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Men’s Enhanced Support Program, Ottawa Fred Victor Centre, Toronto

PROGRAM REVIEW RESOURCE GUIDE
Selected Longer Term Housing Stability Programs for
People Experiencing Persistent Homelessness in
Hamilton, Toronto and Ottawa

July 2011

The Oaks, Ottawa St. Andrew’s Place, Ottawa

Brigid’s Place, Ottawa Birchmount Residence, Toronto

Program Review Resource Guide: Selected Longer Term Housing Stability Programs for People
Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa

Program Review Resource Guide:
Selected Longer Term Housing Stability Programs for People Experiencing
Homelessness in Hamilton, Toronto and Ottawa

by

Social Planning, Policy, and Program Administration
Regional Municipality of Waterloo

© Regional Municipality of Waterloo, 2011
Parts of this report may be reproduced on the condition that
proper reference is made to the Regional Municipality of Waterloo.

Recommended citation:
Social Planning, Policy and Program Administration (2011). Program review resource
guide: Selected longer term housing stability programs for people experiencing
homelessness in Hamilton, Toronto and Ottawa. Waterloo, ON:
Regional Municipality of Waterloo.

ISBN 978-0-9868622-2-9

Should you have any questions about this report please contact:
Regional Municipality of Waterloo Social Services
99 Regina Street South, 5th Floor, Waterloo, ON N2J 4G6
Tel.: (519) 883-2117 Fax: (519) 883-2234

This report and the other six background reports are available on-line at:
www.regionofwaterloo.ca

Docs #952038


Acknowledgements

Program Review Resource Guide: Selected Longer Term Housing Stability Programs
for People Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa was
made possible through the committed staff and managers of the programs described
within. Thank you for devoting significant time and effort to participating in face-to-face
meetings, editing program drafts and remaining open and responsive to follow-up
communication over the past two years.

Report Contributors:

Primary

Nicole Francoeur Social Planning Associate, Social Planning, Policy and
Program Administration

Support:

Marie Morrison Manager, Social Planning, Policy and Program
Administration
Lynn Randall Director, Social Planning, Policy and Program
Administration
Collette Whelan Program Assistant, Social Planning, Policy and
Program Administration

Funding for this report was provided by:


Table of Contents

BACKGROUND .............................................................................................................. 1

STRUCTURE .................................................................................................................. 2

LEVEL 5 PROGRAMS (MANAGED ALCOHOL) ........................................................... 5
The Annex Harm Reduction Program (the Annex) ...................................................... 5
Managed Alcohol Program/Men’s Enhanced Support Program (MESP) ..................... 9
The Oaks ................................................................................................................... 15
Claremont House Special Care Unit (Claremont House ............................................ 16

LEVEL 4 PROGRAMS (SUPPORT) ............................................................................. 23
Brigid’s Place ............................................................................................................. 23
Fred Victor Housing ................................................................................................... 29

LEVEL 3 PROGRAMS (ACKNOWLEDGEMENT) ....................................................... 32
515 MacLaren – Supportive Housing for Women ...................................................... 32
Overview of Hope Living, St. Patrick’s Residence and St. Andrew’s Residence ....... 36
Hope Living (Stage 1) ............................................................................................ 36
St. Patrick’s Residence (Stage 2)........................................................................... 37
St. Andrew’s Residence (Stage 3) ......................................................................... 38
Options Bytown.......................................................................................................... 39

LEVEL 2 PROGRAMS (DAMP) .................................................................................... 41
Birchmount Residence ............................................................................................... 41

SUMMARY .................................................................................................................... 44
REFERENCES .............................................................................................................. 45

LIST OF APPENDICES
Appendix A: Brigid’s Place Agreement to Reside ........................................................ 46
Appendix B: Birchmount Residence Community Contract........................................... 47
Appendic C: Annex Care Compared to Usual Shelter Care ........................................ 51
Appendix D: Promising Practices: Specific Design Features ....................................... 52
Appendix E: Site Visit Data from Other Communities .................................................. 57
Appendix F: Local Site Visit Reference Information ..................................................... 58
Appendix G: Summary Table of Level 3-5 Programs in Other Communities ............... 59
Appendix H: Site Visit Reference Information In Other Communities .......................... 60

LIST OF FIGURES
Figure 1. Background Reports Informing STEP Home Year 3 Evaluation ...................... 2
Figure 2. Substance Use Services Continuum in the Context of Housing ...................... 3
Figure 3. Medical Services Continuum in the Context of Housing .................................. 3
Figure 4. Timeline: Opening of Managed Alcohol Programs .......................................... 5
Figure 5. Claremont House Special Care Unit – Resident Composition ....................... 21
Figure 6. Shepherds of Good Hope Housing Continuum ............................................. 36


BACKGROUND
In September 2007, the Regional Municipality of Waterloo (the Region) released a
report of the Ad-Hoc Working Group on Persistent Homelessness1 (the Persistent
Report). The Persistent Report was one of ten background reports commissioned as
part of a larger project – the development of All Roads Lead to Home: A Homelessness
to Housing Stability Strategy for Waterloo Region (the Strategy). The Strategy was
released in 2007 and was designed to promote housing stability in Waterloo Region.
One of the actions of the Strategy was to “Develop a strategy for flexible, affordable, low
demand housing with support for people experiencing persistent homelessness”. The
Program Review Resource Guide: Selected Longer Term Housing Stability Programs
for People Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa
(Program Review Resource Guide) has been developed in response to this action.
The Program Review Resource Guide summarizes features of innovative programs
designed to serve people experiencing persistent homelessness. Data has been
collected through site visits conducted throughout the spring and summer of 2009 at
various supportive housing programs in Hamilton, Toronto and Ottawa. Each site visit
involved a tour of the program by front-line staff, an open-ended interview with a
supervisor and/or front-line staff and an informal conversation with residents/tenants2,
as available and appropriate. Several appendices further inform the Program Review
Resource Guide.

This document has been produced to support local planning and program development
and informs the companion document We’ll Leave the Lights on For You: Housing
Options for People Experiencing Persistent Homelessness Who Use Substances
(Alcohol and/or Drugs) (Lights On). The Lights On report explores approaches to
services and introduces a substance use and medical services continuum in the context
of housing.

1
A variety of scenarios indicate that a person may be approaching or experiencing persistent
homelessness:
• When homelessness has become the new “normal” and skills are oriented to surviving on the streets
rather than living in housing.
• When there is a longer term pattern of cycling between experiencing homelessness and being at-risk of
housing loss.
• When a person may not be strongly connected to the idea of more “conventional housing” (e.g., family
home, housing covered under the Residential Tenancies Act, 2006 or Long Term Care).
• When it would be challenging to find another suitable alternative if the current housing was lost.
• When a longer period of time may be needed to build a trusting relationship with another person.
• When a person has either extensive use of emergency services and/or a large number of
disconnections with community-based programs.
2
Note that “tenants” is used to describe housing participants who are covered under the Residential
Tenancies Act, 2006 (RTA) and “residents” is used to describe those who are not covered under the RTA.

1


It provides an overview of select supportive housing and community support services for
people experiencing persistent homelessness both locally and across Ontario.
Promising practices and recommendations for moving forward are included. The Lights
On report is available on the Region of Waterloo’s website at www.regionofwaterloo.ca.
Resources to support this report were provided through The Aging at Home Strategy
(2008-2011). The Aging at Home Strategy is a provincial initiative that was launched by
the Ministry of Health and Long-Term Care (MOHLTC) and administered by the Local
Health Integration Networks (LHINs).
This Program Review Resource Guide serves as one of seven background reports
informing the STEP Home3 Year 3 Evaluation Report. All STEP Home background
documents are illustrated in Figure 1.

Figure 1. Background Documents Informing STEP Home Year 3 Evaluation

STRUCTURE

The programs described in this document are presented according to where they are
situated on the Substance Use Services Continuum in the Context of Housing (see
Figure 2). In total, 12 programs are reviewed and presented from Level 5 to Level 2.

3
STEP Home refers to a set of seven person-centered programs designed to end and prevent persistent
homelessness in Waterloo Region offered through eight agencies at 13 sites. For further information, visit
the Region of Waterloo’s website at www.regionofwaterloo.ca.

