When tenants ‘graduate’ from Housing First programs
By Nick Falvo, PhD
Nick Falvo is Director of Research and Data at the Calgary Homeless Foundation.

With limited resources at their disposal, System Planners—such as the Calgary Homeless Foundation (CHF)—like to know how long various subgroups of persons experiencing homelessness will likely require various forms of housing support. With this in mind, Ali Jadidzadeh and I have co-authored a study that appears in Housing Studies—a leading housing journal. Titled Patterns of exits from housing in a homelessness system of care: The case of Calgary, Alberta, the study looks at the case of CHF-funded Housing First programs.[1]
Here are 10 things to know:

  1. The study uses survival analysis and hazard models. To quote from the study: “[S]urvival analysis tells us when we can expect new housing units to become available for new tenants, and which programme types will have available units more quickly… [while] hazard analysis can tell us which tenants will be most likely to graduate, based on the individual characteristics of those tenants” (p. 7).
  2. The data in the study comes from Calgary’s Homelessness Management Information System (HMIS). Gathered between 1 April 2012 and 31 March 2015, the data pertain to people residing in Housing First programs funded by CHF. Literally thousands of people were involved in this data collection effort, including: persons living in Housing First programs who signed release of information forms; staff in Calgary’s Homeless-Serving System of Care who inputted the data; CHF staff who provided training and support to community on how to use HMIS; as well as CHF staff who then cleaned the data.[2] The data in question were gathered on each person residing in Housing First every three months. An intake form was first completed by a case manager at intake into the program; then, another assessment form got completed every three months. There was also a form completed at exit from the program. These forms ask basic demographic information, as well as information about education, income, employment, history of family violence, use of health services and involvement in corrections. Most of the data gathered is based on self-reporting by an experienced case manager who receives accreditation. Blank copies of these forms can be accessed here.
  3. Key to the study is a concept known as graduation. Alberta’s provincial government provides homelessness funding to System Planners (such as CHF). To quote directly from the study: “In line with provincial programme guidelines in place during the period under consideration in the present study, a client is said to graduate from CHF-funded housing when they no longer require ‘housing support’ (i.e. case management). And in the case of temporary housing funded by CHF, a client is said to graduate once they complete programme requirements and move into a more permanent form of housing—either subsidized or unsubsidized…” (p. 3). [Note: subsequent to the period of study, the definition of graduation has changed for Calgary.] For a recent academic consideration of graduation, see this 2018 article.
  4. One of the study’s findings is that single adults without dependents require housing support longest, and families for the least amount of time. Put differently: single adults without dependents who have recently been homeless require social work[3] support longer than other groups. I suspect a few factors may be at play here. First, single adults without dependents sometimes don’t have dependents because their children have been taken into child protection (possibly stemming from the parent’s challenges with mental health and/or substance use). It’s therefore intuitive that a person with such challenges would require social work support for a longer period of time. Also, in Alberta, singles without dependents receive less income assistance than other groups, making it more challenging to live independently (I encourage people to read the poverty chapter in this year’s Alberta Alternative Budget, which argues that the poverty gap for singles without dependents is much larger than for other groups).
  5. Women require social work support for longer periods than men (even when we control for employment and income). In fact, the study finds that men are 32% more likely to graduate than women. As noted in the study: “One possible reason for this is that women experiencing homelessness often find themselves in relationships with people who in turn jeopardize their housing stability…” (p. 20).
  6. Having a history of addictions does not appear to affect a client’s graduation rate. This is consistent with findings from the At Home/Chez Soi study, which found that formerly-homeless persons who consume large amounts drugs and/or alcohol maintain housing about as well as other formerly-homeless persons. This reaffirms the importance of the Housing First approach, which holds that a person should not have to go to a drug or alcohol treatment program as a precondition to receiving permanent housing.
  7. Older clients have lower graduation rates (meaning that it takes longer for them to move on to independence). Put differently: older people who have recently been homeless require social work support longer than other groups. The study notes: “Older clients having lower graduation rates should also not be surprising to many readers, as the health outcomes of seniors are poorer than those of younger clients” (p. 21). This is an especially important findings for System Planners across Canada, as older adults are making up an increasingly large share of the homeless population. In Calgary’s homeless shelter system, adults aged 55 and over now account for 19% of bed spaces on any given night; in 2008, they accounted for just 9% of all bed spaces.[4] This trend will likely continue for at least another decade or two.
  8. Findings pertaining to Indigenous peoples have already had ramifications on the ground. Indeed, the study finds that Indigenous peoples in the study needed support longer than non-Indigenous peoples. This holds even after controlling for income, education, and a history of family violence. Future research is needed that looks at factors that inhibit success among Indigenous peoples in Housing First.[5] These findings have also informed CHF’s engagement strategies with Indigenous peoples, including CHF”s hiring of an Indigenous advisor (since promoted to Director), a business case for two supportive housing buildings for Indigenous peoples (not yet funded) and future Indigenous-focused research (to be discussed in future blog posts).
  9. The study finds that having a source of income is positively correlated with graduation rates (i.e., it speeds up the move toward independence)—and this has already led to several changes in Calgary’s Homeless-Serving System of Care. This finding has helped inform an effort by CHF to identify, in collaboration with community partners, specific individuals in CHF-funded Housing First programs who, with some additional (short term) financial support, could likely graduate. This particular effort has been taking place for roughly one year; thus far, it has involved approximately 170 individuals with considerable success. The additional financial assistance provided varies by individual and is not intended to be permanent.
  10. In Calgary’s family homelessness sector, the study’s finding pertaining to income has led to the development of a new Adaptive Case Management (ACM) approach. ACM has a strong focus on providing short-term financial assistance to households in need (and it is discussed in detail in our Family System Planning Framework).

