A WISH to be Housed: Exploring the Winter Interim Solution to Homelessness (WISH) Temporary Accommodation Model in London, Canada

Abstract

Temporary housing programs (THPs) aim to serve the homeless population. This article explores the impacts of a THP, the Winter Interim Solution to Homelessness (WISH) in London, Canada, which applied a barrier-free, harm reduction model. Adopting an intersectional lens and interpretive description methodology, we analyzed data collected from WISH residents, utilizing a thematic analytic approach. Identified themes included: (1) “(It’s) kinda like a real home” (WISH is unlike other shelters); (2) “It’s like a buddy system” (A sense of community was fostered); (3) “It’s the same size as a jail cell” (Problems with infrastructure); (4) “To keep us on focus” (Un/supportive staff/volunteers); (5) “I’m not sure what I’m going to do after” (The dearth of permanent housing creates trauma); and (6) “Too much bloody money in too little hands” (Distrust of housing providers). Although WISH was helpful to some residents, the temporary nature of the program limited its long-term impact.

Introduction

Temporary supportive housing programs, also called Transitional Housing Programs (THPs), are part of the array of services offered to people experiencing homelessness (Dordick, 2002). THPs are intended to gradually ease individuals into housing by satisfying “the prerequisites for independent living” (Williams, 2020, p. 3). This approach assumes that for people to become ‘housing ready’ they must first address their traumatic histories, addictions, and/or mental health challenges. THPs offer supportive accommodations, tools for skills development, and can foster a sense of community among residents (Novac et al., 2009). Given that housing is intentionally withheld from individuals as they engage in treatment-first programs or live rough outdoors, some researchers and sector service providers now refer to this population as ‘people deprived of housing’ (PDH). This terminology places emphasis on the system itself, drawing attention to the way actors within it produce and maintain housing deprivation through the intentional enactment of policies and practices that favour the status quo (e.g., Scallan et al., 2021). The purpose of this study was to explore the perspectives and experiences of residents in a THP called Winter Interim Solution to Homelessness (WISH), built on a barrier-free and harm reduction model that operated in London, Canada over the winter of 2020 to the summer of 2021.

At the commencement of the COVID-19 global pandemic, concerned individuals, social service providers, homelessness outreach workers and city staff formed an ad hoc committee to discuss possible solutions to the growing epidemic of homelessness in London (Richmond, 2020). London is a mid-sized city of 511,000 people, in Ontario, Canada’s largest and most populous province. The Coalition was particularly troubled that the existing shelter system would not be able to accommodate the number of PDH seeking indoor winter shelter, particularly given the expectation of physical distancing requirements, which was believed to render countless individuals living rough (another term for homeless), along a rising river embankment, and exposed to the extreme winter climate in the area. Such weather is a serious concern for PDH, causing severe morbidity or death from frostbite, hypothermia, and the cold-related injuries that can ensue from harsh winter conditions (Zhang et al., 2019). Temperatures in London range in the winter months from zero to below − 20 degrees Celsius (− 4 °F), and occasionally dip down to − 30 degrees (− 22 °F) (Current Results, n.d.).

After several meetings of the WISH Coalition, a handful of members worked to establish guiding principles, the vision, and mission statements, while others worked to secure the material resources needed to operate the sites within the $2.4 million dollar budget allocated by the City of London (Lupton, 2020). Out of this initial dialogue, the Coalition developed WISH, a program intended to ensure the survival of PDH in London in a humanizing and dignified way.

WISH aimed to adhere to the principles of harm reduction and barrier-free programming. A pragmatic strategy that promotes the dignity of the person, harm reduction is an evidence-informed approach intended to reduce the risks and harmful effects of substance use, including stigma and discrimination, while highlighting the harms of criminalizing drug consumption (Schlosser & Harris, 2020). Recognizing that abstinence may not always be a desirable or realistic goal for individuals in the short term, the use of substances is understood as a given, so the focus is on ensuring a supportive means of survival for PDH in the given context. (Gomez et al., 2010). The approach then is to provide services that promote safety and reduce the potential harms of substance use, such as using in isolation and a lack of access to safe equipment. Once the contributing factors (e.g., trauma, poverty, homelessness, etc.) underlying individuals’ addictions are addressed, substance use has been shown to decline (Patterson et al., 2013).

The WISH Coalition also sought to create a barrier-free program right from the first point of contact. Barrier-free programs, now in operation for over 30 years in Canada, take a systems approach, include multiple stakeholders and service providers to provide a seamless, comprehensive individualized plan for the client (i.e., ensuring access to appropriate social services, income assistance, accommodation, health and mental health supports, substance use services). Here, the focus is on honouring individuals’ autonomy, recognizing they are the experts of their own lives, and amplifying opportunities for empowerment and choice in housing e.g., when to remain housed, where, and what supports to incorporate (Latimer et al., 2020; Macnaughton et al., 2012; Oudshoorn et al., 2021). Barrier-free housing programming is often (conceptually and operationally) linked to Housing First (HF) programs, which seek to provide individuals uninterrupted access to housing and social services (Tsemberis, 1999).

WISH was comprised of two pop-up shelters i.e., trailers retrofitted into separate units, and larger trailers reconstructed to offer community rooms. One site was tucked into a residential area, a short distance from the downtown core, while the other site was set up in a parking lot adjacent to a men’s homeless shelter, making residents visible to those passing by. Each site sheltered roughly 30 people, including couples wishing to reside together in the same space, and provided participants’ basic needs on-site, including prepared meals. There was one washroom and shower available per site, accommodating upwards of 30 residents. Residents had 24-hour access to come and go from their own personal living quarters, although visitors were not permitted due to pandemic concerns. On-site security was contracted from a private company that tracked the coming and going of people onto the WISH sites.

