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Effect of Portable Rent Subsidies and Mentorship on Socioeconomic Inclusion for Young People Exiting HomelessnessA Community-Based Pilot Randomized Clinical Trial

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Do young people exiting homelessness with 24 months of portable rent subsidies and adult mentorship experience more socioeconomic inclusion relative to young people who receive only 24 months of portable rent subsidies?

Findings  In this randomized clinical trial of 24 youths who transitioned out of homelessness and into market-rent housing, all socioeconomic inclusion outcomes were stable or showed nonsignificant improvements at 18 months compared with baseline; however, there were no significant improvements within the group that received mentorship relative to the group that did not receive mentorship.

Meaning  The effectiveness of mentorship for young people exiting homelessness—especially under pandemic-related restrictions—is uncertain; stable socioeconomic inclusion outcomes during the COVID-19 pandemic may be attributable to portable rent subsidies.

Abstract

Importance  There have been no published randomized clinical trials with a primary outcome of socioeconomic inclusion for young people who have experienced homelessness.

Objective  To explore whether young people exiting homelessness who received rent subsidies and adult mentorship experienced more socioeconomic inclusion relative to young people who received only rent subsidies.

Design, Setting, and Participants  This was a convergent mixed-methods, unblinded, 2-group, parallel randomized clinical trial with 1:1 allocation embedded within a community-based framework in 3 cities in Ontario, Canada. Participants were enrolled between March 1 and September 30, 2019, and were followed up through March 31, 2022.

Interventions  Participants (n = 24) were randomly assigned adult mentors (n = 13) who had been recruited and screened by community partner agencies. All participants received portable rent subsidies (subsidy not tied to a specific location) for 2 years.

Main Outcomes and Measures  Primary quantitative outcomes were self-reported measures of community integration (psychological and physical) and self-esteem—proxy indicators of socioeconomic inclusion. Community integration was measured with the Community Integration Scale, with a score range of 1 to 7 for the physical component and 4 to 20 for the psychological component; higher scores indicate higher integration. Self-esteem was measured with the Rosenberg Self-Esteem Scale, with a score range of 0 to 30; higher scores indicate greater self-esteem. Secondary quantitative outcomes included social connectedness, hopelessness, and academic and vocational participation. All analyses followed the intention-to-treat principle.

Results  A total of 24 youths (12 women [50.0%]; mean [SD] age, 21.8 [2.2] years [range, 18-26 years]; race and ethnicity: 10 White [41.7%], 8 Black [33.3%], 2 Asian [8.3%], 2 Indigenous [8.3%], and 2 different choice [8.3%]) transitioned out of homelessness and into market-rent housing. All youths in the group that received mentorship and in the group that did not receive mentorship had stable or nonsignificant improvements in all study outcomes at the primary end point of 18 months compared with baseline (mean [SD] Community Integration Scale psychological score: mentorship group, 11.3 [2.6] at baseline and 11.2 [3.9] at 18 months; no-mentorship group, 10.8 [4.1] at baseline and 13.2 [2.9] at 18 months; mean [SD] Rosenberg Self-Esteem Scale score: mentorship group, 16.0 [4.6] at baseline and 18.1 [5.2] at 18 months; no-mentorship group, 16.3 [6.1] at baseline and 19.6 [5.7] at 18 months). However, there were no significant differences between the 2 groups in the Community Integration Scale psychological score (adjusted mean difference, −2.0; 95% CI, −5.0 to 1.0; P = .18) and Rosenberg Self-Esteem Scale score (adjusted mean difference, −1.4; 95% CI, −5.0 to 2.3; P = .44) 18 months after randomization. Ancillary analysis suggested that youths with informal mentors (mentors outside the study) at baseline felt more psychologically integrated at 18 months relative to those with no informal mentors at baseline (adjusted mean difference, 3.6; 95% CI, 0.4-6.8; P = .03).

Conclusions and Relevance  In this randomized clinical trial, COVID-19 pandemic–related restrictions made it challenging for mentors and mentees to connect, which may have affected the findings. Steady socioeconomic outcomes—potentially attributable to portable rent subsidies—are noteworthy, given the socioeconomic inequities this population has faced during the COVID-19 pandemic. The possible benefit of informal mentorship warrants further investigation. This small pilot study was designed with the intention of generating data and hypotheses for a full-scale study; findings should be interpreted with caution.

Trial Registration  ClinicalTrials.gov Identifier: NCT03779204

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: September 12, 2022.

Published: October 27, 2022. doi:10.1001/jamanetworkopen.2022.38670

Correction: This article was corrected on January 13, 2023, to fix an error in a table note.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Thulien NS et al. JAMA Network Open.

Corresponding Author: Naomi S. Thulien, NP-PHC, PhD, MAP Centre for Urban Health Solutions, 30 Bond St, Toronto, ON M5B 1W8, Canada (naomi.thulien@unityhealth.to).

Author Contributions: Dr Thulien had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Thulien, Hwang, Kozloff, Nisenbaum.

Acquisition, analysis, or interpretation of data: Thulien, Amiri, Kozloff, Wang, Akdikmen, Roglich, Nisenbaum.

Drafting of the manuscript: Thulien, Amiri, Roglich, Nisenbaum.

Critical revision of the manuscript for important intellectual content: Thulien, Hwang, Kozloff, Wang, Akdikmen, Nisenbaum.

Statistical analysis: Amiri, Roglich, Nisenbaum.

Obtained funding: Thulien, Hwang.

Administrative, technical, or material support: Hwang, Wang.

Supervision: Hwang, Kozloff, Nisenbaum.

Conflict of Interest Disclosures: Dr Thulien reported receiving grants from St Michael’s Hospital Foundation and the Canadian Institutes of Health Research (CIHR) during the conduct of the study; and personal fees from Covenant House Toronto; and being employed part-time at Covenant House Toronto, a community partner on the project, outside the submitted work. Ms Amiri reported receiving grants from St Michael’s Hospital Foundation and the CIHR during the conduct of the study. Dr Hwang reported receiving grants from the CIHR during the conduct of the study. Mr Akdikmen reported receiving grants from St Michael’s Hospital Foundation and the CIHR during the conduct of the study. Ms Roglich reported receiving grants from the CIHR and St Michael’s Hospital Foundation during the conduct of the study. Dr Nisenbaum reported receiving grants from CIHR and the St Michael’s Hospital Foundation during the conduct of the study. No other disclosures were reported.

Funding/Support: This research was supported by CIHR Foundation grant FDN-167263: Interventions Research in Homelessness, Housing, and Health (primary grant holder, Dr Hwang) and by the St Michael’s Hospital Foundation.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The views expressed in this publication are the views of the authors and do not necessarily reflect those of the funders.

Data Sharing Statement: See Supplement 2.

Additional Contributions: Thank you to Elizabeth McCay, RN, PhD, Toronto Metropolitan University, who participated as a coinvestigator on this study until her retirement—your thoughtful insights continue to shape this work (note: Dr McCay did not receive financial compensation from the study funder). Special thanks to our 3 community partners: Covenant House Toronto, The RAFT, and Living Rock Ministries—this study would not have been possible without your collaboration. Thank you to the 24 young people who participated in this study and patiently answered our questions every 6 months—we are inspired by your wisdom and hope these findings help deepen understanding of the supports you need as you transition away from homelessness.

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