The Identity Project
Condition: Youth; Homelessness
Study type: Interventional

Summary: 
      Understanding how to create successful pathways out of homelessness is crucial. Thirty young
      people (aged 18 - 26 years) who have transitioned out of homelessness within the past three
      years will be offered scholarships to participate in a six week intervention that focuses on
      building identity capital (sense of purpose and control, self-efficacy and self-esteem) and
      providing career direction. The intervention will be designed and carried out by dk
      Leadership - an established, highly successful leadership and counseling centre in Toronto
      with a track record of significantly improving the life trajectories of teens and adults.
      Importantly, study participants will be incorporated into the centre's current programming,
      meaning the intervention will be held at a location not associated with homelessness. Study
      participants will be collaboratively recruited by dk Leadership and Covenant House Toronto -
      Canada's largest agency for street-involved and homeless youth.

      This impact and process evaluation aims to address critical gaps in knowledge about
      transition-related supports by asking whether and how an identity capital intervention
      delivered outside the social service sector impacts the life-trajectories of formerly
      homeless young people. Particular attention will be paid to whether this intervention shows
      promise as an unconventional way to tackle poverty and improve social inclusion.

      It is hypothesize that, for the primary quantitative outcome measures of hope, community
      integration, social connectedness, and self-esteem:

        1. Significant improvements in the mean scores of the intervention group compared to the
           delayed intervention comparison group immediately post-intervention will be observed.

        2. Significant improvements in the mean scores of both groups (intervention and delayed
           intervention) immediately post-intervention will be observed.

        3. These significant improvements will be sustained in both groups for at least three
           months post-intervention.
    

Detailed description: 
      Young people comprise almost 20% of the homeless population in Canada. It is estimated
      between 35,000 and 40,000 Canadian youth (aged 13 - 25 years) are homeless at some point
      during the year and at least 6,000 on any given night. In Toronto, an estimated 1,000 - 2,000
      youth find themselves searching for a place to sleep on any given night.

      While a great deal is known about the risk factors associated with young people entering and
      remaining entrenched in street life (e.g., intergenerational poverty, childhood abuse,
      inadequate education, and limited employment opportunities), less is known much less about
      how to facilitate and sustain transitions off the streets for youth experiencing
      homelessness.

      The scarcity of evidence on this issue means there are critical gaps in understanding how
      best to help homeless young people move forward in life after they become housed. For
      example, results from a recent longitudinal mixed method study of 51 formerly homeless youth
      living in Toronto and Halifax - led by Dr. Sean Kidd and colleagues and one of the most
      rigorous investigations to date - showed that obtaining stable housing did not necessarily
      translate into a sense of belonging or connection to mainstream society. While study
      participants demonstrated incredible commitment, the structural barriers they experienced
      during the transition process (e.g., inadequate education and underemployment) led to fragile
      identities (i.e., self-concept) as they experienced a significant decline in hope and a sense
      of being 'stuck'. Youth described feeling unprepared for and overwhelmed by the realities
      associated with the transition process, undermining their sense of belonging and confidence
      in achieving larger life goals.

      Building on the Kidd et al. study, Dr. Naomi Thulien (the lead investigator for this study)
      spent 10 months following nine young people who had left the shelter system and moved into
      market rent housing in Toronto. The study - believed to be the first of its kind - captured
      the crucial role identity plays in the transition away from homelessness. Despite their
      remarkable determination, study participants lacked sufficient identity capital -
      conceptualized as a sense of purpose and control, self-efficacy, and self-esteem - to help
      them press on in the face of significant structural inequities. Thulien asserts that failure
      to understand and incorporate identity capital into transition-related supports may result in
      a poor return on investment as these supports are likely to be ineffective, underutilized, or
      rejected outright.

      One notable identity-based intervention is a randomized controlled trial that targeted 264
      eighth graders from high-poverty and high-unemployment neighborhoods in Detroit, Michigan.
      Participants who attended the seven-week intervention aimed at aligning the students' current
      identities with achievable positive adult identities, demonstrated improved outcomes on
      measures pertaining to academics, mood, and behavior, which was sustained through the
      two-year follow-up. The authors suggest brief identity-based interventions can have
      significant effects on outcomes. Despite being suggested as a promising approach, the
      investigators know of no other interventions (nationally or internationally) that are
      specifically targeting the enhancement of identity capital for formerly homeless young
      people. Given the limited evidence-based interventions for youth transitioning out of
      homelessness, the investigators believe there is a critical need for evaluations that compare
      findings based on different approaches, reflecting the diversity of the population and their
      corresponding needs.

      The proposed intervention is based on two premises: 1) identity is socially constructed and
      malleable; and 2) people act in identity-congruent ways. Thus, the intervention aims to
      change socially constructed life trajectories by providing identity-enhancing resources to
      formerly homeless young people.

      This impact and process evaluation aims to address critical gaps in the literature about
      transition-related supports by asking whether and how an identity capital intervention
      delivered outside the social service sector impacts the life-trajectories of formerly
      homeless young people. Particular attention will be paid to whether this intervention shows
      promise as an unconventional way to tackle poverty and improve social inclusion.

      Specifically, this evaluation will investigate and disseminate important new knowledge on the
      following outcomes

        1. The impact of the intervention on measures of hope, community integration, social
           connectedness, and self-esteem.

        2. The effectiveness of the intervention to increase the number of young people in
           education, employment, or training.

        3. Understanding any practical challenges encountered during the intervention
           implementation and how these challenges were resolved.

        4. Understanding what young people found most beneficial about the intervention and their
           suggestions for how it could be improved.

