Transitioning Youth Out of Homelessness: A Mixed Methods Community-Based Pilot Randomized Controlled Trial of a Rent Subsidy and Mentoring Intervention in Three Canadian Cities
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Unity Health Toronto
- Enrollment
- 24
- Locations
- 1
- Primary Endpoint
- Community Integration Scale Score at 18 Months
Study Overview
Brief Summary
Compared to the vast amount of literature about the risk factors associated with young people entering and becoming entrenched in homelessness, much less is known about how to facilitate and sustain transitions off the streets.
Current evidence indicates that while structural supports such as subsidized housing and social service providers are important, these things alone are insufficient to help young people integrate into mainstream society. Connecting these young people with an adult who exhibits the relationship-based components of mentoring that young people value most (e.g., genuine interest in their well-being and belief in their ability to succeed, a non-judgmental attitude and a willingness to listen, the provision of advice, guidance, affirmation and encouragement) may be key to helping them move forward and integrate into the mainstream.
This intervention will provide 24 young people (ages 18-26) who have transitioned out of homelessness and into market rent housing within the past year with rent subsidies for 24 months. Half of the young people will be randomized to receive regular mentorship from an adult mentor, tasked with helping their mentee bridge the gap between homelessness and mainstream living.
It is hypothesized that, for the primary outcome measures of community integration and self-esteem:
- Better mean scores (community integration and self-esteem) in the participants who receive rent subsidies plus mentorship (intervention group) will be observed compared to the participants who receive rent subsidies only (control group) by the primary endpoint of 18 months of study participation.
It is hypothesized that, for the secondary outcome measures of social connectedness, hope, and academic and vocational participation:
- Better mean scores (social connectedness and hope) in the intervention group relative to participants in the control group will be observed by 18 months of study participation.
- Participants in the intervention group will be more likely than the control group to demonstrate sustained engagement in academic and vocational activities (education, employment, and/or skills training) by 18 months of study participation.
This pilot will be the first to test the impact of economic and social supports on meaningful social integration for formerly homeless young people living in market rent housing.
Detailed Description
The overarching aim of this mixed methods study is to assess whether and how rent subsidies and mentorship influence social integration outcomes for formerly homeless young people living in market rent housing in three urban settings.
Specifically, the objectives of this study are to:
- Determine whether rent subsidies plus mentorship results in better social integration outcomes than only receiving rent subsidies with respect to: a) community integration (psychological and physical); and b) self-esteem at the primary endpoint of 18 months.
- Determine whether rent subsidies plus mentorship results in better social integration outcomes than only receiving rent subsidies with respect to: a) social connectedness; b) hope; and c) sustained academic and vocational participation at 18 months.
- Explore whether rent subsidies plus mentorship results in better social integration outcomes than only receiving rent subsidies with respect to: a) income; b) perceived housing quality; c) psychiatric symptoms; and d) sense of engulfment at 18 months.
- Integrate qualitative data to facilitate a fuller understanding of the quantitative data and deepen understanding of what the study participants (young people and mentors) found most beneficial about the intervention and how it could be improved.
This study will employ a convergent mixed methods design (i.e., quantitative and qualitative data are collected concurrently, and the findings combined) embedded within a randomized controlled trial (RCT) and a community-based participatory action research (CBPAR) framework. A mixed methods RCT is appropriate given the complex explanatory pathways (i.e., social and behavioral processes that may act independently and interdependently) of this intervention. In addition, the qualitative data will provide insights on contextual factors that may impact the external validity of the findings. Most importantly, this design provides a crucial (and under utilized) youth-informed perspective on social integration.
The study will be conducted in three Canadian cities: Toronto, Ontario (pop. 2.8 million); Hamilton, Ontario (pop. 552,000); and St. Catharines, Ontario (pop. 133,000). All of the study participants (n = 24) will receive rent subsidies (ranging from $400 - $500/month) for 24 months as a part of the intervention. This study includes funding for the rent subsidies and will be paid directly to the landlords by the community partners. St. Michael's Hospital will establish a service provider agreement with each of the community partners for this purpose. Participants in the intervention group (n = 12) will be matched with an adult mentor recruited by one of the community partners.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 26 Years (Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Be between ages 18-26
- •Left homelessness within the past year
- •Living in market rent housing
- •Plan on staying in or nearby the community in which they were recruited (Toronto, Hamilton, or St. Catharines) for the duration of the 24-month study
- •Be willing to be matched with an adult mentor who has been screened and chosen by one of the community partners
Exclusion Criteria
- •In imminent danger of losing their housing (e.g., facing jail time or impending eviction)
- •Enrolled in another study with enhanced financial and social supports
- •Unable to provide free and informed consent
- •Unable to communicate fluently in English
Outcomes
Primary Outcomes
Community Integration Scale Score at 18 Months
Time Frame: Change from baseline to 18 months
This outcome is a measure of behavioural (e.g., participation in activities) and psychological (e.g., sense of belonging) aspects of community integration. This will be measured using the Community Integration Scale (CIS), an 11-item scale. The CIS includes a psychological subscale (possible score range is from 4-20, 4 being low psychological community integration and 20 being high integration), and a physical subscale (total score range is 0-7, 0 being low physical community integration, and 7 being high integration). Only the psychological subscale has been reported here.
Rosenberg Self-Esteem Scale Score at 18 Months
Time Frame: Change from baseline to 18 months.
This outcome is a measure of global self-worth and will be measured using the Rosenberg Self-Esteem Scale, a 10-item scale, internal consistency α = .77 - .88. The total scoring range is 0-30, a score of \<15 is categorized as low self-esteem, and 15-30 is categorized as normal self-esteem.
Secondary Outcomes
- Social Connectedness Scale Score at 18 Months(Change from baseline to 18 months.)
- Beck Hopelessness Scale Score at 18 Months(Change from baseline to 18 months.)
- Academic/Vocational Participation as Assessed by a Questionnaire at 18 Months(Change from baseline to 18 months.)