Housing First and Indigenous Communities

Lessons learned from the City of Winnipeg

The Winnipeg At Home Chez Soi (AHCS) project delivered a housing first program that had high fidelity to the model and it incorporated local elements to ensure that culturally based options for Indigenous participants (the majority of staff and just over 70% of program staff and program participants were indigenous) and helped to anchor and integrate the housing first program into this community’s setting.   This module was written collaboratively with clinical and research members of the Winnipeg AHCS team to ensure that the material presented here is based in clinical experience and practices that produced excellent outcomes for housing stability and improvements in quality of life for participants and this was documented in rigorous research evaluations.

This module provides an overview of Winnipeg’s approach to HF with an emphasis on:

• How an Indigenous lens was developed and used in the local approach to HF;
• What local inclusions were incorporated and what are some examples of how the HF model was augmented; and
• What were the lessons learned with respect to incorporating elements that ensured the model remained relevant for the local community?

The intent here is to highlight some of the ways in which Winnipeg adapted services and supports while also achieving program fidelity with HF principles. Links to additional resources are included at the end.

The module begins with an overview of the teams that provided HF in Winnipeg and then shifts to the unique governance model before addressing key questions related to the operation of HF during the AHCS project.

Key Messages

• It is essential to carefully localize HF to relevant cultural groups, as this assists staff and participants in seeing themselves in the project while enhancing HF fidelity and principles.  
• One shoe does not fit all! Winnipeg’s approach to HF, set within its traditional communities, worked because it had strong community leadership and ownership. Each community must establish its own set of values and ideas for how to adapt HF to ensure that people feel respected, included and can see themselves reflected in the staff, the program and the ways in which the program operates. 
• Creating the right local governance model that respects, reflects and embraces local cultural diversity and inclusion is a key early step. You can’t deliver HF without a solid community leadership base.
• In Winnipeg, the inclusion of Elders and traditional teachers provided the foundation for ensuring participants had access to culturally meaningful supports and teachings.
• Ultimately, HF provided the foundation to create the necessary structure and operation to carry out and support local approaches. This is fundamental for program success and achieved by supporting local communities in their efforts to control their way of engaging with each other.

A starting point for this module is to introduce two fundamental questions that will help shed light on better understanding the local approach used:

• What do we mean by “culturally appropriate approaches or interventions” and are they necessary for HF?
• Do HF interventions need to be modified or adjusted to include culturally appropriate approaches?

To address the first question, each community will need to reflect internally on what this means for their respective members.  For Winnipeg, we acknowledge our location on Treaty One Territory on the original lands of Anishinaabeg, Cree, Oji-Cree, Dakota, and Dene peoples, and on the homeland of the Métis Nation.

For Winnipeg, the HF program, from the moment it was introduced to tis community, strived to align closely with the traditional peoples and practices of many Nations, each bringing their own practices and ways of knowing.

There was much work undertaken to establish a local approach that connected those representing the many Nations of Manitoba with those seeking to launch housing first. Our journey began with lots of questions and a sustained period focused solely on building trust and relationships among many communities and systems. Ultimately, all our work and effort centred on ending homelessness in Winnipeg for those persons most in need.

Local community leaders must address the second question given they are knowledge carriers and aware of the local practices for a given Nation or community.  For Winnipeg, we describe the approaches used by local organizations who represented some of the Nations in Manitoba. We also outline some of the ways we shaped the model.  Perhaps this can help other communities in gathering together to share their collective wisdom and knowledge that will inform how they too need to adapt HF along their journey to end homelessness for local persons.

The Winnipeg Model: Using a local lens to deliver Housing First

In Winnipeg, Aboriginal Health and Wellness, The Mount Carmel Clinic and the Ma Mawi Wi Chi Itata Centre, mobilized to deliver housing first during AHCS.  Each organization had extensive experience in addressing the needs of both Indigenous and non-Indigenous persons while being situated within the communities serving the local population who were at heightened risk of homelessness.

Most important for Housing First in Winnipeg was ensuring approaches reflected the fact that over 70 per cent of the population experiencing being homeless was Indigenous. Tailoring HF to the local community began with the manner that AHCS rolled out and how the teams were formed (hiring the right staff to reflect the community) and how they shaped their approaches and philosophy.

The following section briefly notes three components of this early period that helped set a tone for localizing the approach by highlighting the importance of:

• the relationship and coalition-building phase;
• the knowledge gathering stage; and
• the development of a locally crafted governance model.

Building Awareness by Building on Local Strengths and Gifts 

Establishing a local approach to HF began and ended with community leadership. This included an extensive consultation and relationship-building period among local community-based organizations, the agencies serving individuals who were experiencing homelessness, people with lived experience, government and academic partners. For a period of nearly a year, groups worked to support and strengthen relationships to better understand the resources and wisdom each partner was able to share, and to learn from each other.