The WISH Coalition, spearheaded through the leadership of a Christian non-profit organization that had spent years working with this population, aimed to provide a peer-support and collaborative staffing model, consisting of a combination of over 70 full-time, part-time, and relief staff, as well as a large roster of volunteers to support the 24/7 operations of the program (Lupton, 2020). Complementing its low-barrier, harm reduction approach, WISH also aimed to apply a trauma-informed lens to its work and offer peer-led unsanctioned safe consumption sites, and if required, lifesaving interventions for residents (e.g., naloxone). Social and recreational programming was also periodically provided on-site, such as art sessions, and games and movie nights. The research was initiated at the invitation of the WISH Coalition, with input from the research team. The research ethics protocol was approved by the two principal investigators’ academic institutions.

Theoretical Framework

We applied an intersectional lens to this research. Originating in the work of Kimberlé Crenshaw in 1989, intersectionality theory recognizes that some social identities (based on identities such as gender, race, socio-economic status, age, ability, and sexual orientation) are assigned privilege, while others are marked with disadvantage. Occupying multiple intersections of identity associated with disadvantage generates cumulative effects, leading to heightened experiences of discrimination, inequity, oppression, and injustice (Crenshaw, 2017). Intersectionality offers a valuable lens in yielding rich qualitative research that advances an exploration of the complexities of privilege and penalty, and generates reflexive data that captures the perspectives and experiences of participants and researchers as they socially co-construct knowledge (Atewologun & Mahalingam, 2018).

Methods

Using a case study methodology (Yin, 2017), we collected qualitative data from WISH residents, staff/volunteers, and Coalition members. This paper focuses on the experiences and perspectives of WISH residents specifically using a thematic analytic approach, grounded in interpretative description methodology. Other research captures the experiences of WISH staff/volunteers and Coalition members (Smith-Carrier et al., In Press). We triangulated our findings (Merriam, 1997) on WISH residents using quantitative outcome data from a staff-led program evaluation. The research questions addressed: (a) what are the experiences of people accessing WISH, and what are their understandings of the impact the program has on their lives; and (b) what are participants’ perceptions of barrier-free, harm reduction approaches to temporary housing?

Sampling, Recruitment, and Data Collection

With each WISH site as a ‘case’, a convenience, snowball sampling technique was employed for recruitment. On-site supervisors assisted with recruitment by notifying residents of the date and time the researcher would be available to conduct interviews. Peers who had previous training and experience collecting data from PDH were hired as community-based researchers to conduct the interviews. As it takes time to develop trusting relationships with this population (Dorney-Smith et al., 2020), nascent research suggests that a more collaborative approach to data collection may be appropriate (see Bardwell et al., 2018; Neale et al., 2017). Given that the community-based researchers had already established a relationship with many of the WISH residents in their adjacent grassroots activities, including people who use drugs, sex workers, and people recurrently stigmatized and criminalized, they could effectively collect data from participants at a time when they were able and wished to do so (Hall et al., 2020). As with every component of the initiative, time was of the essence. With the project funding secured only weeks before the doors were slated to open, and during a global pandemic, the research team had to be nimble.

Upon arrival, the community-based researchers introduced themselves to residents in the common areas, and instructions were given on where to hear more about the study, and participate, if they so desired. The researchers informed potential candidates about the voluntary nature of the study, answering any questions participants had. Residents were informed that the services they received through WISH would not be affected by their participation decision. Residents were also informed that participation in the interview could potentially elicit experiences of stress, fear, and/or anxiety. Therefore, they were asked to only answer questions they felt comfortable answering, in as much or as little detail as they wished, and they could stop or withdraw from the interview at any time. Research candidates were advised that absolute confidentiality could not be guaranteed, as there may be individuals who could observe them meeting with a researcher around the shelter.

Informed consent was provided in written form and orally. Once verbal consent was secured, the community-based researcher asked the participant if they could sign the consent form, and then inquired whether they could record the interview via digital recorder, or whether they prefer hand-written notes be taken (all consented to the digital recording). Participants were given a $25 honorarium at the start of the interview in recognition of their time and contributions to the qualitative research. These data were collected from January 2021 to April 2021, after which time in-person research was halted due to a pandemic-related stay-at-home order. Interviews were held in person by the community-based researchers (e.g., in private spaces around the shelter), adhering to physical distancing and masking policies.

During intake, residents were asked if they would like to voluntarily have their data included for the purposes of the research. These program evaluation data were collected by WISH administrators, who asked for participants’ informed consent to transfer their data in aggregated form to the team. The variables included: individuals served, average length of stay, number of referrals to services, etc. These data were used to triangulate the qualitative findings both within and across the two case sites. Research candidates were thus given options for participating in the research: (a) including their quantitative intake data; (b) participating in a qualitative interview; and (c) either a. and/or b. above. No honorarium was provided to those having their data added to the quantitative evaluation.

Data Analysis

We adopted Thorne’s (2016) interpretive description methodology for this research. This approach recognizes that qualitative researchers often explore research problems and related data from a disciplinary perspective infused with rich a priori theoretical foundations and with specific practice-level outcomes of focus. In this study, our research team, explicitly rooted in an intersectional theoretical framework, was motivated to garner data that would help us generate policy and practice-level guidance related to temporary shelters. Interpretive description then guides the analysis not as a ‘fishing expedition’ that starts from a fully open, objective perspective, but rather as a process that advances disciplinary needs. The design techniques of the research may differ, employing a thematic analysis or other qualitative analytic approach that best suits the research question(s) posed (Thorne, 2016). In this case, a thematic approach was deemed most appropriate. Pragmatically, the qualitative data were analyzed first independently and then collaboratively among all team members, according to the six-phased approach to thematic analysis outlined by Braun and Clarke (2006). Data were analyzed for research categories and themes with the specific intent of furthering our understanding of the impacts of barrier-free, harm reduction shelter models, such as WISH. NVivo research software (version 12) was utilized for the data management and analysis. A numbering system was employed to identify participants in the interview transcriptions and coding documents to ensure anonymity. We used pseudonyms in our research findings to humanize our participants.

