Homeless in Canada

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Afterword

Sat, 20/01/2018 - 2:00pm
A YOUTH PERSPECTIVE Being homeless is stressful. It’s 24 hours a day. Even if you experience a good week or month, there is always an underlying and pervasive feeling of instability, that everything around you is temporary. Despite the positive things you experience, there is still a strong fear that you will lose everything you have gained or relapse into homelessness. As a young person who has experienced homelessness and a transition back to housing, I have found that homelessness had a large impact on my mental health. I have learned, from myself and others, that the experience of homelessness can easily trigger previous or new mental health symptoms. For example, feelings of loneliness, isolation, and a general lack of family and community support often lead to an overall sense of hopelessness or depression. This depression can then translate into substance use or risky behaviours as youth seek comfort through harmful coping strategies because they lack healthier or more adaptive options. These risky coping measures can then lead to even greater or longer lasting mental health challenges and harm. This is why support for young people who are homeless is essential. In my own experience, the most helpful services have come from dependable and flexible outreach workers, as well as highly trained and accessible mental health professionals. Outreach workers have been a lifeline for me. They created the feeling that somebody was actively helping me because they would come to wherever it was I needed them to be. Trustworthy, dependable and flexible service was key. However, access to these services is not very easy; wait lists are often over a year long or require specific referrals from physicians to which youth may not have access. These are barriers for youth who live on the street and who are forced to remain homeless longer because services are lacking or because they don’t know how to get connected to a professional. Unfortunately, many youth who are homeless experience serious mental health challenges and require intervention, but cannot easily access highly qualified and trained mental health professionals such as psychologists and psychiatrists. I feel that this access is an investment in the well-being of youth that helps prevent further escalation of already stressful experiences. I had the opportunity to enroll in an integrated program called HOP-C that linked me with a supportive team that stayed connected with me and with each other. I had access to high-quality mental health care, an outreach worker, and peer mentorship in the community. This included the opportunity to attend fun community events. These events helped me and others in the program see past our current circumstances and have fun and let loose. They reminded me that there is more to life than my current situation and that I had the capacity to be happy. My own improved mental health has increased my capacity for life and my ability to work toward a better future. It enables me to put actions to my words. This change started with attending appointments and making efforts to maintain a healthy balance, and then led to working toward education and employment goals. Improved mental health has shifted my perspective on life: I feel hope, that I can achieve things. The focus of my life is no longer on mere survival, but on seeing and experiencing what life has to offer. I support resources that assist workers and systems in better addressing the mental health and addiction challenges of youth. These supports help youth who need extra assistance, due to their histories and difficult experiences, to realize their potential and see a better future for themselves. Service providers who have solid training in mental health and addiction make us feel more secure and supported, and help ease the burden of homelessness. For me, they made getting through life just a little bit easier. They instilled hope and reminded me that there is life after homelessness. The best workers were constant sources of motivation, encouraging me to not give up on my life goals. All youth deserve this. M.H. - ABOUT THE EDITORS Sean Kidd, PhD, CPRP, is a senior scientist and division chief of psychology at the Centre for Addiction and Mental Health in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto. His career has focused on marginality and service enhancement, specifically among youth experiencing homelessness and people with severe mental illness. He has published landmark papers in qualitative methods in psychology, and is internationally recognized for his research on youth homelessness, including being one of the most published scholars in that area. He has done extensive work in developing and testing psychiatric rehabilitation interventions and in examining social inclusion among marginalized populations. Natasha Slesnick, PhD, is a licensed clinical psychologist. At Ohio State University, she is associate dean of Research and Administration in the College of Education and Human Ecology, and a professor of couple and family therapy, human development, and family science. Her research focuses on youth and families experiencing homelessness, specifically on developing and evaluating interventions for substance use, HIV risk, mental health, and housing. She has evaluated and refined an ecologically based family systems intervention for shelter-recruited adolescents who have run from home, and for their families. She has also modified and tested individually focused interventions for street-recruited youth and young mothers with children in their care. Dr. Slesnick launched two drop-in centres for youth who are homeless: one in Albuquerque, New Mexico, and another in Columbus, Ohio. Tyler Frederick, PhD, is a sociologist and an assistant professor at the University of Ontario Institute of Technology in Oshawa. He is a community-based researcher with a focus on marginalized young people. His research focuses on how young people navigate homelessness and how this process shapes their mental health, identity, and well-being. Jeff Karabanow, PhD, RSW, is a professor of social work at Dalhousie University in Halifax, Nova Scotia. His research focuses on housing stability, service delivery systems, street health, and homeless youth culture. He has completed a documentary about the plight of street youth in Guatemala City and several animated shorts on Canadian street youth culture. Dr. Karabanow is one of the founding members of Halifax’s Out of the Cold Emergency Shelter and is co-director of the Dalhousie School of Social Work Community Clinic.334  Stephen Gaetz, CM, is a professor in the Faculty of Education at York University in Toronto, and director of the Canadian Observatory on Homelessness/Homeless Hub. His program of research has been defined by his desire to “make research matter” by conducting rigorous scholarly research that contributes to our knowledge base on homelessness, and that at the same time can be mobilized to have a bigger impact on policy, practice, and public opinion. Dr. Gaetz has pioneered efforts to bring together researchers, practitioners, policy makers, and people with lived experience of homelessness to participate in community-engaged scholarship and knowledge creation designed to contribute to solutions to homelessness. As director of the Canadian Observatory on Homelessness, one of his key projects is the Homeless Hub, an innovative web-based research library internationally recognized as a leading example of innovation in knowledge mobilization.
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4.2 Pragmatic strategies & considerations for evaluating mental health programs

