Transitioning Youth Out of Homelessness 2.0 (TYOH 2.0)

Transitioning Youth Out of Homelessness 2.0: A Pilot Randomized Controlled Trial of a Rent Subsidy and Identity Capital Intervention for Youth Exiting Homelessness

Introduction: This 12-month pilot randomized controlled trial (RCT) built on previous community-engaged work and explored whether portable rent subsidies and an intervention targeting identity capital (purpose, control, self-efficacy, and self-esteem) hold promise as a way to facilitate socioeconomic inclusion for youth (age 16 - 24 years) exiting homelessness and living in market rent housing in Ontario, Canada. All (n = 40) participants received rent subsidies; half were randomly assigned an identity capital intervention (co-designed leadership guide + coach).

Methods and analysis: This study employed a convergent mixed methods, two-arm parallel RCT, open-label design with 1:1 allocation embedded within a Community Based Participatory Action Research framework and underpinned by Critical Social Theory.

Specifically, the objectives and measures were:

1. Primary - to examine whether targeted economic and identity-based supports are a feasible and acceptable way to foster socioeconomic inclusion. Measures: recruitment/enrolment/dropout metrics; self-report composite checklists regarding intervention engagement; coaching session attendance; qualitative focus groups.
2. Secondary - to assess differences between targeted economic and identity-based supports (intervention group) and economic supports only (control group) at the 12-month primary endpoint with respect to self-reported socioeconomic inclusion measures of: 1) education, employment and training (EET); 2) housing security; and 3) identity capital. Measures: self-report composite EET checklist; self-report measures of housing security and identity capital.
3. Exploratory - to explore whether the estimated effect of the intervention differed by baseline variables or level of engagement with the intervention. Measures: select variables from the baseline demographic questionnaire; GAIN-Short Screener questionnaire for those in the intervention group.

Ethics and dissemination: This study received ethical approval from the Unity Health Toronto Research Ethics Board. The investigators will continue working alongside community partners - including youth with lived expertise - to disseminate findings broadly and in diverse formats.

Study Overview

• Status: Completed
• Conditions: Homelessness; Youth
• Intervention / Treatment: Behavioral: Identity Capital Intervention (Coach + Co-designed Leadership Guide); Other: Monthly Rent Subsidies

Detailed Description

The overarching aim of this mixed methods study was to determine the feasibility and acceptability of a strengths-based intervention focused on building identity capital, as a way to facilitate socioeconomic inclusion for youth (age 16 - 24 years) exiting homelessness and living in market rent housing.

Specifically, the objectives were to:

1. Primary - examine the feasibility and acceptability of a RCT of targeted economic and identity-based supports to foster socioeconomic inclusion.
2. Secondary - estimate the effect of adding identity-based supports to economic supports (intervention group) compared with economic supports alone (control group) at the 12-month endpoint with respect to self-reported proxy indicators of socioeconomic inclusion.
3. Exploratory - among the intervention group, explore whether the estimated effect of the intervention differs by baseline variables or level of engagement with the intervention.

This pilot study employed a convergent mixed methods (quantitative and qualitative data collected concurrently and the findings combined), two-arm parallel RCT (participants randomly assigned to either the intervention or control group), open-label (participants and research team aware of random assignment) design with 1:1 allocation (equal number of participants in each study arm) embedded within a CBPAR framework.

The study was conducted collaboratively with four community partners who serve youth who are experiencing or have experienced homelessness: 1) Covenant House Toronto (Toronto, ON); 2) Living Rock (Hamilton, ON); 3) The RAFT (St. Catharines, ON); and 4) StepStones for Youth (Toronto, ON). Study participants were recruited from the cities in which our community partners are located: Toronto, ON (Greater Toronto Area population 6.7 million); Hamilton, ON (population 785,000); and St. Catharines, ON (St. Catharines-Niagara population 416,000).

