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Core outcome areas, domains, measures, and interval schedule. Interval Measures and instruments Core outcome areas, variables, and domains
Source publication
Background
Emerging evidence at the international level suggests that the Housing First approach could improve the housing stability of young people experiencing homelessness. However, there is a dearth of literature in Canada on whether the Housing First intervention for young people experiencing homelessness can improve outcomes including housing...
Contexts in source publication
Context 1
... and interview data in Ottawa and Toronto are being collected at multiple time points over the course of 4 years to capture a range of outcomes, as listed in Table 1. Data collection is expected to be completed at both sites by March 2024. ...Context 2
... evaluating complex interventions, there are a range of factors that likely have an impact on housing stabilization, including sufficient and stable income, health and well-being, involvement with the justice system, involvement in education and employment, and social inclusion [56,57]. The core primary outcomes are thus selected to assess the effectiveness of HF4Y interventions on housing stability (as defined by a joint function of the number of days housed and the number of moves), health and well-being (mental and physical health status), and access to complementary supports, with secondary outcomes consisting of participation in education and employment and social functioning, as listed in Table 1 [55]. Multimedia Appendix 1 provides a comprehensive description of the measures. ...Context 3
... entry into the study (baseline), youth participants were interviewed using a range of questions aimed at collecting demographic data, physical health conditions, access to care, housing retention (using residential timeline follow-back), and employment (using vocational timeline follow-back; refer to Multimedia Appendix 1 for a detailed description of the interview measures). Following the interview, the participants were administered a battery of survey measures for physical and mental health and well-being, social inclusion, self-esteem and self-efficacy, resilience, hope, quality of life, and a measure reflecting complementary skills that impact the various domains (Table 1). In-person and phone-based follow-up quantitative interviews are being conducted at 3-or 6-month intervals depending on the instrument used. ...Context 4
... HF4Y study has been registered with the International Standard Randomized Controlled Trial Number (ISRCTN10505930). Human participant research ethics approval has been obtained from the Office of Research Ethics at York University. ...Context 5
... and interview data in Ottawa and Toronto are being collected at multiple time points over the course of 4 years to capture a range of outcomes, as listed in Table 1. Data collection is expected to be completed at both sites by March 2024. ...Context 6
... evaluating complex interventions, there are a range of factors that likely have an impact on housing stabilization, including sufficient and stable income, health and well-being, involvement with the justice system, involvement in education and employment, and social inclusion [56,57]. The core primary outcomes are thus selected to assess the effectiveness of HF4Y interventions on housing stability (as defined by a joint function of the number of days housed and the number of moves), health and well-being (mental and physical health status), and access to complementary supports, with secondary outcomes consisting of participation in education and employment and social functioning, as listed in Table 1 [55]. Multimedia Appendix 1 provides a comprehensive description of the measures. ...Context 7
... entry into the study (baseline), youth participants were interviewed using a range of questions aimed at collecting demographic data, physical health conditions, access to care, housing retention (using residential timeline follow-back), and employment (using vocational timeline follow-back; refer to Multimedia Appendix 1 for a detailed description of the interview measures). Following the interview, the participants were administered a battery of survey measures for physical and mental health and well-being, social inclusion, self-esteem and self-efficacy, resilience, hope, quality of life, and a measure reflecting complementary skills that impact the various domains (Table 1). In-person and phone-based follow-up quantitative interviews are being conducted at 3-or 6-month intervals depending on the instrument used. ...Citations
... Whereas HF programs for youth have been formalized in the Canadian context (HF4y; Gaetz et al. 2021) and are in the process of being studied through a randomized controlled trial (Gaetz et al. 2023), explicit implementation of HF programs, to our knowledge, have not been studied in the United States. More work is needed which explores the possibilities and considerations for young adults in permanent housing programsas well as the ways that housing program models guided by a HF philosophy need to adapt or expand to meet young peoples' needs in the US. ...
... The key principles guiding the HF4Y model include a right to housing with no preconditions, youth choice and voice, self-determination, a positive youth development and wellness orientation, client-driven supports with no time limits, and social inclusion through community integration (Gaetz et al. 2021). This model, which is in the process of being studied through a randomized controlled trial with youth in Ottawa and Toronto, Ontario, Canada (Gaetz et al. 2023), seems to address many of the tensions we identified in our two case examples. As HF models tailored to the unique developmental needs of youth have not been as strong a focus in the United States as they have been in Canada, our findings suggest the importance of moving forward the HF conversation for youth in the United States. ...
