The elusive goal of social integration: A critical examination of the socio-economic and psychosocial consequences experienced by homeless young people who obtain housing

Abstract

Objectives

The objective of this study was to provide an insider perspective on the experiences of nine formerly homeless young people as they transitioned into independent (market rent) housing and attempted to achieve meaningful social integration.

Methods

The study was conducted in Toronto, Canada, and guided by the conceptual framework developed for the World Health Organization by the Commission on Social Determinants of Health. A critical ethnographic methodology was used. Over the course of 10 months, the lead author met every other week with nine formerly homeless young people who had moved into their own homes within 30 days prior to study recruitment.

Results

Unaffordable housing, limited education, inadequate employment opportunities, poverty-level income, and limited social capital made it remarkably challenging for the young people to move forward. As the study progressed, the participants’ ability to formulate long-range plans was impeded as they were forced to focus on day-to-day existence. Over time, living in a perpetual state of poverty led to feelings of “outsiderness,” viewing life as a game of chance, and isolation.

Conclusion

Rather than a secure, linear path from the streets to the mainstream, study participants were forced to take a precarious path full of structural gaps that left them stuck, spinning, and exhausted by the day-to-day struggle to meet basic needs. Despite their remarkable agency, it was almost impossible for the participants to achieve meaningful social integration given the structural inequities inherent in society. These observations have implications for practice, policy, and research.

Introduction

Young people (aged 13–24 years) comprise almost 20% of the homeless population in Canada (Gaetz et al., 2016a). An estimated 35,000 to 40,000 Canadian youth are homeless at some point during the year and at least 6000 on any given night (Gaetz et al., 2016a). Frequently, these young people are fleeing unstable and complicated home lives marked by abuse, poverty, and neglect (Kulik et al., 2011; Gaetz et al., 2016b). Other commonalities include inadequate education, limited employment opportunities, and poor physical and mental health (Kulik et al., 2011; Gaetz et al., 2016b; Karabanow et al., 2010). While we know a great deal about the risk factors associated with young people entering street life, we know much less about how to facilitate and sustain homeless youth transitions off the streets (Karabanow et al., 2010; Mayock et al., 2011). Understanding pathways out of homelessness is crucial because once youth become entrenched in street life, it is much harder for them to exit homelessness (Karabanow et al., 2010; Milburn et al., 2009).

There have been a handful of important national and international longitudinal (longer than 6 months) studies documenting youths’ pathways out of homelessness (Mayock et al., 2011; Milburn et al., 2009; Brueckner et al., 2011; Kidd et al., 2016; Roy et al., 2014; Slesnick et al., 2008; Tevendale et al., 2011; Cheng et al., 2013; Karabanow et al., 2016); however, there is no consistent definition among these studies of “housing” (own apartment, foster home, shelter-based transitional housing, family, etc.) for the participants who became housed at various points in time during the study period. This makes it challenging to compare the studies and to understand the nuances and implications associated with the transition to specific kinds of housing options. Moreover, only four of the aforementioned studies had a qualitative component (Mayock et al., 2011; Brueckner et al., 2011; Kidd et al., 2016; Cheng et al., 2013; Karabanow et al., 2016) and explored the transitioning process from the perspectives of the youth living the experience.

The limited research on this issue means our understanding about what homeless youth need to succeed may not match their lived experience. For example, results from a recent longitudinal mixed methods study of formerly homeless youth (n = 51) show that obtaining stable housing does not necessarily translate into a sense of belonging or connection to mainstream society (Kidd et al., 2016; Karabanow et al., 2016). Youth in that study described feeling unprepared for and overwhelmed by the realities associated with their socio-economic context and position, undermining their confidence in achieving larger life goals (Kidd et al., 2016; Karabanow et al., 2016). This was especially true for youth transitioning from the streets to independent (market rent) housing (Kidd et al., 2016) — a group yet to be the exclusive focus of an empirical study.

This study seeks to address this knowledge gap by sharing the perspectives of formerly homeless young people as they transitioned into independent housing and attempted to achieve meaningful social integration. The purpose of this paper is to highlight two key findings: (1) structural inequities and (2) the psychosocial consequences of trying to maintain independent housing amid inequitable structural contexts. Specifically, we illustrate how inequitable structural contexts make it almost impossible for formerly homeless young people to integrate into mainstream society.

Conceptual framework

Prior to beginning this research, we wrestled with how best to capture the myriad of factors the young people would have to contend with to achieve meaningful social integration. We also wanted to utilize a broad definition of social integration, one that incorporated both community participation (e.g., familiarity with neighbours and local attractions) and economic participation (e.g., employment and income) (Quilgars & Pleace, 2016). We chose the conceptual framework developed for the World Health Organization (WHO) by the Commission on Social Determinants of Health (CSDH) (Solar & Irwin, 2010). The CSDH framework (Fig. 1) is unique in that the social determinants of health are not presented as a grouping of equally important factors. Instead, the CSDH divides these factors into upstream structural determinants (or social determinants of health inequities) and downstream intermediary determinants (or social determinants of health) (Solar & Irwin, 2010). Read from left to right, the CSDH framework illustrates how the structural factors that make up socio-economic and political contexts (e.g., economic, social, and public policies; culture and societal values) and socio-economic position (e.g., social class, gender, race, education, occupation, and income) play a crucial role in determining intermediary factors such as living and working conditions, mental health and addiction, and access to the health system (Solar & Irwin, 2010). In other words, people’s material circumstances, behaviours, and “choices” are not viewed in isolation; rather, they are tied back to the structural context of people’s lives. Social capital and social cohesion are considered cross-cutting determinants (i.e., both structural and intermediary) given the amount of social capital and social cohesion one has can both determine their socio-economic position (structural determinant) and be a consequence of their socio-economic position (intermediary determinant) (Solar & Irwin, 2010).

Fig. 1.

Commission on social determinants of health conceptual framework

Given what we knew from the literature and from our clinical practices about the challenges faced by homeless young people, we felt that the CSDH framework was an ideal and pragmatic tool to help us understand and organize our findings. Accordingly, we aligned our conception of social integration with the CSDH framework, defining it as the ability to achieve equity in health and well-being, taking into account the causal role that structural determinants play in the integration process.

Methodology

The study was conducted using a critical ethnographic methodology. Critical ethnography is situated within the critical social research paradigm. This paradigm is frequently utilized by those working in social sciences and humanities to critique social conditions (e.g., historic, socio-economic, and political contexts) that perpetuate power imbalances within society (Denzin & Lincoln, 2011). Critical ethnography is similar to traditional ethnography in that both involve prolonged field engagement in order to gain a deeper understanding of study participants and the social context of their lives; however, critical ethnography pays closer attention to power relations, critiques the social structural causes of inequities, and actively seeks to bring about social change (Breda, 2013; Jamal et al., 2005). In other words, the use of critical ethnography signals the social justice orientation of the research. Importantly, during data analysis and interpretation, critical ethnographers link micro-level individual findings back to changes that need to be made at macro-level structural contexts (Breda, 2013; Jamal et al., 2005), making this methodology a good fit with the CSDH conceptual framework.

Methods

From March 2015 to January 2016, the lead author (NT) met every other week with formerly homeless young people who had moved out of the shelter system and into their own homes in Toronto, Canada, within 30 days prior to study recruitment. Participants who remained until study completion were followed for 6 to 9 months. The study began with nine participants, but three left the study because they lost their housing (two left after 2 months and one left after 5 months). Those who left the study consented to the continued use of their data for analysis. All the participants were living in Toronto and paying market rent. The meeting locations were chosen by the participants and were generally in or nearby their homes or at other locations meaningful to the participants. Most participants met individually with NT 13 to 19 times.

Data was generated using participant observation, informal interviews, and questionnaires. Participant observation allowed NT to document interactions with people of influence (landlords, teachers, neighbours, close friends, social service providers, etc.) in environments where participants lived, worked, studied, and “hung out.” Informal interviews acted as a form of data triangulation, facilitating the confirmation of inferences made through participant observation (Hammersley & Atkinson, 2007). During these informal conversations, particular attention was paid to how socio-economic contexts (monthly income, type of employment, etc.) were influencing the transition to independent housing and, ultimately, to meaningful social integration. In addition to baseline demographic questionnaires, monthly questionnaires regarding upstream structural determinants (e.g., education, occupation and income) and downstream intermediary determinants (e.g., cost of rent, food availability, and access to transportation) were administered. These questionnaires were utilized to help evoke deeper conversations about the challenges of social integration (finding meaningful employment, struggling to pay rent, etc.).

In keeping with the emergent, iterative nature of qualitative research (Denzin & Lincoln, 2011; Eakin & Mykhalovskiy, 2003), data analysis and interpretation began during fieldwork and continued for several months after the field visits were completed. All the informal interviews were audio recorded and transcribed verbatim. The interviews were conversational in nature and guided by the overall research aim of understanding what it was like for the young people to attempt to achieve meaningful social integration. Immediately after each meeting, NT typed up field notes to record her contemporaneous perspective of the visit. Prior to subsequent meetings, NT conducted a preliminary data analysis, reviewing her field notes, reading and comparing transcripts from previous interviews, separating the data into coded segments, making analytic memos beside large portions of the interviews and field notes, and identifying new questions prior to going back into the field. While each new set of questions guided the informal interviews, they were not prescriptive, meaning the questions were often altered according to the data generated during the interview.

Participants were asked for their perspectives on the emerging interpretations at each visit, and these perspectives played a key role in helping shape the data analysis. The study authors met approximately every 3 months to review the data and discuss the emerging analysis. As this iterative process continued, earlier interview transcripts were reread and reconceptualized in light of the emerging analysis and interpretation. During this latter stage of analysis, a more nuanced examination was conducted as the transcripts were analyzed for “evidence that resides ‘between the lines’” (p.190) (Eakin & Mykhalovskiy, 2003)— short responses, uncooperative tones, and literal silence (Eakin & Mykhalovskiy, 2003; Kawabata & Gastaldo, 2015). Throughout the study, NT maintained a reflexive journal, paying particular attention to how her own social location as a clinician working with street-involved and homeless youth, privileged academic, middle-class woman, and visible minority immigrant with a history of economic precarity may be influencing the way she interpreted the data. These perspectives, when appropriate, were discussed with the study participants and the study authors during the emerging analysis. For example, feedback from participants helped NT understand that, while she perceived less meaningful minimum wage jobs as a step toward something greater (as it was for her immigrant parents), the participants saw the same jobs as a dead-end trap that reinforced their low socio-economic position.

Ethical approval for this study was obtained from the University of Toronto Health Sciences Research Ethics Board as well as the Research Review Committee at a local shelter where most of the participants were recruited. Pseudonyms (chosen by the participants) were used during data generation and are used throughout this paper.

Results

In general, participants were a racially diverse group (Table 1) with five identifying as male and four as female. Participants ranged in age from 19 to 24 years. Six had completed high school. At baseline, five participants were unemployed and seven were receiving welfare subsidies. All the participants lived in a youth shelter immediately before moving into independent housing. Four had never attempted to move off the streets, and three had done so only once before. Only one participant was co-parented by his biological mother and father. The rest were raised by their biological mothers and had minimal contact with their biological fathers. All the participants cited various forms of family dysfunction (typically physical, emotional, and/or sexual abuse) as the reason for leaving home, and five lived in homes where the child welfare system was involved.

Table 1.

Demographic characteristics of participants at baseline (n = 9)

Characteristic	n
Age
19–21  22–24	6 3
Sex/gendera
Female  Male	4 5
Race/ethnicity
Black  White  Asian  Mixed	3 3 2 1
Immigration status
Canadian citizen  Permanent resident	8 1
Sexual orientation
Heterosexual  Bisexual  Questioning	7 1 1
Education
Less than high school  Completed high school  Attended post-secondary school (not completed)	3 5 1
Attending school (high school upgrading)	2
Living situation
Independent housing, alone  Independent housing, with roommate	7 2
Employment status
Formally employed full-time  Formally employed part-time  Informally (cash job) employed part-time	2 1 1
Welfare subsidy	7
Years living away from family
0–4  5–10  > 10	6 2 1
Most recent previous accommodation
Shelter	9
Number of previous exits (at least 2 weeks housed in their own place)
0  1  4  5	4 3 1 1
Child welfare involvement	5

^aNote: In this study, participant’s sex matched their gender

Socio-economic context and position

Inequitable structural determinants made it remarkably challenging for the study participants to move forward in life. Here, we discuss the socio-economic context of the participants’ lives and provide a brief overview of some of the factors that contributed to their low socio-economic position. While these contributing factors are presented separately, it is important to understand that they were experienced simultaneously. Due to word limitations, we have chosen to save discussion about the structural determinants of social class, gender, and race/ethnicity for a forthcoming publication; however, it is important to point out that the intersecting disadvantages of being in a low social class, abiding and being limited by gender norms, and belonging to a non-dominant ethno-racial community was intrinsically and inextricably linked to the participants’ low socio-economic position and added to the complexity of achieving meaningful social integration.

Unaffordable housing

During the study period, Toronto had the most expensive rent in Canada and had the 4th lowest vacancy rate (Toronto Foundation, 2015). There were more than 80,000 Torontonian households waiting for affordable housing (social housing for low-income residents) with a wait list of many years given only about 3000 households were housed the previous year — the lowest in 6 years (Toronto Foundation, 2015). All the youth were paying market rent, which ranged from $430.00 CAD to $800.00 CAD per month. Most of the young people lived in small basement suites or tiny rooms inside rooming houses. Most of the suites appeared haphazardly constructed for the sole purpose of offering accommodation to low income tenants.

Limited education

Education is a strong determinant of future employment and income (Solar & Irwin, 2010). Six of the nine youth in the study graduated high school — much higher than the 35% national average reported in the literature (Gaetz et al., 2016b). Most were streamed after the 8th grade into the less abstract and more practical-focused applied stream, in a sense marking them as incapable of succeeding alongside their university-bound (academic stream) peers. Several participants shared that they were not particularly confident with their academic knowledge because, shortly after they entered the 9th grade, they started missing classes, hanging out with the “wrong crowd,” etc.; consequently, their marks suffered. Notably, Toronto students taking mostly applied courses in grade 9 are less likely to graduate in 5 years compared to those taking academic courses (40 vs. 86%), and students from the lowest-income neighbourhoods are significantly more likely to take the majority of their courses as applied courses compared to students in the highest-income neighbourhoods (33 vs. 6%).(People for Education, 2015)

Inadequate employment

In general, employment opportunities for all youth in the study were limited to minimum-wage, seemingly “dead-end” jobs with inconsistent hours and no benefits. None of the youth who were on welfare at baseline were able to gain stable employment and exit the welfare system during the 6 to 9 months they were in the study. The majority spoke of the ongoing temptation to seek informal or illegal employment. In fact, more than half of the youth worked at these types of jobs at some point in time during the study. Informal and illegal jobs were easy to come by and offered quick cash. Importantly, cash jobs meant no “claw back” of welfare income (in Ontario, those on the Ontario Works [OW] program [welfare for those without a diagnosed disability] can keep up to $200 a month of employment income; after that, $0.50 is deducted for every $1.00 earned) (Ontario Ministry of Community and Social Services, 2013).

Poverty-level income

All but one participant relied on welfare as their primary source of income. Those on the Ontario Disability Support Program received $13,176 CAD/year and those on the OW program received $7872 CAD/year — significantly below Canada’s low-income cutoff (LICO) of $20,160 CAD/year (Statistics Canada 2015). Most participants were on the OW program and spent an average of 73% of their welfare income on rent, leaving them with $176.00 CAD/month on average. Because the participants’ new homes were scattered throughout the city, the youth relied heavily on public transit to access supermarkets, education, healthcare, and employment. However, if they chose to purchase a monthly transit pass, most participants were left with an average of $36.00 CAD/month to cover all other necessities including food. Most chose the less affordable pay-as-you-go transit option; however, this meant they were constantly juggling basic needs for transportation, housing, and food, simply struggling to exist.

Limited social capital

The notion of drawing on social relationships as currency to gain access to resources and opportunities that help move one forward in life (Putnam, 2004) seemed like a foreign concept to study participants. Most of the participants’ mainstream relationships were with social service providers or those in their own lower socio-economic stratum. While these relationships provided some emotional and tangible supports, they did not offer youth the opportunity to extend their social networks to those in a higher social class. For example, most of the study participants knew no or very few people who had completed post-secondary education, owned their own business, or had “white collar” jobs. To be clear, by highlighting the participants’ limited social capital we do not mean to suggest that social capital would mitigate the plethora of other structural inequities; rather, we want to point out that participants had very little access to the informal knowledge commonly passed between friends and family regarding how to get ahead in life — knowledge taken for granted by most in the mainstream and yet another example of the inequitable distribution of structural resources.

Psychosocial consequences of maintaining housing

Initially, the young people believed that obtaining a home would have a domino effect, setting into motion a chain of events that would open doors to other opportunities such as satisfying jobs or the ability to pursue post-secondary education. However, as the study progressed, their ability to formulate long-range plans was impeded as they were forced to focus on day-to-day survival. Moreover, participants began to despair of long-term planning as they realized how far short their financial means were of enabling any such plan. Over time, living in a perpetual state of poverty exacerbated feelings of “outsiderness,” viewing life as a game of chance, and isolation.

“Outsiderness”

After leaving the shelter, participants existed in a sort of “no man’s land”— no longer an insider in the homeless community, yet barred from insider status in mainstream society. Moreover, in mainstream society, their low socio-economic position was exposed in a way it had not been when they were dwelling alongside other homeless youth. Study participants were now spending time alongside those in much better economic circumstances. Even though participants were no longer homeless, they felt marked by the fact that they were still living in poverty and believed that, somehow, everyone else could sense this inadequacy as well. During the first month of the study, 21-year-old Robert shared how it felt to live in poverty1:

NT: When you don’t have money in your pocket, Robert, and you are sort of walking around, does it make you feel different than other people?

Robert: Me personally, yes (...) It’s like...I don’t know...I feel like I’m...a lower class...I don’t...like...I don’t know how to explain it. I just feel like...you know, like there’s people that I see and I know, oh that guy has at least $50,000 in his bank account. In the meanwhile, I don’t even have five bucks in my pocket. So, it’s like, he’s probably looking at me like, “Oh look at this bum, I’ve got this amount of money in my pocket, he can’t even buy a cellphone, he can’t even buy this...I could buy him a cellphone right now if I wanted to.” So, it’s just...I don’t know. Me personally, it makes me feel low... (Month One)

Over time, the stigma of poverty began to erode the participants’ self-esteem, self-efficacy, and sense of control. Twenty-four-year-old Ashley was the only participant who maintained a full-time job throughout the study, leaving her in the best financial position. Despite this, her minimum wage job meant that, like the rest of the study participants, she was living below the poverty line, struggling to make ends meet:

Ashley: (...) Money...it’s connected to: “How am I going to get to work if I don’t have money? How am I going to buy my food if I don’t have money?” It’s weird...I go out and I find I can’t even shop. I just look at all those people. That’s why I don’t even go to the mall anymore, cause I can’t window shop.

NT: Do you feel like a bit of an outsider in some ways? Do you know what I mean by that?

Ashley: Yeah. That’s why I mostly stay home. I’m mostly at home because, if I have extra money, I can’t go shop, cause I know that there’s going to be something that is going to come up.

NT: There would be another bill.

Ashley: (sadly)Yeah. (Month Four)

A game of chance

As the study progressed, it became apparent how disempowering it was for study participants to be constrained by inadequate structural resources. Everything seemed out of reach and out of their control. Choice appeared to be an illusion. The youth had no margin for error. If anything went awry with their finances, they faced the very real prospect of being back on the streets. Moreover, most study participants were unable to articulate what strategies, other than money and a positive attitude, would best help them successfully navigate mainstream society:

Phillip: (...) really the key difference between being homeless and not being homeless is just the belief that you can make it out or whether or not you let yourself fall into the trap of thinking this is just my life and this is the way it has been and this is the way it always will be.

NT: So, what about you? Do you believe that this is it for you? That you are going to succeed?

Phillip: You can never place money on anything as a 100% sure fire way. Definitely, the first time I was homeless...after I came off the streets...on that occasion...that's for sure what I thought. (...) and less than a year later I was back in that exact same scenario. So, you know you can never tell for sure but I would say that I don't foresee myself becoming homeless as a result of any foreseeable eventuality. Hopefully I would say for the rest of my life, but then again, I said that before and been proven wrong before so...I guess I’ve just got my fingers crossed... knock on wood...so... (Month One)

Notable from this excerpt is the fact that, while 20-year-old Phillip hoped he would not end up homeless, he had given little thought to why he ended up homeless the last time he left the shelter; furthermore, he was unable to articulate strategies — other than “fingers crossed” and “knock on wood”— he could put in place to assure the same situation would not happen again. Like Phillip, the rest of the study participants knew that achieving meaningful social integration was difficult, but they did not fully understand why or how to address this challenge.

Isolation

Participants often used words like “quiet,” “alone,” and “bored” to describe their existence. Most of the participant’s accommodations were eerily quiet with extremely limited interaction between tenants sharing the same roof. No one planned to stay long-term and no one seemed interested in fostering a sense of community. In addition to this physical isolation, there was a kind of self-imposed isolation related to the desire to keep their past lives (homelessness, trouble with the law, sex work, family upbringing, etc.) private from others. Study participants used words like “low class,” “crazy,” “bum,” “dirty,” “disgusting,” “underground,” “uneducated,” “dog,” and “cheap” to describe how mainstream society viewed homeless people. Distancing themselves from these perceptions meant keeping their past a secret, leaving the young people further isolated. Significantly, while all the participants described at least one supportive relationship with a shelter-based front-line worker, they tended to underutilize these relationships because returning to the shelter system to access this support — even though it also meant access to things like free food and clothing — reminded them of their old identities as homeless youth and of the fact that they were only one misstep away from returning to homelessness. Over time, participants began to realize that, with few (or no) mainstream relationships, limited education, inadequate employment options, and scarce financial resources, life in the mainstream was extremely isolating. All the young people described the desire to lead lives that were extraordinary, exciting, and interesting. Each had exited homelessness with great aspirations for the future. Unfortunately, the need to focus on day-to-day survival meant that, for them, life was not full of limitless opportunities; instead, it was a constant, boring reminder that they were living in isolation, trapped in the margins:

NT: You used the word bored. What does boredom mean to you?

Phoenix: Like, bored of the repetition, doing the same thing I guess.

NT: What does repetition remind you of? Like what does that symbolize for you?

Phoenix: (...) Repetition I guess reminds me that my life is average. I don't want my life to be average. I want it to be extraordinary. You know what I mean? I want to travel. I want to...do all these things.

NT: What does average mean to you?

Phoenix: Just like...repetition...boring (...) [goes on to describe working full-time at a minimum wage job]

NT: Right. So, if I understand you correctly, if I was an average person, I would have perhaps a minimum wage job somewhere that I go to every day that I wouldn't really love. Is that the average?

Phoenix: Yeah. (Month Nine)

Twenty-one-year-old Phoenix’s description of an “average” person as someone working a minimum wage full-time job is telling of his social class — a class he wanted to escape. It was hard to live an “extraordinary” life without the structural resources required for full societal participation.

Discussion

In keeping with the unidirectional nature of the CSDH framework, we observed first-hand how the provision of a downstream determinant like housing did not “work backwards” to influence upstream structural inequities. Even though most participants had graduated from high school and some gained income through formal and informal channels, they all lived in chronic precarity, undereducated and inadequately employed given today’s economic realities with virtually no financial or social capital from which to draw. While it may seem natural to leave home between the ages of 20 and 24, the reality is that 63% of Canadian young adults aged 20–24 years still live at home (Statistics Canada 2017). This number has been steadily rising over the past 30 years (it was 42% in 1981) and has been attributed, in part, to the cost of housing and higher education, difficulty finding employment, and the need for parental emotional and financial support (Statistics Canada 2017). Study participants were struggling to live independently — something most Canadian youth the same age are not able to do—without supports comparable to mainstream youth.

One may be inclined to assume it was the type of housing (i.e., market rent vs. subsidized) that was to blame for the challenges experienced by the study participants. In theory, subsidized housing models should diminish some of the stress and precarity associated with exiting street life. Nevertheless, one of the key findings from the previously mentioned longitudinal Canadian study — where the majority of youth were living in some form of subsidized housing — is that, “despite this population being perceived as successes once they find housing, they experience themselves as highly stressed, strained, overwhelmed, and fragile” (p. 138) (Kidd et al., 2016). The authors add that it was “disheartening” (p. 211) to find that the transition away from homelessness was often “demoralizing” (p. 211) — the majority of participants struggled over the course of 1 year to move beyond marginal or basic stability. In addition, no gains were made in community integration and participants’ hope declined significantly during the latter half of the study (Kidd et al., 2016). These findings are especially concerning given participants in that study were housed longer (mean of 8.8 months at baseline) than the participants in this study. The study authors posit that declining hope may have been related to the “false promises that attend housing life” (p. 216) (Kidd et al., 2016). Participants described feeling unprepared for and overwhelmed by the realities associated with their socio-economic context and position, undermining their confidence in achieving larger life goals (Karabanow et al., 2016) — core narratives from this study as well.

