto Research Ethics Board.  
 
 

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4.1. Risks, Benefits, and Safety  
Given the nature of this strengths-based leadership program and our close relationship with the 
TYOH 2.5 program coaches (also coaches in our TYOH 2.0 study), we believe the harms and 
risks to participants will be minimal. While we have intentionally not chosen deficit-focused 
questions/scales for the quantitative questionnaires, it is plausible that some participants could 
find certain questions distressing. For this reason, participants will be informed that they can skip 
questions if they choose, or stop the questionnaire at any time. The focus group questions will 
also target participant strengths; however, participants will be reminded at the start of each 
session that they do not have to answer any questions that make them uncomfortable. They will 
also be reminded that we cannot guarantee other focus group members will not share discussion 
topics outside of the focus group sessions. As noted in the consent form, participants will be 
made aware that they may withdraw from the study at any time.  
 
Coaches and participants will also be provided with a mental health resource document (see 
Appendix L: Mental Health Resources) to utilize as needed. The study team/coaches will reach 
out to Dr. Thulien to discuss a case if there are any concerns related to mental health distress. Dr. 
Thulien will reach out to community partners at RAFT (St. Catharines), StepStones for Youth 
(Toronto), and/or Covenant House Toronto to help connect youth to psychosocial supports as 
needed. We have employed a similar strategy with our community partners for the past seven 
years. In our experience, these cases are rare, and our management plan has worked well.  
 
All participants will likely benefit from participating in the weekly leadership sessions. 
Participants may also benefit from having the opportunity to contribute their expertise during the 
focus group sessions; this has been our experience with previous studies.  
 
4.2. Confidentiality  
Privacy and confidentiality considerations have been woven throughout the research process: 
1. Recruitment: Interested participants will reach out to the lead research coordinator 
directly rather than community partners sharing contact information with the team.  
2. Eligibility screening: No personal health information or personal identifying information 
will be collected. 

TYOH 2.5 Study Protocol – v1.2 – May 27, 2024 
19
3. Enrollment: Consent will be required prior to baseline data collection. The consent form 
indicates that limits to confidentiality apply if a participant discloses that they intend to 
hurt themselves or others, or if they inform a member of the research team that someone 
under the age of 16 years is suffering abuse and/or neglect. 
4. Quantitative data collection: Paper copies of the consent forms and questionnaires will be 
stored in a locked filing cabinet at the MAP Centre for Urban Health Solutions in an area 
only accessible to those with electronic and key access.  
5. Qualitative data collection: Focus groups will be audio recorded on a password-protected 
application and on a password-protected device. The audio-recorded files will be securely 
sent to a research team member via Unity Health email with a link that expires in 24 
hours. After the team member has transcribed the audio file, they will delete the file. All 
transcripts will be stored on a SMH secure server and uploaded to Dedoose 
(SocioCultural Research Consultants, LLC, 2024). Pseudonyms will be used in place of 
real names in focus group transcripts. 
6. Linking log: A key that links each participant’s name with their participant identification 
number will be created by the lead research coordinator and stored as a separate 
electronic file on the SMH secure serve (Appendix M: Linking Log).  
7. Data access: Only authorized members of the research team will have access to 
quantitative and qualitative study data, and an access log will be maintained by the lead 
research coordinator. De-identified raw data will be made available upon reasonable 
request (e.g., request comes from a researcher affiliated with an academic institution). 
8. Data retention: All data will be destroyed after 7 years. Dr. Thulien will be responsible 
for ensuring the data is destroyed.  
 
4.3. Dissemination  
Our team is committed to diverse and accessible forms of knowledge mobilization. For example, 
Dr. Thulien was the executive director on the documentary film Searching for Home, which 
followed three participants from TYOH 1.0 (www.searchingforhome.ca). Dr. Thulien also co-
produced a five-minute animation (www.searchingforhome.ca) about TYOH 1.0 findings. Key 
mobilization activities for this project include collaborating with youth advisors on dissemination 

TYOH 2.5 Study Protocol – v1.2 – May 27, 2024 
20
to multisectoral stakeholders through plain language reports, policy briefs, social media, op-eds, 
academic and non-academic presentations, and at least one publication in an open-access journal. 
 
4.4. Significance 
If this leadership program shows promise, we plan to take findings from this project and: 1) 
incorporate them into a national scale-up alongside rent subsidies and coaching; 2) explore 
offering the leadership program in settings such as schools and/or community-based after-school 
programs; 3) co-share broadly with frontline workers, educators, and policymakers the value in 
targeting the inequitable distribution of identity capital as part of a homelessness prevention 
strategy.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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