Ensuring Research Rigour

We adopted a thematic analysis, built on an interpretative description methodology, given that researchers such as Nowell et al. (2017) argue that it can yield insightful and trustworthy findings. Lincoln and Guba (1985) contend that trustworthiness in qualitative research is established through (a) credibility—demonstrating the fit between the views expressed by the participants and the researchers’ representation of them (Tobin & Begley, 2004); (b) transferability—referring to the potential transfer of research findings to other contexts; (c) dependability—ensuring that the research process is logical, traceable, and clearly articulated; and (d) confirmability—when credibility, transferability, and dependability have been achieved (Nowell et al., 2017).

To address: (a) credibility: we comprised a team of seasoned and competent researchers, with disparate disciplinary training, engaged in studying the impacts of homelessness and poverty from different vantage points (housing, health, criminalization, digital surveillance), several of our team members have had prolonged engagement with this population for over a decade, contributing to researcher triangulation; we also engaged in peer debriefing sessions to discuss the identified analytic categories, themes, and quotes selected to represent them; (b) transferability: we sought to provide thick descriptions to allow other researchers to judge how the findings might transfer to their own sites, and a robust review of the literature was completed to assess how emerging findings confirmed, questioned or broadened current understandings in the field; (c) dependability: details of the study context and analysis were described to produce an audit trail of our analytic processes; and (d) confirmability: we aimed to provide the rationale for the analytic choices made to allow the reader to understand how and why decisions were carried out (see Nowell et al., 2017).

Results

Sample

The sample of participants were a diverse group of individuals, representing intersectional identities (along the lines of race, gender, disability, religion, culture), life experiences, and so forth. Many used criminalized drugs and/or experienced complex marginalities (e.g., experiences of abuse and trauma, poor mental and physical health, disability). The qualitative research involved roughly 1-hour semi-structured interviews with WISH residents (n = 9). This was smaller than the original sample size proposed (originally n = 15–20) due to the imposition of a Covid-19 lockdown and directive that we desist from collecting further in-person data with human subjects. See Table 1 for exemplars of themes and categories from the research.

Perspectives on WISH

“Kind of Like a Real Home”

A strong theme identified in the data was the sense that WISH was unlike shelters people had previously experienced. Jarod shared,

I was camped out in the woods for a while and then other people came out there too and they started coming down to interview us asking why we weren’t in the [shelter]. And we all had very good reasons why we weren’t there and they took those considerations and kind of used them as a basis for making this place in the first place. So, I think that went a long way to making this what it is now.

For Casey, residing at WISH offered “a little more dignity and respect. Yeah. Having our own little private unit. Like it’s all the difference in the world.” The differences in approach may have had to do with being extended dignity and respect in the mundane aspects of everyday life that are often controlled in shelters settings (e.g., curfews), and the sense of autonomy and freedom that residents felt WISH had fostered that they had not experienced at shelters elsewhere. Rebecca stated, “It’s nice to actually get a place that’s kind of my own, my own area. You know, I can clean my clothes when I want, shower when I want, [get] food I want.” She added, “Yeah, so there’s more a sense of being able to come and go as you would in your own home, right, and being able to set your own rules.” Similarly, Caroline shared,

Yeah. I think the advantages is (sic) that you have your personal freedom and your personal rights at the same time as having shelter. It’s not as rigid as a shelter, you can come and go as you please and you can eat when you want. You know what I mean?

The fact that WISH allowed people to be housed with their partner or to have their pets on site was deemed especially helpful as it eased the transition into the sites, and provided a greater sense of home. Sammy shared:

Yeah. And they also give food for pets. They supply that too…Yeah, so that’s good. Well, it’s a bonding thing. Like it’s like kind of like a real home.

For Mark, it was simply “the fact that it was a roof” over his head that would allow him to heal that was important.

I had some heat, because when I got here there was a cold spell that was going through…but I needed a place that I could have my surgery and heal because well you can’t really heal in a tent. You could but there’s more of a risk for infection and stuff like that.

For Peter, it was safety, akin to a home where you set your own course, and not having to jump through hoops,

It’s not getting bullied around or kicked out of your—away from your stuff for the whole duration of the day or like having to carry everything, you know, when you’re in crash beds. Like it’s just a lot of bullshit. Just the jumping for (sic) the hoops for the sake of jumping through hoops.

“It’s Like a Buddy System”

WISH, in adopting a harm reduction approach, gave some residents the sense that they would be cared for in a safe environment in the case of an accidental poisoning (overdose). Jarod shared,

Some people here are, you know, addicts and as such they need to take care of their addictions. People here are not against that. In fact, they kind of encourage it to be done in a safe environment rather than behind closed doors where it’s unsafe.

In fact, being together in a community space, for some, allowed for the development of a “buddy system” to emerge whereby residents could help ensure each other’s safety. Mark commented,

Like you know, like there’s a lot of people here with mental issues, a lot of drug addicts, stuff like that, and you tend to do the blind eye thing but you still keep an eye on them…I know all the fenny users here…they’ll actually come up to me and say check on me in ten minutes, and I check on them every ten minutes for three or four times. Once I hit that fourth time, I know they’re past that initial stage. They’re not going to do the death thing any more or whatever. So okay. You’re good, and I let them know, you’re good. All right. It’s all done. It’s like a buddy system.

There was a group that, prior to entering WISH, had developed a sense of community while living in a nearby encampment in the city. By allowing people from this group to be housed together, some felt they were able to continue building on that sense of community. Casey shared,

I really am grateful for (WISH). I’m just happy I got to, had the opportunity to be involved in it…this whole community thing, (it’s) a really good thing for people that are in my situation…because I believe it gives you an advantage of getting back to the basic fundamentals of living…because there’s a lot of people live here like me and like I believe that…it helps them mentally.

Without roots in a community and the accompanying support, PDH can find themselves sliding backwards. As Casey shared,

It sucks when you go and you get your own place and then you are kind of isolated now again and it’s like, it’s like that causes depression…that causes people to relapse…if you don’t have people around you and the supports then you are kind of (profanity)...it sucks in a way because I like having people around.

“It’s the Same Size as a Jail Cell”

Not all residents felt a sense of connection and belonging at WISH. For example, Ali did not feel like they were part of the community, or that they were included in the decision-making processes at their site. Significantly, for Sammy the WISH shelter resembled more of a jail cell than a welcoming, inclusive community space. She stated, “It’s like a jail. It’s kind of like a (profanity) halfway house kind of. That’s what I think.” Caroline echoed this sentiment: “You know, it’s the same size as a jail cell, but it’s warm.”

Other barriers identified by WISH residents included the fact that they were not permitted to have visitors (a decision rendered due to the COVID-19 lockdown order), that the trailers were loud, and the walls thin, leaving residents little privacy. The infrastructure could certainly be improved upon, given that, as Mark estimates, “I figure like for every ten people you should have a shower or at least a toilet or something like that, and there’s like 30 of us here and there’s only the one shower and, you get the point,” He added,

[H]eaters [that] can be turned off. Because there was a lot of half decent days that didn’t need a blistering heat in the rooms…The windows aren’t big enough to even get anything to blow out really. Other than maybe get the walls a little thicker so you’re not listening to the people next door to you or you can actually hold a conversation in your room without having ten ears eavesdropping, because that’s pretty much what it is right now…There’s no privacy. Like basically it’s like a college dorm gone wild. Somebody scratches their ass five doors down and you can tell how many fingernails they broke. You know what I mean?

“To Keep us on Focus”

WISH supervisors had mere weeks to recruit, onboard, and orient staff and volunteers, while the sites themselves were being constructed and resourced right up until, and during, residents’ intake. The Coalition placed emphasis on hiring staff with lived/living experience of homelessness to cultivate authentic relationships between people with firsthand insight into the experience of being deprived of housing. Invariably, the mixture of lived experiences, educational backgrounds, discipline-specific training, and professional credentials among staff was at times a notable asset of the framework, and at other times, a marked challenge. Consequently, divergent views surfaced with regards to the supportive nature of WISH staff/volunteers. Jarod commented on.

(The) staff’s ability to keep us on focus when we’re getting things done that need to get done…I have a hard time trying to fill out forms and things on the computer that are very confusing to me sometimes. So, for them to be able to help me get through that, that’s been very helpful. Phone calls too…If I call the government offices…(it’s) so frustrating to me that I can’t really get through an entire phone call a lot of times…

Casey remarked,

When I first started staying here, it was good…like the staff…was warming to me and like they were cool...I like them a lot because…they’re warming and they’re not judgmental and they just, they seem like they do understand for the most part. And it’s good to have because they’re not…basically stuck-up people that are just there for their pay and like whatever. They actually do kind…of give a shit, you know.

This dialogue with Mark also demonstrated a deep level of respect and support received from the staff.

Interviewer: “You feel supported by the staff here? Treated with respect by the staff?

Interviewee: Always, always, always. I’ve never had a bad day with them yet, and even if I did, for what I’ve saw that they’ve handled themselves very professionally, very courteously and very forthcoming to the emotional and physical needs of whoever they deal with.

While some residents commented on the apparent effort staff and volunteers made in fostering supportive relationships, there was no universal consensus among participants. Casey maintained that the staff needed more training, particularly to intervene when altercations arose between residents, or to adequately support people experiencing a mental health crisis. She expressed,

I don’t think staff…should be having to deal with like a lot of like the mental health issues at hand…like how severe sometimes it is here. Like a person like [Name] that’s like screaming at the top of her lungs, like…I could hear that girl screaming from the basketball court…that’s not fair to people that live around here...because like she obviously has like a very, very severe issue and like I don’t think the staff is equipped with like that knowledge or the skills to basically deal with that, with that person.

Regarding staff training, Caroline noted that:

There should be a screening process…And those with severe mental health issues should be off in one spot with specialized workers for mental health issues…Because there’s been numerous problems with that, on our site specially.

Noah felt that some of the staff/volunteers were “a little grumpier or have their own things going on in their life” and therefore could use a program “just for like the workers themselves.”

“I’m not Sure What I’m Going to do After”

Many residents connected to health supports that they had not connected with before their stay at WISH. At intake, some residents were significantly malnourished and/or were being treated for a range of conditions, e.g., scabies, syphilis, hernia, complications from a miscarriage. Although connecting to such supports may have improved their health to a certain extent while at WISH, many had concerns about what awaited them once it closed. Jarod expressed,

It depends on what time of the pandemic you’re referring to. At the beginning of it I was doing not so great. Then it got a little better. Then I came here and did a lot better. And now it’s coming to an end and I’m not sure what I’m going to do after that. It might be a lot worse.

Casey also remarked, “Like, like the City can come here and shut this place down any time. Like you know, like we can be (profanity), we can get screwed over big time.” The inability of the city and program administrators to address or resolve the fears and anxieties among WISH residents about their future may have exacerbated existing mental health and substance use issues.

“Too Much Bloody Money in too Little Hands”

When asked what residents would envision as a long-term strategy to homelessness in the city, many expressed a desire for more permanent housing options. Casey noted the importance of needing “a place to socialize and be with other people—otherwise you’re isolated and that causes depression.” What the vision resembled was not always apparent, although at times it seemed simple, people needed: “A regular building. A regular apartment building with numbers on the doors,” Rebecca noted. She added,

I think something like this would be a good way to start it up, although… [there should be] certain things that would differentiate between people that are able to govern themselves and people that are not. Some people here don’t have the life skills necessary in order to be on their own and live on their own housing environment…programs [have to be] available to them that can teach them…and kind of guide them in the right direction…I think this place, as good as it is, needs to address those issues…so they can actually not just release people into the wild and say ‘good luck’.

