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Effect of a Rent Subsidy and Mentoring on Youth Transitioning Out of Homelessness

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03779204
Recruitment Status : Active, not recruiting
First Posted : December 19, 2018
Last Update Posted : January 22, 2021
Sponsor:
Collaborators:
Covenant House Toronto
The Living Rock Ministries
The Resource Association for Teens (RAFT)
Information provided by (Responsible Party):
Unity Health Toronto

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:

1. 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:

  1. 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.
  2. 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.


Condition or disease Intervention/treatment Phase
Homeless Persons Behavioral: Mentorship Behavioral: Rent Subsidies Not Applicable

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: 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 RCT and a CBPAR framework. 24 participants will be assessed for eligibility, and then randomized into 1 of 2 arms using covariate adaptive randomization. 12 are allocated to the intervention group (rent subsidies + mentoring), while 12 are allocated to the control group (rent subsidies only). Participants in the intervention group (n = 12) will be matched with an adult mentor recruited by one of the community partners. Mentors are selected and matched through one-on-one interviews with someone in a leadership role within the organization. A common mentoring guide will be used for all sites; these booklets cover information ranging from ideal mentor characteristics to mentor code of conduct.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: 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
Actual Study Start Date : February 28, 2019
Estimated Primary Completion Date : May 1, 2021
Estimated Study Completion Date : May 1, 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Rent subsidies + Mentorship
Participants in this arm (n = 12) will receive rent subsidies (ranging from $400 - $500/month) for 24 months as part of the intervention and be matched with an adult mentor recruited by one of the community partners.
Behavioral: Mentorship
The mentors will be encouraged to incorporate the key relationship-based components of natural mentors (e.g., a 'coach' or 'cheerleader' role) to assist with mainstream integration. The mentors will have more flexibility than a typical formal mentorship program in the types of activities they pursue with their mentees. They will not be mandated to attend shelter-based social events, but rather engage in activities that direct their mentees away from the shelter system (and their old identities as homeless youth) and toward the mainstream (e.g., meeting for coffee at a local university campus). All of the mentors will meet monthly with their mentees for two years. In addition, the mentor will be encouraged to touch base with their mentee via phone or text message every week. If a mentor is unable to continue their role and there are at least six months left in the study, the study participant will be matched with a new mentor.

Behavioral: Rent Subsidies
Participants will receive rent subsidies ($500 for those living in Toronto, $400 for those living in Hamilton or St. Catherine's due to differences in cost of living) for 24 months.

Active Comparator: Rent subsidies only
Participants in this arm (n = 12) will receive rent subsidies only (ranging from $400 - $500/month) for 24 months as part of the comparator group intervention. This group will not receive mentorship.
Behavioral: Rent Subsidies
Participants will receive rent subsidies ($500 for those living in Toronto, $400 for those living in Hamilton or St. Catherine's due to differences in cost of living) for 24 months.




Primary Outcome Measures :
  1. Mean Change from Baseline in Community integration (psychological and physical) Scores as Measured by the Community Integration Scale (CIS) at 18 Months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]

    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, an 11-item scale. The CIS includes a psychological subscale (scores possible range from 4-20, 4 being low psychological community integration and 20 being high integration), and a physical subscale (total scoring range is 0-7, 0 being low physical community integration, and 7 being high integration). This scale was used extensively in the Chez Soi/At Home study, but psychometric properties have yet to be reported.

    This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.


  2. Mean Change from Baseline in Self-esteem Scores as Measured by the Rosenberg Self-Esteem Scale (RSS) at 18 Months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    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. This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.


Secondary Outcome Measures :
  1. Mean Change from Baseline in Social Connectedness Scores as Measured by the Social Connectedness Scale (SCS) at 18 Months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    This outcome is a measure of belongingness - the degree to which people feel connected to others. It is measured using the Social Connected Scale, a 20-item scale, internal consistency α = .92. The total scoring range is 20-120, 20 being low social connectedness and 120 being high social connectedness. This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.

  2. Mean Change from Baseline in Hope as Measured by the Beck Hopelessness Scale at 18 Months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    This outcome is a measure of motivation, expectations, and feelings about the future and will be measured using Beck's Hopelessness Scale, a 20-item scale, internal consistency α = .93. The total scoring range is 0-20, 0-3 = None or minimal, 4-8 = Mild, 9-14 = Moderate - requires monitoring, 15+ = Severe - suicide risk. This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.

  3. Change in Academic Participation/Educational Attainment as Assessed by a Questionnaire at 18 Months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    Participant engagement with school or a training program will be assessed. Participants will be prompted to answer questions about their current educational pursuit every 6 months in a questionnaire, including whether the individual is pursuing education, and the type of education. This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.