In Sum. This study finds that some groups move on from Housing First programs more quickly than others, and that some factors (such as a source of income) appear to accelerate graduation from Housing First. Because CHF embeds research into its day-to-day operations, we were well-positioned to start acting on findings well before the research was published.

For assistance with this blog post, I wish to thank Tim Aubry, Carla Babiuk, Victoria Ballance, Candice Giammarino, Ali Jadidzadeh, Stephen Metraux, Shane Rempel and one anonymous source. Any errors are mine.

[1] For a full copy of the article, please email me at

[2] Note: Ali Jadidzadeh has spent many hours cleaning this data so that it can be used for analysis—not only for this study, but for other stakeholders in community, including other researchers.

[3] People working in Calgary’s Homeless-Serving System of Care refer to such support as ‘case management.’

[4] These figures apply to single adults without dependents. The 19% figure is for 2017.

[5] Some research has already been undertaken on this in Edmonton. Check out this 2011 report and this 23-minute video.

Blog PDF download here.

The need for mental health supports

By Janice Chan

Janice Chan is a System Planner at CHF

Alberta’s Health Funding Agreement March 10th announcement of an additional $1.3 billion over the next 10 years, including $586 million in support of mental health initiatives is good news for Albertans.  Given that this funding falls short of the 5.2% increase the Alberta Government requested of Ottawa[1], the Alberta government will need to be prudent with its spending to make the greatest impact in a cost-effective manner.

Greatest Impact

People experiencing mental illness are at greater risk of homelessness and the experience of homelessness, “in turn, amplifies poor mental health.”[2]  We know this to be true in Calgary.  Ganesh et al. (2013) screened clients at the Calgary Drop-In & Rehab Centre for common psychiatric disorders and found 92.8% experienced one or more psychiatric illness and 60% had been undiagnosed and (or) untreated for their illness.[3]  Furthermore, according to CHF’s Homelessness Management Information System (HMIS) data collected between April 1, 2012 and March 31, 2014, 48% of clients in CHF’s housing programs experience mental illness.  Given the pressing need to address mental illness amongst people experiencing homelessness, we believe this critical investment would have a substantial impact on Calgary’s most vulnerable people.

Cost Savings

The At Home/Chez Soi study demonstrated that, for people experiencing chronic and episodic homelessness, there are substantial savings associated with the provision of housing with supports. The final report demonstrated that for the 10% of participants who were using the most services upon enrolment, every $1 invested in housing and professional support during the course of the study resulted in average savings of just over $2. And across all study participants, every $1 invested in housing and professional support resulted in $0.75 in savings on health, justice-related and social services.[4]  The 2016 State of Homelessness in Canada report estimates that homelessness costs Canadians over $7 billion per year.  Investing in critical social services, like mental health supports for Calgary’s most vulnerable can provide much needed cost savings to the public purse.


What’s Needed

CHF’s 2017 budget submissions to federal and provincial governments, have asked for $8 million to help meet critical local funding needs to support vulnerable tenants in 166 new affordable housing units, scheduled to be built through the RESOLVE Campaign.  Funding for the full capital costs of these buildings is in place, however, program funding required to support tenants living in these buildings has not been confirmed. Long-term funding for adequate supports must be secured for people experiencing chronic and episodic homelessness to remain stably housed.

Bradley et al. (2016) concluded that money invested in health should not be limited to spending on health care, but also in social services and public health.[5] We hope that the recent additional mental health funding will be used not only to support health care, but also social services to help stabilize Calgary’s most vulnerable in housing through collaboration between Alberta Health and Community and Social Services.  Calgary’s Bridgeland and Ophelia Support Program, cost-shared by the two ministries, demonstrates the benefits of collaboration to provide stable housing and mental health services for people with severe and persistent mental illness and experiencing homelessness.  Not only will this investment make a substantial impact, but also provides cost-savings in health and justice public expenditures.

CHF welcomes the opportunity to further consult with the provincial government as it develops “a detailed plan on how these funds will be spent, over and above existing programs,” with the hope that it will include support to people experiencing mental illness and homelessness.

[1] Kaufmann, B. (2017) ‘Alberta says it hoped for more in $1.3-billion health funding deal with Ottawa’, Calgary Herald, Available from:, [29 Mar.2017].

[2] Homeless Hub. (n.d.) Mental Health, [online]. Available from: [Accessed 16 Mar. 2017].

[3] Ganesh, A., Campbell, D., Hurley, J., Patten, S. (2013) ‘High Positive Psychiatric Screening Rates in an Urban Homeless Population’, Canadian Journal of Psychiatry, 58(6), 353-360.

[4] Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., Nelson, G., MacNaughton, E., Streiner, D., & Aubry, T. (2014) National At Home/Chez Soi Final Report. Calgary: Mental Health Commission of Canada.

[5] Bradley, E., Canavan, M., Talbert-Slagle, K., Ndumele, C., Taylor, L., and Curry, L. (2016) ‘Variation in Health Outcomes: The Role of Spending on Social Services, Public Health and Health Care, 2000-09’, Health Affairs, 35(5), 760-768.