Mark, however, suggested:

(F)or every apartment building that they put up, they should put up one of similar, if not value or size or whatever, for combatting homelessness…Like if they can afford to do that, they got more than enough money that they’re going to make off the damn thing, help the cause out. There should be some sort of law or tax thing that puts in, you want to do this, you got to put in this much. You know, you got to give to get, right? …That’s the way I look at it because there’s too much bloody money in too little hands is what it boils (down) to.

Mark also felt that we need a,

…(T)otal revamp of the system. Rents are way too high. Landlords are more scummier and slummier nowadays than they ever were because they can get away with it a lot more because there’s no enforcement…There’s enforcement on like the renters as being evicted or this, that or whatever. Like we get the shaft 90 percent of the time instead of the landlord being held responsible for their end. They need to do something about the rising cost of housing to begin with. Whether there should be a cap or whatever, I don’t know…All I know is that it’s…way too high according to the basic salary that people make, myself included. I’m on welfare right now and I’m lucky to get a room for what I can afford on what they give me…

Discussion

The WISH program was successful in providing PDH with a temporary housing support option. Although participants could not always clearly articulate (given, in many cases, being denied access to higher education and to the research evidence) the array of structural solutions needed to remedy homelessness, they could cogently identify important differences between WISH and traditional emergency shelters. The latter, unlike WISH, do not provide 24-h services, ease of access to resources and referrals (many delivered on-site), personal spaces to accommodate partners and pets, or the “personal freedom” to make one’s own choices (regarding meals, rules, medications, and so forth). Through the WISH model, residents appeared to experience a sense of autonomy and a “place of their own”, even though this space had significant limitations (i.e., the lack of soundproofing, inadequate shower capacity and plumbing, and small, confined rooms akin to “jail cells”).

Given the support some residents experienced, the sense of community they developed (at one site in particular), and the “personal rights” (i.e., self-determination) afforded through the model, it might be fair to say that WISH, for some, could be deemed a considerable step above emergency shelters. This was particularly helpful in the context of a global pandemic when access to supportive resources was limited, and traditional shelter beds scarce. WISH, however, reflected a transitional, short-term approach, and typical of THPs built on austerity budgets, its most significant, foreseeable (and conceivably preventable) flaw was that residents were not assured of permanent housing, either at WISH or in a housing placement thereafter. There was always a looming awareness that the sites would close, and while considerable advocacy efforts by the Coalition to maintain them, residents were all too aware that it was only a matter of time before they would be permanently closed. The impact of residents’ awareness of this reality cannot be overstated; significant trauma, fear, and anxiety was (and is) produced by continually creating uncertain futures for PDH (see Bransford & Cole, 2019; Hopper et al., 2010). Although there were some positive aspects to the WISH program identified by some residents, the program became yet another THP, and one with a particularly short timeline.

Research on shelter and housing programs for PDH has proliferated over recent years, yielding a rich evidentiary base documenting that HF programs, if implemented using HF principles (homeless hub, 2022a), can in fact end homelessness in urban centres, particularly for individuals with psychiatric disabilities (see Stergiopoulos et al., 2015). Research on the efficacy of HF on disparate populations is not as voluminous but is growing (Woodhall-Melnik & Dunn, 2016; see for example, with veterans, Forchuk et al., 2021; Indigenous populations, Young & Manion, 2017; and youth, Gaetz et al., 2018). THPs, and the research on their utility, also continue to expand (e.g., Abramovich & Kimura, 2021; Fotheringham et al., 2014). Approaches to housing for PDH are largely divided into several distinct categories: traditional shelters; HF programs; rapid re-housing; low-barrier shelters; case management models; and emergency warming shelters. This is not a comprehensive list, for other categories and their descriptions, see Munthe-Kass et al. (2018).

Rigorous evidence on THPs remains thin and inconclusive. Studies on THPs reflect methodological weaknesses and gaps demonstrating their long-term cost-effectiveness (Novac et al., 2009). Some may in fact be associated with negative impacts and appear more costly to run vis-à-vis permanent housing options. Indeed, the preoccupation, inherent in THPs, of fixing the individual to becoming “housing ready” shifts attention away from the systems that continually perpetuate poverty (see Smith-Carrier & Lawlor, 2017) and homelessness (Gaetz, 2010). As Wallace et al. (2019) argue, the “focus on the individual in defining the problem (homeless counts) and planning the responses (plans to end homelessness) can detract needed attention to the contexts of housing availability and affordability, income adequacy, and social and health supports” (p. 15).

Moving beyond the THP model, evidence supporting rapid access to permanent housing, primarily through variations of HF, is amply documented in the literature. Since the 1990s, the scattered-site HF approach, largely employed with individuals with a psychiatric disorder (Tsemberis & Eisenberg, 2000), has been shown to offer residents the choice of living arrangements, including an individual housing unit in the larger community (e.g., independent apartment units scattered in buildings rented by private landlords). In these units, residents are assured the provision of supportive services, using for example, a consumer-driven Assertive Community Treatment (ACT) approach or an intensive case management (ICM) model; the latter involving a dedicated case manager who works one-on-one with an individual to maintain their housing and advance their quality of life (e.g., addressing health and mental health needs, community and social supports, recovery services).

The ACT model involves the deployment of integrated, multidisciplinary teams (e.g., including social workers, nurses, substance use specialists, physicians, peer support workers, case managers, etc.), generally located off-site but offering 24/7 on-call access, who adopt a recovery-oriented practice philosophy that promotes consumer choice and harm reduction (Stefanic & Tsemberis, 2007). Services are offered on a time-unlimited basis. ACT teams broker access to housing and services, basic skills training, education and employment assistance (homeless hub, 2022b). Built on the ACT model, HF has been associated with increased housing retention (Stefancic & Tsemberis, 2007); lower costs (which in the HF program in Seattle, Washington, averaged $2,449 per person per month, relative to research controls, in total cost offsets after accounting for program costs; Larimer et al., 2009, p. 1349), improved perceptions of consumer choice (Tsemberis et al., 2004), and reduced alcohol consumption over time (Tsemberis et al., 2012). In research on the Pathways to Housing program in New York City, which supported housing for PDH with psychiatric disabilities, Tsemberis and Eisenberg (2000) found that, after five years, 88% of the HF program’s residents remained housed compared to only 47% of those in the residential treatment system (p. 487).