2


Note that there are no Level 1 or Level 6 programs represented, as it was determined
early on that Dry programs (Level 1) would not be the focus of this research and there
are no Managed Drug Use programs (Level 6) in Ontario. For further detail with respect
to promising practices around specific design features for longer term housing stability
programs that serve people experiencing persistent homelessness, refer to Appendix D.
Figure 2. Substance Use Services Continuum in the Context of Housing

LEVEL 1: DRY
No substance use on site (i.e., “dry”)
Typically not allowed access if under the influence

LEVEL 2: DAMP
No substance use on site
Allowed access if under the influence

LEVEL 3: ACKNOWLEDGMENT
Acknowledge (formally or informally) use on site
WET: Use on site

LEVEL 4: SUPPORT
Various forms of support to reduce harm

LEVEL 5: ALCOHOL ADMINISTRATION
Providing and administering safe beverage alcohol on site

LEVEL 6: MANAGED DRUG USE
Offering supervised injection and/or direct support for non-
injection substance use (e.g., inhalants)

This document also makes reference to comprehensive, partial and non-medical
services as described in the diagram to follow.

Figure 3. Medical Services Continuum in the Context of Housing

NON-MEDICAL

No on-site or visiting medical services available to the program
May or may not support adherence to prescribed medication

PARTIAL MEDICAL

Some on-site and/or visiting medical services available to the program
Support adherence to prescribed medication

COMPREHENSIVE MEDICAL

Some level of 24/7 medical services (e.g. physicians, psychiatrists, nurses)
on-site and/or visiting
Regular visits from other healthcare professionals
May or may not provide palliative care 3


For further detail with respect to the Substance Use Services or Medical Services
Continuum in the Context of Housing, please refer to the Lights On report.
Where possible, each program is presented according to six main topic areas:
• Background – program development, capacity, program funding source, RTA,
non-RTA
• Population Served – demographics of population served
• Transition from Homelessness to Housing – referral and intake process
• Housing Model – model and features. Refer to Appendix D for additional details
related to specific design features.
• Support and Services Model – staffing model, how services are organized,
harm reduction approach
• Program Outcomes - results of program evaluation
To review summary tables of program information, see Appendix G and H. For further
information with respect to data sources for used to inform the Program Review
Resource Guide, please refer to Appendix E and F.

4


LEVEL 5 PROGRAMS (MANAGED ALCOHOL)

Figure 4. Timeline: Opening of Managed Alcohol Programs

1996 2001 2006

Annex opens MAP opens Claremont
House opens

2010

- MAP transforms into
MESP (includes
Recovery and
Overflow beds)
- The Oaks opens

The Annex Harm Reduction Program (the Annex)
Background
In the winter of 1996, there was a coroner’s inquest into
the freezing deaths of three men on three separate
nights on the streets of Toronto. The coroner’s jury
recommended that 24-hour in-shelter harm reduction
programming be implemented in the shelter system to
address the serious gap in service for these men through
mainstream services such as police, prisons, emergency
departments, hospitals and other societal services
(Svoboda, 2006). Seaton House Men’s Shelter
(the Annex), Ottawa.
In response to this recommendation, the Annex Harm
Reduction Program was established as a satellite
program of Seaton House Men’s Shelter in November 1996. It was originally described
as a City-run emergency shelter with 20 beds. The purpose of the program was to
provide housing for men experiencing persistent homelessness who avoided shelters or
who were repeatedly restricted from using shelters due to challenging behaviours
related to alcohol use, mental health issues or other factors (Svoboda, 2006). For a
comparison of the Annex to usual shelter care, please see Appendix C.

Within a couple of days of formally opening, the Annex was at its maximum capacity.
During these early days, men slept on mats and there was no food served because it
was considered to be an overnight program only.

5


The vision was one of an alcohol storing rather than an administration program, where
alcohol would be handed in upon entry to shelter staff and returned to the resident in the
morning. Despite these guidelines, alcohol was informally being administered to
residents to limit panhandling and avoid the onset of seizures due to alcohol withdrawal.
The program also included an alcohol exchange component where non-beverage
alcohol (e.g., cooking wine, rubbing alcohol, Lysol) could be traded in for less harmful
alcohol beverages (e.g., wine, beer, whiskey, sherry).
Throughout the years, the Annex had been located in several buildings, but is currently
housed on the third floor of The Seaton House Men’s Shelter located at 339 George
Street in downtown Toronto. Seaton House is one of Canada’s largest emergency
shelters, with space to accommodate over 400 men. The Annex is Canada’s first and
largest managed alcohol program. Two managed alcohol programs in Canada have
since been inspired by the Annex, including the MAP (Managed Alcohol Program) in
Ottawa and Claremont House in Hamilton.
Since its establishment in 1996, the Annex has been supported through Emergency
Shelter funding (per diem) administered through City of Toronto. It is considered to be a
“hostel” and is therefore not subject to the conditions of the Residential Tenancies Act,
2006 (RTA). With respect to the managed alcohol component of the program, residents
pay $0.50 per glass of wine (each glass is 180ml). Each resident’s consumption is
noted throughout the day and they are billed at the end of each month for the wine they
consume. Annex residents in receipt of Personal Needs Allowance (PNA) are required
to turn over their PNA as a show of good faith. In turn, residents can participate fully in
the program and people who smoke are provided with four cigarettes per day.
Residents who have an income (usually Ontario Disability Support Program (ODSP),
some Canada Pension Plan (CPP), Old Age Security (OAS)) pay a 30% maintenance
fee and pay for the wine they consume. These residents can also purchase their own
beverage alcohol and cigarettes for storage and distribution by Client Support Workers
(CSWs).
Population Served
The Annex serves “vulnerable”4 men experiencing persistent homelessness who avoid
shelters or who face service restrictions from shelters due to difficult behaviours related
to alcohol use, severe mental health issues and other factors. The Annex is well
equipped to address behavioural issues and will not permanently restrict service to any
resident who requires service. Essentially, the program serves those for whom there is
no other option.
The age range of residents is 28-73 with the average age being in the mid-forties and
the average length of homelessness being 14 years. Although the program has a
maximum capacity of 128 at any given time, the reality is that a reduction in funding has
resulted in inadequate staffing levels to support this number. As such, it is generally
understood that there is no more than 100 people in the program at one time.

4
The word “vulnerable” is commonly used by the Annex to encapsulate the diversity in the population
served.

6


Transition from Homelessness to Housing
Men are generally referred to the Annex from the Seaton House Men’s Shelter
(including the Infirmary5), other shelters across Toronto, and medical institutions (There
is a strong referral relationship with St. Michael’s Hospital). Occasionally, men are also
referred from other communities. Out-of-town referrals are limited however, as it is
people are supported to develop connections in the area from which they are being
referred.
Housing Model
The Annex offers a congregate living environment on a single floor of the shelter. The
Annex residents can access any of the services available at Seaton House Men’s
Shelter. There are approximately 25 shared bedrooms with four to six beds per room
and four shared washrooms, along with one attendant care washroom located in one of
the bedrooms. The floor design resembles that of a hospital or long-term care home
with one main hallway with bedrooms and sitting areas that branch off. In total, there
are four common areas including, a bar room, TV room, library (often used for family
visits) and a dining area.
The kitchen area and laundry facilities are located on the main level of the shelter, and
are not commonly accessed by residents. There is no outdoor space, with the exception
of a small paved courtyard at the front of the building that is shared by all shelter
residents. Additionally, there is no designated staff meeting or break space.
Support and Services Model
The Annex offers a managed alcohol program (Level 5) and partial medical services.
The Annex is staffed by CSWs, who provide a wide range of support to residents. There
are a minimum of four CSWs on-site 24/7 at the Annex. CSWs work three 12-hour days
in a row and are then off for three days. They are recruited based on experience and
compassion working with the population served and are skilled in de-escalating conflict.
It is the expectation of the program that CSWs continue to provide support to residents
despite challenging behaviours.
The program also offers support management and counselling services. In the ideal
scenario, the Annex would have five support managers on staff; however, the program
was operating at a reduced capacity with two case managers in 2009 due to cutbacks in
funding. In addition to the on-site staff, other support is provided to Annex residents
through Community Care Access Centre (CCAC) and a Family Health Team. The
Family Health Team includes a variety of professionals such as an Addictions and
Mental Health Worker and a Recreation Therapist, which will vary depending on the
needs of residents.
Although the Annex offers partial medical services, it is the expectation that CSWs
advocate with the mainstream health care system should health issues arise. Medical
supports available on-site include an Infirmary and nursing care.

5
The Infirmary includes dedicated space to care for people with physical health issues. It serves as an in-
house medical clinic shared by residents of Seaton House and The Annex.

