Final Report At Home in Winnipeg: Localizing Housing First as a Culturally Responsive Approach to Understanding and Addressing Urban Indigenous Homelessness 2018 Prairie Research Centre Authors and Affiliations Jino Distasio, Sarah Zell, and Marcie Snyder, The Institute of Urban Studies, University of Winnipeg The Urban Aboriginal Knowledge Network, the UAKN, is a community driven research network focused on the Urban Aboriginal population in Canada. The UAKN establishes a national, interdisciplinary network involving universities, community, and government partners for research, scholarship and knowledge mobilization. For more information visit: www.uakn.org

2018

UrbanAboriginalKnowledgeNetwork(UAKN),PrairieRegionalResearchCentre

TheInstituteofUrbanStudies,UniversityofWinnipeg

AtHomeinWinnipeg:LocalizingHousingFirstasa

CulturallyResponsiveApproachtoUnderstandingandAddressingUrbanIndigenousHomelessness

Jino Distasio, Sarah Zell, and Marcie Snyder

August2018

Final Report

Final Report for the UAKN Prairie Regional Research Centre

© 2018, The Institute of Urban Studies, University of Winnipeg

Institute of Urban Studies University of Winnipeg 599 Portage Avenue, Winnipeg P: 204 982-1140 F: 204 943-4695 E: ius@uwinnipeg.ca Mailing Address: 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9 Authors: Jino Distasio, Sarah Zell, and Marcie Snyder Suggested citation: Distasio, J., Zell, S., & Snyder, M. (2018). At Home in Winnipeg: Localizing Housing First as a Culturally Responsive Approach to Understanding and Addressing Urban Indigenous Homelessness. Winnipeg: Institute of Urban Studies. The Institute of Urban Studies is an independent research arm of the University of Winnipeg. Since 1969, the IUS has been both an academic and an applied research centre, committed to examining urban development issues in a broad, non-partisan manner. The Institute examines inner city, environmental, Aboriginal and community development issues. In addition to its ongoing involvement in research, IUS brings in visiting scholars, hosts workshops, seminars and conferences, and acts in partnership with other organizations in the community to effect positive change.

AtHomeinWinnipeg:LocalizingHousingFirstasa

CulturallyResponsiveApproachto

UnderstandingandAddressing

UrbanIndigenousHomelessness

AcknowledgmentandDedicationOverthelasttenyears,manyhavecometounderstandtheroleHousingFirstcanplayinendinghomelessnessinCanada.ThisnewperspectiveonaddressinghomelessnessowesmuchtoaninnovativeresearchprojectknownasAtHome/ChezSoi(AHCS).FromtheAHCSstudy,welearnedabouthowtobringtogethertherightmixofpeople,housing,andsupportstomakeadifference.

Thisreportisdedicatedtothe2,148peoplewhotookpartinthislandmarkstudyandsharedsomuchoftheirliveswithus.Wealsomark,withdeepsorrow,thepassingofmanybraveindividualswhosecontributionsareimmeasurableandformanintegralpartoftheAtHome/ChezSoilegacy.

Formepersonally,InotethelossofFreemenSimard,whohelpedguidetheearlypartoftheprojectandsharedhiswisdomwithmeovermanyyears.Heremainswithusinspiritbutisdeeplymissed.Aswell,wemarkthepassingofDr.PaulaGoering,whowastheoverallresearchleadfortheAHCSstudy.HerlegacyandpursuitofbetterhealthandsupportsforCanadianswillnotbeforgotten.

InWinnipeg,manyorganizationscametogethertoensurethoseinthestudyhadaccesstotherightsupportsandservices.ToallthestaffattheMaMawiWiChiItataCentre,AboriginalHealthandWellness,andMountCarmelClinic,yourcontributionstothewellbeingofparticipantswerecritical.

Ontheresearchandadministrationsideoftheproject,thepartnershipbetweentheUniversityWinnipeg’sInstituteofUrbanStudiesandtheUniversityofManitoba’sDepartmentofPsychiatrywasfundamentalinsupportingdatacollectionandprojectoperation.Dr.JitenderSareen’sleadershipwascriticaltothesuccessoftheWinnipegSite.SusanMulliganandCorinneIsaakwereinstrumentalintheearlystagesoftheresearchdesignandongoingeffortstocoordinatesome6,000localinterviews.AspecialthanksaswelltoMarciaThomson,whowasWinnipeg’skeygovernmentalcontactandwhoensured,atthepolicylevel,thattherightmessagesresonated.LucilleBruce,aSiteCoordinator,andteamleadsDonRobinson,BettyEdel,DarleneHall,PaulaHendrickson,andLukasMaitlandwereatthefrontlineofmakingchangehappen.

TothepastandpresentmembersoftheLivedExperienceCircle(LEC),whocontinuetomeetandsharetheirgifts,Iremaindeeplymovedbyyourlevelofresiliencyandhope.IwillforevercherishmytimewiththeLECandthegiftsyouhaveshared.TomyfriendJoe,whoeventriedtoteachmesomeguitar,ithasbeenonehellofajourney.Iamgratefulwecontinuetolearnfromeachother.

Weowesomanyforwhatwasachievedduringaprojectthatwassimplylookingathowwemightbettersupportthosestrugglingwithfindinghome.OurjourneytogetherdidnotsolvehomelessnessforallCanadians,butwemadeimportantgainsandshedlightonapathwaythathadbecomedarkened.

JinoDistasio,InstituteofUrbanStudies

Contents

AcknowledgmentandDedication………………………………………………………………………………… iiContents……………………………………………………………..….….………………………………………………… iiiListofAcronyms………………………………………………………………………………………………………… ivPreface………………………………………………………………………………………………………………….……… v1.IntroductionandBackground……………………………………………………………………………… 1 SettingtheContext/ResearchRationale 4 HousingFirstandAtHome/ChezSoiinWinnipeg 52.ResearchApproach,Methods,andGuidingPrinciples……………………………………………..7 EthicalConsiderationsandResearchCaveats 83.ANationalPerspectiveonWinnipeg’sApproachtoHousingFirst…………………………….9 TranslatingaNationalProjecttotheLocalLevel 10 IndigenousCommunityPriorities 124.PathwaysWalkedTogether:StagingAtHome/ChezSoiWinnipeg………………………..…15 TheWinnipegSite:AnIntroductiontotheParticipants 18 TheWinnipegSiteHousingFirstTeams 21 WalkingTogether:TheWiCheWinModel 23 TheWinnipegThirdArm:NiApin 25 FindingGifts:TheWiisocotatiwinModel 265.AtHome/ChezSoiGovernanceModel…………………………………………………………………….. 28 TheWinnipegModel 30 TheProjectLeadershipTeam 31 TheWinnipegAdvisoryCommittee 32 TheAboriginalLensCommittee 33 TheLivedExperienceCircle 34 StrengthenedCapacitythroughLocalEngagement 367.Conclusion……………………………………………………………………………………………………………….…41References……………………………………………………………………………………………………….……….……43

ListofAcronyms

AC–AdvisoryCommittee

ACT–AssertiveCommunityTreatment

AHCS–AtHome/ChezSoi

ALC–AboriginalLensCommittee

BUILD–BuildingUrbanIndustriesforLocalDevelopment

CLC–CommunityLiaisonCoordinator

HF–HousingFirst

HN–HighNeed

HPS–HomelessnessPartneringStrategy

ICM–IntensiveCaseManagement

LEC–LivedExperienceCircle

MGR–ManitobaGreenRetrofit

MHCC–MentalHealthCommissionofCanada

MN–ModerateNeed

NWG–NationalWorkingGroup

PI–PrincipalInvestigator

PLT–ProjectLeadershipTeam

PWLE–Peoplewithlivedexperience

RCT–Randomizedcontrolledtrial

TAU–TreatmentasUsual

WRHA–WinnipegRegionalHealthAuthority

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PrefaceInthespringof2008,theMentalHealthCommissionofCanada(MHCC)beganworkontheAtHome/ChezSoi(AHCS)project,alandmark$110milliondollarstudyofhomelessnessandmentalhealth.ImplementedinfiveCanadiancities,AHCShadanimmenseimpactonthelivesofthe2,148peoplewhoparticipatedinthestudyandonthoseofuswhohelpedlaunchandmanagetheeffort.By2014,findingsfromAHCShadinformedandgreatlyalteredthetrajectoryofpolicyandprogramdeliverynotonlyinCanadabutglobally.MoreandmorecitieswereimplementingwhathadbecomeaprovenCanadianHousingFirst(HF)approach.

InthedecadesincethelaunchofAHCS,themannerinwhichhomelessnessisunderstood,addressed,andendedhasfundamentallychanged,withmanymoreremaininginstable,long-termhousing.TheoutcomesoftheAHCSprojectaredocumentedinthescholarlyliteratureandarebeyondthescopeofthisproject(Aubryetal.,2016;Goeringetal.,2011;Goeringetal.,2016).

Thisstoryisadeparturefromoutcome-basedanalysesandfocusesmoreononecity’sjourneytodevelopingandimplementingaHousingFirstapproach.InWinnipeg,ourmethodwasuniqueinmanyways.In2008,HousingFirstwasneitherknownnorunderstoodmuchbeyondwhathadbeenemerginginNewYorkCity,wherein1993,Dr.SamTsemberislaunchedthePathwaysModeltoEndHomelessness(TsemberisandAsmussen,1999;TsemberisandEisenberg,2000).Throughthe1990sandintotheearly2000s,Winnipegwitnessedariseinhomelessnessandpoverty,especiallyincentralneighbourhoodsandthefringesofdowntown.However,WinnipegwasunlikeNewYorkbothinsizeandscaleandalsowithregardtohowlocalresponsestohomelessnesswereaddressed.

WhatdefinedHFinWinnipeg,morethananyothercityintheAHCSproject,wasitsrootednessinthecommunity.In2008,Winnipeg’scommunity-basedorganizationsinterrogatedHFanditsWestern,psychiatric-basedapproach,questioningwhetherandhowitwouldapplyinacitywhosehomelesspopulationwasmorethan70%Indigenous.TheearlytensionandchallengesraisedamongcommunitygroupsinformedtheapproachadoptedbytheorganizationsthatwouldultimatelyformthelocalAHCSWinnipegSite.

Inmanyways,Winnipeg’scommunity-basedmodelsupportedandstrengthenedlocalcapacitywhilestrivingtoendhomelessnessandpoverty.The“WinnipegWay”includedmanyuniqueadaptationsofHF,withacapacity-buildingemphasisremainingfrontandcentre.

ThisreportfocusesonWinnipeg’smodelandgovernancestructure,onethatarosepartlyoutofthecity’sstruggletounderstandhowanAmericanapproachcouldholdrelevanceinaCanadianprairiecontext.Theintentistosharehowcapacitywasbuiltandmaintainedamongthevariousproject

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partners,includingcommunity-basedorganizations,governmentrepresentatives,andacademics,allofwhomworkedtosupportthe540peoplewhoparticipatedinthestudyinWinnipeg.WealsoexaminehowthisapproachwasviewedfromanationalperspectivebyincludingthoughtsfrommembersoftheMentalHealthCommissionofCanadaandgovernmentactorswhoplayedapartinselectingWinnipegasasitefortheAHCSproject.

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1.IntroductionandBackgroundWinnipegisamid-sizedprairiecity.Itsrootsrundeepinthecommunity,withastrongsenseofresiliencyandhopeamongtheagenciesthatworktirelesslytosupportthoseinneed.ThemannerinwhichWinnipeg’scommunityrespondedtoincreasinglevelsofhomelessnessoverthelastdecadeformsthebasisoftheanalysispresentedinthisreport.Inparticular,theobjectiveistoexaminetheAtHome/ChezSoi(AHCS)projectandhowanumberoforganizationscametogethertolaunchatransformativeapproachtoaddressinghomelessnessforthosestrugglingwithmentalhealthissues.Ourspecificfocusisonhowlocalcapacitywasbuiltandstructuredtoundertakewashasbeencalledthelargestdemonstrationprojectofitskindintheworld(Macnaughtonetal.,2010).TheWinnipegapproachwasdistinctandinvolvedtheinclusionofIndigenouspracticestodeliverHousingFirst(HF).Thisreporthasaparticularfocusonhowauniquegovernancemodelemergedoutofpartnershipsamongcommunity-basedorganizations,government,researchers,andotherswhocollaborativelystrengthenedlocalcapacitywhileendinghomelessness.