In addition to research on the scattered-site HF model, literature also affirms the use of the single-site HF approach i.e., programs that provide residents with individual units (e.g., semi-private units or private studio apartments) within a single housing project, with on-site supportive services and case management. The single-site HF model has also been shown to increase housing stability (Chen, 2019), cut costs, decrease jail time (Larimer et al., 2009), and reduce alcohol consumption (Clifasefi et al., 2013) for PDH experiencing chronic homelessness.

Although HF programs show significant benefits for PDH related to increased privacy, a sense of independence, and experiences of security and stability, some women have identified having feelings of isolation, the loss of connection with others in similar circumstances, and enduring safety concerns (Oudshoorn et al., 2018). Women in Fotheringham et al. (2014) study, for example, felt “they could not have gone from homelessness directly into permanent housing” (p. 13) and that they have differing needs that require tailored programming. This may be why congregate HF programs and scattered-site HF programs—ones that foster community and social connections—appear to be more successful (Somers et al., 2017), and cost effective (Latimer et al., 2020), in augmenting housing stability and retention rates. Whichever model (i.e., ACT or ICM, congregate or scattered-site), Nelson et al. (2007) suggest that “the most effective approach in reducing homelessness…(is) providing permanent housing and support” (p. 358).

Conclusion

The WISH program in London, Canada was developed in response to the significant increase in the number of people living rough during the pandemic, and the oncoming cold winter temperatures. Using a low barrier, harm reduction approach it provided residents with greater autonomy, basic needs, access to vital services, shelter from the elements, and for some, a sense of community and belonging. However, the lack of assurance of exits into permanent housing resulted in residents’ anxiety and despair.

As we write, the City of London is embarking on another rendition of WISH, offered in the same retrofitted trailers, to be located on separate golf courses on the outskirts of the city (CBC London, 2021), without public transportation or pedestrian sidewalks, and away from much-needed employment, social supports, and community resources. One location is an Indigenous-led site that was recently the target of arson (McDougall, 2021). Another location was offered by a community partner to provide a more central location (and access to the aforementioned services and infrastructure), while retaining access to land-based offerings for residences. The other peer-led site remains on the outskirts of the city, with day-to-day activities regimented by staff, including chores and mealtimes (Stacey, 2021a, 2021b).

Both sites are funded until March 2022. What is concerning is the perpetuation of temporary approaches that will presumably expose residents to the greatest fear they shared in this study, that they will again be de-housed at the end of the project. The voices of participants in this study should serve as a reminder of the value of providing rapid access to permanent housing with required supports. In a neoliberal world that values cost-savings more than human life, permanent housing, built on HF principles, is a sound investment. Institutional responses to homelessness are costly (roughly $66,000–$120,000 annually for prison/detention and psychiatric hospitals or $13,000–$42,000/year for emergency shelters). Permanent housing, on the other hand, is far less expensive (i.e., supportive and transitional housing cost about $13,000–$18,000/year, and affordable housing roughly $5,000–$8,000/year without supports) (Pomeroy, 2005). Indeed, at a cost of $24,000 per person, over 100 people could have been housed for a year with the WISH budget utilized last year (Lupton, 2020). That approach would also have been more humane, dignified, and valuable in reducing the trauma, anxiety, and fear that WISH residents faced. Ultimately, while a temporary winter solution provides safer options than living rough, we recommend refocusing responses on permanent housing.