7


The nursing staff is on site 16 hours per day, seven days per week from 6:15am to
10:00pm. There is also a doctor training program run through the Inner City Health
Program where resident doctors have the opportunity to gain experience serving
residents of Seaton House. There are no medical clinics available on week-ends and
there are no dental services offered. The Annex has provided palliative care on
occasion where deaths were expected, although it does not formally offer this service.
Medical services offered do not include intravenous administration.
Managed Alcohol Services (Level 5)
It should be recognized that although the alcohol administration component receives the
bulk of media attention from the general public, it is only one piece of the overall harm
reduction approach that can lead to a significantly improved quality of life for residents
at the Annex. The stability and self-control that this general approach offers can be the
catalyst for other changes such as self-care, respect and dignity (Johnstone, 2008).
For some men at the Annex, managed alcohol services are introduced gradually after
being in the program for a period of time, whereas others are able to start soon after
entering the program. Residents receiving managed alcohol services (Level 5) must
agree to drink only in the program and not to consume alcohol out of doors or alcohol
not provided by the program. In the event that a resident goes off the property, the first
drink once returning is skipped (90 minutes). There is flexibility exercised for residents
who leave the property for medical appointments. Residents can remain in the program
24 hours a day (Svoboda, 2006).
Residents receive seven ounces of white wine (or another beverage alcohol that is
submitted to CSWs for distribution) every 90 minutes in the bar room. Intake is closely
monitored by CSWs as many men have liver damage when they enter the program and
have a reduced tolerance to alcohol. Residents can have up to ten drinks per day,
where the amount of alcohol administered is determined based on a person-centred
support plan. For example, some residents have only four cups of wine per day, others
have a glass of water before each cup of wine and some only have a half cup of wine.
A U-Brew service used to accommodate the large quantities of wine is needed but the
City requires that the wine now be purchased through a City bidding process. This has
caused the price of alcohol to rise substantially since the program opened. In 1996, the
price was two dollars per litre, and by 2009, the price had doubled to four to five dollars
per litre. This increase in price has been absorbed by the City of Toronto Hostel
Funding. The annual cost of wine is approximately $100,000.
Program Outcomes
Research has found that the Annex is more effective than the abstinence-based usual
shelter care approach. One study found that there was an 87% drop in emergency room
visits and a 43% decrease in detoxification unit visits that could be directly attributed to
the program (Svoboda, 2006). Further, many people receiving managed alcohol
services (Level 5) reduce their alcohol intake and approximately five per cent stop
drinking altogether and go on to treatment, long term care or stay with family.

8


Managed Alcohol Program/Men’s Enhanced Support Program (MESP)
Background
In 1999, the City of Ottawa undertook a
collaborative planning process, which resulted
in the first action plan to end homelessness.
The plan outlined the need to improve health
services for people experiencing persistent
homelessness including for those requiring
palliative and long-term care. In response, an
ad hoc cross-sectoral group formed to explore
ways to implement the health-related
recommendations in the action plan, and
Ottawa Inner City Health Inc. (OICH) was
formed.
Shepherds of Good Hope Emergency Men’s
The ‘founding partners’ of the OICH included Shelter (MAP), Ottawa
several emergency shelters and service centres
for people experiencing homelessness, primary health care facilities, public health,
Canadian Mental Health Association (CMHA), the City of Ottawa and the University of
Ottawa. Although the project did not have the support of the police during the early
years, it now shares that support.
At that time, through an informal count, it was recognized that approximately 70 people
within the population of people experiencing persistent homelessness were accessing
shelters and not being well cared for despite their complex health needs and frequently
used emergency services. The inability to address the needs of this population
stemmed from a combination of complex issues including serious physical health,
mental health and substance use issues as well as challenging behaviours. In
response, OICH developed a harm reduction approach to deliver health services to
people experiencing persistent homelessness with substance use issues within the
shelter system.
Shepherds of Good Hope shared an interest in developing a harm reduction approach
that included managed alcohol serves (Level 5) to meet the needs of shelter residents.
A relationship was established with the Annex Harm Reduction Program in Toronto,
which provided support, advice and staff training during the program development
stage. There was little resistance to the idea of developing the Managed Alcohol
Program (MAP), most likely because of its status as a pilot project and its location in the
Lowertown area of Ottawa where there is a high concentration of poverty and
community housing.
In 2001, $60,000 in funding was secured to support the pilot project through the federal
Supporting Community Partnerships Initiative (SCPI) to be delivered in partnership
with OICH and Shepherds of Good Hope. The pilot served ten people in one room
and had one staff. There was no medical component at that time.

9


Despite an extremely positive program evaluation and demonstrated cost savings of
$3,000,000-5,000,000, the pilot project funding ended in March 2003 without a
commitment of ongoing funding from the MOHLTC. Between March 2003-2005, the
program continued to operate on a combination of donations from partner
organizations and one-time funding from the MOHLTC. In 2006, MAP received
permanent funding from the MOHLTC. Each resident contributes $100.00 per month
towards alcohol and cigarettes from their PNA and keep $28.00. Residents are assisted
with managing finances, as required.
Population Served
Men and women can be accepted for admission to MAP if it is clear that an abstinence-
based environment would not be a viable option. Additionally, a person must meet the
following criteria:
• Long history of “street drinking” which has been unresponsive to addictions
treatment and which poses a serious health risk to the individual.
• Complex health problems, which are not being addressed due to alcohol use.
• Frequent user of emergency services (police, ambulance and emergency).
• Cause concern in the community due to alcohol-related behaviors.
There is space for 28 tenants in MAP, and a waiting list is being kept. At the time of the
site visit, there were 26 men and two females in the program who ranged in age from 35
to late 50’s.
Referrals for MAP are accepted from across the City of Ottawa and, in some situations,
from across the Province. Most commonly, potential tenants are referred by shelter
staff, police or community workers familiar with the person’s history of persistent
homelessness. A person can also self-refer to OICH or Shepherds of Good Hope.
At the time of referral, a person is assessed to determine if they meet the criteria listed
above and, at that point, it is determined whether or not they will be accepted into the
program or placed on the waiting list. The waiting list is quite flexible and people’s
names can be re-ordered depending on the severity of the need.
Admission is arranged upon agreement by the resident, program staff, program
manager and a registered nurse. When accepted for admission, the program is
explained in detail and an opportunity to enter the program on a trial basis (usually for a
few days) before deciding whether to be admitted is presented. People who are
admitted must consent to participate in OICH. This means that they must consent to:
• Agree to the “house rules” which are set in partnership by staff and the other
tenants in the program
• Participate in health care provided by a team of health care professionals
• Contribute $100 of $128 monthly personal needs allowance (PNA) toward
program expenses (i.e., tobacco and wine covering approximately 60% of the
total program costs).

10


• Not drink outside of the program, panhandle, or engage in other behaviours that
may cause a disturbance to the public
At the point of formal admission, the resident remains in the program for six weeks
before a decision on continued participation is made. This decision is made based on a
team meeting (including the participation of the resident). The program is very lenient
with new tenants and it is not expected that they follow any strict guidelines for the first
six months. During this time, a ‘two steps forward, one step back’ philosophy is
anticipated as long as tenants agree to take any medications recommended by a mental
health professional. There is no time limit with respect to length of stay provided that
the person continues to benefit from participation.
Housing Model
MAP is housed on the second floor of the Shepherds of Good Hope Men’s Emergency
Shelter. The Shepherds of Good Hope Men’s Emergency Shelter has a total capacity to
serve 100 men (including the 28 spaces in MAP). There is very little outdoor space
around the main doors of the shelter as it is located at a busy downtown intersection.
There are cameras in each hallway and in the common rooms that are connected to a
digital video recorder (DVR) in the staff office (providing live feed).
The housing model at MAP offers a congregate living environment, where there are
approximately ten shared rooms (three to five people per room). There is one room
designated for females (males and females do not share rooms). Each room is
furnished with a single bed and one full-sized locker per person. MAP also has one
shared kitchen and dining area where meals are served, two common areas, a laundry
room, two bathrooms, two shower stalls, and access to a tub room during the day in the
shelter on the main floor.
There are two staff offices in the program: one for Shepherds of Good Hope staff and
one for staff of the OICH Team. A particularly unique feature of this program is the
“smoking balcony,” which provides a safer way for tenants to smoke outside. The
alternative is interacting with all other shelter residents outside of the main doors, where
entrenchment back into street life is a constant threat.
As of 2006, funding to support MAP has been provided by the MOHLTC through the
Local Health Integrated Networks (LHIN’s) and the program is governed under the
Residential Tenancies Act (RTA).
MAP offers a managed alcohol program (Level 5) and partial medical services. Support
for MAP tenants is provided by both support workers and Client Care Workers (CCWs).
Support worker services are offered through Shepherds of Good Hope who provide
non-medical day-to-day support such as preparing meals, organizing recreational
activities, filling out applications for OW and ODSP. CCW services offered through
OICH provide support for more specialized medical needs such as nutrition, hygiene,
health needs and medications. CCWs also dispense regular medications and manage
alcohol intake for tenants.

