Housing Focused Client Supports

Housing Focused Client Supports is one of several grant programs the City of Toronto provides for non-profit, community-based organizations to provide a variety of housing supports and homelessness services to residents. Projects are selected to receive grant funding from the City’s Housing Secretariat after a comprehensive review process using a standardized methodology to ensure all projects meet the defined service criteria for the funding program, known as the Service Delivery Requirements.

Housing Focused Client Supports provide person-centered, client-driven supports through case management services that assist people exiting homelessness to increase housing stability and promote successful long-term housing outcomes. The Housing Focused Client Supports funding program is made up of the following funding categories: Follow Up Supports and Service-Specific Case Management Programs.

Follow Up Supports projects provide tailored, in-person services rooted in harm reduction and Housing First principles that assist an individual’s transition from homelessness into permanent housing. These supports help people connect to their community and provide linkages to ongoing services, supports and resources that help ensure successful housing outcomes and ongoing housing stability.

Service-Specific Case Management Programs provide specialized services rooted in harm reduction and Housing First principles to support people at risk of homelessness with their goal of housing sustainability. Services include, but are not limited to personal support worker services, occupational therapy services, trusteeship services, harm reduction supports, support for collecting behaviors, etc.

The following projects have been selected to deliver Housing Focused Client Supports services for the funding term of April 1, 2025 to March 31, 2028.

Organization Project Name
The 519 2SLGBTQ+ Housing Support Services
Agincourt Community Services Association ACSA Voluntary Trusteeship Project
Agincourt Community Services Association Follow up Supports
Albion Neighbourhood Services Etobicoke Follow Up Program
Albion Neighbourhood Services Etobicoke Volunteer Trustee program
Anishnawbe Health Toronto Enhanced Circle of Life
Christie Ossington Neighbourhood Centre Housing Follow-Up Supports
COSTI Immigrant Services COSTI Follow-Up Supports
COTA Health Keys to Housing Stabilization
Covenant House Toronto Community Housing Follow Up Support
Elizabeth Fry Toronto Housing Success
Eva’s The “You Got This” Program
Fife House IBPOC Housing Supports
Fred Victor Enhanced Housing Support Program
Good Shepherd Ministries Follow Up Supports
Homes First Critical Time Intervention Mental Health (CTI-MH) Follow-Up Program
La Passerelle – I.D.E Black Racialized Francophones – Finding a Home
Na-Me-Res Indigenous Housing and Aftercare
Native Child and Family Services of Toronto Housing Focused Client Supports for the Indigenous population in Toronto
Neighbourhood Information Post Voluntary Trusteeship Program
Parkdale Activity-Recreation Centre Follow Up Support Case Management Program
Parkdale Activity-Recreation Centre Money Matters – Trustee Services
Reconnect Health Services Follow-up Supports: Developing Life Skills and Community Connections
Sistering Follow Up Supports for Stability and Wellness
Street Haven at the Crossroads Pathways to Independence: Through Housing Stability
The Neighbourhood Group Community Services Enhanced Follow-Up Supports
The Neighbourhood Group Community Services Voluntary Trustee Program
Unison Health and Community Services Unison Follow Up Case Management
VHA Home HealthCare Toronto Safer Spaces: Hoarding Support
West Neighbourhood House (Formerly St. Christopher House) Housing Stability Case Management
Wigwamen Incorporated Follow-up Supports Program
Wigwamen Incorporated Cultural Supports Program

If you are interested in learning more about the services offered, please contact the organizations above directly.

Key Operational Requirements: Follow Up Supports projects are expected to meet the following operational requirements:

  • Level of Support – Caseload Ratio:
    • Low support: 1:20+
    • Moderate Support: 1:15
    • High Support: 1:10
  • Level of Support – Frequency of Service:
    • Low Support: 0-1x/week
    • Moderate Support: 2-3x/week
    • High Support: 4-5x/week
  • Operational Reporting Requirements:
    • Referral confirmation
    • Transfer of service
    • Status updates
    • Discharge
  • Work collaboratively with referring agency to ensure smooth transition of services for clients
  • Participation in Community of Practice and Quarterly Managers meetings
  • Use of the City’s Common Assessment Tool (STARS) to identify support levels

The following Service Delivery Requirements are essential for Follow Up Supports projects to address the diverse needs of clients and to create a supportive and inclusive environment that fosters housing stability, well-being and independence:

  1. Client Identification: Work directly with the City of Toronto’s Shelter & Support Services Division (TSSS) and the Coordinated Access team that uses a system-wide approach to connecting people exiting homelessness to appropriate Housing Focused Client Supports.
  2. Case Management: Provide individualized, flexible support plans tailored to each tenant’s needs, strengths and goals. Case managers will work closely with clients in person to set and achieve goals related to housing stability, including basic needs, social integration, health and wellness and ensure effective discharge planning. Specific components of case management will focus on:
    1. Housing Stability: Provide individualized support services to help clients sustain their tenancy within the housing setting. This requires a collaborative approach that empowers tenants with pre-crisis supports like mediation, landlord liaising, hoarding assistance and rent payment plans to prevent evictions and returns to homelessness.
    2. Connecting to Community-Based Resources: Support tenants in engaging with community resources and activities to foster independence through social support networks and creating a sense of belonging in the community.
    3. Legal Assistance: Provide services to help tenants understand their rights and responsibilities, resolve housing-related legal issues and access appropriate legal support when needed.
    4. Counselling and Mental Health Services: Facilitate and support access to therapy, counseling and mental health services to engage and support tenants’ emotional and psychological well-being. This may include services for trauma, substance use and mental health issues.
    5. Substance Use Harm Reduction Services: Provide resources for tenants looking for support with substance use including facilitating and supporting access to safe supply, treatment programs, counseling and support groups.
    6. Life Skills Training: Provide workshops and training on essential life skills such as budgeting, cooking, job readiness and conflict resolution to enhance tenants’ independence and self-sufficiency.
    7. Education and Training Programs: Connect tenants to educational resources, skill-building workshops and access to training programs to support tenants in pursuing academic or vocational goals and career development.
    8. Culturally Appropriate Supports: Provide non-judgmental, trauma-informed, strengths based, culturally responsive, anti-racist and anti-oppressive services rooted in harm reduction, eviction prevention and Housing First approaches.
  1. Discharge Planning: Work collaboratively with clients to develop appropriate and goal focused transition plans that support ongoing housing stability following the completion of case management support services.
  2. Data Management and Reporting: Ensure the accurate collection and maintenance of client records, including client progress, and report on key performance indicators to track outcomes, demonstrate impact and inform program planning and decision making using the Shelter Management Information System (SMIS), the City’s Homelessness Management Information System (HMIS).

 

The following Service Delivery Requirements are essential for Service-Specific Case Management Programs to address the diverse needs of tenants and to create a supportive and inclusive environment that fosters housing stability, well-being and independence.

  1. Tenant identification: Work directly with the City of Toronto’s Shelter & Support Services Division (TSSS) and the Coordinated Access team that uses a system-wide, prioritization-driven approach to connecting people exiting homelessness to appropriate Housing Focused Client supports.
  2. Serve all populations across the City of Toronto: Projects designed to serve specific geographic areas and/or target population groups will need to accept referrals of all client populations across Toronto to maintain a full caseload.
  3. Housing Stability: Provide individualized support services to help clients sustain their tenancy within the housing setting. This requires a collaborative approach that empowers tenants with pre-crisis supports to prevent evictions and returns to homelessness.
  4. Case Management: Provide individualized, flexible support plans tailored to each tenant’s needs, strengths and goals. Case managers will work closely with clients in person to set and achieve goals related to housing stability and ensure effective discharge planning.
  5. Connecting to Community-Based Resources: Support tenants in engaging with community resources, activities, fostering independence through social support networks and creating a sense of belonging in the community.
  6. Counselling and Mental Health Services: Facilitate and support access to therapy, counseling and mental health services to engage and support tenants’ emotional and psychological well-being. This may include services for trauma, substance use and mental health issues.
  7. Substance Use Harm Reduction Services: Provide resources for tenants looking for support with substance use including facilitating and supporting access to safe supply, treatment programs, counseling and support groups.
  8. Life Skills Training: Provide workshops and training on essential life skills such as budgeting, cooking, job readiness and conflict resolution to enhance tenants’ independence and self-sufficiency.
  9. Culturally Appropriate Supports: Provide non-judgmental, trauma-informed, strengths based, culturally responsive, anti-racist and anti-oppressive services rooted in harm reduction, eviction prevention and Housing First approaches.
  10. Data Management and Reporting: Ensure the accurate collection and maintenance of client records, including client progress, and report on key performance indicators to track outcomes, demonstrate impact and inform program planning and decision making using the Shelter Management Information System (SMIS), the City’s Homelessness Management Information System (HMIS).
  11. Collaborate with the City of Toronto to establish clearly defined eligibility criteria: Ensure that services are directed to priority and vulnerable populations.
  12. Collaborate with the City of Toronto to develop Key Performance Indicators: Measure the effectiveness of client’s outcomes and make recommendations to enhance the program model.