      An impact and process evaluation utilizing a mixed method prospective cohort design with an
      intervention and delayed intervention comparison group is the most appropriate because it:

        1. Addresses the crucial need to understand and disseminate evidence regarding the impact
           and process of interventions targeting homeless youth - both will help assess and inform
           questions related to scalability.

        2. Provides a more complete and synergistic utilization of data.

        3. Balances scientific rigor with the ethical principle of fairness.

      This evaluation is a mixed-methods design with a strong qualitative component. Quantitative
      data collection will occur at six weeks pre-baseline (for the delayed intervention group
      only), baseline (immediately pre-intervention), immediately post-intervention (one week),
      three months post-intervention, six months post-intervention, and nine months
      post-intervention. At each data collection period, participants will be asked whether they
      are enrolled in education, employment, or training in the questionnaire. They will also be
      asked about their housing status. Hope, community integration, social connectedness, and
      self-esteem will be measured quantitatively using scales.

      The frequencies, means and standard deviations will be calculated for all evaluation
      variables. To address the question about the extent to which the outcome variables change
      over time, independent t-tests will be conducted on the continuous variables (hope, community
      integration, social connectedness, and self-esteem) and chi-square tests on the categorical
      variables (education, employment, training, and housing) to report on changes between: 1)
      baseline and immediately post-intervention; 2) baseline and three months post-intervention;
      3) baseline and six months post-intervention; and 4) baseline and nine months
      post-intervention. To address the question about whether the intervention group demonstrates
      a statistically significant difference in outcomes compared to no intervention, the outcome
      variables between the intervention group and the delayed intervention group will be compared
      six weeks after the baseline questionnaires (i.e., the intervention group will have just
      completed the dk Leadership program and the delayed intervention group will not have started
      it yet).

      Qualitative measures are an important feature of this evaluation and will consist of: 1)
      participant observation and 2) focus groups.

      Over the six-week intervention period, the co-investigator will attend the weekly meetings as
      an observer. She will do this with both the intervention and the delayed intervention group.
      During these meetings, the investigator will take field notes, documenting her perceptions
      about the way the workshops and group coaching sessions are being run, and how they are being
      'taken up' by the young people in the intervention group.

      Focus groups, will take place immediately (one week), three months, six months, and 9 months
      post-intervention. Participants in the intervention and delayed intervention will be in
      separate focus groups. The questions posed during the focus groups will be guided by the
      evaluation objectives, but will be conversational and exploratory in nature with particular
      attention to identity capital, life-trajectories, and social inclusion. It is anticipated
      that the focus groups will last 60 - 90 minutes. All will be conducted by the co-investigator
      at locations most convenient for the study participants, and will be audio recorded and
      transcribed verbatim.

      In keeping with the emergent, iterative nature of research using a qualitative design, data
      analysis and interpretation will begin at the onset of the intervention. The handwritten
      field notes from the participant observation sessions will be typed into Microsoft Word by
      the co-investigator immediately after each biweekly meeting. The focus groups will be audio
      recorded and transcribed verbatim. In order to conduct a more nuanced analysis of the data,
      the transcriptionist will be instructed to note short responses, uncooperative tones, and
      literal silence. Prior to each meeting with the participants, the co-investigator will
      conduct a preliminary data analysis, reading the field notes multiple times, separating the
      data into coded segments, making analytic memos beside large portions of the field notes or
      transcripts, identifying emerging themes (and comparing/contrasting these between
      participants), and complying new questions to ask the participants. Participants will be
      asked for their perspectives on the emerging interpretations at each visit and these
      perspectives will play a key role in helping shape the data analysis and help ensure the
      trustworthiness of the data. The web-based application Dedoose39 will be utilized to assist
      with sorting and coding the qualitative data.

      Study participants may benefit from the opportunity to share with the co-investigator and
      with each other about whether and how an identity-building intervention delivered outside the
      social service sector impacts their life-trajectories. Additionally, participants may derive
      satisfaction from knowing that their contributions will help advance understanding about how
      best to design interventions that help tackle poverty and improve social inclusion for young
      people transitioning out of homelessness.
    

Intervention name(s): dk Leadership
Intervention type(s): Behavioral
Intervention description(s): Participants will attend two full-day workshops and four half-day group coaching sessions over the course of six weeks. The workshops and coaching sessions will be supplemented by on-line (e.g., podcasts) and print (e.g., workbooks) material. The full-day workshops will focus on identity-enhancing topics such as self-understanding, creating a life of meaning and purpose, and strategic career development. The half-day group coaching sessions will focus on workshop debriefing and on exploring solutions to transition-related challenges faced by study participants. The program was designed and carried out by dk Leadership - an established leadership and executive coaching centre in Toronto, Canada.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Thirty young people (aged 18 - 26 years) who have transitioned out of homelessness within the past three years will be offered scholarships to participate in a six-week intervention that focuses on building identity capital and providing career direction. The intervention will be designed and carried out by dk Leadership - an established, highly successful leadership and counseling centre in Toronto with a track record of significantly improving the life trajectories of teens and adults. Importantly, study participants will be incorporated into the centre's current programming, meaning the intervention will be held at a location not associated with homelessness. All of the participants will be invited to attend two focus groups, which will be conducted immediately post-intervention and at six months post-intervention. Each focus group will contain approximately 8 - 10 youth. Participants in the intervention and delayed intervention will be in separate focus groups.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hopelessness; Self Esteem; Social Isolation; Employment Status; Education; Housing Problems; Identity, Social; Self Efficacy; Control Locus; Poverty; Youth; Homelessness; Homeless Youth