Beginningin1999,therewasincreasingpressureinCanadatoaddressmountingpovertyandinequalityinourcitiesandcommunitiesthatwascontributingtoariseinhomelessness(Hwang,2001).Toronto’s“TentCity”of1999wasawatershedmomentinbringingtherealityofthehomelesscrisistotheattentionofthenationandaglobalaudiencewhowonderedhowsuchapropitiouscountrycouldbestruggling(Ranasinghe&Valverde,2006).Muchoftheattentionwasraisedbyactivistsandotherswhopushedforaction(Gilbert&Phillips,2003).However,earlyresponsestoCanada’shomelesscrisiswereoftenrudimentaryandsoughttoputmoreheadsonshelterbedsasopposedtoaddressingrootcausesorfocusingonprevention.Duringtheearly2000s,despitebiggerissuessimmeringonthehorizon,includingagrowingshortageofaffordablehousingandashortfallintheservicesaimedatendinghomelessness,Canadianpolicyemphasizedexpandingthecrisissupportsystem(Frankishetal.,2005;Gaetz,2010).Aswell,therewasagrowingrecognitionthatthosestrugglingwithreoccurringperiodsofhomelessnessandmentalhealthwereprogressivelybeingforgottenordeemed“toohardtohouse”byasystemnotgearedtowardaddressingtheneedsofthosestrugglingwithco-occurringdisorders,suchasaddictionandmentalhealth(Goeringetal.,2011).

In2006,areportbySenatorMichaelKirbycalledforanoverhaulofthementalhealthsystemthatwasfailingfartoomanyCanadians(Senate,2006).Thereport,entitledOutoftheShadowsatLast:TransformingMentalHealth,MentalIllnessandAddictionServicesinCanada,wouldserveasthebasisfortheestablishmentoftheMentalHealthCommissionofCanada(MHCC)in2008.Inreality,fromthemid-1990sonward,addressinghomelessnessdisproportionallyemphasizedthenotionthatwecouldbuildourwayofthecrisisbycreatingshelterbedsandaddressingshortfallsinaffordablehousing.While

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expandingthestockofhousingwasessential,itwouldtaketimebeforewerealizedthismustoccursimultaneoustoaddressingthehealthcircumstancesofindividuals.

Itisin2008whereourstorybegins,whenanumberoflocalgroupsandorganizationsinWinnipegfirstbecameawareofSenatorKirby’sintenttolaunchaproject.TheMHCCwasbeginningtoreachouttothefivecitiesthatwouldbecomethestudysitesintheAtHome/ChezSoi(AHCS)project(Moncton,Montreal,Toronto,Winnipeg,andVancouver).Atthesametime,community-basedorganizationsinWinnipegbegantomobilizetobetterunderstandwhatwasbeingproposedbytheMHCC,howthecitywouldplayarole,andwhowouldbeinvolved.Thisearlyrelationship-buildingprocessandtheinterrogationoftheHFapproachwereintegraltotheformationoftheWinnipegteamandtothedevelopmentofitsuniquelocalapproachandmodelproposedtotheMHCC.

InCanadaandWinnipeg,therewereanumberoffactorscontributingtothegrowingdesiretoaddresstheneedsofpersonsstrugglingwithmentalillnessandhomelessnessthattheMHCC(2008)citedasreasonsforundertakingthestudy,including:

v Duringtheearly2000s,therewasaheightenedsensethatCanadiancitieshadexperiencedsubstantivegrowthinthehomelesspopulation(whichhadbeenacceleratingsincethemid-1990s);

v Therewasincreasedawarenessoftheprevalenceofmentalillness,substanceabuse,andchronicphysicalhealthconditionsamongthosepersonshomeless;

v Therewasincreasingrecognitionthatdifferentsubgroupshadvaryinglevelsandtypesofneed(e.g.,youth,seniors,immigrants,andIndigenouspeople);and

v Thosechronicallyhomeless(estimatedat15%ofthetotalhomelesspopulation)hadhighlevelsofneedandconsumedalargeproportionofserviceandsocietalcosts.

Asnoted,fivecitiestookpartintheMHCCstudywitheachhavingauniquesetofcharacteristicsthatofferedacross-sectionofissuesforassessmentoverthecourseofthestudy.Thefollowingisasimplifiedoverviewofthegeneraldistinctionsamongthecities:

v Vancouver:anemphasisonpeoplewithamentalillnesswhostrugglewithsubstanceabuseandaddictionsissues(ofteninaconcentratedareaoftheDowntownLowerEastSide);

v Winnipeg:anurbanIndigenouspopulationandaconcentratedareaofpovertywithintheinnercity;

v Toronto:agrowingimmigrantpopulationandethnoculturaldiversity,includingmanywhowerenon-Englishspeaking;

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v Montreal:distinctmentalhealthservicesprovidedtohomelesspeopleinQuebecandauniquesocialhousingindustry;and

v Moncton:veryrapidlygrowingsmallcitywithashortageofmentalhealthservicesandafocusontheruralpopulation.

TheoverallintentoftheAtHome/ChezSoiprojectwasto“collectpolicyandprogramrelevantevidenceabouttheserviceandsysteminterventionstoachievehousingstability,improvedhealth,andwellbeingforthosewhoarehomelessandmentallyill”(MHCC,2008).ThiswastobeachievedbytestingtheeffectivenessofHousingFirstinfiveCanadiancities,assessingwhetheritofferedbetteroutcomescomparedtothosepersonsusingexistingservicesandsupports.

ThefollowingreportreflectsonandanalyzesWinnipeg’spathwayintotheAHCSproject.ItprovidesbackgroundonHFandtheMentalHealthCommissionofCanada,followedbyanexaminationoftheWinnipegSite’smodelandphilosophyofcare.TheprimaryobjectiveofthisresearchistoreflectontheearlydesignandimplementationoftheIndigenousandcapacity-buildingcomponentsoftheWinnipegSiteoftheAHCSproject.Weexaminethe2008–2014period,chroniclinghowthecitydevelopeditsgovernancemodelandplantoaddresshomelessnessusingtheHFmodel.Asnotedabove,whatisuniqueaboutWinnipegishowtheHFmodelwasadaptedlocally.Weexploretheprocessesoftheearlyrelationship-buildinganddevelopmentphaseaswellasthegovernancestructurenecessarytolocalizeandadapttheproject,withanemphasisontheWinnipegSite’suniquecapacity-buildingoutcome.

ThroughoutthisreportweusethenameAtHome/ChezSoi(AHCS)todescribetheMentalHealthCommissionofCanada’sresearchproject.Thisnamewasselectedin2009inTorontoatthemeetingofprojectstakeholders,whofeltthattheprojectneededatitlefocusedontheconceptofhome.ThenameandsubsequentlogowoulddefinetheMHCC’sprojectoverthecourseofthestudyandintothepresent.ItsselectionrepresentedtheviewthatallCanadiansshouldbe“athome”andnotinthestreets.Italsoreflectedthebilingualimportanceoftheprojectinconnectingthefivecities.Locally,eachcityusedAtHome/ChezSoiorAHCStocreateasenseofunityamongthecities.

WhatisalsoimportanttonoteisthatultimatelyAHCSwasalarge,randomizedcontrolledpragmaticfieldtrial(RCT)thatenrolled2,148peopleacrossthefivecityresearchsitesintoahighlyscriptedstudy(Goeringetal.,2011).Becauseofitsnatureasademonstrationresearchproject,sitedevelopmentandHFimplementationinvolvedadherencetoarigorousresearchprotocoltoensureHFwasdeliveredconsistentlyamongthesites.Thereislittledoubtthattheresearchstudycontextcreatedtensionsandchallenges(indeed,thisisdocumentedelsewhere;e.g.,McCullough&Zell,2016).However,italsoofferedtheopportunitytohaveWinnipegplayakeyroleinpushingthelimitsofhowHFcouldoperatewithinadistinctparadigm.Inthisresearch,theobjectiveistodistilhowtheWinnipegSitewasabletoadaptandlocalizeHFtoaddressthecommunitycontext.

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Specifically,weexplorethefollowingquestions:

1. Whatprocessesdefinedtherelationshipbuildingphaseamongarangeofstakeholders,includinglocalmembersofthecommunity,government,thehomelessservicesector,andspecificallytheIndigenouscommunity,attheWinnipegSitewhocametogethertolaunchtheAHCSproject?

2. Howdidthisrelationship-buildingprocessinfluencethesubsequentdevelopmentofauniquegovernanceandprogramstructurethatlocalizedaculturallyresponsiveadaptationoftheHousingFirstmodelinWinnipeg?

3. AttheWinnipegSite,theapproachtogovernancewasunderpinnedbyashared,community-driven,Indigenous-centeredunderstandingofHousingFirst.Howdidthisapproachcontributetobroadercapacitybuilding,whichinturncontributedtothesuccessfulimplementationofthedemonstrationproject,anddidthisimpactongoingsustainability?

4. WhatWinnipegexperiencescaninformbroaderadaptationoftheHousingFirstinCanadaandwithinIndigenouscommunitiesandaretheredistinctpolicyimplications?

SettingtheContext/ResearchRationaleTheurbanizationofIndigenouspeopleslivinginCanadahasbeenincreasingforseveraldecadeswithanestimated56%ofIndigenouspeoplenowlivingincities.InWinnipeg,whichissituatedgeographicallyonTreatyNo.1territoryandthehomelandoftheRedRiverMétis,approximately12%oftheurbanpopulationidentifiesasIndigenous(StatisticsCanada,2017).Despiteanincreasingurbanpresence,Indigenouspeoplescontinuetofaceadisproportionateburdenofsocio-economicandhealthdisparitiesascomparedtonon-Indigenouspopulations.Furthermore,Indigenouspopulationsexperiencehigherratesofhomelessness.Anestimated1in5urbanIndigenouspersonsinCanadaarelikelytobehomelessonanygivennight,ascomparedto1in128non-Indigenouspersons.InWinnipeg,over70%ofthehomelesspopulationidentifiesasIndigenous,andthisnumberisthoughttohaveremainedlargelyunchangedforsometime(MaesNinoetal.,2016).

Theseongoingdisparitiesarecoupledwithacross-sectionofintertwinedhealthfactors,includinghousingdistress,mentalandphysicalhealthchallenges,substanceuse,poverty,andloweroveralllifeexpectancy(Adelson,2005;Kingetal.,2009;Smylie2009).Therootsofthesedisparitiesareintimatelytiedtosocio-economicandpoliticalinequities,whichstemfromtheintergenerationalimpactsofcoloniallegislationthatactivelydispossessedanddislocatedIndigenouscommunitiesfromtheirfamilies,lands,languages,andculture.Culturaloppression,routineracism,andintergenerationaltraumaplayacontributingroleinhighratesofhomelessness(Patrick,2014).TheseinequitiesareexacerbatedbymainstreamhousingmodelsthathaveremainedrootedinWesternideals.Thesemodels

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mayhaveintrinsicculturalbiasesandoftendonotfullycomprehendtheworldviews,housingneeds,andself-determinationofurban-basedIndigenouspeoples.

AlthoughIndigenousurbanizationisbynomeansarecentphenomenon,adequatehousingsupportsremainsakeyissue(Distasioetal.,2013;Snyder&Wilson,2015),andthereisanongoingandpervasivelackofcohesiveurbanIndigenouspolicy(Walker,2008;Walkeretal.,2011).Fordecades,thefederalgovernmenthaslargelyneglectedthehousingneedsoftheurbanIndigenouspopulation,focusingmoreonreserve-basedhousing(Belangeretal.,2012).Furthermore,issuesofurbanIndigenoushomelessnessremainunderrepresentedintheliterature(Wilson&Cardwell,2010),andresearchonIndigenoushomelessnessrevealsalackofpracticalapplication.Giventheseconcerns,thereisaneedforIndigenous-specificresponses(Patrick,2014)thatlookbeyondhousingneedsalone,toincludeholisticapproachesthatreconstructlinksbetweenindividual,family,community,andnations(Menzies,2008).

HousingFirstandAtHome/ChezSoiinWinnipegThisresearchexaminesandexplorestheconceptofalocalized,Indigenous-focusedapproachtoHousingFirst.HousingFirstinitselfisadeparturefromconventionalmethodsofendinghomelessness,wherehousingisoftencontingentonclientsfirstaddressingmentalhealthand/oraddictionschallenges.Often,suchinterventionsemployanabstinence-basedapproachthatrequiresadherence,whichtranslatesintoconditionsplacedonobtainingormaintaininghousing.Incontrast,HFisconsumer-driven,recovery-orientedapproachprioritizingcommunity-basedservicesandsupport(Tsemberisetal.,2004).Researchindicatesthatprovidinghousing,alongwithaccesstohealthandsocialsupports,reduceshomelessnessandhospitalizationandincreasespositiveoutcomessuchassocialnetworksandwellbeing(Gaetzetal.,2013;Goeringetal.,2011).