11


The program is staffed 24/7. Days are staffed by one support worker and one CCW.
Nights are staffed by one CCW. Due to the connection with OICH, MAP is able to
incorporate a medical component into the program. Nurses and doctors visit MAP
periodically to assess and treat tenants. MAP staff work to advocate with the
mainstream health care system and tenants are encouraged to seek health care from
family doctors, specialists and the hospitals. Although palliative care is not formally
offered, many tenants will experience end-of-life while in the program.
MAP also operates a Day Program where men from other supportive living programs in
the city of Ottawa can participate. The funding for the Day Program is the same as for
the residential program in that each participant makes a contribution towards program
expenses (i.e., wine and tobacco). The Day Program provides a flexible and creative
way to serve additional people, despite capacity limitations of the residential program. It
has been very useful for former tenants who have transitioned from MAP, but continue
to require managed alcohol services (Level 5).
At the time of the site visit, there were four participants enrolled in the Day Program
(three males and one female). The structure of the Day Program is similar to the
residential program with the exception that the tenant’s last drink is one hour before that
of the residential tenant. Due to the limited amount of space in the common areas of
MAP, the expansion to offer a Day Program has also caused some challenges with
respect to triggering incidents for tenants. Such incidents can occur when there are too
many people with complex issues in a small space.
The managed alcohol component of the program is person-centred and based on an
intake and assessment process. It can vary in a number of ways from person to person
in terms of the amount and frequency of alcohol administered, and each person is
assessed before every drink. At a maximum, MAP provides five ounces of wine (red or
white at 12% alcohol) between the hours of 7:30am to 9:30pm to tenants in the program
(up to 14 drinks per day). Tenants receive seven ounces of wine for their first drink of
the day. Tenants can also purchase their own alcohol off-site for administration, based
on preference. Yearly cost of wine is $20,000 for all managed alcohol
tenants/participants. The wine is made on the first floor of the shelter. Each tenant is
also given the equivalent of one pack of cigarettes per day. The amount is broken up
over the morning and early afternoon.
Program Outcomes
Over time, the benefits of MAP have been shown through reduced need for emergency
services as well as the reduced number of people on the street. Further, many MAP
tenants have reduced their alcohol intake as a result of the managed alcohol services
(Level 5) and a small number of tenants have become abstinent. Such tenants have
chosen to remain in the program because the hourly ritual of receiving an hourly drink
with peers (e.g., grape juice) continues to provide a sense of security and consistency.

12


Men’s Enhanced Support Program (MESP)
MAP was transformed in April 2010 and is now called the Men’s Enhanced Support
Program (MESP). Although the funding structure remains the same, the program is a
more clearly defined, and less “quasi supportive living”. The new program inhabits the
same physical space as MAP (located on the second floor of the Shepherds of Good
Hope Emergency Shelter), and now has the capacity to serve 50 men. It is also possible
for MESP to lay eight mats down at night in case of absolute emergencies, which would
bring the program’s total capacity to 58 (not included in the description below). Since
opening the program had 58 tenants on two occasions and it averaged 45 tenants for
the month of May, 2010.
The MESP program was able to increase capacity (i.e., from 28 to 58 spaces) due to its
expansion to include a Recovery and Overflow program, of which there is a substantial
degree of overlap between these two programs. For example, when Recovery runs out
of beds, Overflow beds are used. As such, the Recovery and Overflow beds are often
presented as a combined program. For the purposes of clarity however, the two
programs are described separately below.
The three program components of MESP are as follows:
12 MAP beds
Essentially, this program has started over again as many previous tenants have moved
to the Oaks (refer to section that follows for a description of the Oaks). Tenants in MAP
require intensive support and are active in their substance use. MAP only serves men,
however there is a Day Program able to accommodate four women. The MAP area of
the program currently consists of three dorms (with four tenants per dorm), the
kitchen/dining area, and the former Ottawa Inner City Health office (now shared space
for both MAP and OICH staff). There is a door between Dorm 3 and Dorm 4 to separate
MAP from the Recovery and Overflow programs.
MAP differs from the Recovery and Overflow programs because it is longer term and
there are managed alcohol services offered (Level 5). It is the intention that the MAP
tenants progress and are eventually able to move to the Oaks as space becomes
available.
30 Recovery beds
There are a total of 30 Recovery beds. These beds are shorter term and provide a safe
area, where people under the influence of alcohol and or mood alternating substances
can become sober from 8:00pm to 6:30am. It offers Level 2 services on the Substance
Use in the Context of Housing Continuum (see Figure 2).
This program serves people with high-level needs who have faced service restrictions
from all other agencies. If tenants request help, they will be referred to a Royal Ottawa
Hospital Addiction Counsellor who also visits the program twice a week. However, it is
a non-judgemental program that puts “zero pressure’” on people. There is an
understanding that treatment will not work unless the resident is ready, and on their own
terms.

13


This program also existed prior to April 2010, as a 21-bed program on the first floor of
the Shepherds of Good Hope Emergency Shelter. Upon establishment of the MESP,
the floors were divided by gender so recovery for men was relocated to the second
floor. In addition to these 30 beds, there is a Recovery Program for women operating
out of the first floor of the Shelter.
8 Overflow Beds
There are a total of eight Overflow beds (usually mats on the floor), which are used
when the Recovery Program is at capacity. This program operates similarly to the
Recovery Program.
The MESP has retained the same staff from the former MAP. Note that there is also a
nurse coordinator assigned to the MESP five days per week.
Below is the adjusted staff schedule for MESP:
7:00am to 3:00pm
• MAP: 1 Support Worker, 1 CCW
• Recovery/Overflow: 1 Support Worker
3:00pm to 11:00pm
• MAP: One CCW
• Recovery/Overflow: One Support Worker
5:00pm to 1:00am
• One Support Worker operating between all three programs

11:00pm to 7:00am
• Two Support Workers operating between all three programs. (MAP is closed
from 10:00pm to 6:30am as tenants are sleeping or relaxing in lounge)

14


The Oaks
The reduction in the number of MAP
beds from 28 to 12 coincided with the
opening of The Oaks, which began
operating in January 2010 in two
former hotels located in the west end
of Ottawa. The supportive housing
program is a partnership between the
Shepherds of Good Hope, OICH and
the Canadian Mental Health
Association, coordinating the housing
and health services, respectively.
The capital purchase was funded The Oaks, Ottawa
using six million dollars from the
federal and provincial governments. The provincial Domiciliary Hostel Program provides
operating funding for 45 units. The Canadian Mental Health Association provides
support (paid through the LHIN’s) to 10 self-contained units for which tenants pay
affordable rent.
The Oaks consists of a total of 55 rooms (19 and 36 units per building, respectively), in
semi private self-contained units (including kitchenette). The smaller building and the
top three floors of the larger building consist of apartments and rooms that house the
tenants. The ground floor of the larger building houses the administration functions, staff
offices, and common areas for both buildings, such as the kitchen, dining room, TV
rooms, exercise room and wine-making room (Homelessness Forum and Managed
Alcohol Program, 2009). Two tenants share each room and have access to cooking
and cleaning services (Mauro, 2010).
The Oaks provides supportive housing to men and women who have experienced
persistent homelessness with concurrent mental, physical and substance use issues.
Thirty units are reserved specifically for tenants in MAP who are ready to move onto a
more independent supportive living environment.
The Oaks offers a managed alcohol program (Level 5) and comprehensive medical
services. Tenants receive the same managed alcohol services (up to five ounces of
wine each hour) as tenants who participate in MAP located at the Shepherds of Good
Hope Emergency Shelter.
In January 2010, 40 tenants moved into their units at the Oaks and the remainder of the
units were occupied in May 2010. Intensive case management support is provided on a
24/7 basis by at least two staff from Shepherds of Good Hope and Ottawa Inner City
Health (OICH). Staff provide assistance with activities such as cooking, laundry,
bathing and transportation to appointments. There is also a full-time nurse, a registered
practical nurse (RPN) and a psychiatric nurse available to tenants. A doctor visits twice
a week (CBC News).

