Housing for vulnerable people: what works?

Today we publish an evidence review that looks at what works when it comes to interventions for housing-vulnerable people. It builds on evidence gaps identified in our scoping review earlier this year. In today’s blog we run the key findings against practitioner perspectives of what works. The practitoner perspective comes from Chris Fields, CEO of Leeds-based homeless charity St Georges Crypt, based on his experience of what makes delivering interventions successful.

Download the full report and cost-effectiveness model

Practitioner perspective: Good identification of needs is important; avoid one cap fits all – everyone is different

Was this found in the evidence review?

• Even housing interventions that work for most respondents don’t work for everyone – abstinent-contingent housing does not work for all people who are homeless with a substance problem; similarly immediate independent living does not work for everyone.
• There is an evidence gap in relation to what works for successful identification of individual needs and suitability for different housing models.
• A key challenge is to identify and offer housing that is suitable (and cost-effective) for each individual (and sustain flexibility for client transition between approaches).
• The link from improved housing to improved personal wellbeing is not always direct; improved housing stability may be a necessary but not sufficient condition to improve the wellbeing of individuals with long term and complex needs.
• There was promising evidence that, on average, a Housing First approach improves personal wellbeing, mental health and relationships. However, there was also some evidence that this approach leaves some individuals isolated and lonely.
• Abstinent recovery houses managed by residents with open-ended residency, such as those following an ‘Oxford House’ model, showed some promising evidences in terms of substance use, criminality and employment.
• Substance users have distinct needs in relation to housing and their environment. For example, substance users were unable to get the benefits of community living experienced by non-substance users. Other evidence found perceived coercion around undergoing treatment or stopping substance misuse did not to lead to better outcomes.

Practitioner perspective: Support and engagement needs to be positive and long-term

Was this found in the evidence review?

• The promising interventions of the Housing First and Oxford House models share characteristic of offering open-ended support.
• We cannot assess what works when it comes to the duration and intensity of support, due to the absence of evidence on the relative cost-effectiveness.

Practitioner perspective: Build a sense of purpose and structure

Was this found in the evidence review?

• The review found minimal research into efforts to build a sense of purpose into people’s lives.
• The success of housing interventions in improving employment outcomes was mixed.
• Targeting employment as a key short-term outcome can be problematic. The focus on immediate employment may not be realistic for some groups, such as young new mothers or prison leavers, and may hinder the pursuit of long-term goals of recovery and training and education.

Practitioner perspective: Good training and enabling life skills

Was this found in the evidence review?

• The review identified the need for time within programmes and evaluations to provide time for training and life skills, and the opportunity to evaluate its impact.

Practitioner perspective: Avoid stigmatising attitudes

Was this found in the evidence review?

• This is hard to assess as the review found minimal evidence on attitudes of staff in relation to stigma. In an evaluation of housing intervention for young parents in Rochdale it was judged by the authors that the non-judgmental, persistent and supportive ethos was imperative to the successful outcomes

Practitioner perspective: Do not use poor quality housing stock

Was this found in the evidence review?

• The evidence suggests housing quality is significantly positively associated with housing stability. This comes from a Randomised Control Trial in Canada.

Practitioner perspective: Do not create social and community ghettoisation

Was this found in the evidence review?

• Problems of participants continuing to live in communities with higher crime rates and lower income and education rates, in addition to the potential loss of in social support arising from moving away from communities were found in this review, based on a study in the US that looked at the location of homeless people within a supported housing initiative.

Practitioner perspective: Do not rely on weak partnerships and integration

Was this found in the evidence review?

• Evaluating partnership working is difficult when projects are on fixed short-medium term timescales and evaluations are rarely more than one or two years.
• An evaluation of a program to prevent homelessness for women exiting prison in Australia noted the difficulties in finding employment for participants without corporate partnerships.