AlthoughcitiesacrossCanadahaveadoptedvariationsoftheHFapproachoverthepastdecade,itwastheAHCSresearchdemonstrationprojectthat“solidifiedHousingFirstasaparadigm-shiftingapproachtoendinghomelessnessinCanada”(Gaetzetal.,2013,4).Eachofthefivecities,aspartoftheAHCSproject,deliveredHFprogrammingthroughbothanAssertiveCommunityTreatment(ACT)teamandanIntensiveCaseManagement(ICM)serviceteam(Tsemberis&Asmussen,1999).Inaddition,eachsitehadtheoptiontodevelopa“thirdarm”serviceteam,toinvestigateinnovativeadaptationsthatreflectedlocalcontext,culture,andneeds(Nelsonetal.,2013).InWinnipeg,thethirdarmteamwasanIndigenous-focused,trauma-informedintervention,whichwasdeliveredbyanIndigenousagency.ItfocusedonanIndigenousprimaryhealthcaremodeltoprovideholistic,culturallybasedservicesforIndigenouspeoplesinWinnipeg.Theapproachcombines“theMedicineWheelandtheuniversalprinciplesofsharing,caring,kindness,humility,trust,honestyandrespect”(Goeringetal.2011,10).While,Winnipeg’sthirdarmserviceteamwasdevelopedspecificallytodeliverIndigenous-focusedservices,itisimportanttonotethattheothertwoWinnipegAHCSserviceteamsalsodeliveredaspecificlocalizedversionofHF.Indeed,theentireSitewasinformedbythelocalcontextandinfused

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localandIndigenousaspectsintoitsmodelandapproach.ThefactthatthethreeAHCSHFteamswerehousedanddevelopedwithincommunity-basedorganizationsofferedanopportunityforthemainstreamHFmodeltobeinfusedwithlocallybasedsolutions.

Winnipeg’sapproachtodeliveringHFwasdeeplyrootedinpartnershipsformedandconsolidatedbetweenIndigenouscommunitymembers,healthpractitioners,academicmembers,andgovernment.Elders,traditionalteachers,thosewithlivedexperienceofmentalhealthandhomelessness,andIndigenouscommunityorganizationsactivelycollaboratedwiththeresearchteamfrominceptionandthroughimplementation,delivery,andtheprocessofsecuringsustainablefundingpost-AHCS.Althoughnotwithoutitschallenges,thepositiveimplicationsofthiscommunity-drivenmodelremainnoteworthy.

TheintentionofWinnipeg’sAHCSprojectwastobuildthecapacityofcommunity-basedteamstoeffectivelyandequitablyshareknowledgeofHFpracticeswithinthehousing/healthservicesectorandthebroadercommunity.WhenfederalfundingfortheHFprogramsestablishedthroughAHCSendedin2013,thethreelocalserviceteamsthathadbeendevelopedaspartoftheresearchprojectnotonlysurvivedbutremainedrelativelyunified(Distasioetal.,2014).Thesuccessofthe“sustainabilitystory”inWinnipegisdueinlargeparttothestrongrelationshipsinitiatedandforgedthroughtheproject,andespeciallytoitscommunity-drivenapproach(McCullough&Zell,2016).TheWinnipegAHCSapproachwascommunity-centredandensuredcommunityinvolvement,mobilizedcommunityassets,andworkedtopromoteequityandwellbeing.

InWinnipeg,addressingthespecificneedsoftheIndigenouscommunitywascentraltotheapproachusedlocally.DespiteextensivepublicationonAHCS,andasHFinterventionsproliferateacrossCanadaandinternationally,littletonoresearchhasexaminedcommunity-driven,culturalapproachestoendingIndigenoushomelessness.FewresourcesexistthatidentifyculturallyresponsiveservicesforIndigenouspeoplesexperiencinghomelessness(McCallum&Isaac,2011).ThisresearchaddressesthisgapbytellingthestoryofhowWinnipeg’scommunitycametogethertoinformandadaptthemainstreamHFmodeltoholisticallyreflecttheneedsandconcernsoftheIndigenouscommunity.

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2.ResearchApproach,Methods,andGuidingPrinciplesThisisacommunity-drivenprojectcommitteddeeplytoprivilegingIndigenousknowledgeinshareddialogueandactionthatoffersfreshperspectivesbycombiningtraditionalwisdomwithcontemporaryurbanneeds.ThePrincipalInvestigator(PI)forthisstudy,JinoDistasio,wasalsothePIfortheWinnipegAHCSproject.ThefirststepinundertakingthisworkwastoreconnectwithkeyIndigenousleadersfromtheinitialAHCSproject,toseektheirsupportandtoaskandreflectuponthemostbeneficialapproachtotellingtheWinnipegHFstory.Assuch,weundertookthefollowing:

v Launchedtheprojectwithafeast.ThisinvolveddrawinginthethreeHFteams,membersoftheoriginalAHCSWinnipegSiteAboriginalLensCommittee,theLivedExperienceCircle,andothercommunity/governmentleaderswhowereclosetotheoriginalprojecttoworkshopandprovideguidanceandsupportforthemethodology.

v Engagedinareviewoftheliterature/materialsrelevanttotheinitialstagesoftheAHCSproject.

v ConductedstakeholderinterviewstounderstandtheprocessbywhichtheAHCSWinnipegSitedevelopedacommunity-based,Indigenous-focusedapproachtoimplementingtheproject.

Ourmainobjectivewastodocumentanddescribetheprocessofapplyingalocalized,IndigenouslenstoHF.Werelyontwoprimarysourcesofdatatodoso.First,weconducted16in-depth,semi-structuredinterviewswithacross-sectionofstakeholdersinvolvedintheearlydevelopmentoftheAtHome/ChezSoiWinnipegSite.Theseincludedprojectleadersatthelocalandnationallevel,programteamleaders,andmembersoftheAboriginalLensCommitteeandtheLivedExperienceCircle(whichwascomprisedofstaffandparticipantsinthestudy).SeeTable1foranoverviewofthesample.Interviewswereconductedin-personorbyphonebetweenJuneandOctober2017.Theylasted30–60minutesandweretranscribedverbatim.Weusedapurposivesamplingstrategytoidentifyparticipantsandemployedthematiccodingtoanalyzethekeyissuesandthemesthatemerged.InterviewfindingswillhelpdevelopaframeworkfromwhichtodescribetheestablishmentofalocalizedmodelofHF.

Inaddition,weengagedinanin-depthanalysisofawealthofsecondarymaterials.Theseincludedboth(1)documentationfromtheearlyAHCSWinnipegSitedevelopmentphase,suchasmeetingminutesandagendasandcorrespondenceandcommunicationsbetweenkeystakeholders,aswellas(2)transcriptsfrominterviewsandfocusgroupsfrompreviousiterationsofresearchonotheraspectsofWinnipeg’sdevelopmentandsustainingofHF.Thesematerialswerereviewed,coded,andanalyzed,andthesedatacomplementandinformtheoverallanalysispresentedinthisreport.

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Table1:SampleofInterviewRespondents

StakeholderGroup N

NationalLevel–MHCCandHousingFirst 3

WinnipegSiteLeadership 6

WinnipegSiteServiceandHousingProvision 4

WinnipegSiteResearch 2

Elders,AboriginalLensCommittee,LivedExperienceCommittee

3

Total* 16

*Notethereissomeoverlapinroles,particularlythoseservingasSiteLeadership.

EthicalConsiderationsandResearchCaveatsWeview researchas apathway to reconciliation, andas suchactively value theOCAP/SprinciplesofOwnership,Control,Access,andPossession/Stewardship(Schnarch2004).Theprinciplesunderpinningourresearchapproachare(USAI):

v Utility,inthatresearchispracticalandbenefitsthecommunity;

v Self-voicing,wherecommunityisapowerfulknowledgeholder;

v Access,wherelivedexperienceandcommunitynarrativeareunderstoodtobevalidexpressionsofauthorshipandthatresearchisneverstaticorfinished;and

v Inter-relationality,whereresearchissocio-historicallysituated.(OFIFC2012)

Weremainedcautiousnottopathologizementalhealthconcernsandhomelessness.DespiteglaringinequitiesthatpersistformanyurbanIndigenouspeoples,weusethisresearchasanopportunitytouncoversuccessesandopportunitiesthatarisewithinalocalized,Indigenous-focusedHFframework.Furthermore,itisnotourintentiontoconflateFirstNations,Métis,andInuitpeoples,butforthepurposesofthisproject,weseektodemonstratehowwecametogetherasIndigenousandnon-Indigenouscommunities,theimpactsoftheserelationships,andhowthisapproachmayserveasamodelforcommunitiesaddressinghomelessnessthroughprogrammaticinterventions.

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3.ANationalPerspectiveonWinnipeg’sApproachtoHousingFirstIn2009,thefederalgovernmentallocated$110milliontotheMentalHealthCommissionofCanada(MHCC)toconducttheAHCSproject,amulti-cityevaluationthatwouldmeasuretheeffectivenessoftheHousingFirstmodelintheCanadiancontext.Theintentionofthisprojectwastoprovidepolicy-relevantevidenceabouthowacomplexhousinginterventionworkedontheground.TheMHCCinitiativewasalsodesignedtoprovideamorecomprehensiveunderstandingoflocalsuccessesandchallenges.Asmentioned,beyondtheconventionalACTandICMserviceteams,eachAHCSsitehadtheoptionofdevelopingathirdarm,thepurposeofwhichwastoinvestigateinnovativeadaptationsandstrategiesthatreflectedlocalcontext,culture,andneeds(Goeringetal.,2011;Nelsonetal.,2013).InToronto,thethirdarminterventionwasfoundedonananti-racist/anti-oppressivephilosophytoaddressdiscrimination(Stergiopoulosetal.,2012);inVancouver,itwasbasedonthedeliveryofcongregatehousing;inMontreal,personalizedemploymentsupportsforinterestedparticipants;andinMoncton,theneedsofruralcommunitieswereevaluated(Goeringetal.,2014).InWinnipeg,thethirdarmemergedasacommunity-basedIndigenouspeer-supportmodelandtrauma-informedhousingintervention.IndigenousleadershipandperspectiveswerecentraltoadaptingtheHFmodeltothelocalcontext.Thisapproachaddressedtheneedforculturallysafeservicesandsupportivehousing(Distasioetal.,2014).

Overall,AHCSdemonstratedthatHFcouldbesuccessfullyimplementedindifferentCanadiancontextswhileadaptingtomeetthelocalneedsofdiversepopulations.ThepurposeofAHCS,fromanationalperspective,wastobetterunderstand“whatworks,atwhatcost,forwhom,andinwhichenvironments”(Goeringetal.,2014,11).InthecaseofWinnipeg,theIndigenousperspectivewascrucial,giventhatanestimated70%ofthehomelesspopulationinWinnipegidentifiesasIndigenous(MaesNinoetal.,2016).TounderstandpathwaysintohomelessnessforIndigenouspeople,itisnecessarytounderstandthatitoccurswithinthecontextofcolonialandculturaltrauma,compoundedbyincomeinequalityandracisminahousingmarketalreadysufferingfromashortageofaffordablehousing.

SincetheconclusionoftheAHCSprojectin2013,theHFapproachhashadasignificanteffectonhowhomelessnessisaddressedandunderstood,andthereisagrowinginterestinhowHFcanbeadaptedtoothercommunitycontexts(Gaetzetal.,2013).Inthissection,weanalyzefindingsfromkeyinformantinterviewsconductedwithnationalrepresentativesinvolvedintheAHCSprojecttounderstandhowtheWinnipegSite—informedbyanIndigenous-ledapproach—wasperceivedfromthenationallevel.ItincludesreflectionsonhowtheAHCSnationalteamtranslatedthenationalprojecttothelocallevelandontheimportanceofrelationshipbuildingandtheinclusionofIndigenousvoicesandcommunityprioritiesattheoutset.

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TranslatingaNationalProjecttotheLocalLevelMostparticipantsspokeaboutthelarge-scalenatureoftheAHCSproject,giventhetimethatitspanned,aswellitsimplementationacrossfiveurbanareas.ReflectingontheimplementationoftheMHCCprojectatthelocallevel,oneparticipantexplained:

Imeananytimeyouattemptto,inavery,veryshorttimeperiod,take$119millionandyou’vegotfiveyears,notonlytointroducetheintervention,buttobuildinterventionteamsandbuildacapacitythatdoesn’texistinthecommunity,plus,getalltheresearcherstogether,createaresearchprotocol,createprograms,implement,troubleshoot,andthentrytosustainandyoudothatsuccessfullywithinfiveyears…Imean,itisquiteremarkable.Imperfect,butremarkable.

Indeed,theAHCSwasthelargest-scalerandomizedcontrolledtrialofitskindthathadneverbeenundertaken(Macnaughtonetal.,2010).Asaresearchdemonstrationproject,itmeantthatitwasunfoldinginrealtime.Oneintervieweespoketothisasbeing“atremendouschallengebecauseyouhavetoreactasit’soccurring,andthereisalotatstake.Notreallytimetoreflectwhenmovingonaprojectofthisscaleinrealtime.”ThisrespondentdescribedtheWinnipegprojectasashipbeing“built…aswesailedit.”Whileeachsiteadapteditslocalsitecoordination,teams,andprogramsasneeded,ultimateresponsibilityrestedwiththeMHCC,fundedbyandaccountabletothefederalgovernment.

