Generating Evidence for a Support Package to Stabilize Youth Trajectories Out of Homelessness
Condition: Youth; Homelessness
Study type: Interventional

Summary: 
      This project builds upon initial proof of concept work examining the optimal set of supports
      for youth who have recently exited homelessness - an intervention comprised of mental health
      and peer supports alongside transitional case management. This collaborative model will be
      tested as a proof-of-concept in Thunder Bay with Indigenous youth and a trial will be
      conducted in Toronto to optimize and determine the effectiveness of the existing model of
      support.
    

Detailed description: 
      In response to the challenges outlined above, and with the support of a grant from the
      Ontario Ministry of Child and Youth Services, the investigators developed and tested a
      tertiary prevention strategy called the Housing Outreach Program Collaborative (HOP-C) which
      launched in the summer of 2015. In this approach the investigators focused on collaborations
      and interventions that have the greatest potential to be effective with this population. The
      investigators brought together partners from a number of sectors in the GTA and have tested a
      3-pronged set of supports (intervention described in detail in the methods):

        -  Transitional Case Management

        -  Mental Health Interventions: Group, individual, family

        -  Peer Support This is an intensive, 6-month critical time intervention - one that jointly
           addresses many points of vulnerability (mental health crises, housing instability,
           justice involvement) while fostering resilience and connection with resources in
           employment, education and training domains. It is unique in both content
           comprehensiveness and integrated process of delivery. Also important was the development
           of a collaborative and responsive partnering process, to facilitate effective
           organizational interfaces and seamless service integration so participants can
           experience a tailored and coherent set of supports. With CAMH, the Centre for
           Mindfulness Studies, Covenant House, LOFT, and SKETCH at the service level and the
           Wellesley Institute leading evaluation, the investigators have carefully attended to a
           collective impact framework.

      This initiative has proven feasible and is demonstrating good outcomes - with excellent youth
      engagement, reports of lower social isolation, improved mental health, and engagement with
      resources, and spin-off benefits of closer collaboration between organizations. The
      investigators successfully met the target of youth engagement, with a total of 31 youth
      participating, minimal attrition (n=2), and the investigators observed no indications that
      HOP-C resulted in risk of any form, both with respect to the intervention itself and the
      mixed methods research methodology. This promising feasibility work formed the foundation
      from which the investigators were successful in obtaining a grant from the Local Poverty
      Reduction Fund to support the study described in this proposal.

      Current Project Determine through a randomized trial in Toronto if the positive outcomes the
      investigators are observing are due solely or primarily to transitional case management and
      if the additional peer and mental health components are necessary.

      Engaging in intensive, tertiary prevention shows clear promise in disrupting a cycle of
      poverty and marginalization at a critical time - if proven and scaled a key driver of chronic
      homelessness would be addressed.

      Research Questions The objective of this two-part project is to examine the effectiveness and
      transferability of the Housing Outreach Program-Collaboration (HOP-C) transitional
      intervention. HOP-C has proven to be feasible with promising outcomes in the Toronto
      proof-of-concept work currently underway.

      1. Are the benefits of the complex HOP-C intervention with all components in place greater
      than transitional case management in isolation?

      • It is hypothesized that the full model will provide benefit in domains of housing
      stability, mental health, and quality of life that are significantly greater than case
      management alone.

      The investigators have data in hand from their recent national work in the area which
      provides data on 'treatment as usual' or the outcomes that attend typically available
      supports. The proposed trial will unpack benefit and be essential in economic and viability
      arguments to be made going forward.
    

Intervention name(s): HOP-C; Transitional Case Management Only
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.; Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment