Chronicity refers to the length of time an individual or a family spends in homelessness. It can be divided into three categories:
Chronic homelessness is experienced by individuals and families who have been continuously homeless for at least one year or have had at least four episodes of homelessness in the past three years.
To fall into this category, a person must be sleeping in an emergency shelter or a place not designed for human habitation. You can find out more about what counts as a place not designed for human habitation here.
Episodic homelessness is experienced by individuals and families who have been continuously homeless for less than one year or have had fewer than four episodes of homelessness in the past three years.
Like chronic homelessness, a person must be sleeping in an emergency shelter or a place not designed for human habitation to fall into this category.
Transitional homelessness is experienced by individuals and families who have been continuously homeless for the first time for less than three months or have had less than two episodes in the past three years.
To fall into this category, CHF considers a range of living conditions that extends beyond emergency shelters and places not designed for human habitation. For example, couch surfing or lengthy stays in hospitals and prisons may all cause a person to experience transitional homelessness.
Complexity refers to the level of a person’s needs. An individual or a family may rank as high, moderate or minor complexity depending on how much help they need to overcome the barriers that prevent them from maintaining permanent housing.
To determine an individual’s complexity, CHF focuses on three types of personal barriers:
Physical health problems;
Mental health problems, and
Substance misuse issues.
If a person faces all three personal barriers, they are deemed to have tri-morbidity. If they face any combination of two out of the three barriers, they are said to have bi-morbidity.
Based on morbidity, CHF can identify whether a person has high, moderate or minor level of complexity.
High complexity: individuals and families who are high complexity are the most vulnerable people in the homeless population. They are tri-morbid, which means they have high rates of severe mental illness, substance misuse, and physical illness, injury or trauma. High complexity individuals or families are frequent users of emergency services and public safety systems.
Moderate complexity: individuals and families who are moderate complexity have difficult exiting homelessness on their own, because of financial barriers and bi-morbidity. That means they have serious mental illnesses, physical disabilities or chronic substance misuse issues, though not all three.
Minor complexity: individuals and families who are minor complexity face financial barriers, but no personal barriers such as substance misuse issues, physical or mental health challenges. These people have lived independently in the past and can do so again after a short-term intervention.
Chronicity, Complexity and the Coordinated Access and Assessment System
CHF uses chronicity and complexity to triage individuals and families experiencing homelessness. Triaging means determining the priority of clients based on the severity of their condition and identifying the programs and supports that will best suit their needs.
This process takes place during weekly triage meetings for youth, family and adults that are hosted by CHF and attended by our staff, the heads of agencies and other system partners.
These meetings, which form the heart of the Coordinated Access and Assessment (CAA) system, use data about individuals and families to place them in the appropriate services and programs, including Housing First programs.
In general, the CAA concentrates its efforts on moderate to high complexity individuals experiencing chronic or episodic homelessness:
High complexity, chronically homeless: individuals and families with a lengthy history of homelessness and tri-morbidity (serious physical health problems, mental health challenges and chronic substance misuse issues.)
Moderate complexity, chronically homeless: individuals and families with a long history of homelessness and bi-morbidity.
High complexity, episodically homeless: individuals and families who have experienced homelessness with short periods of precarious housing in between. They have a history of tri-morbidity that prevents them from maintaining permanent housing.
Moderate complexity, episodically homeless: individuals and families who have been housed for long periods of time, but who are bi-morbid and have experienced homelessness.
The complexity and chronicity of people being triaged through the CAA system is demonstrated in the statistics below. For example, the CAA reported the following number of tri-morbid adults awaiting or entering Housing First programs as of June 2019:
The CAA also noted the number of tri-morbid or bi-morbid adults, youth and families on the triage list for Housing First programs:
Individuals who are low complexity tend to be helped at the level of shelters, rather than by the CAA and Housing First programs.