Translatingalarge-scale,nationallydeliveredprojecttothelocallevelwasnotwithoutitschallenges.Thereweremultipleanddiverseviewpointsaboutthisprocess.Fromthenationalperspectiveitwassuggestedthat“weneededtoberunningthesameHousingFirstprogramthateverybodyelseinthecountrywasrunning,youknow,intermsofitsprinciplesandpractices.”Atthelocallevel,communitymembers“feltlike…listenweknowwhatwe’redoing…Whoaretheseoutsiderscomingtotellushowtorunourhomelessservices?”Consequently,earlyissuesaroseregardinghowtotakea“nationalresearchprotocolandtailoritandmodifyitandadaptit”toreflectthelocalWinnipegcontextaswellastheconcernsofIndigenousstakeholders.

National-levelintervieweesindicatedthatfromtheirperspective,theintroductionoftheprojectinWinnipegwasmetwith“resistance”and“mixedreviews”frombothIndigenousandnon-Indigenouscommunitystakeholders.Stakeholdersfelttheyknewbestwhatthecommunityneeded,aswellashowtoaddresslocalhousingchallenges.OnerespondentsuggestedthattheprojectwasinitiallyreceivednegativelyinWinnipeg:

Thereweresomeprettytestypointsaboutwhowas[MHCC]todothis?WhowastheCommissiontothinktheIndigenouscommunitywasinterested?Whowas…theCommission,tosaypeopleneededhousinginthisway?Um,onandonandonandon.So,itwasa,verymuchatrustbuildingprocess,trust-built,totally.

Asthequoteindicates,theprocessofsitedevelopmentandHFdeliveryinWinnipegwouldcometobebuiltontrustandcommunication.Thecommunityhadtocometogethertobalancetensionsbetween

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expectationsandprojectdeliverablesthathadalreadybeendefinedatthenationallevelandtheneedtoshapeprocessestomeetlocalneeds.Inresponse,Winnipegstakeholderssoughttocreateacommunity-based,Indigenous-ledapproach.Anotherinterviewparticipantreflectedonthiscommunity-basedapproachtoresolvingnational–localleveltensions:

ThecoreWinnipegplanningteam…workedwiththeresearchteam,theyhadacorecommitmenttomakingsure[AHCS]wasreallycommunitydriven…Ithinkthatwasatrickythingtodobecausetherewasalotofcentrally,nationallydriven,corecomponentsthatneededtobethesameatallthesites,thereweresomeresearchstructuresthatwerethesame,sotheyhadtonavigatethosekindsofthings.

Whilethecollaborativeprocesswasattimesdifficultandinvolvedcomplexpartnershipswithmultiplestakeholders,itwassuggestedthatWinnipeg’scross-sectorgovernancestructure“brokedownsilos...[bringingtogether]peoplewhodon’ttraditionallyworktogether.”Ultimately,aniterativeandcollaborativetrustandrelationshipbuildingprocessledtoWinnipeg’scommunity-drivenapproach.

InterviewparticipantsatthenationallevelrecognizedthatWinnipegstakeholdersrealizedtheimportanceoftakingthetimetobuildrelationshipswasakeyandnecessarymeansofnegotiatingthesetensions.Thisfeelingresonatedmanytimesduringtheearlystagesoftheproject,whenMHCCstaffandothernational-levelstaffcametoWinnipegtogivepresentationsonHFandexpressedtheirinterestintheinclusionofWinnipegasastudysite.Community-basedandIndigenousorganizationsinterrogatedtheMHCC,itsproposaltoincludeWinnipegasaresearchsite,aswellasHFitself,withtheultimategoalofensuringtherewascomfortintheapproachandthattherightrelationshipswerebeingestablished(McCulloughetal.,2012;McCullough&Zell,2016).

TheemphasisonrelationshipbuildingandtimeinvestedinpartnershipdevelopmentatthefrontendwasnotedbymanytobeoneofWinnipeg’sstrongestcontributionstolocalizingtheHFapproach.IntheearlystageoftheWinnipegproject,manycommunitymeetingswereheldtoshareideasandtobringinexpertsfromtheMHCCandelsewheretoexplainanddiscussHF,whichin2008hadverylittlemeaninginthelocalcommunity.“IthinkthatthecommunitypieceinWinnipegwasverystrong,”saidonerespondent.“Ialwaysattributedthattothefactthatitwaskindofasmallenoughcommunitythateveryone,youknow,allthestakeholders,couldeasilybebroughtaroundthetableandaddressanissue.AndIthinkthatpeoplelearnedquicklythatthatwasdefinitelytotheiradvantage.”

WhenmeetingwiththosecomingintothecitytosharethoughtsandideasonhowHFcouldmoreeffectivelyendhomelessness,Winnipegwasabletoleveragelocalcapacityandtrustamongtheplayersbroughtaroundthelocaltable.OnerespondentreflectedthatonethingthatmadeWinnipeguniqueamongtheAHCSSiteswas“thewaythatpeopletookthe[HousingFirst]principlesandmadethemlocal,youknow,intermsofhiringpeoplewithlivedexperience,hiringelders,theflexibilityofhavinghealingpracticesandotherculturalpracticesthatweremeaningfultotheclients.”Anotherpersonspoketothe

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importanceofbringingthosewithlivedexperiencearoundthetable,andtohowtheWinnipegapproachcouldserveasanexampleforadaptingHF:

Otherplacescanreallylearnfromthinkingabouthowyouensurethere’sstrongvoiceofpeoplewithlivedexperienceatalllevelsofplanning.OneofthelessonsisthatWinnipegtookthetimetodothatcommunityconsultation.Ithinkthatit’sveryeasytounderestimateexactlyhowmuchtimethatwilltakeandhowcomplexitpotentiallycanbe…Ithink,too,demonstratingthatusingacommunitydevelopmentapproachpositionstheprojectreallywell,goingforward.

Meetingnationalobjectiveswhileconsultingwithcommunityandreflectinglocalneedstooktime,whichthelocalteamhadtobalancewithpressuretoadheretostructuredtimelinesanddeliverables.Althoughrelationshipbuildingwasrecognizedtobeanimportantcomponentoftheproposaldevelopmentandimplementationprocesses(McCulloughetal.,2012;McCullough&Zell,2016),oneinterviewparticipantnotedthat“therewassomediscomfortoruncertainty[fromthenationallevel]aroundWinnipeg’sapproachbecauseitwassocommunity-drivenand,frankly,tooklonger.”Thisbeingthecase,thissameintervieweepointedtothisapproachasakeyfactorshapingthesuccessfulimplementationofHFinthelocalcontext:

Myreflectionfromthenationallevel…ifIeverhavethechancetobeinvolvedwithaprojectlikethisorwhenIgiveadvicetootherpeopleonundertakingprojectslikethis,that’soneofthepieces—totakethetimeatthefrontend,don’trushthat,andthatwasinpartmyobservationsfromWinnipeg’sapproach.

Thisearlyrelationshipbuildingprocesstookplaceamongallactorsinvolvedintheproposalandsitedevelopment,includingbetweenIndigenousandnon-Indigenousstakeholders.Thisattimesmeantnegotiatingmultipleworldviews,workingcollaboratively,andintegratingacapacitybuildingfocus.Thechallengeinundertakingacollaborativeapproachwasthatthetimeinvestedinthefrontend,atthelocallevel,increasedtensionsrelatedtodelaysintheestablishmentofthevariousserviceandhousingteamsandtherecruitmentofstudyparticipants.

IndigenousCommunityPrioritiesIndigenouscommunityknowledgeandleadershipwerecrucialtoshapingnon-IndigenousunderstandingsofIndigenoushomelessnessinWinnipeg.OnenationalrepresentativenotedthathecametounderstandthatexperiencesofIndigenoushomelessnesswerenotjustaboutbeingwithoutahouse,butalsoaboutexperiencingasenseofhomelessnessthatentaileddisplacementfromtraditionallands,compoundedbytheimpactsofracismanddiscriminationinanalreadychallenginghousingmarket.

AlthoughtheprinciplesoftheHFmodelaremeanttohonourclientchoiceinabottom-upapproach,thislarge-scaleprojectdidnotnecessarilyreflectIndigenouscommunitypriorities.Oneinterviewparticipantnoted,“ThemainbarrierinWinnipegwasthefactthat[HousingFirst]wasa

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Western…intervention.ItwasnotanIndigenousintervention…Ithinkthattheemphasisonchoicewasvery,veryhelpfulinhelpingpeoplewhowererunningsomeoftheIndigenousprogramsinWinnipegfeelmorecomfortablewiththefactthatthisisnotakindofprogramthathasakindofcookbookapproachthat’sgoingtointroduceWesternpracticeorphilosophy.”

Itwassuggestedthatacommunity-drivengovernancestructurehelpedtoreconcilesomeofthesedifferences.Thiscommentemphasizedthatneedingtotaketimeandcometogetherindialoguewascrucial:

Iwouldneversayitwas100%reconciled,butIthinkwhathelpediswefoundawaytoengage…notasaproject,andnotasresearch,butanapproach…Soittookalongtime,butIthinkaswestartedtohavemoremeetings…themoregoodconversationsstartedtohappen.Thathelpedalot…Butitwasaprocess.

Anotherinterviewparticipantsimilarlystatedthat:

Toooften,researchprojectsinparticulararejustimposedorit’sbroughttotheIndigenouscommunityandsaid,“We’redone,thisisit,doyousupportit?”SoIfeellike,intheearlydaystherewassomebumpinessandlotsofconversationsthatneededtohappenwiththeWinnipegcommunityandwiththe[Indigenous]communityinWinnipegaroundwhatexactlyistheproject,whatexactlyareweaskingpeopletoengagein.

Itisimportanttorecallthat,atthetimetheMHCCwasconsideringWinnipegasapotentialAHCSresearchsite,andWinnipegcommunity-basedorganizationswereconsideringwhethertobuyintotheproject,HFwasstillarelativelynewanduntestedapproachinCanada,andtherewaslittleevidencesupportingitsadoption.Thelevelofmistrustamongcommunityorganizationsthathadbeenaskedtosimply“swallow,hook,lineandsinker,”anapproachthatwasnotproventobeeffectiveinCanada,noramongIndigenouspopulations,wascritical.OneintervieweespoketotheimportanceofIndigenousserviceteamsandleadershipinshapingalocalapproachtoAHCS:

TheprograminWinnipegendedupverydifferentinlotsofwaysfromanywhereelsebecauseofthewayinwhich...[Indigenous]agenciesutilize[d][Indigenous]typesofinterventions....TherewerecorecomponentsthatneededtoexistfromaHousingFirstperspective,butlotsofadaptations.So,intermsof[connecting]peoplesocially,[approaching]healthandwellnessusingthemedicinewheel,theinvolvementofelders...weresupportedinthatcontext.

Acommunity-drivenapproachshapedtheformationoftheAHCSprojectandHFapproachinWinnipeg.“OneofthefirstthingsyounoticedaboutgoingtoWinnipeg,”onenational-levelrespondentnoted,wasthat“therewasalwaysaprayerorawelcomingritual…Itwasalways,itwasbeautifulthatway,justalotofrespectforlocalculture.”Thatbeingthecase,itwassuggestedthateventhoughtheprojectwasbuiltfromthegroundupintermsofbeingcommunitybased,thereremainedaneedfor:

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More[Indigenous]agenciescomingtothetabletoparticipateinthedialogue…Justmorevoicesatalllevels,right?Serviceproviders,consumers,peoplewithlivedexperienceinformingtheperspectiveandbuildingtheprogramfromtheverybeginning.Soagain,thatwasdone,butIwouldlovetoseetherebeevenmore.

Althoughnotwithoutsomechallengesandconflictingviewpoints,Winnipegstakeholderstookthetimetodeveloprelationshipsandbuildtrust,bringingtheAHCSprojecttolifeinamannerthatsoughttoberespectfulofthelocalcontextandhistory.Asoneinterviewparticipantstated,“Thiswastotallyaboutcapacitybuilding…[Winnipeg]wentthroughamuchmoredeliberatecommunitydevelopmentapproach.”Anotherpointedtohow“Winnipeg...tookwhatwasessentiallyanationallyconceivedprojectwiththesamesetparameters,andIfeelthatWinnipegtriedtotakethatandmakeitacommunityownedproject.”Whatemergesasclearisthatrelationship-building,andmakingtimeforit,iskeytotranslatingalarger-scaleorstandardizedmodelorapproachtothelocallevel.

Inaddition,IndigenousvoicesandleadershipwerekeytodeliveringtheHFprograminawaythatwasrelevanttothelocalcommunityinWinnipeg.AlthoughtheAHCSprojectwasinitiallydeliveredasaWesternapproach,imposedbyfederalrepresentatives,communitymembersworkedtogethertomakeitlocallyresponsiveandculturallyappropriate.OneinterviewparticipantnotedhowtheHFprogramwasdifferentinWinnipeg,inthatIndigenousagenciesdeliveredhousingandsupportinterventions(seealsoMcCullough&Zell,2016).ThishelpedensurethatcommunitywellbeingandthecontextofIndigenoushomelessnesswereunderstoodandrespected.RespondentsalsospoketothenecessityofIndigenous-directedserviceswithintheAHCSproject,aswellastotheimportanceofputtinggovernancestructuresinplacethat“incorporatecommunity-basedknowledge.”Thisdemonstratesnotonlytheimportanceoflocalownership,butalsotheimportanceofbringingdifferentworldviewsandknowledgebasestotheHFmodelasitplaysoutontheground.

ThisnationaloverviewcapturesaglimpseintothecomplexitiesanddifficultiesofimplementinganunprovenmentalhealthinterventioninalocalcommunitythathadmuchapprehensionaboutWesternwaysofaddressinghomelessness.WhenHFwasexplainedtothecommunityasasuccessemanatingoutofNewYorkCity,theearlychallengewastocreateanenvironmentoftrustamongthelocalgroupsandorganizationsthatHFlessonsfromelsewherecouldbetransferabletoWinnipeg.Whentrustwasbuiltduringtherelationship-buildingphase,respectwasearned,andwithrespectcamebetterrelationshipsamongthelocal,national,andeveninternationalmembersoftheMHCCandthelocalWinnipegSite.

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4.PathwaysWalkedTogether:StagingAtHome/ChezSoiWinnipegBetween2008and2014,theWinnipegSitemobilized,established,delivered,andultimatelysustainedHousingFirstinamanneruniqueamongtheAHCScitiesandHFapproachesgenerally.Weillustratethispathwayasconsistingofsevenstepsintroducedbelowandexpandedinthefollowingsections.

ItisimportanttoreiteratethatthisAHCSwasarandomizedcontrolledtrial(RCT)investigatingtheeffectivenessofHFinCanada(Distasioetal.,2014;Goeringetal.,2011).Thescaleoftheprojectandthefactthatitwaslaunchedinatop-downmanner,withtheMentalHealthCommissionofCanadaestablishingtheparametersofthestudyandcitiesselected,contributedtothetensionexperiencedamongthelocalgroupsandorganizations.MuchofthistensionstemmedfromtheuncertaintyaboutwhatHFwasandwhowouldbechargedinWinnipegwithundertakingtheimplementationofresearchandservicedelivery,aswellasfromaneedtodefinetherelationshipsamonglocalservicesgroups,researchers,andthenationalteam.ThisearlyphaseoftheprojectwasparticularlyimportantinsettingacontextandapproachthatwasdistinctiveamongtheAHCScities.InWinnipeg,therewasaninherentneednotonlytobringvariouspartnerstogether,butevenmoresotoensuretherewasalevelofcomfortandtrustamongthelocalgroupandthosefromtheMHCC.

ToexplorethedesignoftheWinnipegapproach,thefollowingsevenstepsofferanoverviewofthepathfromtheearlystagesofcoalitionbuildingtotheultimatestruggletosustainWinnipeg’steamastheMHCCfundingendedattheconclusionofthestudy.

1. Pre-project Relationship Building Phase:In2008,Winnipegengagedinanearlyrelationshipbuildingandnurturingphase.Thiswascriticalforshapingthedevelopmentofthelocalmodelandinachievinglonger-termsustainability.Duringthisphase,thelocalcommunitybecameawareofHFprinciplesandpractices(throughworkshopsanddiscussions).Atthesametime,theMHCCstaffandothernationalornon-IndigenousactorsbecameawareoftheexistinglocalIndigenousleadershipandsocialenterpriseexpertiseinWinnipeg.Thisstepwaspartofanearlyyearlongefforttobuildtrustandbringtogetherthepeople,bothIndigenousandnon-Indigenous,whoultimatelyinterrogatedandchallengedtheNewYorkHFmodel.Inmanyways,WinnipegcollectivelystruggledtoadoptaHFapproach,questioningwhetheritwasanappropriatefitfortheIndigenouspopulationandthecity.Whilemuchofthistensionwasresolved,itsetafoundationforcreatingtheWinnipegmodelthatsoughttoensurealocallensguidedtheapproach.

2. Leadership and Governance Planning Phase:Creatingtherightmodelforservicedeliverywithastrongleadershipcorewasakeyearlystep.Thisincludedhavingcommunitymembersandothersco-sharethemanagementoftheWinnipegproject.Inmanyways,thiswasdifficulttoachieve,giventhescopeandscaleoftheproject.WhileWinnipeg’sapproachwasuniqueinitsstructureandachievingconsensus,leadershipremainedtricky,especiallyinthenegotiationofrelationsamongthevariouslocalstakeholdersandbetweenlocalstakeholders

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andthenationalAHCSteam.Akeylearningfromthisphaseisthathavingtherightmodeltoequalizepowerisessentialtoensurethevoicesofvariedstakeholdersareheardandconsidered.InWinnipeg,thisincludedworkingwithdepartmentsandunitswithingovernmentwhowerebarrierstohousingandsupportsforparticipantsinthestudy.Forexample,theinclusionofManitobaHousingandEmploymentIncomeAssistanceattheleadershiptablewascriticalinchangingattitudesaboutprovidingsupportstopersonsdeemed“toodifficulttosupport”bysystemsthathadotherwiseexcludedthem.

3. Localizing Phase:Aboveallelse,itwasessentialtoensurethelocalcommunityandtheserviceteamscreatedapproachesinformedbylocalexperience.TheWinnipegmodelusedaculturallensapproachtoensureIndigenousvaluesguidedtheproject’sstructure.ThisincludedmuchreflectiononHFprinciplesthroughongoingstakeholderengagementtoensurelocalexperiencesandvoiceswereincluded.ChallengesintheadoptingtheAHCSmodelalsoincludedunderstanding:howacademicresearch/analysiswastooccur,howcontinuededucationwastobeoffered,howWinnipegwouldcontributetovariousnationalandlocalteachings,howtheHFmodelwouldbeadaptedlocally,andhowlocalcapacitywouldanchorandsustainthemodel.LocalizingandadaptingtheHFapproachwasfundamentalforsuccess.OurviewisthatHFprovidesthescaffoldinguponwhichlocalizedstructuresandactionsaregraphedtosustainanenvironmentnecessarytoendhomelessness.Inaddition,wecontendthatthisprocessshouldinvolveacomprehensivelocalanalysisofmanyfactors,includinghousingmarketconditions,communitycapacity,governmentalrelations,andlandlordengagement.

4. Housing First Team(s) Development:TolaunchandmanageHFrequiresacollectiveandinclusiveframeworkinordertocreateprogramstructures,aprocessthatincludeshiringandtrainingstaffforservicedelivery,housing,andresearch/monitoring.ForWinnipeg,thisphasefocussedonidentifyinglocalcapacitywithahistoryofaddressingcommunityneed.ThisincludedcollaboratingwiththreelocalserviceorganizationsthatcollectivelybroughtacenturyofexperienceworkingwithinWinnipeg’sinnercity.Inaddition,theAHCSWinnipegSitewasuniqueintheinclusionofasocialenterpriselensthathelpedgrowlocalexpertiseandcapacitythroughthecreationandlaunchingofHousingPlusandManitobaGreenRetrofit(MGR).MGR’sgrowthoverthestudyremainsoneoftheonlyexamplesofhowaHFinterventionsuccessfullylaunchedasocialenterprise.Inaddition,itimportanttonotethatforminglocalpartnershipsandcollaboratingwithotherlocalbusinessestodeliversupportsandserviceswaskeytohavingthediversitynecessaryforsuccess.

ThetwomainHFmodelsandorganizationsinvolvedintheAHCSWinnipegSitearedescribedinthetextbelow(especiallyTables4and5).HFprinciplesandphilosophyguidedserviceteamstructuresandsupportedoperationalization(seealso:http://housingfirsttoolkit.ca/).However,giventhatAHCSwasaresearchdemonstrationproject,itisimportanttomentionthatresearch

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monitoringandevaluationwasunique.Forexample,theresearchteamwaslargeandrequiredsignificantexperienceworkingwithinthecommunitytoleveragepartnershipsintherecruitmentandmonitoringstagesoftheproject.TheWinnipegSitewasalsouniquewithintheAHCSprojectinthecreationoftheCommunityLiaisonCoordinator(CLC)position.TheobjectiveoftheCLCwastoofferparticipantsrandomizedintothe“TreatmentasUsual”(TAU)armofthestudyacontactwhowasapeerandabletodrawonlifeexperienceandknowledgeoftheIndigenouscommunity.Ultimately,thisroleevolvedintotwopositionsasthestudyenteredthefinalphase.

5. Delivery Phase:TheWinnipegSitefunctionedbecauseofstrongcommunitypartnershipsconsolidatedandforgedthroughintensivesitedevelopmentandimplementationplans.Theteamshadtremendousexperienceengagingandprovidingservicesinthelocalcommunity.Thelocalgovernancemodelwassupportiveofacollaborativeapproachtodeliveryofservicesandmonitoringoftheproject.Thiswasimportantincreatingbalancebetweentheservicedeliverycomponentandtheresearchteamchargedwithassessingprogress.Ultimately,bringingtherightgroups,whounderstoodthecommunity,aroundtheleadershiptablewascentraltoongoingsuccess.ForWinnipeg,theemphasisremainedoncreatingcapacityinHFbyharnessinglocalexpertise.

6. Monitoring Phase:TheAHCSprojectwasaresearchdemonstrationprojectthatrequiredallfivecitysitestoassessandachieveHFprogramfidelityusingaconsistentapproach.Withinthelocalcontext,understandingtheimportanceandchallengesofresearchandmonitoringandworkingwithanoftentop-downnationalmodelwasdifficulttonegotiateattimes.Forthelocalsite,thechallengewastorecruitover500participantsintothestudy.Todothisrequiredlocalbuy-infromtheserviceteamsandthecloseto50agenciesthathelpedsupporttherecruitmentphase.Overall,Winnipegworkedhardtocreateastrongcommunity-basednetworkthathelpedgetthewordoutonrecruitmentandfollow-up,whichwasadeparturefromtheapproachofothercitiesintheproject.TherewasagreementabouttheimportanceoftheresearchandfindingsinsupportingAHCS,andultimatelyinsustainingtheHFapproachinpolicy.

7. Sustaining Phase:AkeycomponentandobjectiveofAHCSwastosupportbroadereffortstosustainfundingandmulti-levelgovernmentinvolvementpost-AHCS.Astheprojectenteredthefinalmonthsofthestudy,therewastremendousangstamongserviceteams,researchers,andmostimportantlyparticipants,whofearedtheproject’sendwouldresultinsupportandservicedisruption.Thisfinalstagewasparticularlychallenging,asseparatingthe“researchproject”fromtherealityofsustainingpeopleinhousingwasimmenselystressful.ForWinnipeg,thismeantthatthelivesofupwardsof300peoplewouldbeaffectedinsomemannerifaserviceorfundinginterruptionoccurred.Itwascriticalforallstakeholderstobeinvolvedingovernmentrelationsgearedtowardsustainingfunding.ThefactthatAHCSwasaresearchprojectwitha

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definedtimelineandenddatemadethisparticularlydifficult.ItismostimportanttonotetheWinnipegSiteandthenationalteamdeliveredastrongandrepeatedmessagetogovernment,policymakers,andthepublicontheimportanceofmaintainingservices.Themessageincorporatedevidencefromthestudytoinfluencepolicy,andultimatelytheWinnipegteamsweresustainedandtheFederalGovernmentmadeamassiveinvestmentinHFnationallythroughtheHomelessnessPartneringStrategy(HPS).

ThesevenstepsdescribedaboveserveasachronologicalframeworkfortheestablishmentofHFinWinnipeg.WhiletheyorienttheprocessthroughwhichthelocalsitecametounderstandanddeliverHF,itisimportanttonotethattheWinnipegSitebuiltonandbenefittedfromorganizationsandlocalknowledgeholderswithdecadesofexperiencedealingwithhomelessnessandpovertyinthecommunity.Eachorganizationandpersonwhocontributedtotheprojectbroughtauniquegift,withtheculminationbeingalargelysuccessfulprojectthatwasabletoadaptanAmericanmodeltofitaCanadianprairiecity.Thisfitwasneverperfectandtherewasmuchtensionbut,ultimately,WinnipegprovedthatHFcanbedeliveredwithinapopulationthatisprimarilyIndigenousandinamannerthattriestobesensitivetocommunityneeds.

TheWinnipegSite:AnIntroductiontotheParticipantsOverthecourseof18months,theWinnipegSiteworkedhardtorecruitover500personsintothestudy.Recruitmentwaspossiblethroughconnectionswithcommunity-basedorganizations.Itwastheintentoftheresearchteamtoensurethatparticipantsweredrawnfromarangeoflocationsandproviders.Overthistime,theworkoftheresearchteamandothersresultedinreferralsfromcloseto50differentorganizations.EachrecruitedparticipantwasrandomizedintoeithertheHFinterventionarmofthestudyorthe“TreatmentasUsual”(TAU)group;therandomizationprocessisexplainedinGoeringetal.(2011).ParticipantswereassessedaseitherHighNeed(HN)orModerateNeed(MN)and,ifrandomizedtoreceiveHF,assignedtooneoftheSite’sthreeHFprograms.Inadditiontothepersonswhowererandomizedintooneofthethreeteams,theWinnipegSitealsocoordinatedinteractionswithanadditional240personswhowereassignedtotheTAUgroup.ForthepurposesoftheRCT,thisgroupwasthecomparisongroup.ThereasonfortheinclusionofacomparisongroupinthestudywastobeabletoassesswhetherHFwasmoreeffectivethanthecurrentstandardofcareinimprovinghousingstabilityforpersonstransitioningfromhomelessness.