Sat, 20/01/2018 - 2:00pm
Evaluation research involves gathering a wide variety of indicators in order to better understand how a program is operating, its impact, and what can be done to improve it. The performance indicators that many organizations collect routinely as part of their daily operations can provide important information for a program evaluation (e.g., attendance, client demographics), but are not themselves considered evaluation research. Evaluation involves systematically and intentionally collecting and reviewing information in order to understand and strengthen a program.  This chapter offers service providers guidance around evaluating programming within their organizations, with a particular focus on mental health initiatives. It discusses developing evaluation questions and choosing sources and methods for obtaining information. It also examines ethical considerations in conducting evaluation research. 
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4.1 Assessment tools for prioritizing housing resources for youth who are homeless

Sat, 20/01/2018 - 2:00pm
In almost all communities in North America, the number of youth experiencing homelessness exceeds the capacity of the housing resources available to them. This situation leaves communities with the predicament of trying to decide who to prioritize for the precious few spots available in housing programs. For adults, this same dynamic exists and many communities have turned to vulnerability assessment tools to help them make these difficult decisions. Most communities have moved to a coordinated entry system. In such systems, most agencies within a community pool their housing resources in a centralized system. People seeking housing are first assessed for eligibility. Criteria usually include being chronically homeless, in addition to veteran status and vulnerability (U.S. Department of Housing and Urban Development, 2015, 2016). Based on these assessments, individuals are prioritized for housing and placed on waiting lists until appropriate housing becomes available in the community.  In the context of adult homelessness, tools for assessing vulnerability have focused on assessing factors associated with premature mortality (Hwang, Lebow, Bierer et al., 1998; Juneau Economic Development Council, 2009; Swanborough, 2011) or with greatest system costs (Economic Roundtable, 2011). However, since youth under age 24 are unlikely to experience health-related premature mortality or to have created enormous system costs, new assessment tools have been developed in recent years that reflect the needs and realities of youth who are homeless. Most widely used are the TAY Triage Tool (Rice, 2013), developed by the Corporation for Supportive Housing (CSH) and myself, and the Next Step Tool for Homeless Youth,1 which was developed by Orgcode Consulting (2015) with CSH and myself. 
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4. ASSESSMENT & EVALUATION

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3.9 Resilience-based mental health intervention for street children in developing countries