Youth in both arms (n = 40) were provided monthly rent subsidies ($700.00 CAD/month Hamilton and St. Catharines; $800.00 CAD/month Toronto) for 12 months, which was paid directly to landlords and facilitated by our community partners. Youth randomized to the intervention group (n = 20) were also provided a co-designed leadership guide and assigned a study coach. The control group (n = 20) was offered the co-designed leadership guide at the end of the study.

The strengths-based leadership guide - Finding Home: A Guide for Youth in Transition - was co-designed with 12 youth who had experienced homelessness, including youth who participated in TYOH 1.0. The Leadership Guide contained 12 chapters with the overarching aim of enhancing identity capital along with providing strategies to achieve participant-identified goals. Each chapter contained four activities (e.g., self-reflection exercise or listening to a podcast). While the guide was designed for individual study, it was also meant to serve as a reference point for individual and group discussions with the study coaches.

The role of the coach was to speak with youth about how to draw on internal resources to help orient them toward their preferred future. This role was different from case management or mentorship in that a specific coaching methodology (Brief Solution-Focused Coaching) was utilized to walk alongside youth as they developed strategies to reach self-defined goals. Each coach was instructed to devote 2.5 days/week to the intervention and was given a caseload of 9-11 youth. The coaches were instructed to meet individually with each youth on their caseload every two weeks and collectively with the rest of the youth in their group every month.

Questionnaires were completed at baseline. four-, eight-, and 12-months post-randomization. Quantitative analysis was performed using the intention-to-treat principle; that is, all participants were included and analyzed in the groups they were originally randomized. Baseline characteristics of the intervention and control groups were summarized using descriptive statistics (i.e., mean, standard deviation, median and interquartile range for continuous variables, and frequencies and proportions for categorical variables).

Primary outcomes were analyzed by estimating the recruitment rate as the proportion of contacted individuals who expressed interest in participating in the study. The enrollment rate was calculated as the proportion of recruited individuals who were eligible and consented to participate in the study. Dropout rates were separately calculated for intervention and control groups at the end of the study as the 1 - proportion of randomized participants who completed the study at 12 months. Exact (Clopper-Pearson) 95% confidence limits were also calculated.

Secondary outcomes were analyzed by calculating descriptive statistics at each study time point and exploring differences in trajectories from baseline to 12 months follow-up between intervention and control groups using scatterplots and box-plots. Adjusted mean group differences with 95% confidence intervals in continuous outcomes at 12 months (housing security and identity capital) between participants who received the intervention and control participants were estimated using analysis of covariance (i.e., linear regression models), including an indicator of intervention group and the baseline value of the outcome, adjusting for site. We performed regression diagnostics and repeated analyses using the non-parametric Wilcoxon rank-sum test if there were extreme outliers or influential observations.

Exploratory sub-group analysis was conducted considering only the intervention group and stratifying the primary outcomes by selected baseline demographics (for example, gender) or severity levels of components of the Global Appraisal of Individual Needs Short Screener (GAIN-SS) V.3.0.2. We also calculated the correlation between secondary outcomes and the level of engagement with the intervention measured as the percentage of class sessions attended out of a maximum of 24 over the 12-month period. Spearman correlation and Spearman partial correlation coefficients were calculated.

Focus groups with those in the intervention group was conducted at four-, eight-, and 12-months post-randomization. Focus group questions primarily centred around intervention acceptability but also explored the impact of the intervention on identity capital and socioeconomic inclusion (e.g., connection to broader social networks). Analysis began during and after the first data generation session, meaning the questions asked evolved over time based on our preliminary interpretations of the data.

Working alongside community partners to disseminate findings with the aim of highlighting sociostructural inequities, building community capacity, and improving the lives of the youth we serve is fundamental to this work. We anticipate disseminating our findings broadly to community-based and academic audiences in a variety of formats ranging from oral presentations to scientific journal papers.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada
      • Unity Health Toronto

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 24 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Eligible young people ages 16 - 24 years who have left homelessness within the past 12 months and are currently living or planning to live in market rent housing will be identified by the community partners. This age mandate was chosen because this is the age group served by the community partners. The investigators have chosen to target the first year of exiting homelessness because their collective experience has shown that this is a particularly precarious time for youth in terms of mental health challenges and risk of returning to homelessness.