Appendix 1 Types of shelter/housing models

Types of housing models	Definitions
“Traditional” shelters and housing models (i.e., treatment as usual [TAU] or TF programs)	Emergency shelters and housing services for women and families experiencing domestic violence or eviction, or without an alternative housing option (Siemiatycki, 2021)
	Homeless shelter: “a staffed institution that provides overnight shelter on a temporary (non-permanent) basis for people without homes or people seeking asylum from their homes due to abuse or domestic violence” (Moffa et al., 2019, p. 2)
	Canadian federal homelessness partnering strategy Phase 1 (2007 to 2014): TF model: “…individuals experiencing homelessness are generally required to participate in treatment programs and demonstrate readiness before they are offered housing” (Chen et al., 2021, p. 6)
	At home/Chez Soi trial TAU control group has “access to services such as shelters, hospitals, and community-based health and housing services” (Latimer et al., 2020, p. 2) TAU control group has “no housing or supports provided by the study” (Patterson et al., 2013, p. 2) Comparison group “described as usual services (care as usual), other types of housing programs or case management interventions, or other types of interventions” (Munthe-Kaas et al., 2018, p. 28)
Transitional housing	Transitional shelter: “…provides an alternative type of temporary accommodation for residents seeking exits from homelessness…also provides additional one-on-one supports and case management services” (Wallace et al., 2019, p. 4)
	Mainstream THPs: “offer a supervised, structured setting in which to gradually transition a household to a state of residential independence…pairs housing provision with intensive supportive services…” (Rodriguez & Eidelman, 2017, p. 4)
	THPs: “intended to help gradually ease the individual into satisfying the prerequisites for independent living” (Williams, 2020, p. 3)
Housing first models	Canadian federal homelessness partnering strategy Phase 2 (2014 to 2019) HF model: “…moved individuals experiencing chronic or episodic homelessness from the street or shelter directly into stable housing as quickly as possible, complemented by individualized supports” (Chen et al., 2021, p. 6)
	HF “independent scatter-site apartments and ACT” (Stefancic & Tsemberis, 2007, p. 5)
	Scattered-site HF: “residents are offered a choice of individual housing units located throughout the larger community and can access supportive services delivered via an assertive community treatment (ACT) Model” (Collins et al., 2012, p. 2)
	Project-based HF: “involves the provision of low-barrier, non abstinence-based, immediate, and permanent supportive housing to chronically homeless individuals; however, residents are provided with individual units (e.g., private studio apartments or semi-private cubicles) within a single housing project; residents can elect to receive on-site case-management and other supportive services” (Collins et al., 2012, p. 2)
	HF/permanent housing programs: offer “upfront provision of permanent housing with no pre-conditions” (Williams, 2020, p. 2)
	At Home/Chez Soi trial Scattered-site variant of HF with ACT (Latimer et al., 2020)
	At Home/Chez Soi trial Three variants of HF:  HF (independent apartments) with ACT  Congregate housing with on-site support  HF (independent apartments) with ICM (Patterson et al., 2013, p. 2)
	At Home/Chez Soi trial HF with two levels of support:  ACT for high needs  ICM for moderate needs (Macnaughton et al., 2012)
Rapid Rehousing	Federal U.S. department of housing and urban development strategy Rapid re-housing typically involving three components: (1) recruiting landlords and identifying suitable housing, (2) offering moving and rent assistance, and (3) providing access to case management at home and other supportive services (Garcia & Kim, 2020, p. 2) Employs a HF model to move families off the streets to the emergency shelter as soon as possible and placing them into either: (1) temporary housing or (2) permanent supportive housing, which is reserved for the chronically homeless who need case managers and other services on site (Garcia & Kim, 2020, p. 4)
	Federal U.S. Department of Housing and Urban Development Strategy Rapid re-housing aims to: “move(s) households rapidly from homeless shelters to independent housing—preferably in a matter of weeks. Households are moved directly into apartments in the private market (with their own names on the lease) and receive partial rental assistance and limited services from the service provider for up to a year” (Rodriguez & Eidelman, 2017, p. 3)
Low-barrier Shelter	“A form of emergency shelter for individuals experiencing homelessness which facilitates easy access by keeping historical barriers to shelter entry to a minimum” (Ang & Wasserman, 2021, p. 2)
Emergency Warming Centre	A “harm reduction [pilot] project, loosely based on a Housing First model” (Young & Manion, 2017, p. 2)