It was understood from the beginning that we would be entering into a reciprocal relationship with everyone and that no one was better than anyone else. We all had something to teach each other and to learn from each other. This included inviting housing first experts and representatives from government and the Mental Health Commission of Canada. Ultimately, this period of teaching and learning from each other was central to creating trust among the various stakeholders, which includes the people with lived experience.  Ultimately this process of mutual learning helped to establish a level of comfort and a better understanding what housing first was and how it would or would not fit in the community.

Building relationships and trust also stemmed from the need to understand housing first and the role of the MHCC in the delivery of what regarded as an unproven approach in addressing the needs of Indigenous persons. It is important to note that setting a federally led project in the community is very challenging given the history of that relationship in this community.  It took time and effort and many open discussions with respect to demonstrate and ensure that there is flexibility in this project and all participants can be trusted to work together to  create a strong sense of community control and direction while also adhering to the top down federal requirements.   

In addition to the period of building local awareness and trust among partners involved in AHCS, Winnipeg also included a critical step in convening a Council of Elders to talk about the program and to seek guidance and wisdom.

• Meeting with local Elders and having an extended period of community engagement contributed to the process of exchanging information, learning from each other, and earning trust while strengthening relationships.
• Also ensured that the community was able to include the traditional teachings (“our ways of knowing and being are just as valid as others”) and ways of being in relationship with each other;
• This part of the local journey was also about facilitating the gathering of information about HF and the role of the funders in this large-scale national project.
• In general, there was compatibility between the values of the HF program with the values of the community: a consumer directed approach, encouraging participants to design and develop their own plans, honoring and respecting participants choices indicated to the community stakeholders that this was not another “top down” program.  

Ultimately, a critical sticking point for the community was the significant apprehension about why more research was proposed, and whether this would be a benefit or serve to further entrench the level of mistrust between community and government.

While some may regard the early tension and mistrust as a negative, the local community saw this is an important part of building stronger coalitions while enhancing the level of trust with the overall outcome resulting in:

• Having stronger community inclusion and people feeling heard and respected in the early stages and created awareness and trust among the various stakeholders;
• It helped to resolve some of the tensions and apprehensions related to a “another federal dropped into our community program”; and
• Local support developed only after the stakeholders felt there was some level of agreement on the fit of HF after the program was designed to include local teachings and practices and an assurance that other approaches that emerge will be be considered.

Having the Right Local Approach Means Good Governance

Perhaps most important in developing a local approach in Winnipeg was in the creation of a governance model that reflected the central role of community organizations and Indigenous leadership.  The intent of the Winnipeg model was to include an Indigenous lens to approaches, practices and processes. This was achieved by creating a shared governance model that emphasized a co-leadership approach with consensus-based approvals. In addition, Winnipeg also created additional layers that localized the model’s leadership structure.

Having the right approach was essential for local organizations to feel included, respected and heard. Overall, the model consisted of two site co-coordinators who shared much of the administrative functions of the project and helped guide discussions among a diverse project leadership team comprised of members from the services teams, community, government and academia. This group also served on the national leadership group and was the intermediary for the national and local leadership groups. 

The strength of Winnipeg’s model was also in the inclusion of additional committees who provided expertise and wisdom. This included:

• An Advisory Committee comprised of community leaders with tremendous local experience and knowledge.
• An Aboriginal Lens Committee made up of Elders and members from the Indigenous Community who offered their knowledge and teachings; and
• The Lived Experience Circle that formed early in the project to engage persons with lived experience with members from service teams, research and participants sharing their, knowledge, skills, experiences and wisdom collectively.

Winnipeg’s governance model helped ensure a more equitable distribution of power and decision making among stakeholders, Indigenous leaders, Elders and community members by trying to equalize ownership of the approach.

To ensure local success, the approach remained anchored in the community where it began and ended with local involvement and leadership. For Winnipeg, this included extensive and broad dialogue with stakeholders, inclusive of those with lived experience. It also involved seeking the advice and guidance of a Council of Elders and local Indigenous and Non-Indigenous leaders who came together to share their views on how all communities could come together to end homelessness.

• The Winnipeg model was ultimately focused using an indigenous lens that better reflected local ways of knowing while leveraging existing capacity.

The Winnipeg HF Teams: Building Local Approaches to HF

This final section examines the teams that provided HF in Winnipeg and the manner in which they provided supports and approaches that were adapted to align with the needs of the local community.

The teams began their journey by seeking a traditional name for their respective HF approach. The significance of a Traditional Naming Ceremony is it provides direction and a path for how the work will be undertaken. For the local community, this step was essential to begin their journey and to draw strength from local practices.