15


Claremont House Special Care Unit (Claremont House
Background
For many years, people experiencing persistent
homelessness with substance use issues had very
limited housing options in Hamilton, due to the
abstinence policies in place at emergency shelters.
The exception was Wesley Urban Ministries6 that took
a harm reduction approach, serving people active in
their substance issues. It was open 24 hours a day
and offered a needle exchange program. In response,
Hamilton health and social service providers, along
with police, shelter staff, and addiction workers took
the initiative to address the issue by forming a Claremont House resident, Hamilton
Steering Committee in 2003.
A summary of actions taken by the Steering Committee in the development of
Claremont House included:
• Site visits to Seaton House (the Annex) in Toronto and Shepherds of Good Hope
(MAP) in Ottawa.
• Information gathering regarding the potential demand for this service in Hamilton.
Discussions regarding potential participants occurred with outreach workers,
shelter staff and police officers.
• From those discussions, there was agreement to propose the creation of a 20
bed managed alcohol program (Level 5) that would reach out to both men and
women.
• Discussions were held with municipal and provincial funders to brainstorm
possible longer term funding strategies should such a project come to fruition in
Hamilton. Although no commitments were made, the inclusion of funders at an
early stage laid the groundwork for future discussions.
• Discussions were held to determine the structure for operating this project in
Hamilton. The steering committee agreed that Wesley Urban Ministries was best
positioned to lead this project from an operations perspective.
• A partnership with McMaster University School of Nursing to support the
development of primary health supports for the project was established.
• To leverage the strength of collaborating partners, a comprehensive model was
proposed to the community that could coordinate both health and social services
to deliver clinical evidence-based care through an inter-professional team.

6
In August 2010, in response to a significant drop in the number of overnight emergency shelter
residents, Wesley Urban Ministries closed its emergency shelter (Wesley Centre) and transitioned to a
day-time drop-in program. This allowed the other existing emergency shelters to remain open. Now,
people are allowed to enter all other shelters, which have extended their hours to have 24/7 access. The
needle exchange program is not being administered by any other shelter.

16


The development of a managed alcohol program (Level 5) was included as a special
priority item in the Hamilton Community Plan Update for 2003-2006 and the project was
successful in acquiring funds from the federal Supportive Communities Partnerships
Initiative (SCPI) in 2004-2007. Subsequently, the program was funded by the Ministry
of Health and Long-Term Care (MOHLTC) 2007-2008; and the Local Health Integrated
Network (LHIN’s) from 2008 to present. Support for the project was strengthened as a
result of the timely release of a local research study that involved tracking the use of
medical services for 21 people experiencing persistent homelessness in the downtown.
The study found that it was a much more appropriate use of resources to house people
experiencing persistent homelessness than it was to keep them in a homeless situation.
In March 2006, Claremont House opened its doors to residents. From concept to
completion, the program took four years to develop, and the building itself took seven
months to renovate. Claremont House is located on a multi-acre property that is home
to St. Joseph’s Healthcare Hamilton (SJHH), about a ten minute drive away from the
downtown. Claremont House residents do not make direct use of mental health
outpatient clinics offered through SJHH, but do use services available through SJHH
Rehabilitation Services (e.g., recreation, smoking cessation, computer skills). SJHH
provides specialized tertiary mental health services and community services to
thousands of outpatients.
Claremont House is managed by Wesley Urban Ministries and governed by the Wesley
Board of Directors. In addition, there is a community advisory board. The advisory board
is comprised of members of the neighbourhood, shelter representatives, public health,
SJHH, police, addictions, etc.
The purpose of the advisory board is to:
• Provide a forum for sharing information amongst the staff and interested
community stakeholders about Claremont House, its accomplishments and
challenges
• Build capacity to support the program
When Claremont House initially began operation, the community advisory board met
monthly. Over time, meeting intervals have been reduced to quarterly; however the
ability to call further meetings as necessary remains an option.
Upon opening, a staggered intake approach was used in order to allow staff to become
comfortable with protocols and the model of service delivery. As such, it took close to
six months for the program to reach full capacity.
Population Served
Claremont House serves men and women experiencing persistent homelessness who
have substance use issues combined with serious health issues that have led to a cycle
of repeated visits to emergency rooms, hospitals, detoxification centres and correctional
facilities.

17


Claremont House has a total capacity of 16 spaces. Residents range in age from 40-75
years (mean age is 52 years). The program has one room that locks and is suitable for
two female residents. A waiting list is kept and, at the time of the site visit, there were
three to five people on that list.
Referrals are made as a last report in situations where other treatment options have not
been successful. Referrals are accepted from any source such as hospitals or shelters,
as well as self-referrals. It has also become more common for judges to court order
residents to Claremont House. Several residents have chosen to remain in the program
after the court order has expired.
In the 18 months preceding the site visit, a total of 90 referrals were made to the
program. An intake interview is completed for all referrals made to the program.
Approximately 40% of referrals are accepted (others are seen as inappropriate and
counselling on alternative programs is provided).
All referrals are discussed with program staff and a joint decision with respect to
acceptance is made. If accepted to the program, residents must complete End of Life
Planning including a Living Will. All residents are strongly encouraged to have a
trustee.
Housing Model
As indicated above, Claremont House is located on an expansive property that is home
to SJHH. There is one main entrance into the building, where clear sight lines for staff
eliminate the need for an external security system.
Claremont House provides a congregate living environment and is conceptualized as a
health facility. The program is housed in a single-floor building that formerly served as
office space for SJHH staff. The building is historic, but was renovated with an open
concept design that allows for a great deal of light. Upon entry, the kitchen, small
common area, and front reception desk are all within full view.
During the renovation process, six bedrooms on the main floor along with a combined
palliative/clinic room, overflow and staff office space were constructed. There are two
washrooms on the main floor (one for residents and one for staff). There is a recreation
room along with a laundry room and pantry in the basement.
One of the most prominent features of Claremont House is the expansive back
yard/patio space. This space is used for eating, socializing, smoking, recreational
activities as well as resident appointments with counsellors and psychiatrists. The
outdoor area can be easily accessed by residents.

18


Claremont House offers a managed alcohol program (Level 5) and comprehensive
medical services. The program provides short stay assessment, longer-term continuing
care and palliative care. In addition to managed alcohol services (Level 5), the following
services are offered at Claremont House:
• 24/7 Nursing Care
• 24/7 Social Services
• Physician care (Through the Shelter Health Network)
• Psychiatric care (Through the Shelter Health Network)
• Personal Counselling
• Housing Counselling
• Health Assessment and monitoring
• Stage-based motivational strategies
Claremont House delivers comprehensive medical services and formally offers palliative
care. The care model resembles service delivery in a long-term care home with 24 hour
supervision and 24 hour access to a social worker (BSW), registered nurse (RN) or
registered practical nurse (RPN), and physician. In situations where an RPN is on staff,
there is an RN on-call. Additionally, there are psychiatrists on staff that visit Claremont
House monthly.
Further, the program makes use of a variety of additional services to include Transitions
to Homes Program (formally called Hostels to Homes and operated by Wesley Urban
Ministries); Mission Services for Trusteeship; PX Dermody Funeral Home for
Counselling; and Mental Health Public Health Outreach Team (for residents who
formerly had case workers from the team). Claremont House does not often make use
of services such as Community Case Access Centre (CCAC), and the Assertive
Community Treatment Team (ACTT).
Staff also share the responsibility of planning daily recreational activities which may
include going to the SJHH gym, walks, bowling, a boat cruise, Society for the
Prevention of Cruelty to Animals (SPCA) pet therapy, Wii, pool tournaments, etc. On-
site staff work 12 hour shifts (9am-9pm and 9pm-9am) coinciding with Wesley Urban
Ministries staff scheduling model.
Claremont House also offers short-term assessments of up to two weeks, where a
resident’s substance use behaviour is monitored and a harm reduction plan is
developed (e.g., context, pattern, quantity, etc.). The plan can then be applied to a
community setting where the resident resides and staff continue to be available to offer
guidance and support throughout its implementation. The need to expand capacity for
short-term assessments was identified.
At the time of the site visit, there was one person enrolled in the Day Program. This
person was abstinent and spent his days in the program enjoying the company of other
residents and participating in recreational activities. At its peak, there were four people
in the Day Program.

19


There is a high level of student involvement from social services, nursing, medicine and
rehabilitation sciences. Such placements are an integral part of the program. Not only
are McMaster University students given the opportunity to complete course work but are
in addition, they are provided the opportunity to be immersed in a setting serving a
population facing a number of barriers in mainstream society. In addition, McMaster
University students from a variety of disciplines across campus are given opportunities
for Service Learning at Claremont through the undergraduate Health Sciences Poverty
and Homeless Course.
Several volunteers offer services to Claremont House residents. Volunteer activities
include: cooking, attending AA meetings with residents and recreation activities such as
attending football and hockey games.
The managed alcohol services (Level 5) offered at Claremont House consist of the
administration of four to seven ounces of white wine or a serving of beer per hour from
7am until 10 pm (based on a person-centred plan). Other alcohol (e.g., scotch and
sherry) can be purchased by residents and served as well; where one and a half ounces
is the equivalent of 5 ounces of wine or a serving of beer. Claremont House has an
agreement with the same winery used by Seaton House for the purchase of wine
(DeSousa Wine Cellars). The beer is made at a U-Brew location, where residents
participate in its preparation every two weeks.
Program Outcomes
The program was described as a “journey” by one Claremont House resident because it
helps a person to transition from a certain way of life on the streets that is focused more
heavily on survival, getting alcohol, and finding shelter to being able to address
traumatic experiences and persistent mental and physical health concerns.
Of the total composition of Claremont House residents, 30% are re-integrated into the
community, 25% have multiple admissions, 25% experience end-of-life care and 20%
are in the program on a short-term assessment basis (less than two weeks).

