Accommodation-based approaches help people remain healthy and stably housed
Accommodation-based approaches are mostly effective for increasing housing stability and health outcomes, except for those which offer low support housing without behavioural conditions. These approaches led to worse outcomes related to housing stability and health than receiving nothing at all. Agencies working together and sharing resources such as time and staff creates a commitment to ending homelessness.
What is this review about?
Globally, almost 1.6 billion individuals lack adequate housing. Many accommodation-based approaches have evolved to incorporate support and services beyond delivery of housing. This review looked at whether these approaches are effective on outcomes including housing stability, health, employment, crime, wellbeing, and cost for individuals experiencing or at risk of experiencing homelessness.
What is the aim of this review?
This Campbell systematic review of qualitative and quantitative evidence examines how useful accommodation-based approaches are for people experiencing homelessness. The quantitative data summarises evidence from 28 studies, reported in 51 articles, mainly from North America. The qualitative data summarises evidence from 10 articles from high-income countries.
What studies are included?
The quantitative research provides an overview of effectiveness findings from 28 intervention studies reported in 51 articles of accommodation-based interventions. Twenty five out of the 28 studies are from the USA, two from Canada and one from the UK. The quality of the research is generally low and represents important weaknesses in the evidence base.
The qualitative data presents one evaluation based on an intervention conducted in the UK, two in Ireland, one in Australia, one across Europe and the remaining five carried out in North America; three in the USA and two in Canada. The quality of the evaluations was average and did not directly evaluate the effectiveness interventions discussed in this review.
Do accommodation-based approaches help people experiencing homelessness?
Interventions which provide the highest levels of support and do not place rules on the person receiving the intervention are best at improving housing stability and health outcomes.
Interventions which offer the lowest levels of support and do not place rules on the person might harm those individuals. For those individuals, housing stability and health outcomes were worse than for all other interventions, including individuals who are not receiving any intervention at all.
What implementation factors affect how well accommodation-based approaches work?
Staff, resources and time often impacted the delivery of accommodation programmes most. Programme managers knew that members of staff working on the ground took initiative and were capable in their roles. However, they need adequate training and time to build good relations with service users.
There is a tension in funding allocated between new and established services, which can cause issues when services collaborate. It can also impact upon the shared commitment to ending homelessness. Buy-in at all levels of influence can impact how successful a programme is and how many people experiencing homelessness it can engage with.
What do the findings of the review mean?
Those interventions which are described as Basic/Unconditional (i.e., those that only satisfy very basic human needs such as a bed and food) harm people: meaning they had worse health and housing stability outcomes even when compared to receiving nothing at all. This invites questions on whether these types of accommodation-based interventions should be discontinued so that other more suitable and effective offers of support can be made available.
Too few studies assess the cost, or important participant characteristics like age and gender. There are also gaps related to where the research is conducted. Most of the studies included are from the USA and Canada which have very different social welfare systems to those of the UK. The process evaluations were conducted in high-income countries with different housing contexts and social welfare systems.
The studies were of average quality and not connected to the effectiveness studies, which presented issues when drawing connections between the available data. Researchers conducting studies into accommodation-based interventions should consider evaluating and publishing the factors impacting upon the trial, reflecting on why the intervention did or did not work, and for whom.
How up-to-date is this review?
Quantitative studies were downloaded from the Effectiveness Evidence and Gap Map on 12 April 2019. Qualitative reports were downloaded from the Process and Implementation Evidence and Gap Map on 10 May 2019.