For Winnipeg, Indigenous values reflected through all aspects of the project, from governance to program delivery. The intent from the outset was to be inclusive with a focus on being holistic in thinking about need; celebrating and re-establishing relationships among people, families and communities; being strengths-based to find gifts in all; and ensuring participants and staff had access to cultural supports and services.

Much of this was achieved by having Elders and Traditional Teachers as members of the teams and accessible to staff and participants. The roles of Elders and Traditional Teachers was to guide ceremonies, sharing circles, and to provide support through the journey of healing from complex trauma both in healing circles and individually. This helped create a sense that local practices were embedded in program structures in philosophies and ways of knowing.

Housing First in Winnipeg – Naming as a Process
Organization	Indigenous Name	Translation	HF Model
Aboriginal Health and Wellness Centre	Ni Apin	I am sitting at Home	Winnipeg Model
Ma Mawi Wi Chi Itata	Wi Che Win	To walk along side	ICM
Mount Carmel Clinic	Wiisocotatiwin	To find hidden gifts	ACT

Delivery of Service in Winnipeg: A Local Lens to HF

Each team in Winnipeg adhered to the HF principles as developed by the MHCC for the AHCS project. In addition, each organization also included a number of very relevant local components that offered participants access to services and supports that aligned closely to local practices and approaches to support persons on their healing journey as individuals, and part of families and community. In the movement from dependence, independence and interdependence.

As noted above, the teams delivered both ACT and ICM models. Perhaps most important to the approaches used in Winnipeg was that each team was able to leverage the internal strength of their organizations that had extensive histories of providing supports and services within the community (see resources below for links to each organization).   

The composition of several teams was modified to ensure that the team can provide culturally relevant support and services.  People of Indigenous descent were hired as staff, some had lived experience and had faced the kinds of challenges faced by the program participants.  Some teams hired Elders and offered participants a choice between seeing a medical doctor, a psychiatrist or an Elder.  Culturally observed practices, rituals and ceremonies were routinely incorporated into an approach that was often guided by a medicine wheel philosophy both among the team members and with the program participants.    There was an emphasis in social activities and community events. 

It is also important to address three final questions that can be helpful in understanding how to localize an approach that is more reflective:

• How do we effectively engage and work with program participants from indigenous groups?
• Is case management the same of different?
• Are housing options the same or different?

Engaging program participants is the most profoundly important element that must be set locally to truly be meaningful. In Winnipeg and Manitoba, this meant that the teams needed to be mindful of many Nations. As well, within Indigenous communities, being aware of historic traumas related to Colonization, Residential School, The Placement of Indigenous Children in Foster Care or Adoptions in the 1960s onward that placed children in the homes of mostly non-Indigenous households in many parts of the world, represented deep traumas that needed acute local awareness to both understand and address.

The centrality of these historic traumas and a history of racism and discrimination furthered the need to ensure each person providing services and supports was aware of and able to guide persons on their journeys to recovery and healing. This alone remains the fundamental reason that local leadership and organizations with knowledge of not simply the issues facing those in need, but more so the ways of engaging with others to understand and help walk with others on their healing journey are so vital and rise above all else. Again, it must be emphasized that the staff understood the journey with participants was a reciprocal one, as much as we give, we receive.

In Winnipeg, each team leader and organization brought experience and knowledge necessary to understand trauma and offer guidance. This makes the role of the case manager and housing specialist complex in being able to address challenges using a model of care focussed on recovery but acknowledges that as a country, we have failed Indigenous communities. This includes creating cities free of racism, which influenced securing housing. Yet part of the gifts each team brought, was an immense level of resiliency and hope to find ways to journey with people in their healing and in journeys that respected people’s choices and the timing of actions.

Each day, many strived to make a difference. There is no simple description of what worked best or was helpful. Ultimately, it was the collective agency of many groups and people in Winnipeg who each brought their understanding of what would make a difference for someone trying to end homelessness in a city that had long struggled with poverty and hopelessness. Through the community, the spirit of hope and reconciliation resonated with many who were able to find a way home.

Wrap Up and Summary

In the salient literature, the evidence is clear: Housing First offers an effective means by which to address chronic homelessness among those struggling with mental health. In Winnipeg’s journey, the intent was to adhere to the core elements of the HF but shape and tailor a model within a locally relevant framework. By creating opportunities for local leaders to offer expertise and knowledge about the additional supports necessary, and to see themselves in the approach, we were successful.

Ultimately, we began and ended our journey with and in community. In addition, our early approach and governance model helped ensure an Indigenous Lens focused our attention on what was needed most, supports and services that were rooted in addressing those issues that persons faced in Manitoba.