Sat, 20/01/2018 - 2:00pm
“Street children” are an underprivileged group that is visible in public places of urban areas in developing countries. These children engage in informal economic activities to make a living for themselves and their families. They are found in every corner of the globe, but are more visible in developing countries in Africa, South Asia, and parts of Latin America (Thomas de Benítez, 2011). There is debate about the size of this population, with estimates ranging anywhere between several million and 100 million. Part of the difficulty in determining the exact number is the lack of a universally accepted definition of street children1 (Thomas de Benítez, 2011).  These challenges aside, the question remains: Why do these children leave their homes for the complex hardships of street life? Research from developing countries tends to view children’s movement to the street through two lenses: poverty and family dysfunction. Chronic poverty often creates unbearable conditions at home for young children and exerts pressure on family members to find economic means for survival (Ballet, Bhukuth, & Radja, 2013). In this situation, children migrate to the streets voluntarily or involuntarily to support their families. From the family dysfunction perspective, family environments that feature conflict, violence, abandonment, and authoritarian behaviour weaken or disintegrate ties among family members, prompting the child’s eventual departure from the home (Ballet et al., 2013). Moreover, population growth, urbanization, war, and HIV epidemics affect the stability of economic and social institutions in developing countries; when these institutions are unstable, families and individuals migrate to urban centres that are themselves economically depressed and thus offer limited opportunities. Some families disintegrate under these conditions and children are forced to take to the streets for survival (Kombarakaran, 2004). 
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3.8 Partnerships that support mental health intervention for street-involved youth

Sat, 20/01/2018 - 2:00pm
After decades of fragmentation within the community-based child and youth mental health sector, there is an emerging trend and understanding of how cross-sectoral partnerships and integration between organizations can improve mental health outcomes for children, youth, and young adults. This chapter describes the benefits of these partnerships and key considerations in developing them. It also presents a case study of a successful partnership that is helping to address mental health issues among youth in the shelter system. 
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3.7 The digital lives of youth who are homeless: Implications for intervention, policy, and services

Sat, 20/01/2018 - 2:00pm
Each year, 1.5 million to 3 million youth in the United States experience homelessness1 (Toro, Lesperance, & Braciszewski, 2011). They are considered to be one of the most marginalized groups in the country. Among the many challenges they face are acquiring health care, employment, and stable housing. It is becoming increasingly important to consider how to use information and communication technologies (ICT) to increase service engagement and outreach and improve health outcomes and quality of life among youth who are homeless.  ICT encompasses a range of interactive tools and platforms; these include social networking sites such as Facebook and Twitter, where people create profiles and share them with network contacts; content-sharing sites such as YouTube and Flickr, which are used to share, rate, and discuss videos and photographs (Adewuyi & Adefemi, 2016); and mobile phones and mobile phone–based applications, which have become a popular alternative to traditional websites for delivering information.  This chapter discusses recent research on ICT use among youth who are homeless. It also describes interventions in the United States that have used these technologies to engage this population, and explains how what we have learned can be translated into service and policy initiatives that reduce disparities in accessing information and other resources in this vulnerable group. 
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3.6 Peer support work to enhance services for youth experiencing homelessness

Sat, 20/01/2018 - 2:00pm
Across contexts, peer workers and peer mentors are becoming an increasingly important resource in delivering youth-focused programming for young people who are homeless or street involved. Peer work has been established across a number of practice areas, including public health, addictions, education, and community-based research. The most considerable development in the role has been within the mental health sector, where peer work is gaining increasing visibility and legitimacy as a central component of a recovery-based approach that is demonstrating positive outcomes (Nesta, 2015). While the incorporation of adult peers is relatively well established in many service sectors, youth and young adult involvement is still developing.  Peer work can encompass a number of activities, and although the role lacks a clear definition, a defining feature is the use of lived experience as a support to individuals in similar circumstances (Vandewalle et al., 2016). Within this broad conceptualization, various authors (Ansell & Insley, 2013; Ontario Centre of Excellence for Child and Youth Mental Health, 2016; Paradis, Bardy, Cummings, Athumani, & Pereira, 2012) have identified the common peer worker roles. These roles include:  Peer mentor: partners with a client or participant and offers support and encouragement regarding program-specific goals and broader life goals;  Peer educator: helps develop educational materials and leads educational presentations and workshops;  Peer navigator: provides help with systems navigation (e.g., accompanying people to appointments, connecting to services, helping to fill out paperwork);  Peer specialist: a broader role that encompasses some of the above activities and might include some case management, advocacy, and group facilitation; and  Self-help and mutual aid group: this includes peer support groups and peer knowledge exchanges.
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3.5 Beautiful trouble: Possibilities in the arts with street-involved youth