Appendix 2 Themes, categories, and illustrative quotes

Themes	Categories	Quotes
“Kind of like a real home”	Resident input existing community	Jarod “Oh, that was great too, like because we… I was camped out in the woods for a while and then other people came out there too and they started coming down to interview us asking why we weren’t in the (shelter name). And we all had very good reasons why we weren’t there and they took those considerations and kind of used them as a basis for making this place in the first place. So, I think that went a long way to making this what it is now.”
	Privacy	Peter “a little more dignity and respect. Yeah. Having our own little private unit. Like it’s all the difference in the world.”
	Autonomy	Rebecca “It’s nice to actually get a place that’s kind of my own, my own area. You know, I can clean my clothes when I want, shower when I want, [get] food I want.” “Yeah, so there’s more a sense of being able to come and go as you would in your own home, right, and being able to set your own rules.”
	Autonomy	Caroline “Yeah. I think the advantages is that you have your personal freedom and your personal rights at the same time as having shelter. It’s not as rigid as a shelter, you can come and go as you please and you can eat when you want. You know what I mean?”
	Meeting needs	Sammy “Yeah. And they also give food for pets. They supply that too…Yeah, so that’s good. Well, it’s a bonding thing. Like it’s like kind of like a real home. Like, right?”
	Meeting needs	Mark “The fact that it was a roof. I had some heat, because when I got here there was a cold spell that was going through…but I needed a place that I could have my surgery and heal because well you can’t really heal in a tent. You could but there’s more of a risk for infection and stuff like that.”
	Autonomy low-barrier	Peter “It’s not getting bullied around or kicked out of your—away from your stuff for the whole duration of the day or like having to carry everything, you know, when you’re in crash beds. Like it’s just a lot of bullshit. Just the jumping for (sic) the hoops for the sake of jumping through hoops.”
“It’s like a buddy system”	Harm reduction	Jarod “Some people here are, you know, addicts and as such they need to take care of their addictions. People here are not against that. In fact, they kind of encourage it to be done in a safe environment rather than behind closed doors where it’s unsafe.”
	Harm reduction low-barrier meeting needs	Mark “Like you know, like there’s a lot of people here with mental issues, a lot of drug addicts, stuff like that, and you tend to do the blind eye thing but you still keep an eye on them, if that makes sense…I know all the fenny users here and I make sure that if I see them doing something or I know they’re doing something…they’ll actually come up to me and say check on me in ten minutes, and I check on them every ten minutes for three or four times. Once I hit that fourth time, I know they’re past that initial stage. They’re not going to do the death thing any more or whatever. So okay. You’re good, and I let them know, you’re good. All right. It’s all done. It’s like a buddy system,”
	Meetings needs	Casey “I really am grateful for this program. I’m just happy I got to, had the opportunity to be involved in it…I believe that it’s as very good thing for people to have…this whole community thing, like having a small community is a really good thing for people that are in my situation…because I believe it gives you an advantage of getting back to the basic fundamentals of living…I believe that that is very, very, helpful…because there’s a lot of people live here like me and like I believe that…it helps them mentally.”
	Meeting needs	Casey It sucks when you go and you get your own place and then you are kind of isolated now again and it’s like, it’s like that causes depression. That causes like, that causes people to relapse. That causes a lot of things, right, and it’s like you don’t have the… if you don’t have people around you and the supports then you are kind of (profanity), you know…it sucks in a way because I like having people around
“It’s the same size as a jail cell”	Autonomy	Sammy “It’s like a jail. It’s kind of like a (profanity) halfway house kind of. That’s what I think.”
	Autonomy meeting needs	Caroline “You know, it’s the same size as a jail cell, but it’s warm.”
	Autonomy meeting needs privacy	Mark “I figure like for every ten people you should have a shower or at least a toilet or something like that, and there’s like 30 of us here and there’s only the one shower and, you get the point,” “(T)he heaters can be turned off. Because there was a lot of half decent days that didn’t need a blistering heat in the rooms and some of the rooms are a little more susceptible to heat. The windows aren’t big enough to even get anything to blow out really. Other than maybe get the walls a little thicker so you’re not listening to the people next door to you or you can actually hold a conversation in your room without having ten ears eavesdropping, because that’s pretty much what it is right now…There’s no privacy. Like basically it’s like a college dorm gone wild. Somebody scratches their ass five doors down you can tell them how many fingernails they broke. You know what I mean.”
“To keep us on focus”	Meeting needs Low barrier	Jarod “(The) staff’s ability to keep us on focus when we’re getting things done that need to get done…for example, I mean that was a big one there. I have a hard time trying to fill out forms and things on the computer that are very confusing to me sometimes. So, for them to be able to help me get through that, that’s been very helpful. Phone calls too, same thing. If I call the government offices for example, are so frustrating to me that I can’t really get through an entire phone call a lot of times…” Interviewer: “You feel supported by the staff here? Interviewee: Yup Interviewer: Treated with respect by the staff? Interviewee: Always, always, always. I’ve never had a bad day with them yet, and even if I did, for what I’ve saw that they’ve handled themselves very professionally, very courteously and very forthcoming to the emotional and physical needs of whoever they deal with. So always, yes
	Meeting needs	Casey “Like and when I first started staying here, it was good…like the staff…was warming to me and like they were cool…I like them a lot because…they’re warming and they’re not judgmental and they just, they seem like they do understand for the most part. And it’s good to have because they’re not…basically stuck-up people that are just there for their pay and like whatever. They actually do kind…of give a shit, you know. And that’s a good thing to have.”
	Meeting needs autonomy staff capacity	Casey “I don’t think staff should like, here…should be having to deal with like a lot of like the mental health issues at hand. Like they’re not…like for the mental health, like how severe sometimes it is here. Like a person like [Name] that’s like screaming at the top of her lungs, like…I could hear that girl screaming from the basketball court. And that’s not cool. Like that’s not, that’s not fair to people that live around here…because like she obviously has like a very, very severe issue and like I don’t think the staff is equipped with like that knowledge or the skills to basically deal with that, with that person.”
	Meeting needs	Caroline “There should be a screening process…And those with severe mental health issues should be off in one spot with specialized workers for mental health issues…Because there’s been numerous problems with that, on our site specially.”
	Staff capacity	Noah “a little grumpier or have their own things going on in their life” and therefore could use a program “just for like the workers themselves.”
“I’m not sure what I’m going to do after”	Uncertainty	Jarod “It depends on what time of the pandemic you’re referring to. At the beginning of it I was doing not so great. Then it got a little better. Then I came here and did a lot better. And now it’s coming to an end and I’m not sure what I’m going to do after that. It might be a lot worse.”
	Uncertainty	Casey “Like, like the City can come here and shut this place down any time. Like you know, like we can be (profanity), we can get screwed over big time.”
“Too much bloody money in too little hands”	Meeting needs	Casey “a place to socialize and be with other people—otherwise you’re isolated and that causes depression.”
	Meeting needs	Rebecca “A regular building. A regular apartment building with numbers on the doors,” “I think something like this would be a good way to start it up, although… (there should be) certain things that would differentiate between people that are able to govern themselves and people that are not. Some people here don’t have the life skills necessary in order to be on their own and live on their own housing environment…programs (have to be) available to them that can teach them…and kind of guide them in the right direction…I think this place, as good as it is, needs to address those issues…so they can actually not just release people into the wild and say good luck but actually instead follow up on things where they can see the progress of what’s been done and see the needs of the people…Some people here definitely can be put into housing right away, but not everyone can, and I think the ones that can’t might have to have a different program altogether for it. Something like this maybe but something separated at the same time if it’s possible.”
	Meeting needs	Mark “…(T)otal revamp of the system. Rents are way too high. Landlords are more scummier and slummier nowadays than they ever were because they can get away with it a lot more because there’s no enforcement…There’s enforcement on like the renters as being evicted or this, that or whatever. Like we get the shaft 90 percent of the time instead of the landlord being held responsible for their end. They need to do something about the rising cost of housing to begin with. Whether there should be a cap or whatever, I don’t know…I’m not privy to those numbers…All I know is that it’s…way too high according to the basic salary that people make, myself included. I’m on welfare right now and I’m lucky to get a room for what I can afford on what they give me…”
	Meeting needs	Mark “(F)or every apartment building that they put up, they should put up one of similar, if not value or size or whatever, for combatting homelessness…Like if they can afford to do that, they got more than enough money that they’re going to make off the damn thing, help the cause out. There should be some sort of law or tax thing that puts in, you want to do this, you got to put in this much. You know, you got to give to get, right? …That’s the way I look at it because there’s too much bloody money in too little hands is what it boils (down) to.”

Author Contributions

All authors contributed to the study conception and design. Data were collected by TSC, JH, LB, JB, and AL. Data analysis was performed by TSC, JH, and LB. The first draft of the manuscript was written by TSC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

This study was funded by Ark Aid Outreach Services. The authors declare they have no financial interests.

Declarations

Conflict of interest

Jodi Hall, Julie B., Amber Lindstrom, and Abe Oudshoorn are unpaid members of the WISH Coalition. Tracy Smith-Carrier, Lindsey Rawlings, and Ilene Hyman have no non-financial interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the Tri-Council 2018 Policy Statement for Ethical Conduct for Research Involving Humans. The study was approved by both King’s University College at Western University and Fanshawe College.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.