Personsbeingrecruitedtothestudyfaceda50%chanceofreceivingHForbeingrandomizedtotheTAUgroup.ThosereceivingHFwouldbeoutfittedwithafullyfurnishedapartment,whilethoseintheTAUgroupwouldreceiveasmallhonorariumandmeetwiththeresearchteamforaregularfollow-upatthree-monthintervals.Theethicsofthismethodologyweredebatedextensivelybythenationalandlocalteams,andcreatedmuchtensionduringthedevelopmentphaseinWinnipeg.Ultimately,theconclusionremainedthattheinclusionoftheTAUgroupwasimportanttoassesstheeffectivenessof

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HF,themainoutcomeofthestudy(Silvaetal.,2011).Tables2and3offerasnapshotofthegeneralcharacteristicsofthestudyparticipants.

Table2:AHCSWinnipegSiteDemographicCharacteristicsofParticipantsatBaseline

TotalSampleN=513

HighNeedN=199

ModerateNeedN=314

% % %AgeGroups

34oryounger35–5455orolder

37576

41572

35578

GenderMaleFemaleOther

6436

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AsshowninTables2and3,morethanhalfoftheWinnipegSitesamplewasmiddle-aged,andmostbecamehomelessintheirlate20sandearly30s.Whilemalesaremorevisiblynumerous,theSitestroveforahighersampleofwomen(36%ofthesample).Themajorityofthesample(71%)reportedtheywereofAboriginaldescent.Abouthalf(47%)reportedhavingchildren(thoughonly5%reportedtheyweremarriedorlivingcommon-law),thoughveryfewchildrenwerelivingwithparticipantsatthetimeofrecruitment.Therearemanyindicationsthatparticipantsfacedmultiplechallengesthatcontributedtotheircircumstances.Forexample,91%ofthesamplewasunemployedatthetimeofstudyentry,and47%reportedapriormonthlyincomeoflessthan$300.Amongstudyparticipants,69%wereabsolutelyhomelessand31%precariouslyhousedpriortostudyentry.Themajorityofthesamplewasdrawnfrominner-citylocations.Thelongestsinglepasperiodofhomelessnessreportedbyparticipantsaveraged33months.ThetypicaltotaltimeparticipantshasbeenhomelessintheirlifetimespriortotheAHCSstudywasnearly5years.FormoreinformationontherecruitmentprocessandparticipantsseeGoeringetal.(2011)andDistasioetal.(2014).

Table3:HomelessnessHistoryofAHCSWinnipegSiteParticipantsatBaseline

TotalSampleN=513

HighNeedN=199

ModerateNeedN=314

% % %

HomelessstatusatenrolmentAbsolutelyhomeless*Precariouslyhoused*

6931

7128

6832

FirsttimehomelessTheyearpriortothestudy2008orearlier

2278

1684

2674

Longestaverageperiodofhomelessnessinmonths(lowestandhighestroundedtonextmonth)

33(1–324)

38(1–324)

31(1–324)

Totalaveragetimehomelessinlifetimeinmonths(lowestandhighestroundedtonearestmonth)

60(1–420)

61(1–420)

59(1–324)

Averageagefirsthomeless(lowestandhighestroundedtonearestmonth)

29(1–68)

27(1–65)

31(7–68)

Note:Allinformationwasreportedbyparticipantsexceptwherenoted.

*Seehttp://bmjopen.bmj.com/content/1/2/e000323.fullfordefinitionsofabsolutelyhomelessandprecariouslyhoused.

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TheWinnipegSiteHousingFirstTeamsThefollowingsectionprovidesanoverviewoftheserviceteamsinWinnipegandthecaremodelsusedlocally.TheintentofthissectionisnottoprovideaprogramreviewbutmoretoacknowledgesomeoftheuniquecharacteristicsoftheWinnipegSitethatdrewfromtheIndigenouscommunityandotherpartners’contributions.ItisthroughtheselocaladaptationsthatWinnipegwasabletobetterlocalizetheHFmodeltoacreateacommunitydrivenapproachthatwasthoughttoresonatewithparticipants(Distasioetal.,2014).

IntheAHCSWinnipegSite,HFservicesweredeliveredbythreecommunity-basedorganizations,showninFigure1:theMaMawiWiChiItataCentre(whichhousedanddeliveredtheWiCheWinHFprogram),theAboriginalHealthandWellnessCentre(whichhousedanddeliveredtheNiApinHFprogram),andtheMountCarmelClinic(whichhousedanddeliveredtheWiisocotatiwinprogram).EachorganizationhaddeeprootsinWinnipeg’sinnercityandalonghistoryofservingtheneedsofbothIndigenousandnon-Indigenouspersonswhostruggledwithhomelessnessandmentalhealth.

ItisimportanttoreemphasizethatAHCSwasapragmaticRCT.Assuch,thethreeHFteamswererequiredtoadheretoaconsistentapproach(thoughtherewasroomtolocalizeaspects),andallhadtoachievefidelitywiththeHFmodel.TheteamsdeliveredHFusingeitheranIntensiveCaseManagement(ICM)oranAssertiveCommunityTreatment(ACT)model.IntensiveCaseManagementisacarestandardwithfocusedsupportforpersonswithmoderatementalhealthissueswhiletheAssertive

Figure1:WinnipegServiceTeamOverviewDevelopedDuringAHCSCensus2015

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CommunityTreatmentmodeloffersenhancedcaretopersonswithseverementalhealthissues(seeTable4).Foramoredetaileddiscussionofeachmodelandthemannerinwhichparticipantswererandomizedintoeithergroupsee(Goeringetal.,2011).

Table4:AtHome/ChezSoiHousingFirstModelOverview

HousingFirstModel

• Recovery-orientedculture• Basedonconsumerchoiceforallservices• Onlyrequirements:incomepaiddirectlyasrent;visitedataminimumonceaweek

forpre-determinedperiodsoffollow-upsupports• Rentsupplementsforclientsinprivatemarket:participantspaid30%orlessoftheir

incomeortheshelterportionofwelfare• Treatmentandsupportservicesvoluntary–clinicians/providersbasedoff-site• Legalrightstotenancy(noheadleases)• Noconditionsonhousingreadiness• Programfacilitatedaccesstohousingstock• Apartmentswereindependentlivingsettingsprimarilyinscatteredsites• Servicesindividualized,includingculturaladaptations• Reducethenegativeconsequencesofsubstanceuse• Availabilityoffurnitureandpossiblymaintenanceservices• Tenancynottiedtoengagementintreatment

ACT-HighNeed

ICM-ModerateNeed

• Recovery-orientedACTteam• Client/staffratioof10:1orless

andincludedapsychiatristandnurse

• Programstaffcloselyinvolvedinhospitaladmissionsanddischarges

• Teamsmetdailyandincludedatleastonepeerspecialistasstaff

• Sevendaysaweek,24-hourcrisiscoverage

• Weeklyhomevisits

• Intensivecasemanagementforaminimumofoneyearoncehoused

• Client/staffratioof20:1orless• Integratedeffortsacrossmultiple

workersandagencies• Workersaccompaniedclientsto

appointments• Centralizedassignmentandmonthly

caseconferences• Sevendaysaweek,12hoursperday

coverage

Source:MHCC(2008)

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Table5offersanoverviewofeachserviceteam,listingthecommunityorganizationinwhichitwashoused,thecaremodelused,andthemaximumcaseload.TheWinnipeg-specific“thirdarm”modelwascalledNiApin.ItwasdeliveredbyAboriginalHealthandWellness,wascloselyalignedwithICMprinciples,andwasabletoachievegoodprogramfidelity(Nelsonetal.,2014).TheNiApinprogramwastheWinnipegSite’sexperimentalarmoftheAHCSproject,whichallowedlocalcommunityadaptationsoftheHFapproach.OneuniquecomponentofNiApin’sapproachwasadayprogramwithanactivedrop-incentrethatbroughtparticipantstogether.Theprogramalsoexperimentedwithco-housingandotherinclusionsthathelpedlocalizetheapproach.

Table5:WinnipegServiceTeamIndigenousNaming

Organization HFModel MaximumCaseLoad

IndigenousName

Translation

MaMawiWiChiItata ICM 100 WiCheWin TowalkalongsideAboriginalHealthandWellnessCentre

ICM–ThirdArm

100 NiApin IamsittingatHome

MountCarmelClinic ACT 100 Wiisocotatiwin Tofindhiddengifts

ThethreeWinnipegteamsformedthebasisfromwhichservicesandsupportsweredirectedtothe300personsinthestudyreceivingtreatment.TheWinnipegSitealsocoordinatedinteractionswithanadditional240personsassignedtotheTAUgroup.Asnoted,auniquecomponentoftheWinnipegresearchmodelwastheinclusionoftheCommunityLiaisonCoordinator(CLC).Thespiritofthispositionwastoofferthoseindividualsrandomizedtotreatmentasusualwithapersontheycouldconnectwiththroughoutthestudy.ThispositionwasheavilyscrutinizedduringtheearlystagesoftheprojectastherewasthoughtitmayinterferewiththeRCTframework.However,theresearchandleadershipteamwasadamantthatthispositionwouldbevitalinofferingarespectfulmeanstoconnectthisgroupwithapersonwithwhomtheycouldsharethoughtsandaskquestions.Thisoutweighedanypotentialforinfluencingresearchresults.

Overall,thelevelofengagementoftheIndigenouscommunitywaspartofallaspectsoftheproject,includingprojectcoordination,servicedelivery,research,andadvisorycommittees.ThisincludedthosereceivingsupportandhousingandthoseintheTAUgroupwhohadaccesstotheCLCandinterviewers.

Assuch,Indigenousvalueswereinfusedthroughoutservice,programandresearchforstaffandparticipants.TheWinnipegAHCSsoughttobeinclusivewithafocusonbeingholistic,relationship-based,strengths-based,andonensuringparticipantsandstaffhadaccesstoculturalsupportsandservices.

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Inaddition,EldersandTraditionalTeacherswereaccessibletostaff(serviceandresearch)andparticipantsandoftenguidedceremonies,sharingcirclesandone-on-ones.Perhapsthisinclusionwasacounterbalancetothetop-downstructureoftheMHCC,allowingtheWinnipegteamsto“localize”theirapproachesbothinnameandinpracticetocreatecomfortindeliveringservicesthathadthestrongestfitwithinthelocalcontext.

ThesuccessfuldeliveryofHFinWinnipegrequiredtheleveragingofexpertisefromthethreeteamsthatprovidedservicesandsupportstothe300peoplereferredtothestudyandassignedtooneoftheteamsbasedonlevelofneed.Eachteamhadauniquestructurethatofferedasetofservicesandsupportsdrawingontheirdecadesofcommunitybasedexperiences.ThefollowinghighlightssomeoftheuniqueaspectsofeachteamandprovidesmoredetailonhowtheWinnipegSitewasstructuredandtheapproachusedtolaunchanddeliverHF.ThisisfollowedbyanexaminationoftheWinnipeggovernancemodel.

WalkingTogether:TheWiCheWinModelTheWiCheWinprogramwastheICMmodelforWinnipegandwasbasedonleveragingcommunitystrengthstosupportthoseinneed.Themodel’sspiritisbestdescribedbyanintervieweewhoshared:“Thenamemeanswalkwithme.Sothat’sourphilosophy,whentheycomethroughourdoors,wehavetostartwalkingwiththem,whereverthey’regoing,andstartwheretheyare,andwalkwiththemtotheirnewneighbourhoods,theirnewhomes.Eveniftheygotojail,we’llwalkwiththem.That’sourphilosophy.”TheWiCheWinprogramestablishedthefollowingprogramprinciples:

v Strengths-based–foundedonthebeliefthatallindividualshavestrengthsandresiliencetosurvivethestreets,whichcanbebuiltonandenhancedandusedtocreateaplantailoredtotheindividual’slifecircumstances.

v Client choice–determineswhoissignificantintheirfamilynetwork,includingfamilyandfriends,anddetermineswhoshouldbeenlistedtosupporttheparticipant.

v Respectfortheindividual,theirfamily,andtheirculture.

v Respect knowledgeoftheindividual/family.Theindividualandtheirfamilyknowtheirownpersonandfamilyhistory/dynamicsbetterthananyoneelse.

v Individuals need resources, information, and supporttoimplementtheirplans.Workers,throughintensiveinvolvement(homevisits,accompanyingthepersontoresources,etc.),knowwhatresourcesandinformationcanbemadeavailabletofacilitatesolutions.

v Solution-focused–solutionstodealwithlivingsituationsastheyarise,utilizingtheprinciplesofharmreduction,withrecognitionthatrelapsewillbeapartofthechallenge.

v Knowledge and skills transfer is ongoing–workerswilldowith,notforortoparticipants,toprovideopportunitiestogrowincapacityandlearntoproblemsolve.(WinnipegSiteProposal,2009)

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Inadditiontotheguidingprinciplesnotedabove,theWiCheWinmodelalso includedservicecoordinatorsandcasemanagerswithextensiveexperienceworkinginthecommunity.KeytotheprogramwasthesupportandguidanceofEldersandtraditionalandculturalteacherswhowereavailabletoparticipants,asexpressedinthefollowingquote:“Theseindividualsservedasspiritualguidesandteachers,helpingparticipantsunderstandtheirtraditionalrolesandrelationshipswithothers,andsupportingindividualstoachievegreaterbalancethroughunderstanding”(WinnipegSiteProposal,2009).

