What works in homeless services: a rapid evidence assessment
As many as 160,000 households are experiencing the worst forms of homelessness across Great Britain. That is estimated to be just under a quarter of a million people. It is thought that rough sleeping is forecast to rise by 32% by 2026.
In its 50th year, homelessness charity Crisis are developing a plan to end homelessness and, to inform this plan, Crisis have undertaken a wide-ranging evidence-gathering and consultation exercise, involving calls for evidence, reviews of evidence and input from people with lived experience of homelessness. As part of this consultation, Crisis commissioned SCIE to produce this rapid evidence assessment to understand what services work, to address and end homelessness, and to assess the quality of evidence that exists in published studies.
Crisis has five definitions for ending homelessness and SCIE’s review takes these as its starting point:
- No one sleeping rough
- No one forced to live in transient or dangerous accommodation such as tents, squats and non-residential buildings
- No one living in emergency accommodation such as shelters and hostels without a plan for rapid rehousing into affordable, secure and decent accommodation
- No one homeless as a result of leaving a state institution such as prison or the care system
- Everyone at immediate risk of homelessness gets the help they need that prevents it happening.
The assessment has addressed a number of issues including looking the evidence base for what services are effective in addressing, reducing or preventing people from becoming homeless.
Types of effective services
The review suggests that sustained services, targeted to meet specific needs across time are effective. Effective services include those which provide Intensive Case Management, Critical Time Interventions and Housing First. Effective services incorporate Permanent Supported Housing elements, support for people into accommodation through provision of housing vouchers and subsidies, and guidance on benefits and information about services.
Features of effective services
The review suggests that the a number of features contribute to the effectiveness of services, including: adhering to particular aspects of models / designs of service that are found to be successful (fidelity); adapting and aligning services to local settings and context; developing and providing a range of person-centred responses that are attuned to and reflect the personal circumstances of people, particularly with regards to their journey out of homelessness; integration and multi-agency working; and providing a housing market that respond flexibly to the needs of homeless households.
Barriers to effective services
Challenges include a lack of services for people with complex needs such as a mental health issues. People with complex can be more difficult to engage with in terms of assessing needs and providing flexible, responsive and sustained expert-led person-centred support. There are also challenges regarding access to housing in the local market and a lack of data and monitoring to inform service design.
Gaps in the evidence base
The review identified a lack of evidence about what works for a number of specific population groups, for instance with black and minority ethnic (BAME) groups. There are also challenges regarding access to housing in the local market and a lack of data and monitoring to inform service design who have rarely featured in studies and when they have, outcomes have not always been as positive as for other groups.
The assessment suggests a number of opportunities for stakeholders to improve how they work together to end homelessness, for instance by funding and supporting innovative and successful services and by developing reliable and long-term accessible cost-related data sources.
The assessment suggests that involving and engaging people with lived experience of homelessness, and the wider community, in service design that can enable services to better access and engage harder-to-reach groups.
Our assessment of evidence shows that there is potentially a wealth of evidence about what works in services to end homelessness, but the evidence base is as varied in terms of quality as it is vast in scope. The gaps in type of evidence on homelessness include experimental research including Randomised Control Trials, measurement of fidelity of services, long term outcomes and cost benefit analysis. The challenge is to coordinate and develop a more coherent approach to generating reliable evidence about what works in preventing homelessness and to making that evidence more accessible to those who need it. Crisis, via their forthcoming plan to end homelessness and Centre for Homelessness Impact, are doing something about the evidence base.