Sat, 20/01/2018 - 2:00pm
 Beautiful trouble makers who remember, resist and reimagine.  —Min Sook Lee, OCAD University, Art and Social Change  Offering Crys a ride “home” after a jewelry-making workshop led me to a makeshift “shanty town” under the Bathurst Street bridge in Toronto. I was struck by the vivid colour and detail in this woven compilation of blankets, boxes, and condo sales sandwich boards, used to create multi-storey structures, walls, doors, beds, tables, and chairs. It looked like a theatre set. Crys told me that over 20 youth lived there, and it had taken months to construct. Everyone had a role in this “under-the-bridge” community. Someone fed the dogs and another created the schedule for their walks; someone held the alarm clock to wake people for jobs, school, or appointments; others led study and support groups for those in school, and those wanting to “stay clean.” And of course, many of them were musicians, poets, and artists who made things to sell instead of panhandling and who entertained each other in the evenings. They shared their earnings and combined costs, especially for meal-making that happened over their custom-made Bunsen burners. They met weekly to make decisions and talk through problems. Crys was pretty proud of that place and it evoked a kind of envy in me for creative, cooperative, and alternative community. 
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3.4 The individual placement & support model of supported employment for street-involved youth with mental illness

Sat, 20/01/2018 - 2:00pm
More than two million youth in the United States are homeless at some time each year (Whitbeck, 2009). They often have histories of depression, complex trauma, substance abuse, and physical and sexual abuse—all of which make obtaining and maintaining competitive employment difficult. Epidemiologic data indicate that 26% meet the clinical criteria for major depression, 35% have attempted suicide, and 72% use illegal substances to cope (Rotheram-Borus & Milburn, 2004). Their connection to school is also irregular or non-existent, which contributes to low educational levels and limited employment skills. Several studies suggest that over one-third of youth who are homeless have dropped out of school, do not attend school regularly, or fail to earn a high-school diploma by age 18 (Thompson, Pollio, & Constantine, 2002; Whitbeck, 2009). These mental health and behavioural health challenges, combined with low educational and employment skills, contribute to high unemployment rates among youth who are homeless compared with their housed peers. Housed youth in the general population (aged 16–24) have unemployment rates ranging between 8% and 17% (U.S. Department of Labor, Bureau of Labor Statistics, 2016), whereas unemployment rates for youth who are homeless range from 39% to 71% across various samples of youth living on the street or in shelters (Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001; Ferguson & Xie, 2008; Lenz- Rashid, 2006; Whitbeck, 2009). 
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3.3 Strengths-based outreach & advocacy for non-service-connected youth experiencing homelessness

Sat, 20/01/2018 - 2:00pm
Much of what is known about youth who are homeless is obtained from those engaged through service programs, such as drop-in centres or shelters. This means that much less is known about youth experiencing homelessness who are not engaged in services as they are excluded from most studies. This is a significant concern because some reports indicate that youth who are not connected to services represent the majority of youth who are homeless: less than 10% access community resources meant to serve them (Kelly & Caputo, 2007). Furthermore, service-disconnected youth are different from those who already access services; they have more unmet needs and more severe substance use and mental health problems (Kryda & Compton, 2009). Efforts to connect youth to services are essential to prevent a range of public health consequences associated with homelessness, including premature death. 
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3.2 Responding to mental health concerns on the front line: Building capacity at a crisis shelter for youth experiencing homelessness