WhatwasalsospecialabouttheWiCheWinmodelwastheinvolvementoftheMaMawiWiChiItataCentre,whichhasmorethan30yearsofexperienceworkingwithintheManitobaIndigenouscommunity,primarilyservingIndigenouscommunitymembers.ForthepurposesoftheAHCSproject,theyalsoworkedwithandsupportednon-Indigenousparticipants.AllpersonsintheWiCheWinprogramhadaccesstothesameservicesandsupports,withmanynon-Indigenouspersonstakingpartintraditionalceremoniesandteachings.Thisaspectofthemodelwasbestsummedupbyaparticipantinthestudywhoofferedthisview:

Beinganon-AboriginalinanAboriginalagencywasanenlighteningexperience.TheyshowedmewaysofknowingandbeingthatIdidn’tknowexisted.Theymentoredme,tookmetosweatlodges,andintroducedmetoaspiritualityunlikeanyI'vebeenexposedto.

TheWinnipegThirdArmModel:NiApinNiApinwasWinnipeg’sexperimentalmodelandprovidedsupportstoIndigenouscommunitymembers.TheNiApinapproachwas“holistic,cultural-based,pragmaticandspeciallydesignedforurbanAboriginalpersonswhoareseekingassistanceinre-integratingintothecommunityandestablishingahealthy,well-balancedlifeinanurbanenvironment”(WinnipegSiteProposal,2009).

ThemodelalignedcloselywiththeICMlevelofsupportsbutincludedmanyuniquemodifications.TheintentwastocombinebothcontemporaryandtraditionalphilosophiesoftheMedicineWheelandtoensurethatvalues,traditionsandbeliefsembracedtraditionalapproachestohealing.TheNiApinprogramwasdevelopedbasedintheuniversalprinciplesofsharing,caring,kindness,humility,trust,honestyandrespect.TheseprinciplesmakeuptheSevenSacredTeachingsandalloftheseprinciplesexistwithintheMedicineWheelortheCircleofLife.

AnothercentralpartoftheprogramwastoensureopportunitiesforcontactwithEldersandTraditionalHealers,“TheElderisapositiverolemodelforallcommunitymembersandisacatalystforchange.ThroughtheElder’ssharingoflife’sexperiences,theparticipantslearnaboutthegiftsofwisdom,peace,respect,courage,honesty,humility,sharing,andcaring”(WinnipegSiteProposal,2009).

TheNiApinmodelalsoofferedIndigenous-basedsupportsthatincludedhavingaCulturalResourceSpecialisttosupportthespiritualcomponentofwellbeing.Thispositionwasintendedtoworkwith

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participantsandstaffin“developinganddeliveringculturalandspiritualprogramming,suchasSharingandTeachingCirclestomeettheconstituent’sinterestandknowledgeinordertoprovidethemwithoptionstoaddresstheirspiritualwellbeing.”NiApinfocusedsignificantattentiononculturalprograms,anditsentireapproachtoprogrammingwas:

Groundedintheunderstandingoftheimpactsofcolonizationandresidentialschool,andcounterstheseimpactsthroughculturalrevitalizationbyrestoringasenseofbelonging,restoringthewisdomoftraditionalteachings,practices,andmedicinesandprovidingopportunitiestopracticenewwaysofthinking,behaving,andlivingwithotherswhoalsocommittedtobalancedhealth.(WinnipegSiteProposal,2009)

Aspreviouslymentioned,auniqueaspectoftheNiApinmodelwastheinclusionofthedrop-inprogramthatbroughtpeopletogetherinanopenandrespectfulmanner.Thedrop-inwaslocatedintheAboriginalCentreofWinnipeg,whichishighlyrecognizableinthecityandcentrallylocated.Thedrop-inoperateddailyandofferedarangeofprogramsaddressingissuessuchasfoodsecurity,offeredsharingandteachingcircles,andsimplyprovidedaplaceforparticipantstogatherandshare.

Inaddition,theAboriginalCentreofWinnipegbecameanimportantlocationfortheWinnipegSitegenerallyandhostedmeetings,eventsandgatheringsthroughoutAHCS.Fortheresearchteam,thecentrewasalsokeyforinterviewsandreferralsandbecameanimportantmeetingspacefortheresearchteam.

FindingGifts:TheWiisocotatiwinModelThecaremodelusedbytheMountCarmelClinic’sACTteamrequiredadditionalresourcesandsupportsforpersonsrandomizedwithhigherneeds(seeTable4).Thisincludedhavingapsychiatristandadditionalstafftoensurethattheclient-to-staffratioalignedwiththeHFmodelandincludedtherightsetofsupports.

TheACTmodelalsohadbothIndigenousandnon-Indigenousparticipants.WhatwasuniquewithintheWinnipegAHCSACTmodelwasitsIndigenous-focusedapproach,whichincludedaroleforElderswhoprovidedguidanceandsupport.Thisincluded“havingtraditionalceremoniesandteachingstoassistprogramparticipantsandstafftounderstandtheworldthroughanAboriginallensasitisrelatedtohealing.TheroleofElderswasimportantforcreatingatraditionalfoundationforstrengthandchange”(WinnipegSiteProposal,2009).

FortheWiisocotatiwinapproach,servicesandsupportsweresetuptoenableindividualstoregainknowledgeofhistory,traditions,andculture,andtoprovideopportunitiestobuildagreatersenseofself.Thetypesoftraditionalsupportsincluded:

v Opportunitiestoparticipateinsharingcircles;

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v Opportunitiestoattendcommunityeventsandcelebrations,ceremonies,medicinepicking,andnamingceremoniestoobtaintheirspiritnames;and,

v Opportunitiestolearnabouttheimpactofcolonization,residentialschools,andhistoryonself.(WinnipegSiteProposal,2009)

Itisimportanttonotethattherewasastrongemphasisonbringingintherightstaffamongalltheteams.ThetypeofpersonneededtosupportaHFteamrequiredskillsandknowledgeaboutmanyofthestrugglesandchallengesfacingthoseinthestudy.OneACTteammembersharedthatit’s“justamazingtobeabletorecognizethegiftsoftheteam,andtohonourthose,andtoencouragethemtousetheminthatgoodway.”

MountCarmelClinichaddecadesofexperienceworkinginWinnipeg’sinnercity.ThedeliveryoftheACTmodelbyMountCarmelprovidedagoodfitthatbroughttogetherastrongmedicalservicesbackgroundwithanemergingstrengthincommunity-basedapproachesthatofferedbothIndigenousandnon-Indigenouspersonstheabilitytosucceed.

Overall,Winnipeg’sthreeserviceteamsprovidedAHCSparticipantswithasetofservicesthatbothalignedwithHFprinciplesandachievedstrongprogramfidelity.ThiswascriticalforWinnipegtoadheretotherigorsoftheRCTandtherequirementsoftheMHCCindeliveringHFconsistentlywiththeothercitystudysites.However,inadditiontoachievingtheseobjectives,eachofthethreeteamswasalsoabletoaddressmorefundamentallytheneedtoconnectparticipantswithofferingsthatcloselyalignedwithIndigenousapproachesandvalues.ThiscombinedeffortlocalizedHFinamannerthatpersonscouldbetteridentifywithandachievetheirownsenseofrecoverygroundedinacommunity-drivenmodel.

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5.AtHome/ChezSoiProjectGovernanceModelThefollowingsectionexaminestheoverallMHCCmodelandtheWinnipegmodel.TheAHCSnationalgovernancemodelwascomprehensiveinnatureandintegratedthesitesthroughtheinclusionofaNationalWorkingGrouptoensurestrongcollaborationthroughouttheresearchdemonstrationproject(Figure2).Thiswasdeemedcriticaltotheproject’sabilitytoensureprogramfidelitywasalignedamongthesitesandthatallsitesadheredtoHFprinciples(Goeringetal.,2016).

Overthecourseofthestudy,verylittleturnoverensuredstrongcontinuitywithintheprojects’leadershipstructure,whichremainedconsistentbothnationallyandamongthesites.Atthenationallevel,MCCCstaffanditsboardofdirectorsmanagedtheproject’smassive$110milliondollarbudgetandreportedprogresstoHealthCanadaasrequired.TheAHCSprojecthadadualnationalleadershipstructurethatseparatedtheresearchfromtheproject’smoreadministrativefunctions.ThisincludedNationalProjectLeadDr.JayneBarker,wholaunchedAHCSandremainedwiththeMHCCfrom2008to2011,whenCameronKellerassumedtheroleuntiltheendofthestudy.Thispositionfocusedmoreontheadministrativenatureoftheproject.TheNationalAHCSco-leaderwasDr.PaulaGoering,whowastheNationalResearchLeaduntilthecompletionoftheproject.Dr.Goering’sleadershipwasthefoundationforAHCSandcentraltothedevelopmentoftheproject’sresearchframework.

TheNationalWorkingGroup(NWG)actedasthecentralconnectionbetweentheMHCCandthelocalsites.TheNWGwascomprisedofSitePIsandSiteCoordinators,alongwithMHCCstaffandresearchers.Thisgroupworkshoppedmanyideas,addressedproblems,andstructuredmuchoftheanalysisforreportsandpublications.Inaddition,theNWGwasthecentrepointfortheongoingdiscussionwithgovernmentonsustainabilitypost-AHCS.Overall,thetotalnumberofpersonsinvolvedintheleadershipsideoftheAHCSprojectnumberedover50,andincluded6SiteCoordinatorsand40Investigators.

Astheprojectevolved,therearosemoreneedforspecializedsub-groupstoprovidesupport.Thisincludedanumberofcommunitiesofpracticethatweretaskedwithspecificissuessuchashousing,criticalincidents,researchandpublication,andothersareas.Thesesmallerworkinggroupsweremoreinformalbutofferedaccesspointsforhotbuttonissuesandservedasameanstohavearangeofsitestafftakepartinnationalcallsandmeetings.

TheMHCCnationalteamwascentraltothefunctioningoftheprojectandactedastheadministrativearmofthestudy,coordinatingfinances,education,andtrainingalongwithgovernmentalrelations(amongotherroles).TheMHCCteamwaskeytothesuccessoftheproject’sabilitytolinkdataandfindingsamongthesitesandtoshareevidencefromtheproject(onalocal,national,andglobalscale).

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Astheprojectevolved,akeycomponentthatisnotnotedonFigure2wastheNationalConsumerPanel(anMHCCgroup),whichhelpedensurethatpeoplewithlivedexperience(PWLE)hadameaningfulvoiceintheproject(Nelsonetal.,2016).ThroughoutthecourseoftheAHCSproject,theinclusionofPWLEwasessential.InWinnipeg,theLivedExperienceCircle(LEC),whichembracedpeersinameaningfulmannerandisdiscussedinmoredetailbelow,remainsoneofthemostimportantandongoinglegaciesofthelocalproject.

Overall,theAHCSprojectwasawell-structuredresearchdemonstrationprojectthanksinparttotheMHCCleaders,whosuccessfullyguidedimplementationandongoingefforts.Themodelwassuccessful

Figure2:MHCCNationalandWinnipegModel

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indeliveringsupportandmanagingacomplexprojectthatextendedacrossthecountry,fromMonctonintheeasttoVancouverinthewest.Therewerechallengesrelatedtosettingsuchalarge-scaleprojectwithinthecontextofamid-sizedprairiecity,andtherewassomeinitialfrictioninWinnipeg,whereahistoryofstrongcommunityownershipofaddressingissuesrelatedtopovertyandhomelessnesshaddrivenmuchoftheprogramandservicedeliveryfordecades.InWinnipegtheapproachwastotrytoreconcilethegapbetweenalarge,national-levelprojectandtheneedsanddemandsofWinnipegbycreatingalocalmodelthatbetterreflectedtheneedsofthecommunity.Thetensionandongoingstruggleofdoingsowasperhapsinterpretedbysomeinanegativelight,butthoseclosetotheprojectreflectthatitwasthistensionandquestioningthathelpedensureWinnipeg’sapproachwasbetteralignedwiththelocalcommunityanditsneeds.