Inclusion Criteria:

• Be able to provide free and informed consent.
• Be able to understand English (intervention and data collection will be conducted in English).
• Have experienced homelessness (e.g., all non-parental and unstable housing arrangements including shelter stays, couch surfing, and time-limited housing) in the past 12 months.
• Be willing to actively participate in the intervention (co-designed leadership program + coach) if randomized to this arm.

Exclusion Criteria:

• In imminent danger of losing their housing and not able to utilize the rent subsidy to sustain market rent housing.
• Currently receiving rent subsidies.
• Enrolled in a program or study with similar features to the TYOH 2.0 intervention.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Portable Rent Subsidies + Identity Capital Intervention; Young people randomized to the intervention group will receive 12 months of: portable rent subsidies, engage in a co-designed leadership guide, and be assigned a coach (one coach/10 youth).	Behavioral: Identity Capital Intervention (Coach + Co-designed Leadership Guide); Young people randomized to the intervention group will engage in a co-designed leadership guide with their assigned coach. The co-designed leadership guide contains 12 chapters with the overarching aim of enhancing identity capital along with providing strategies to achieve participant-identified goals. Each chapter contains four activities (e.g., self-reflection exercise or listening to a podcast). Ideally, youth will complete one chapter every month. Each young person in this group will meet individually with their coach every two weeks and with a larger group of 10 youth participants and their coach every month.; Other: Monthly Rent Subsidies; All study participants will receive a monthly rent subsidy ($800 for those living in Toronto; $700 for those living in St. Catharine's or Hamilton due to differences in cost of living) for 12 months.
Active Comparator: Portable Rent Subsidies Only; The control group will be offered 12 months of portable rent subsidies.	Other: Monthly Rent Subsidies; All study participants will receive a monthly rent subsidy ($800 for those living in Toronto; $700 for those living in St. Catharine's or Hamilton due to differences in cost of living) for 12 months.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility and Acceptability of the Intervention Over 12 Months (Measured by Recruitment, Enrolment, and Dropout Metrics)	To examine intervention feasibility and acceptability, quantitative measures consisting of recruitment/enrolment/dropout metrics will be utilized. Recruitment rate will be estimated as the proportion of contacted individuals who express interest in participating in the study. The enrollment rate will be calculated as the proportion of recruited individuals who are eligible and consent to participate in the study. Dropout rates will be separately calculated for intervention and control groups at the end of the study as the 1 - proportion of randomized participants who completed the study at 12 months. Exact (Clopper-Pearson) 95% confidence limits will also be calculated.	Assessed at baseline and 12-months.
Feasibility and Acceptability of the Intervention Over 12 Months (Informed by Qualitative Data From Focus Groups)	We conducted focus groups with intervention (rent subsidy + identity capital intervention) participants. Focus group questions explored intervention feasibility and acceptability. Focus group data from all time points was analyzed together.	Assessed at 4-months, 8-months, and 12-months.
Feasibility and Acceptability of the Intervention Over 12 Months (Measured by Coaching Session Attendance Over 12 Months)	Feasibility and acceptability of the coaching component of the identity capital intervention was assessed by coaching session attendance, as recorded by coaches. Overall coaching session attendance was measured as the percentage of total possible coaching sessions attended over the 12-month period (maximum 24 sessions).	Assessed at 12-months.
Feasibility and Acceptability of the Intervention Over 12 Months (Measured by the Intervention Engagement Questionnaire)	Feasibility and acceptability of the co-designed leadership guide component of the identity capital intervention was assessed using the Intervention Engagement Questionnaire (self-report measure was developed for this study and administered only to intervention participants).	Assessed at 4-months, 8-months, and 12-months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline to 12 Months in Housing Security (Measured by the Housing Security Scale) (Continuous Outcomes)	The 20-item self-report Housing Security Scale contains the following sub-scales: Subjective Stability (range 5-30; higher scores indicate more housing security); Safety Net (range 3-18; higher scores indicate more housing security); Threats to Stability (range 7-42; higher scores indicate less housing security).	Assessed at baseline, 4-months, 8-months, and 12-months. Baseline and 12-month scores reported.
Change From Baseline to 12 Months in Identity Capital (Measured by the Multi-Measure Agentic Personality Scale)	The Multi-Measure Agentic Personality Scale (MAPS20) is a 20-item validated self-report measure that explores domains related to identity capital. The MAPS20 contains the following sub-scales: Self-Esteem; Purpose in Life; Internal Locus of Control; Self-Efficacy/Ego Strength. Each subscale has a score range of 5-30, with higher scores indicating greater identity capital.	Assessed at baseline, 4-months, 8-months, and 12-months. Baseline and 12-month data reported.
Change in Employment, Education, or Training From Baseline to 12 Months (Assessed by a Questionnaire)	This five-item self-report measure was developed for this study and explores engagement in education (secondary or post-secondary), employment (full- or part-time; formal and informal), and training (paid or unpaid apprenticeship). Employment, education, and training (EET) is a composite binary outcome, where EET = 1 if participants are attending classes, employed, or participating in a training program, and EET = 0 otherwise.	Assessed at baseline and 12-months.
Change From Baseline to 12 Months in Housing Security (Measured by the Housing Security Scale) (Binary Outcomes)	The 20-item self-report Housing Security Scale contains a composite binary indicator of housing need, in addition to the previously reported continuous outcome sub-scales. The number of participants responding in the affirmative is reported (affirmative response indicates that the participant has unmet housing needs).	Assessed at baseline, 4-months, 8-months, and 12-months. Baseline and 12-month data reported.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Coaching Engagement Stratified by Gender	This 17-item self-report measure was developed for this study and explores domains related to: age; gender; race/ethnicity; sexual orientation; immigration status; child welfare involvement; homelessness entrenchment; education; social support; financial support; physical health support; mental health support; food security.	Demographics assessed at baseline; Coaching attendance assessed at 12-months.