20


Figure 5. Claremont House Special Care Unit – Resident Composition

Claremont House Special Care Unit - Resident
Composition

Short-term
Assessment
20%
30%
Community Re-
integration

Experience
end-of-life

25%

Multiple Admissions
25%

Multiple Admissions
Some residents have multiple admissions to Claremont House. These residents
typically have difficulty adhering to the managed alcohol program and choose to
continue a pattern of binge drinking. In fact, it was estimated that one in five residents
will not be able/desire be part of a managed alcohol program. As such, the decision to
transition from the program is mutually determined after a series of attempts. Residents
may also experience difficulties with the realities of communal living. When a person
leaves Claremont House under these circumstances and has behavioural challenges,
there are few alternatives available beyond the streets, incarceration or finding housing
through the newly funded Transitions to Homes program. Accordingly, it was identified
that there still remains a small group of people experiencing persistent homelessness
who remain difficult to serve in Hamilton.
Community Re-integration
While it was originally anticipated that most residents would remain in the program until
end-of-life, Claremont House has discovered that 30% of residents are being re-
integrated back into the community. In response, there is an increasing need for
housing support co-ordination services as part of the host of services offered through
the program. The Transitions to Homes program has become an important link to
Claremont House for such individuals.
Development of Multiple Addictions
It has been observed over time at Claremont House that some residents experience
challenges with multiple addictions (e.g., crack and alcohol). In addition to the legal
issues, this situation presents complexities because the program is not equipped to
serve people with drug use issues (although methadone can be prescribed).

21


In the scenario where multiple addictions become evident, residents work with the
physicians and staff to determine a suitable plan.
Reduced Alcohol Consumption/Abstinence
Initial research has demonstrated that the managed alcohol services have led to a
substantial decrease in alcohol consumption and, in some situations, abstinence for
residents (6 out of 16 residents were abstinent at the time of the site visit). These
unanticipated outcomes are currently being further studied by a team of researchers
from McMaster and Athabasca Universities.
Research questions generated by the team include:
• What are the staff variables that might contribute to abstinence? What is the
influence of non alcoholic beer? What is the effect of seeing other residents
abstain?
• What is the effect of seeing other residents experience end-of-life?
Need for Additional Supportive Housing On-site
At the time of the site visit in 2009, St. Joseph Healthcare Hamilton (SJHH) was
planning for the re-development of its site. This would displace Claremont House.
Currently, Claremont House is exploring opportunities to relocate to another larger
building at the SJHH site.

22


LEVEL 4 PROGRAMS (SUPPORT)
Brigid’s Place
Background
The City of Ottawa was aware of the need and
lack of resources with respect to housing
options for women experiencing persistent
homelessness with substance use issues and
challenging behaviours. The Hope Outreach
Emergency Shelter of Shepherds of Good Hope
is one of two shelters in Ottawa that accepts
women 18 years of age and older. The women
being served at the Shepherds of Good Hope
are often turned away from other shelters due
primarily to lifestyle choices and behaviour.
Brigid’s Place, Ottawa
In response, a coalition formed which became
known as the “Women’s Roundtable.” The Women’s Roundtable consisted of a group of
women representing some of the key agencies in Ottawa working with women
experiencing persistent homelessness, including: Shepherds of Good Hope, Elizabeth
Fry Society, women’s shelters, housing providers, etc. The group originally consisted of
30 women, which slowly became a group of six core members.
The Women’s Roundtable agreed that, in accordance with the City of Ottawa’s Strategic
Plan, more permanent housing rather than shelters would be the main focus of
attention. The group conducted site visits at other low barrier housing programs serving
women with complex issues across Canada. Brigid’s Place was inspired by “The
Vivian” in Vancouver that provides housing for women experiencing persistent
homelessness living with concurrent mental health issues, addiction and other
challenges using a harm reduction approach. The local program was named Brigid’s
Place in recognition of the Agency’s roots which started in the basement of St. Brigid’s
Church. It also seemed fitting that the name Brigid represents the Gaelic goddess of
survival.
Brigid’s Place is a program of Shepherds of Good Hope located in the Lowertown area
of Ottawa. It offers permanent housing with the intention to be transitional7 for women
who experience multiple barriers to securing and maintaining housing, including but not
limited to substance use, mental health issues, poverty and involvement in the criminal
justice system. A harm reduction approach is adopted where it is not expected that
tenants abstain from using alcohol or drugs, or street-related activities on-site as long as
they do not engage in these activities in common areas of the house and are respectful
of other tenants and staff.

7
Brigid’s Place is funded under the provincial Domiciliary Hostel Program and is therefore considered to
be permanent housing protected under the RTA. However, the intention is that the program will assist
tenants to transition towards greater independence and find permanent housing.

23


Funded through the City of Ottawa, Brigid’s Place opened in 2008 as a six month pilot
project. After the pilot project funding ended in 2008, Brigid’s Place secured two years
of funding through the Provincial Domiciliary Hostel Program (2009-2011) as well as
through the federal Homelessness Partnership Strategy (HPS) to offset the costs of
staffing.
Population Served
Brigid’s Place serves women who:
• Have a concurrent disorder
• Are active in their substance use (most commonly crack cocaine, morphine or
methadone) and are motivated to explore harm reduction alternatives
• Are street entrenched
• Could be involved in sex work
• Could be involved with the criminal justice system
• Have a shelter stay of over 90 days
• Have difficulty accessing housing due to lifestyle
• Need the most assistance
The women residing at Brigid’s Place range in age from 26 to late 50’s. With respect to
housing history, most women have had housing for a few months to a few years, but
have not been able to maintain that housing due to behavioural challenges or unability
to pay rent. Many women have experienced persistent homelessness and may have
experienced service restrictions at emergency shelters.
Brigid’s Place is not intended to serve:
• Men of any age
• Women under the age of 18
• Women not active in their addiction
• Women with very low levels of independence (e.g., unable to shower or eat on
one’s own). However, it is the expectation that the women may sometimes need
to be reminded to do these things
• Women with physical disabilities because there is no elevator
• Women with complex and chronic medical issues because medical staff is not
on-site 24/7
Most referrals for Brigid’s Place are received through the Ottawa Inner City Health
(OICH) Team, which operates a special care project at the Hope Outreach Emergency
Shelter.
When accepted to Brigid’s Place, the intake process is very straightforward with minimal
signing of forms required. Although tenants are protected under the rights of the RTA,
in lieu of signing a lease or tenancy agreement, tenants sign an Agreement to Reside
(Refer to Appendix A). This Agreement to Reside includes an understanding of the
following:

24


• All forms of violence are discouraged. Anyone involved in violent interactions
has the right and responsibility to deal with it accordingly (i.e., call police if
necessary) to resolve or improve the situation.
• Tenants will not bring weapons in the house or onto property in order to maintain
the safety of the environment.
• Tenants will respect the common areas of the house and refrain from bringing
drugs/alcohol/paraphernalia into these spaces.
• Tenants will be accountable for any and all visitors that are invited into the house.
If a tenant is suspected of dealing from on property, she will not be allowed
visitors.
In addition to the Agreement to Reside, the following general guidelines apply to tenants
in the program:
• Treat all other tenants, staff and the house with respect. This includes respecting
personal boundaries, opinions and lifestyle choices.
• Bring forward any feedback in a constructive and non-threatening manner using
the feedback procedure and monthly tenant meetings. Work collaboratively with
staff to ensure the issue is improved upon or resolved.
• Help keep the home safe and clean. This includes maintaining a clean and
hazard-free bedroom, cleaning up after oneself in common areas including the
kitchen and bathroom and taking necessary precautions to prevent hazards from
occurring and when they do alerting staff immediately.
• Provide input on meals, and be present during meal times. Maintain the repair of
all furniture and linens provided by Brigid’s Place and maintain personal hygiene.
Other guidelines at Brigid’s Place are flexible and can be altered in response to the
changing needs of the house with staff and tenant input. It is the expectation that
tenants are involved in all relevant decision-making processes.
Housing Model
Brigid’s Place is housed in a duplex owned by Shepherds of Good Hope located in the
Lowertown area of Ottawa at 78 Nelson Street. The building itself has little identifiable
signage, with the exception of a small plaque on the front door. There are security
cameras located outside of the building, although they are inconspicuously placed.
The housing model at Brigid’s Place offers a congregate living environment with 11
private bedrooms and two washrooms located on two floors. All bedrooms are
furnished in a similar way and include a bed, bed dressing, night stand, TV, small fridge
and window coverings. There is one common area located on the main floor of the
house next to the kitchen. Further, the basement was recently renovated and provides
quiet space for the tenants, computer use and weekly support group meeting space.
There is also a small backyard with a deck and a barbeque. There is a staff office space
with a large window located next to the front door, which allows staff to easily monitor
activity of tenants and guests.
Brigid’s Place tenants are not expected to contribute their personal needs benefit (PNB)
in the Domiciliary Hostel Program. OW or ODSP cheques are mailed to Brigid’s Place
and made out to the Shepherds of Good Hope (pay direct). Cheques are signed by the