  4. Change in Vocational Participation/Employment as Assessed by a Questionnaire at 18 months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    Acquirement of meaningful employment will be assessed. Participants will be prompted to answer questions about their current employment status every 6 months in the questionnaire, including whether they are employed, the type of employment, and the intensity of the employment (hours per month). This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.


Other Outcome Measures:
  1. Mean Change from Baseline in Engulfment Scores as Measured by the Modified Engulfment Scale (ES) at 18 months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]

    This is an exploratory outcome. This outcome is a measure of the degree to which an individual's self-concept is defined by their experience of homelessness. It will be assessed using the Modified Engulfment Scale, a 30-item scale, internal consistency α = .91. The total scoring range is 30-150, 30 being low engulfment, 150 being high engulfment.

    The scale was adapted for use in this study, substituting "experience of homelessness" for "illness".

    This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.


  2. Mean Change from Baseline in Psychiatric Symptoms as Measured by the Modified Colorado Symptom Index (CSI) at 18 months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    This is an exploratory outcome; it is the measurement of the presence and frequency of psychiatric symptoms experienced in the past month. Measured using the Modified Colorado Symptom Index, a 14-item questionnaire, internal consistency α = .90 - .92. The total scoring range is 0-56, 0 being a low frequency of psychiatric symptoms, and 56 being a high frequency of psychiatric symptoms. This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.

  3. Change in Income as Assessed by a Questionnaire at 18 months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    This is an exploratory outcome. Participants will be prompted to answer questions about their current income every 6 months in a questionnaire. This outcome is assessed using a repeated measures analysis and changes in income will be assessed for change over time at the aggregate level. This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.

  4. Mean Change from Baseline in Perceived Housing Quality as Measured by the Perceived Housing Quality Scale (PHQS) at 18 months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    This is an exploratory outcome and is assessed by participant perception of housing choice and quality. Measured using the Perceived Housing Quality Scale.This scale was used extensively in the Chez Soi/At Home study, but psychometric properties have yet to be reported. It has been shortened it from 10 items (Chez Soi/At Home) to seven relevant items. The total scoring range is 7-35, 7 being very dissatisfied with current housing quality, and 35 being very satisfied with housing quality. This outcome is assessed for change at 18 months, and the overall trajectory described over 30 months.

  5. Participant Perspectives of Intervention Barriers and Facilitators, as Informed by Interviews with Participants and Focus Groups with Case Workers at 18 months [ Time Frame: Assessed every 6 months for 30 months, after introduction of the mentor to the participant ]
    This is an exploratory outcome. Through interviews and focus groups, youth will be able to indicate what aspects of the program they found most effective. Understanding of the strengths and weaknesses of the intervention is expected to increase over time.



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Ages Eligible for Study:   18 Years to 26 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03779204


Locations
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Canada, Ontario
St. Michael's Hospital
Toronto, Ontario, Canada
Sponsors and Collaborators
Unity Health Toronto
Covenant House Toronto
The Living Rock Ministries
The Resource Association for Teens (RAFT)
Investigators
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Principal Investigator: Naomi S Thulien, RN, PhD Unity Health Toronto
Publications:
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Frederick, T., Chwalek, M., Hughes, J., Karabanow, J., & Kidd, S. (2014). How stable is stable? Defining and measuring housing stability. Journal of Community Psychology, 42(8), 964- 979. doi:10.1002/jcop.21665.
Gaetz, S. (2014). Coming of age: Reimagining the response to youth homelessness in Canada. Toronto, ON: The Canadian Homelessness Research Network Press. Retrieved from http://www.homelesshub.ca/comingofage
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Gaetz, S., & Redman, M. (2016). Federal investment in youth homelessness: Comparing Canada and the United States and a proposal for reinvestment. Canadian observatory on homelessness policy brief. Toronto, ON: The Homeless Hub Press. Retrieved from http://homelesshub.ca/sites/default/files/Policy_Brief.pdf
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Thompson, A. E., Greeson, J. K., & Brunsink, A. M. (2016). Natural mentoring among older youth in and aging out of foster care: A systematic review. Children and Youth Services Review, 61, 40-50. doi: 10.1016/j.childyouth.2015.12.006.
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Unity Health Toronto
ClinicalTrials.gov Identifier: NCT03779204    
Other Study ID Numbers: 18-251
First Posted: December 19, 2018    Key Record Dates
Last Update Posted: January 22, 2021
Last Verified: January 2021

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Unity Health Toronto:
Social Isolation
Self-Esteem
Hope
Psychiatric Problem
Education
Employment
Income
Housing Problems
Identity, Social
Youth
Rent Subsidy
Mentorship