Housing First for Youth Service Delivery Model

A System of Care

In Part 2 of this training, you learned that communities may come together to develop a strategy to address youth homelessness. Youth-serving agencies across multiple sectors should use a systems approach to coordinate activities that will be required to accommodate the needs of young people who  experience homelessness.  In order to provide a coordinated approach, organizations will need a method to identify and prioritize youth in need of housing and support services.

HF4Y is one part of a solution to youth homelessness. Together with prevention and early intervention strategies, HF4Y is an important part of the broader umbrella of strategies to end youth homelessness. Building an integrated system of service delivery will require Coordinated Access (also known as Coordinated Intake or assessment).

In practice, Coordinated Access is a common point of entry for individuals in need of support. This common access point may take different forms such as community hubs, a dedicated assessment facility, phone lines, web-based platforms, or in-person at emergency shelters. Individuals are assessed to determine their needs and referred to relevant housing-related supports and services.

Sharing information between agencies ensures that services are not duplicated. Sharing data also means that clients get timely access to the most appropriate services based on need. There are more benefits to having a coordinated access system:

  • First, it can support the alignment of program philosophies, activities and outcomes across the sector.
  • Second, it can contribute to enhanced collaboration, systems integration and a rethinking of how to collectively respond to the problem of youth homelessness through Collective Impact.
  • Third and most importantly, it can potentially lead to better outcomes for youth, as they get access to the services that are most appropriate, enable more effective flow through the system, and hold the sector accountable for better outcomes for youth.

Learn more about coordinated access in this guide produced by Reaching Home.

Many resources dedicated to homelessness are focused on emergency response instead of moving upstream to address the systemic and structural reasons people become homeless in the first place, while wrapping housing and supports around those who do become homeless until they stabilize (Amanda Buchnea, A Way Home Canada, SPC Module 1 webinar).

While resources are dedicated to focusing on emergency response, not enough attention is paid to those who have exited homelessness to stabilize and maintain their housing.

Prevention resources:


How can we begin to shift our practice from a crisis response to prevention? The first step toward shifting our practice toward a prevention lens is to recognize that the existing systems are holding youth homelessness in place. These systems (policies, procedures and practices) are preventing us from doing things differently.

A fish is swimming along one day when another fish comes up and says, “Hey how’s the water?

The first fish stares back blankly at the second fish and then says, “What’s water?”

~The Water of Systems Change, Kania et al. (2018)

Two fish talking

What are some ways that we can begin to shift our practice — to "see the water"?

Some ideas are listed below. You can probably think of others.

  • Engage in reflective practice
  • Challenge our assumptions about the conditions of homelessness and service users
  • Stay open to different perspectives and engage with others (e.g. talk to people about their ideas, especially those from cultural groups or communities that are outside of your own experiences.)

Prioritization, Intake and Assessment

To provide coordinated intake and assessment, organizations should have a strategy to identify youth within the larger group of people who are homeless. The idea is to help those in greatest need with a focus on prevention, not just chronically homeless persons. They should also make use of an strengths-based youth assessment and prioritization tool. 

HF4Y recommends using a strengths-based, youth-focused assessment tool such as the Youth Assessment and Prioritization (YAP). The YAP tool is used to assess a young person’s current situation, the complexity of their needs, and the services they currently receive and may require in the future. Assessment tools must account for the factors that contribute to a young person’s personal development, including strengths, risk and resilience, and the role of parents, caregivers, community and environmental factors.

Data Management

To make this shared system work, there needs to be some form of data sharing agreement and a data management platform or system. In Canada, there is the Homeless Individuals and Families Information System (HIFIS). HIFIS is an online system that allows agencies to input and share data so that individuals can be supported across various services. Having agencies and services use common assessment, case management and outcomes measures requires not only agreement within the sector but cooperation from funders.

A systems approach that includes standard data collection with shared data management across multiple agencies offers the following benefits

  • Provide better coordination amongst services and increased expertise, especially for people with complex needs who use multiple services simultaneously.
  • Increased stability for individuals experiencing homelessness with more opportunities for community involvement.
  • Improved cooperation and collaboration among service providers
  • Improved client services and access to services.
  • Reducing the cost of services.
  • Reducing service duplication.