While young adult homelessness impacts nearly one in ten young adults in the United States, limited work has explored the implementation of housing programs which support young adults. In this paper, we describe research on two case examples of housing programs for young adults in the United States: systematic program observations from Marsha and Marian's Neighbors, a shared housing program in the Mid‐Atlantic region, and resident interviews from Laurel House, a permanent supportive housing program in the Rocky Mountain West. While the program designs and methods for researching each program were distinct, we collectively identified tensions which largely impacted both programs: considerations around community , youth choice and voice , and impact and outcomes . Finally, we identify key decision points for young adult housing programs to consider when working to meaningfully support young peoples' needs.
... Understanding the social context and of young people is also crucial. Furthermore, both the project and the model have shown cost-effectiveness and benefits in both the short and long term compared to other similar projects (Gaetz et al., 2023). ...
This article explores the deployment of the Housing First for Youth (HF4Y) model across various European countries. HF4Y, an adaptation of the Housing First approach tailored for young people, prioritises immediate access to stable housing without preconditions, alongside personalised support services. The study highlights significant variability in the implementation and fidelity to the HF4Y model across different contexts. Key findings reveal diverse strategies and success levels in addressing youth homelessness, influenced by local policies, financial investment, and the degree of national cohesion. The research underscores the critical role of sustainable housing solutions and collaborative efforts among stakeholders. It identifies challenges such as funding constraints, service coordination, stigma, and housing availability, calling for enhanced policy support, standardised methodologies, and sustained funding mechanisms to improve the HF4Y model's impact. The study concludes with recommendations for future research and policy development to better support youth experiencing homelessness in Europe.
... Housing First has evolved over time beyond a singular program model from which fidelity can be measured. Although this evolution has yielded important adaptations that are strongly aligned with the tenets of Housing First, such as culturally appropriate support augmentations (Distasio et al., 2019;Stergiopoulos et al., 2012) and Housing First for Youth (Gaetz et al., 2023), the title has also been applied to programs that bear little resemblance to the intervention. In the recent article by Tan et al. (2024), an interesting transitional stabilization program for people experiencing homelessness is described, but it is difficult to see how it could be conceptualized as a Housing First program as has been done by the authors. ...
... The present study uses interviews from a randomized controlled trial for Housing First for Youth (HF4Y), known as Making the Shift (MtS). The MtS demonstration project is a multi-site, 24-month trial conducted in two major Canadian Cities, Ottawa and Toronto (see Gaetz et al. 2023). MtS is a federally funded, mixed methods, randomized controlled trial (RCT) conducted by the Canadian Observatory on Homelessness through York University and A Way Home Canada. ...
... HF4Y is an adapted model of Housing First built on the preconceived understandings of the developmental, social, and legal needs of youth that are distinct from an adult population (Gaetz 2014;Gaetz et al., 2021). Youth were provided a housing subsidy for the duration of the study (four years; (Gaetz et al. 2023, with a range of housing options available, including private rentals, public housing where available, and transitional housing. There were no treatment preconditions, and participants were offered support services related to their housing, health and wellbeing, income and employment, education, and social inclusion. ...
Homelessness presents numerous challenges for youth, including physical health issues, mental health problems, substance use, victimization, legal issues, and dropping out of school. Despite these challenges, youth display significant resilience. Using data from a randomized controlled trial on Housing First for Youth, this study examines qualitative narratives delving into the process of resilience (i.e., stressors, coping, and positive adaptation) among 21 youth over one year. Stressors varied among participants, with childhood abuse and instability being the most prominent. Coping mechanisms included creating barriers with unhealthy relationships, rebuilding relationships, and reframing their circumstances. The findings provide an exploration of the resilience process for youth experiencing homelessness, emphasizing the importance of understanding how youth respond to stressors and adapt to their environment. Additionally, this study highlights the significance of community and relationship-based coping strategies alongside individual approaches, thus displaying
the pivotal role of community support in fostering resilience among homeless youth.
Housing First programs are widely used to house adults with histories of chronic homelessness. Recently, Housing First for Youth (HF4Y) emerged as a targeted response to youth homelessness and is presently cited as the ideal model; however, researchers have yet to synthesize the evidence on which this claim is made. Through a systematic review of literature, the present authors fill this gap by offering a thematic synthesis of available peer-reviewed evidence on the impacts of HF4Y on a variety of outcomes for youth who experience homelessness. Five databases were searched from inception to April 2023 and reference lists of relevant articles were hand searched for additional studies. This search finds seven studies that specifically measure outcomes associated with HF4Y enrollment. Findings indicate that HF4Y can improve housing security, but additional research is needed to develop a more robust evidence base. There is a need for longitudinal studies, randomized controlled trials, and rich qualitative studies of HF4Y.
