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Supported Housing

strength of evidence

Some reliable evidence

Cost effectiveness

Insufficient evidence available

Impact

Mixed or insignificant impact

What is this intervention?

Supported housing combines housing with other services, such as for health, substance misuse and employment issues. There may be a focus on integrating the client into the community. These services may be provided either in the short or long term.

What is its goal?

The integrated package of services, and engagement in the community, are intended to enable the client to become more independent and reduce the risk of experiencing homelessness.

How is the intervention meant to work?

The provision of housing provides security to a person, and the simple fact of having an address of their own makes it easier to utilize a range of services and gain employment. The supporting services provided in the supported housing package will deal with issues such as mental health and substance misuse problems. A care worker may assist the client access public benefits and seek employment.

What does the evidence tell us?

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Supported Housing may reduce reliance on emergency shelters, use of mental health services and incarceration.

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One study reporting reduced utilization of mental health services and reduced incarceration calculates that the savings from these benefits exceed the cost of the intervention.

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Supported housing may perform no better than usual care for most outcomes.

Where does the evidence come from?

There is one high quality RCT of Housing Options from the United States (based in 12 communities across the country) comparing supported housing to a housing subsidy, rapid rehousing and usual care.  This study makes A/B comparisons for 18 outcomes. Supported housing only does better than usual care for one of the 18 outcomes, which is a success rate expected from sampling error.

Studies cover several population groups, especially United States veterans, but also families, and adults with histories of mental illness and substance misuse.

Which groups does it affect?

Various

The intervention is targeted at those in unstable accommodation and experiencing homelessness. It may be used across a broad range of groups, which services adapted to their needs.

Which outcomes does it affect? 

Housing Stability

The Housing Options study makes A/B comparisons of supported housing for housing subsidy, rapid rehousing and usual care for 18 outcomes. Supported housing only does better than usual care for one of the 18 outcomes, which is a success rate expected from sampling error. The subsidy programme does significantly better in improving housing stability. This finding is supported by another RCT, also from the United States, which finds that supported housing plus subsidy does better than supported housing alone. Another study reports that moving straight to supported housing has no benefits compared to an initial period in residential care.

Health and Wellbeing

One study using observational data suggests that supported housing may reduce utilization of mental health services and incarceration.

considerations for IMPLEMENTATION

Match user to appropriate supported housing

If you are implementing a supported housing programme, you must ensure that service users are allocated to housing that meets their needs. Staff need clear methods for identifying service users’ needs and referral routes. Variables to consider are the level and range of support; the level of security and whether facilities are congregate or scatter-site with floating support. Your team should be aware that limiting non-housing support can compromise the stability and recovery of service users in long-term supported housing. Staff should listen to users and try, where appropriate, to accommodate their preferences for living in a congregate facility or accommodation with more independence.

Find the right balance of flexibility

Give your team the flexibility to deal with crisis situations as and when they occur. A key part of this involves building and maintaining strong partnerships with external agencies. To remove (or at least minimise) the need to enforce rules or conditions ensure your team are:

  • Prioritising building open, positive relationships with their service users
  • Being patient and respectful towards service users
  • Taking a proactive and informed approach to finding effective strategies

Invest in maintaining a skilled workforce

Ensure that your team has both the technical skills and emotional intelligence to deliver personalised support. Staff need to be able to build the trust of service users quickly and communicate effectively and consistently with service users and programme partners. Establish ongoing career development and progression opportunities for staff and provide training that is aligned with service users needs (e.g. independent living skills, education and employment).

Ensure consistency of contracting arrangements with scheme goals

When starting or renewing a contract, ensure that the contracting arrangements and policy frameworks are consistent with the aims of the supported housing scheme. For instance, permanent supported housing needs to have contractual arrangements that recognise the long-term nature of the required support. Both flexibility and accountability should be considered in the arrangements.

Be aware of limited availability of suitable housing

If housing availability is limited, make sure your team manages users’ expectations about the likely waiting time required to access supported housing and, if appropriate, timescales for moving on to independent living.

Design smart data processes

Ensure data monitoring and sharing processes meet and respect the service user’s needs; do not cause undue administrative burden; and maintain high-quality data to inform effectiveness evaluations.

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