Sat, 20/01/2018 - 2:00pm
It is well established that youth experiencing homelessness face many challenges with their mental health. For example, a literature review of the topic found that 30%–40% of youth who are homeless experience major depression, bipolar disorder, posttraumatic stress disorder, and substance use (Kidd, 2013). A small number also experience psychotic disorders such as schizophrenia, although this incidence is believed to be larger than that found in the general population (Kidd, 2013). Moreover, an alarming number of youth face some form of emotional distress regardless of whether they have a formal diagnosis. Our administrative data at Covenant House Toronto, Canada’s largest youth-serving agency, show that about 30% of the young people we serve in our emergency shelter have a serious mental health concern, and of a sample of 164 youth using our drop-in, shelter, and transitional housing programs, over 70% reported experiencing at least one symptom of depression, anxiety, hearing or seeing things that others could not, distress from past trauma, sleep disturbances, and/or suicidal ideation in the past three months. 
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Report on Youth Homelessness 2018

Sat, 20/01/2018 - 2:00pm
A Vision for Tomorrow On any given night, more than 6,000 Canadian youths are homeless. Young people account for one in five of the people living in Canada’s homeless shelters. In Kingston the figure was more acute in 2013. One in three shelter residents here were between the ages of 15 and 24.* To help these vulnerable young people put their homelessness behind them and live safe, productive lives, the United Way Kingston, Frontenac, Lennox & Addington embarked on a mission to prevent and end youth homelessness in our region. This mission began with the vision of reducing the number of young people using the shelter system. However as the consultation process gained momentum, it became clear that the root causes of homelessness are complex and require intervention on multiple fronts. Instead of reducing homelessness, then, the United Way opted to focus on prevention, providing timely intervention, and building a sustainable network of supportive resources. While this approach may not have the intended effect of reducing the number of homeless youth, it will ensure that youth homelessness in our community becomes a treatable condition, rather than a chronic one. And so a new vision emerged: “By 2020, 80 per cent of youths who enter the homelessness system in KFL&A will be housed within 30 days.” By pursuing this vision, we can focus our attention and our efforts on identifying and removing the barriers that keep young people from accessing safe, suitable, and sustainable housing, and ensure that every young person in KFL&A has a place to call home. * In 2017, as a result of community wide efforts, one in five shelter residents were between the ages of 15 and 24.
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Rent Assist Rates for Persons Renting in the Private Market

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Outline of rent assistance available in Manitoba. 
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Brandon Poverty Compass

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The Poverty Report attempts to provide a comprehensive image of what poverty is in Brandon. Given the existing work and research that is being done in the community, Statistics Canada, and many other organizations, there is no shortage of quality information on poverty and its indicators in Brandon. However, no one report has yet to cohesively amalgamate this information into one report to benefit local decision-makers and poverty-serving organizations.  Data has been amalgamated from Statistics Canada, Economic Development Brandon, and many other sources. Where Brandon specific information wasn’t available, interviews with local stakeholders and individuals with lived experience have been used to supplement provincial data. Overall, a collaborative approach was taken whereby the emphasis was placed on creating an ongoing dialogue with community members and organizations to provide the fullest picture of poverty.  
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Brandon Homelessness Partnering Strategy Community Plan 2014–2019

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Homelessness partnering strategy plan for implementing Housing First in Brandon. 
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Child and Family Poverty in Ontario

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This manual is a reference for service providers working with families living in poverty who have children under age six. These families face many challenges as a result of living in poverty and often turn to service providers for support in the navigation of these challenges and for needed services. In order to be effective in their work, it is important that all service providers who work with families living in poverty: • Have a broad understanding of the issues facing families living in poverty. • Recognize poverty as a primary social problem and a major determinant of poor health. • Focus their interventions on decreasing the impacts of poverty. This manual was written with a wide range of service providers in mind, such as community workers, child protection workers, teachers, health care providers, early childhood educators, social workers and others who interact with families, parents or children. Questions are raised to encourage service providers to reflect on the influence that poverty has on families as well as the ways they serve these families. In this resource, the voices of parents and service providers are presented as they offer their needs, concerns and experiences. This information helps to create a picture of how services can operate for optimal impact. The final chapter presents examples of services that use innovative approaches to address the concerns and challenges of families living in poverty. Lists of key resources for service providers and for parents are provided at the end of the manual.
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The Action Plan for Preventing Homelessness in Finland 2016-2019: The Culmination of an Integrated Strategy to End Homelessness?