Collaborators and Investigators

• Sponsor: Unity Health Toronto
• Collaborators: Covenant House Toronto; StepStones for Youth; Living Rock Ministries; Resource Association for Teens
• Investigators: Principal Investigator: Naomi S Thulien, NP-PHC, PhD, Unity Health Toronto

Publications and helpful links

General Publications

• Thulien NS, Stark RK, Amiri A, Abramovich A, Akdikmen A, Carasco A, Daley M, Downey B, Fambegbe OP, Frederick T, Hwang SW, Kozloff N, Noble A, Pedersen C, Rampersaud M, Rodney R, Tibebu T, Nisenbaum R. A Rent Subsidy and Identity Capital Intervention for Youth Exiting Homelessness: Protocol for the Transitioning Youth Out of Homelessness 2.0 Pilot Randomized Controlled Trial. JMIR Res Protoc. 2025 Apr 25;14:e66210. doi: 10.2196/66210.

Helpful Links

• TYOH 1.0 study website (includes short documentary and animation of study findings).

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2023
• Primary Completion (Actual): June 17, 2024
• Study Completion (Actual): June 17, 2024

Study Registration Dates

• First Submitted: February 27, 2023
• First Submitted That Met QC Criteria: March 20, 2023
• First Posted (Actual): March 23, 2023

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: May 6, 2026
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Transition; Coach; Control; Youth; Homelessness; Self-Efficacy; Self-Esteem; Rent Subsidy; Purpose; Identity Capital; Socioeconomic Inclusion
• Other Study ID Numbers: 22-230

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No