25


tenant and cashed by the Shepherds of Good Hope Finance Department. In turn,
tenants receive a monthly PNB (in addition to a special diet allowance or transportation
allowance, if appropriate) paid in cash on the day the cheque arrives.
Brigid’s Place offers a Level 4 approach to substance use and non-medical services.
The program has on-site staff 24 hours a day, seven days a week and includes three
shifts. The program is largely single staffed with day and evening shifts benefitting from
more staffing presence. At the time of the site visit, the program had ten staff in total,
including managers, full-time front-line staff and casual staff. Casual staff can work up to
four days per week. Most staff have a background in criminology, social services and/or
counseling.
The bulk of staff duties include assisting tenants to:
• Build and enhance life skills, which could include financial management,
cooking/shopping, accessing services in the community.
• Enhance individual well-being. This could involve safety to self and others, health
services, mental health services, and substance use options. Work on the
options for the future (e.g., housing search, education, income and employment).
• Work through issues by employing support management strategies and using
motivational interviewing techniques.
Staff is responsible for providing tenants with two meals a day (lunch and dinner) based
on the posted menu. Tenants are encouraged to join the others for meals, although the
reality is that often meals will go missed by some or all tenants. With the support of
tenants, staff also help organize events and activities such as crafts, gardening, movie
nights and other events that take place both within the residence and in the community.
A great deal of effort has been made by staff to connect the tenants at Brigid’s Place
with resources available though OICH, Public Health and the health care sector. The
program has connections with mobile outreach workers, sex outreach workers and
CMHA who also visit Brigid’s Place on a weekly basis. Further, there is a concurrent
disorder group offered through CMHA and Oasis on a weekly basis.
One of the many roles of staff is to educate regarding risks and safety as several
tenants have Hepatitis C or HIV/AIDS. With respect to medical support, a doctor and a
nurse visit the residence for two hours on a weekly basis, and tenants can request an
on-site appointment outside of those designated times.
Additionally at the time of the site visit, there was one volunteer providing cleaning
services twice per week and another who prepared dinner for the tenants on a weekly
basis. From time to time, there are also students who volunteer at Brigid’s Place.
Tenants are encouraged to take advantage of the Social Initiatives Program, where
various tasks or chores are completed around the residence in exchange for a gift
certificate (e.g., Giant Tiger, The Bay, etc.).

26


Brigid’s Place originally had a Visitor’s Policy where tenants were able to have up to two
visitors at a time (maximum allowed per room according to the fire code). Visitors were
to be accompanied by the tenant at all times in all spaces of the house (i.e., bedrooms
and common areas). As of 2010, this policy was altered so tenants are now able to
receive a maximum of two visits per day and there are no overnight stays. There are
visitor-free days on Wednesdays and Sundays. As well, from Monday to Sunday, no
visitors are permitted from 5-7pm or after 11pm. Staff on duty keep an up-to-date
“Visitor Log” in the office as a way of staying informed with respect to the number of
people in the house at any given time.
Harm Reduction Approach to Substance Use
Brigid’s Place adheres to a harm reduction philosophy, where risks and consequences
of a particular behaviour rather than the behaviour itself are the focus. In the context of
substance use, this means focusing on strategies to reduce harm. Tenants are not
expected to abstain from using alcohol or other drugs (e.g., crack, heroine, marijuana,
morphine) or from carrying on with street activities while living on-site. Drug use and
other activities are not condemned or condoned, but are addressed as a health
concern.
In order to promote safe use by tenants, SITE Needle Exchange Program provides
supplies (e.g., needles, alcohol swabs, tourniquets, Vitamin C packages, condoms).
These supplies are located in a drawer in the common area and are available at no cost
to tenants. Staff keep 40 syringes in the drawer at all times. Biohazard containers are
also provided so that tenants can safely dispose of their supplies. The only supplies not
provided are crack pipe kits, although tenants are able to obtain these materials from
City outreach workers. Tenants can access supplies without asking staff first and there
is no limit as to how many needles can be given out. Tenants do not need to hand in
needles in exchange for clean ones.
Program Outcomes
Since opening in late 2008, success for tenants has been realized in a number of ways
including:
• A reduction and/or stability in substance use
• Links to community resourcesSetting goals
• Reconnecting with family/children
• Increased quality of life
Further, tenants themselves have noted the following positive impacts as a result of the
program:
• Feeling accepted
• Strong sense of community
• Feeling like my voice is heard
• Feel more “normal”
• A reduction in cravings, substance use and sex trade work
• Having my own space

27


Brigid’s Place

A place for women called Brigid’s Place, all the women here being from
coast to coast.
Every attitude you will find, a lot of addictions on the mind.
All the girls with a horrid past, society wondering if we will last.
Most of us never knowing a home before, so we hang a welcome sign on
our door.
Having house meetings where all are involved, hoping some of our
problems can be resolved.
Waking up from nightmares from our past, bringing them out to talk about
it at last.
Finally people that will listen to us,
All our problems we need to discuss.
As communication is a must, digging our memories out that we just
covered in dust.
Staff, thanks for opening this house with love and care,
A roof over our head for all to share.
Going out in public without fear, big thanks for letting us know there are
people who truly care.

Written by: Dakota, Brigid’s Place Resident

28


Fred Victor Housing
Background
For over 116 years, Fred Victor (FV) in
Toronto has acted as a multi-service
organization with a goal to provide basic
needs to people experiencing
homelessness. Over the years, the
organization has expanded tremendously.
In addition to providing permanent housing,
FV offers shelter services, women’s
programs, food services, employment and
skills training as well as community
programs.
Fred Victor Housing, Toronto
In 1980’s, FV worked with other anti-poverty
organizations to develop a plan for the development of permanent supportive housing
for people experiencing persistent homelessness in Toronto. In response, FV closed its
short term men’s hostel and senior men’s home in 1988 and replaced it with 194 units of
supportive housing on the corner of Queen and Jarvis Streets.
Since opening, there has been a degree of “not in my backyard” (NIMBY) due to the
high concentration of services in the area (there are 1,200 shelter beds in the immediate
vicinity of the building). The NIMBY has been particularly pronounced in more recent
years with the combination of an influx in tenant drug use and the neighbourbood
becoming gentrified as condominium buildings are being erected. FV continues to
prioritize its focus on community awareness and strengthening these relationships.
FV Housing is funded through the Social Housing Unit at the City of Toronto, and the
units are rent-geared-to-income (RGI). As such, the program must comply with the
Social Housing Reform Act. FV Housing is covered for vacancy loss as there is no
financial penalty for non-payment of rent or abandonment of units.
The program collects approximately $300,000 per year total in RGI, which covers about
15% of the total operating expenses (approximately $2 million). It is estimated that 90%
of tenants at FV Housing are in receipt of OW or ODSP. The income from the remaining
tenants comes from a combination of Canada Pension Plan (CPP), Old Age Security
(OAS) as well as paid employment. Other expenses are covered by a combination of
funding sources that include the City of Toronto, federal government, United Church,
individuals, foundations and corporations. FV Housing operates under the Residential
Tenancies Act (RTA), and is therefore permanent housing.
Population Served
FV Housing offers low-barrier housing and serves people with medium to high level
support needs (low level healthcare needs) who have experienced long periods of living
on the streets, in shelters or in health or correctional facilities. Often tenants are active
in their substance use.