Other than the aforementioned study, little has been written about the psychosocial consequences experienced by formerly homeless youth as they struggle to maintain stable housing and integrate into the mainstream. Consequently, our well-meaning but privileged assumptions about what formerly homeless youth want and need to maintain residential stability and achieve meaningful social integration may not match the lived-out experiences of these incredibly resilient and insightful young people. Moreover, as Canada moves toward a “Housing First” model for homeless youth (unconditional and immediate access to safe, subsidized housing coupled with appropriate social supports) (A Way Home, 2017), it is important to keep in mind that, to date the evidence is inconclusive as to whether this model delivers a holistic interpretation of social integration — one that encompasses the ability of formerly homeless individuals to fully (socially and economically) participate in the mainstream (Quilgars & Pleace, 2016).

The day-to-day struggle to maintain residential stability cannot be overstated. The participants’ challenge was not in merely maintaining a home with meager resources, but doing so amid constant reminders that they were in a lower socio-economic position — poor, undereducated, and inadequately employed. Chronic precarity permeated every aspect of participants’ lives, from maintaining a home to developing friable new identities as self-sufficient adults. This precarity threatened to destroy their belief that they were the masters of their own destinies, which is especially concerning given mastery and control are primary criteria in determining whether or not an initiative is health promoting (Rootman & O’Neill, 2012). Paradoxically, the move away from homelessness and into independent housing reinforced to study participants that they did not really have the same life chances as other young people. Instead, the move off the streets exposed their low socio-economic position, highlighted how little control they had over their life circumstances, and challenged their sense of well-being. It was almost as if they were being set up for failure.

Conclusion

Rather than a secure, linear path from the streets to the mainstream, study participants were forced to take a precarious path full of structural gaps that left them stuck, spinning, and exhausted by day-to-day survival. It was as if they were trapped in a “hamster wheel” of poverty.

In the long run, failure to address these inequities will result in a poor return on investment as homelessness ends up being managed and not stopped. We hope that our recommendations (Table 2) will challenge those in practice, policy, and research arenas to consider that sustainable solutions to youth homelessness require a greater investment than the provision of a home.

Table 2.

Recommendations for practice, policy, and research

Sector	Recommendations
Practice	1. Shift transition-related supports (e.g., counseling, food programs, and health care services) from shelters to less stigmatizing locations such as community centers. This will also help foster community and social integration. 2. Develop programs that facilitate social capital (e.g., mentorship programs). 3. Re-define success — set the bar higher than “no longer homeless”; aim to prevent homelessness from reoccurring and break the cycle of poverty. 4. Be transparent with youth about the likelihood of escaping poverty with limited education and inadequate job skills (and develop a plan to directly address this).
Policy	1. Provide more affordable and better quality housing. 2. Ensure all Canadian youth living independently are able to meet or exceed the LICO of $20,160 (consider basic income). 3. Provide free tuition plus associated costs (e.g., rent and books) for post-secondary education without welfare claw backs (Note: In Ontario, tuition is heavily subsidized for families with an annual income of < $50 K; however, this subsidy is counted as “income” for those on the OW program) (Ontario Ministry of Advanced Education and Skills Development, 2017)
Research	1. Define and measure social integration holistically — include community and economic participation. 2. Implement more longitudinal studies on how to best assist youth in their transition out of homelessness — depicts “real world” challenges and highlights gaps in social supports and public policy. 3. Conduct more qualitative studies on this topic so youth-informed perspectives can help guide public policy.

At a minimum, formerly homeless young people need the same supports available to mainstream youth the same age. This means addressing the structural inequities that are preventing them from achieving meaningful social integration. Simply providing young people with a home and welfare supplements is not enough. Failure to tackle structural inequities places too much burden on the marginalized to “make themselves socially integrated” (p.8) (Quilgars & Pleace, 2016). Youth participating in this study made it clear that, like other young people, they desired more than residential stability — they desired pathways to a successful life.

Compliance with ethical standards

Ethical approval for this study was obtained from the University of Toronto Health Sciences Research Ethics Board as well as the Research Review Committee at a local shelter where most of the participants were recruited.

Conflict of interest

The authors declare that they have no conflict of interest.