TheWinnipegModelEachsitedevelopedalocalgovernancemodelthatgenerallyconsistedofaSiteCoordinator,aPrincipalInvestigator,collaboratorsandservice/researchteammembers(Aubryetal.,n.d.).EachsitewasresponsiblefortheirownmechanismsforhowtheywouldstructureanddeliverHFinthecommunityandhowtheywouldmanageoperations.InWinnipegthegovernancemodelincludedanumberoflocaladaptationsthathelpedensurestrongercommunityownershipandpartnership(Figure2).TheWinnipegAHCSprojectisanexampleofasuccessful,culturallysafepartnershipamonguniversities,localAboriginalorganizations,andgovernment,engagedtogetherinthedevelopmentandongoingoperationsoftheWinnipegSiteprojectfromitsinception.

ThefollowingsectionexamineselementsoftheWinnipegmodelthatcontributedtothedeliveryofservices,housing,researchandotherpartnerships.Thiswasaccomplishedbyreviewingsitedocumentationanddrawingfromindividualinterviewswitheightmembersoftheoriginalteamandfourfocusgroupsconductedwithserviceteamstaff,housingdeliverystaff,theAboriginalLensCommitteeandresearchandgovernmentrepresentativesaswellasmembersoftheLivedExperienceCircle.WhatthissectionsattemptstodescribeistheapproachusedinWinnipegandthoseelementsofthemodelthatsetthecityapartfromothersinAHCS.

FromtheinitialproposalofWinnipegasapotentialsitewithinAHCSproject,theinclusionofIndigenouspersonsandorganizationswasfrontandcentre.Thishelpedbalancetheinterestsofthetop-downresearchmodeloftheMHCCwiththeneedtohavemoreofabottom-upownershipapproachamongthelocalstakeholders.BalancingtheseapproachespresentedoneofthemostchallengingaspectsoftheestablishmentandongoinggovernanceoftheWinnipegSite.Thiswasraisedinalmosteveryinterview,withonepersonstatingthatcommunityorganizations“weretickedoffabouttheresearch,researchbeingdoneintheIndigenouscommunityandnotdoneinanIndigenousway.”

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Asecondintervieweealsocapturedthissentimentandshared:

TherewasalotofconcernaboutthisprojectcomingintoWinnipeg.Therewasalotofconcernaboutwhatitmaymiss.ConcernsaboutbringinginamainstreamprojectandworkingwiththeFirstNationscommunities,andhowthatwasgoingtoplayout.Youknow,intermsoftryingtofitkindofacookiecutterprogramintothecommunity.Somethingthatreallydidn’tbelongtous…butbringinginaprogramandsaying,thisishow,youknow,wewouldlikeyoutoworkwiththeFirstNationcommunity.

AthirdintervieweereflectedontheearlyinclusionofIndigenousviewswithinthescaleofanationalproject:“Ithinkthattheprogramissolargethatthere’ssomedisconnecttherebetweenwhatwearetryingtodoandwho’shearingthat.Ithink[high-levelleadership]certainlyseesthebenefitofit[includingusintheprocess];however,thecriticalpieceofthatisifanyoneishearingus,Idon’tknow.Wedon’tseeanyresultsofthat.”

Tocounterbalancetheneedforstrongercommunityawarenessandownership,theWinnipegmodelsoughttobuildanapproachthattriedtogivevoicetothelocalgroupswhilebalancingthecomplexitiesofensuringtheresearchintegrityofthestudy.Often,asisnotedbelow,thismeantWinnipegwouldcontinuallytrytoshifttheapproachtobemoreinclusivebyadaptingthelocalmodelthroughcommitteesandothermeansthattriedtoofferaccesspointsforabroadersetofviews.

Thisresultedincreatingalocalgovernancestructurerootedinunderstandinghowthelocalgroupsworkedtogetherandusingtheirknowledgeofthelocalpopulationwhowerehomelessness.Asoneintervieweestated,“Well,Ithinkthatthegoodpartisthatsomanydifferentfactionscanactuallyworktogether,butIthinkthat’sbecauseweall,althoughwe’reworkingtogether,weallhaveourownfocus,andwe’renotineachother’sface.”Anotherrespondentreflected:“There’sorganizationsthathavenaturalpartnershipshereandwe’veworkedtogetherformanyyearssoalotofthatcameintoplayandbecausewecollaborateandweworktogetheronfillinginthegaps,alotofusareworkingwithsomeofthesamepeople.”

TheProjectLeadershipTeamTheabovecommentsspeaktothescaleoftheprojectandhavingmultipleorganizationscontributetothedeliveryofHFandtotheconcernsabouthowWinnipegconnectedwiththenationalproject.Essentially,eachofthethreeHFteams(andtheorganizationsinwhichtheywerehoused)providedservices,includinghousingprovision,inanindependentmanner.However,wheretheWinnipegSitecametogetherwaswiththeProjectLeadershipTeam(PLT).ThePLTwasthelocalbodythatcoordinatedandmanagedsiteissuesandinteractionswiththeNationalWorkingGroupandtheMHCCgenerally.ItwaschairedbytheSiteCoordinators.

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ThePLTemphasizedaconsensus-basedmodelthatprovidedastrongvoicetoallmembersatthetable.ForWinnipeg,theearlyadoptionofadualSiteCoordinatormodelprovidedasenseofbalanceandinclusion.SitecoordinationwassharedbetweenMarciaThompson,agovernmentalrepresentative(withstrongbackgroundandconnectionswiththeProvince),andLucilleBruce,arespectedIndigenouscommunityleader.ThePLTmetfrequentlyattheoutsetoftheprojectandmoretowardtheendasagendasshiftedtoissuesrelatedtosustainability.ThePLTwasdescribedbyamemberasbeingthecentreofdecision-making:

OurProjectLeadershipTeamhadrepresentativesfromService,Housing,HousingPlus,Research,myself,others,whoactuallytryto,Iguessononelevelmaketheday-to-daydecisions,butmoreimportantlyprobably,makesurewe’reallonthesamepageandworkinginthesameway.Sothingslikeworkingwithlandlords,tenantissuesofpeoplewhohaven’tbeensuccessfulinhousing,lookingattheHousingPlusprocess,andinfact,actuallydevelopinganI.T.systemtosupportthat.AllthosekindsofthingshavebeenmanagedbytheProjectTeam,whichisreallycentraltotheimplementation.

AstheMHCCenteredintothefinalyearoftheresearchproject,allcitiesbecameacutelyawareoftheneedtoworkonsustainabilityplanning.Thiswasparticularlychallenging,giventhereweretwoscenariosconsidered:oneinwhichfundingwouldcontinueandprogramsbeextended,orasecondinwhichtherewouldbedisruptioninthefundingofserviceteams.Thepossibilityofthelatterraisedanxietylevelsofparticipantsinthestudy,ofworkersemployedtoprovidesupports,andofthelocalleadershipteamwhopotentiallyfacedhavingtocutpeopleadriftwithoutsupports(includinghousingsubsidies).

Overall,thestructureofthePLTservedtheWinnipegSitewellandofferedanimportantlayer(andbuffer)betweentheactivitiesoccurringinWinnipegandnational-levelissuesandstructures.SomemembersofthePLTwerealsomembersoftheaforementionedNationalWorkingGroup.Thisofferedanimportantmeansbywhichtoshareinformationandassessprogresswhilealsoworkingoutissues.

TheWinnipegAdvisoryCommitteeLikemostoftheAHCScitysites,theWinnipegSitealsoincludedalargerAdvisoryCommittee(AC),whichconsistedofcloseto20keystakeholderswhobroughttremendousexperienceworkinginthecommunityandwiththosemostvulnerable.TheWinnipegACworkedtopromotepartnershipsamongthegroupsworkingtoendhomelessnessinWinnipegandofferedadviceonthelong-termsustainabilityofHFinManitoba.ThetermsofreferenceforthelocalACweretoensurethattheWinnipegSiteofferedaholisticapproachthatwastransparentandculturallyappropriateinbothresearchandserviceprovisionwhileaddressingtheneedsoftheIndigenouscommunity.TheACmetmorefrequentlyduringtheinitialphasesoftheprojectandhelpedsupportknowledgedisseminationaboutwhatHFwasandhowtheAHCSprojectwouldunfoldinacommunitythatwasincreasinglysensitivetosolutionsbeingimposedbynationalorganizations.AmemberoftheWinnipegSitestated,“I’mreallyhopefulthatthey

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canhelpwithdissemination…Onanindividualleveltheycouldgobacktotheirownagencies,theirowngovernments,theirownwhatever,andsharesomeofthisinformation.HavinganAdvisoryCommitteemadeupofrepresentativesfromvariousexternalinstitutionshelpsspreadawareness.”

TheWinnipegAdvisoryCommitteeplayedanimportantroleintheearlystagesoftheprojectbutbecamelessengagedasrecruitmentproceededandmeetingsbecamelessfrequent.However,thereislittledoubtoftheimportanceofsuchagroupinhavinghelpedshareinformationandexpertiseaboutestablishingthreeHFteamsinacommunitythathadnopreviousexperiencewithHF.

TheAboriginalLensCommitteeForWinnipeg,theAboriginalLensCommittee(ALC)andtheLivedExperienceCircle(LEC)representtwolocalinclusionsthatsetWinnipegapartfromtheotherAHCScities.TheALCprovidedaculturallensthatinformedresearch,supports,andservices.TheALCwasacouncilofIndigenousleadersandElderswhometfrequentlyduringtheearlystagesoftheproject.ThepurposeoftheALCwastoupholdtheintegrityofIndigenousknowledge,wisdom,experience,andwaysofbeingasvalidandnecessarycomponentsofaholisticviewoftheindividualandthecommunity.Thiswasessentialinhelpingcomplementresearchandservicedeliveryaswellasoverallprojectgovernance.ThemembersoftheALCalsohadopportunitiestoengagewithmembersoftheNationalMHCCteamthroughtrainingandeducationevents,meetings,andconferences.

WhilethespiritoftheALCwastrueinstrivingforstrongIndigenousinclusion,theirrolewasnotwelldefinedwithintheoverallgovernancestructureofboththenationalandlocalprojects.MembersoftheALCunderstoodtherewerechallengesfacedbytheWinnipegleadershipteamincreatingalocalizedgovernancemodelwithinabroadernationalproject.Furthermore,theALCrealizedearlythatinthistop-downnationalstudy,theinclusionoflocalvoiceswouldbeconstrained.“Wewerebroughtinatthebeginning…[becauseitwas]thoughtthereneededtobeacouncilofEldersorotherswhohadexperienceworkingwiththecommunity,tobringthatculturalpiece.,”oneALCmemberstated.Asecondmembercommented:

Withinourcircleweareknowledgeableabouttheimportanceofit[traditionalknowledge].Ourpastexperienceshowsthesuccessofhavingthiscircleofpeoplewithdifferentwisdomandgiftsindifferentareasofteachingsandknowledge.Whenwegettogetherit’squitemagical,andtheteachingsarequitemagicalanditiswhatisreallyneededinourcommunity.

TheALCplayedanimportantroleinhelpingtheprojectunderstandlocalIndigenousvalues.Theideaofusinga“lens”committeewastohelpunderstandandsupportthelocalIndigenouscommunitystrugglingwithhomelessness.ThecontributionsoftheALCaredifficulttomeasurebutwereessentialinsharingwisdomandthoughts.Forexample,onemember’sviewoncollectinginformationaboutparticipantsinthestudywas:

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Well,we’reconcernedaboutthesanctityofpeople’sstories,lifestories.Andhowwillthosebeusedaslearningtoolsforotherpeopleandhowwillthosepeoplewhosharedtheirlifestoriesberespectedandhonoured?Andthosepartsthatarebothsacredandshouldn’teverberepeated.Andtherearecertainceremoniestoothatshouldn’tberecordedorshouldn’tbeevenmentioned.

Thiswasanimportantstatementthatprovidedguidancetotheprojectteamentrustedwiththestoriesandteachingsfromparticipantsinthestudy.Thisisaprimeexampleofthekindofchallengefacedbytheresearchteam,whichhadtobalancetheneedtocollectverysensitiveinformationaboutpersonalstrugglesandtraumawiththeimperativetoconducttheresearchinamannerthatwasrespectful.Forthemajorityoftheinterviews,theWinnipegSiteusedatwo-personteamapproach.Thisallowedoneinterviewertofocusonthequestionsandasecondpersontofocusonthewellbeingoftheparticipant.Amemberoftheresearchteamwhoservedinthiscapacitysharedthatthesecondpersonwas:

Notdoingtheleadinterview,butbeingthere.Andmypresencewasjustalwaystosupporttheparticipant.Andtheycouldfeelmywarmthandtheyfeltverycomfortableinthatsetting.SoIwas,afterleavingorgoingalittlewayfromtheinterview,actualformalinterviewpart,Iwouldstartmeetingwiththepeopleonthestreet,orwh