Sat, 20/01/2018 - 2:00pm
This paper begins by setting the 2016-2019 Action Plan for Preventing Homelessness in Finland, hereafter the ‘Action Plan’, in the context of the wider Finnish homelessness strategy. Following a summary of the Action Plan, the paper then undertakes a critical analysis of the preventative approach being taken, considering the strengths of the Finnish approach and the challenges that exist in reducing Finnish homelessness. The paper concludes with a discussion of the potential lessons from the Finnish model for other European countries.
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Financing Cocaine Use in a Homeless Population

Sat, 20/01/2018 - 2:00pm
Abstract:  Background: Cocaine use is highly prevalent among homeless populations, yet little is known about how it is financed. This study examined associations of income sources with cocaine use and financing of drugs in a longitudinal evaluation of a homeless sample.  Methods: A homeless sample was recruited systematically in St. Louis in 1999–2001 and longitudinally assessed annually over two years using the Diagnostic Interview Schedule and the Homeless Supplement, with urine drug testing.  Results: More than half (55%) of participants with complete follow-up data (N = 255/400) had current year cocaine use. Current users spent nearly $400 (half their income) in the last month on drugs at baseline. Benefits, welfare, and disability were negatively associated and employment and income from family/friends, panhandling, and other illegal activities were positively associated with cocaine use and monetary expenditures for cocaine.  Conclusions: Findings suggest that illegal and informal income-generating activities are primary sources for immediate gratification with cocaine use and public entitlements do not appear to be primary funding sources used by homeless populations. Policy linking drug testing to benefits is likely to have little utility, and public expenditures on measures to unlink drug use and income might be more effectively used to fund employment and treatment programs. Keywords:  homelessness; substance use; cocaine; financing; income; public entitlements; longitudinal; diagnostic assessment; urine drug testing; panhandling
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Defining and measuring an end to homelessness: Considerations for the National Housing Strategy

Sat, 20/01/2018 - 2:00pm
The concept of “ending homelessness” has had significant impact on public policy and service responses in recent years. Just consider the number of “ending homelessness” plans, strategies, policy directions, and funding announcements not just in Canada, but internationally. Currently, there is no internationally recognized definition of an end to homelessness, the type of indicators and targets, and a verification process for communities. This is also the case for Canada. In light of the recently launched National Housing Strategy with a clear recognition of housing as a human right and commitment to ending homelessness, we want to ensure that measurable targets and goals drive toward the elimination of homelessness. However, without a clear sense of what homelessness actually means and what an “end” looks like, how will we ever know where we stand on progress towards this objective? Clearly, if we are truly interested in ending homelessness, then we need to move beyond a sole focus (and performance metric) on chronic homelessness, as the National Housing Strategy suggests. This is because we cannot, and should not, wait for people to become chronically homeless before we help them. This is a fundamental violation of their human rights. In fact, if we really want to end homelessness, we need to ensure that people do not become homeless in the first place through a preventive focus that ensures they have access to appropriate supports and housing. One of the main problems with focusing narrowly on chronic homelessness is that we can exclude key populations who are extremely vulnerable in other ways, including women fleeing violence, Indigenous Peoples in substandard housing, couch surfing youth, young people vulnerable to criminal and sexual exploitation, and racialized communities and newcomers. Waiting for these groups to become chronically homeless before we offer them serious help to avoid or exit homelessness is expensive and damaging to individuals, families and communities.   In addition, the important work on defining Indigenous homelessness, from an Indigenous-lived experience lens speaks to the important considerations tied to definitions and their powerful impact. Thus, a Canadian definition must resonate regionally and across populations; it must align with the lived experience voice and look beyond quick fixes if we are to truly leverage this historic moment in social policy for our country. Finally, we need to consider that chronic homelessness underrepresents dynamics involved in small, medium-sized and regional centres as well as rural and Northern remote communities where hidden homelessness is very common. While focusing on chronic homelessness must always be a central priority in community strategies to address homelessness, if we want to truly end homelessness, we need to do more. FROM THE RESEARCH MATTERS BLOG  A Lived Experience View of Functional & Absolute Zero
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