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Continuum of Care

strength of evidence

Limited reliable evidence

Cost effectiveness

Insufficient evidence available

Impact

Mixed or insignificant impact

I. What is this interventionII. What is its goalIII. What does the evidence tell us?IV. What don't we knowV. Where does the evidence come from?VI. Which groups does it affect?VII. Which outcomes does it affect?VIII. Implementation considerations
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What is this intervention?

The Continuum of Care model is a community plan to organise and deliver housing and services to meet the specific needs of people who are homeless as they move to stable housing and self-sufficiency.

The US Department of Housing and Urban Development (HUD) first introduced the Continuum of Care model in 1994. The model consists of a planning body, usually at the local or regional level, which coordinates community-wide resources to ensure efficient and organised distribution of services and accommodation for individuals or families experiencing homelessness. The approach allows communities to address the issues of homelessness in a way that encourages capacity building, strategic distribution of resources, and the long-term provision of services to those who most need them.

Continuum of Care programmes share some common characteristics. Firstly, they identify participants who have specific housing needs and consider the appropriateness of the services offered. Secondly, immediate support to enter transitional housing will ensure that individuals are removed from the streets and placed into shelter. Thirdly, individuals experiencing homelessness will be given an opportunity to access services that promote knowledge and skill development in areas that will be most useful to them when they are placed in stable housing. Finally, when stable housing is attained, families and individuals will be provided with continuing support.


What is its goal?

The Continuum of Care provides users with housing and services tailored to their specific needs. Through this individualised approach, individuals experiencing homelessness can attain housing stability and independence. The community involvement aspect ensures that an action plan is implemented to prevent future homelessness.

What does the evidence tell us?

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When compared to the Housing First model, the Continuum of Care approach was not as effective at increasing housing stability or reducing time spent in hospital.

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The Continuum of Care group cost significantly more than the group who received the Housing First intervention.

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Where does the evidence come from?

This summary included one RCT, which was conducted in North America and had a sample size of 225 participants. Of these, 126 (56%) were randomly assigned to the Continuum of Care intervention and the remainder were assigned to a Housing First intervention.

The study measured three outcomes: housing stability, health and substance misuse, and the cost of the intervention. The effectiveness of the Continuum of Care programme was measured across these three outcomes every six months for two years.

Research with a non-treatment control group is necessary to ascertain the true effectiveness of Continuum of Care interventions across these outcomes.


Which groups does it affect?

The participants included in the RCT were male and female and had a history of mental illness and/or substance misuse.

Which outcomes does it affect? 

Health and Wellbeing

In this RCT, researchers measured the number of days participants spent in hospital. Hospitalisation was defined as an inpatient stay in a general hospital, a veterans’ administration hospital, or a psychiatric hospital. The research demonstrated that participants in the Continuum of Care intervention group spent significantly longer hospitalised than those in the Housing First group. There were no significant differences between the groups at the two-year follow-up.

Housing Stability

In this RCT, participants were assessed on the number of days they had spent homeless. This outcome defined homelessness as living on the streets or in public places or using shelters. The research demonstrated that participants in the Continuum of Care group spent significantly longer homeless than those in the Housing First group. The findings were consistent at the two-year follow-up.

considerations for IMPLEMENTATION

Collaborate with other agencies

If you are implementing a Continuum of Care service, partnership working is vital to ensure high-quality, targeted support. Make sure you engage with organisations who are not funded as part of the programme.

Design effective data processes

The data you collect should enable you to understand the needs of your participants, to find out how well known your services are, and whether you are reaching your target group. When combined with partnership working, manage data carefully to ensure that confidentiality and privacy are maintained. Discuss protocols for data sharing early on with partners.

Set realistic workloads for staff to ensure quality support

Ensure your staff have enough time to focus on helping service users after enrolment rather than on tasks such as helping potential service users meet strict entry criteria. Service users often face considerable barriers to accessing mainstream services, where they may find their needs are poorly understood. They may find that welfare benefits and other bureaucratic systems are not well set up for their specific situation or they may be unaware of support services that could help them.

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