29


Candidates who display extremely violent behaviours and/or cannot reside with others
would not be a good fit for this program as it offers shared accommodation. Tenants
range in age from 20 to 73 years, with the average age being 45 years. There is space
for up to 194 women and men at FV Housing and a waiting list is kept. Average wait
period is six to nine months for men and less than a month for women.
Although FV Housing is governed under the Social Housing Reform Act, the program is
exempt from selecting tenants from the centralized co-ordinated access list due to the
special needs of the population and specialized services provided (there are over
70,000 people on this list). As such, a reverse referral process is used where referrals
are received from other shelters across Toronto as well as through walk-ins and self-
referrals. FV Housing also has a referral agreement for 10 units with Streets to Homes
to provide immediate housing to people in that program.
As a result of the shared accommodation model, the intake process is very important.
Potential tenants are asked about their substance use behaviours as well as their ability
and preferences as they relate to living with others. Honesty by tenants and a non-
judgmental approach by intake workers are critical to this process in order to ensure
that tenants are placed in a unit that is a good fit with his or her lifestyle.
Housing Model
FV Housing consists of two four-story apartment At first, I wasn’t impressed at six
buildings side-by-side in downtown Toronto close to people living in one unit. However,
amenities and other shelter services. The building everything has worked out okay. It is
on Jarvis has been owned by the FV for many years just we have to find different times to
and the building on Queen was purpose-built. use the common area where the
stove and fridge are. We all get
FV Housing has a single point of access, as all along pretty well.
other entrances are secured with magnetic locks.
There is a security guard at the front entrance and Quote from: Toward Effective
cameras located in the elevators. Each building has Strategies in Harm Reduction
two elevators. On-site staff offices are located at the Housing, 2009.
back of the building.
The housing model offers shared accommodations with three to six bedroom units.
Each tenant has a single furnished bedroom (10x12), with a small fridge and lockable
kitchen cupboards. A washroom is shared with one other tenant, and the kitchen and
living space is shared with all other tenants in the unit.
Redevelopment of FV Housing began in May 2010 to be completed in May 2011
At the time of the site visit, FV Housing was in the process of completing floor plans for
renovations that would reduce the density of the population and offer higher levels of
support. The intention was that the first floor would provide additional program and
office space, and the second floor would operate using a shelter per diem model (non
RTA) with 20 smaller units. Second floor units would be smaller than a bachelor unit
and would not have a kitchenette. The programming element and design would be
targeted toward people with high-level needs.

30


The upper floors will provide a shared living arrangement, similar to what currently
exists. The new design provides tenants with larger bedrooms with private washrooms.
All rooms will have air conditioning, and important fire safety features, including
overhead sprinkler units. As such, this new model would provide for a range of housing
options for people with varying levels of support needs.
FV Housing offers a Level 4 approach to substance use and non-medical services.
Support to FV Housing tenants is provided by housing workers who are on site 24
hours a day, seven days per week. There are a minimum of two housing workers on
site at any given time. Housing workers assist tenants in making a successful
transition to permanent housing in a variety of ways, which could include:
• Support and encouragement in decision-making (unit and general building
meetings take place once per month and are facilitated by a housing support
worker)
• Support to overcome isolation through participation in social and recreational
activities, employment opportunities focusing on building safety and
maintenance
• Support in conflict resolution and eviction prevention strategies
• Support co-ordination
Meals are not provided in the program, as this is self-contained housing, although
many tenants eat on-site at Friends Restaurant that is operated by FV. The
restaurant serves low-cost nutritious meals and offers a credit system for those
unable to pay. Generally tenants do their own laundry; however housing workers
and other community services are able to assist, as needed.
Health services are provided by a Family Health Team that consists of a nurse, case
manager, psychiatrist and physician that are available during business hours, and
also have drop-in hours. FV Housing also has a partnership with CCAC (available
during business hours). It was identified that a higher level of primary health care
support is needed in order to meet the specialized needs of FV tenants.
FV Housing staff operate using a harm reduction approach. As such, they work
realistically and in a non-judgmental way when it comes to substance use, accepting
that this behaviour is a reality in the lives of tenants. Staff provide referral services,
peer facilitated support, education about substance use and ways in which to minimize
the potential danger when using. They provide safer use kits, condoms and biohazard
containers, as well as instruction on safe disposal of used products.
Program Outcomes
FV Housing has a vacancy rate of 6% and approximately six to eight units become
available each month due to voluntary departure, abandonment and eviction. There is a
higher turnover rate for women than for men. In 2008-2009, 80% of tenants maintained
their housing. People who move on from FV Housing often go on to live in independent
housing, long-term care facilities, rehabilitation programs, or other shelters in the City.

31


LEVEL 3 PROGRAMS (ACKNOWLEDGEMENT)
515 MacLaren – Supportive Housing for Women
Background
Through the 1980’s in Ottawa, there was a growing recognition that permanent housing
for women experiencing persistent homelessness was in demand. In response, All
Saints Anglican Church established a program called Martha’s, which offered a small
number of cots for women experiencing homelessness. In 1986, Martha’s moved into a
new facility and was able to house 15 women experiencing homelessness. This
program became known as the Women in Crisis Project. In 1989, the Women in Crisis
Project opened a 20-unit supportive housing building at 515 MacLaren St. 515
MacLaren was a program of the Anglican Diocese and in 1999, the organization
changed its name to Cornerstone/Le Pilier.
In 2000, Cornerstone/Le Pilier opened a six bed cooperative living residence for women
recovering from difficult experiences, trauma, newcomer issues as referred from
Cornerstone’s Emergency Shelter and The Catholic Immigration Centre. In 2011
Cornerstone/le Pilier will open a supportive housing facility for senior women
experiencing homelessness in partnership with OICH.
515 MacLaren is owned and maintained by Centretown Citizens of Ottawa-Carleton
Corporation (CCOC) and the units are rent geared-to-income. The manager of the 515
MacLaren program acts as a landlord on behalf of CCOC by collecting rents. The
support component is currently funded through the provincial Consolidated
Homelessness Prevention Program (CHPP), which is administered by the City of
Ottawa. Tenants receive income from a variety of sources including OW, ODSP,
pensions and paid employment. 515 MacLaren is considered to be permanent housing
and is governed under the RTA.
Population Served
515 MacLaren offers low barrier housing for women with medium to high level support
needs (low level healthcare needs). All support is person-centred, and meets the
person “where they are at”. General guidelines (rather than rules) with respect to
behaviour exist.
Originally, 515 MacLaren housed women with mental health issues only; however their
mandate has expanded in response to the need over years. Presently, they support
women over the age of 18 experiencing or approaching persistent homelessness with
complex issues that create barriers to independence. Such issues/barriers could involve
a combination of mental health issues, substance use issues related to alcohol,
developmental challenges, language barriers, and/or physical health challenges.
Women in the program currently range in age from 35 to 67 with the average age being
47 years.

32


515 MacLaren does not house men and is unable to accommodate those who are not
ambulatory as there is no elevator in the building. The program does not typically accept
women with substance use issues related to street drugs because this may pose a
safety issue for other women in the building. However, if a tenant living at 515
MacLaren develops an addiction; she would be able to remain in the program and be
encouraged to access the services of an addictions worker and other community
services. Eviction would only be considered as a last resort and would be based on
behaviour, rather than substance use.
Candidates for 515 MacLaren are identified by Cornerstone’s Emergency Shelter case
managers (75%), outreach workers, and other community agencies such as Citizen
Advocacy, Royal Ottawa Hospital (ROH), ACTT, Canadian Mental Health Association
(CMHA), Ottawa Salus Corporation, etc. Beginning in the Fall of 2010, all candidate
applications will come through the central Supportive Housing Network.
When a room becomes available, the manager of Supportive Housing meets with the
potential tenant and completes a need and eligibility assessment and application form.
Guidelines for behaviour mainly relate to the common areas and include:
• Physical violence or abusive behaviour is not tolerated
• Alcohol and drugs are not allowed in the common areas
• Smoking is not permitted in the home
• Quiet time is respected in the common areas from 11pm-7am on weekdays and
midnight to 7am on week-ends
• Tenants share in all responsibilities of cleaning their own room and common
space (e.g., bathrooms, carpets, after dinner clean-up)
The final candidate selection is determined based on urgency of need for care and
support, and fit with the other 19 tenants. Before or on the move-in day, the tenant signs
a lease and a food plan contract. The support workers and or manager inform the
person’s source of income support (e.g., OW, ODSP) of the change of address and rent
requirements.
Although there is a waiting list of 100 people for 515 MacLaren at any given time, at
times challenges remain filling the units because some women are unwilling to sign a
lease due to mental health issues or because their stay at the temporary Emergency
Shelter has been months (because no openings at 515 MacLaren) and has become
home to them. As such, women are reluctant to leave their new “home” at the shelter.
515 MacLaren is a home and as such visitors (including male visitors) are permitted in
the residence (including overnights) if the guest first meets with the manager for a meet
and greet (assessment). The visitor’s policy and guidelines were created by the
tenants.

33

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