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March 21, 2024

Speech to Homelessness NSW conference in Newcastle, Australia

Dr Lígia Teixeira

Doing good, better: evidence-powered change in homelessness

By Ligia Teixeira

I want to address a challenge that knows no borders, respects no boundaries, and affects countless lives around the globe: homelessness. It's a topic that evokes different images and perceptions, depending on where you are in the world. 

Yet, beneath the surface, the root causes remain eerily similar, binding us in a global struggle against poverty, inequality, and social exclusion. Whether it's the bustling streets of Sydney, the alleyways of London, or the sprawling urban centres of Mumbai, the faces of homelessness may change, but the underlying struggles are universal.

I invite you to join me on a journey—a journey through the complexities of homelessness, the challenges that lie ahead, and most importantly, the evidence-led solutions that offer hope, in Australia and around the world.

There’s a lot that unites us. There are common threads linking us worldwide, shared experiences. 

First, homelessness is a persistent issue. Homelessness remains a significant challenge across the world, with many people and families experiencing housing insecurity and homelessness due to various factors, including poverty, housing affordability, unemployment, and social exclusion.

Second, in recent years, most countries have witnessed a rise in unsheltered homelessness. Factors such as cuts to social welfare, lack of affordable housing, stricter migration policies, and limited access to support services contribute to this trend.

Third, some of us bear a much heavier burden of risk. Certain groups are disproportionately affected, including women and children fleeing domestic violence, people from an ethnic minority and indigenous peoples, refugees and asylum seekers, young people, and those leaving prison or with mental health or substance misuse issues.

And fourth, homelessness trends and costs vary across regions within countries. Urban areas often experience higher rates of homelessness due to factors such as housing affordability, availability of support services, and economic opportunities. While rural homelessness may be less visible or less frequently reported, it still exists and can present unique challenges.

From good to great

Reflecting on these pervasive challenges, if there is one thing that history tells you, is that the goal to end homelessness for good, wherever you are in the globe, is rife with obstacles. However, amidst these challenges, rays of hope emerge.

Imagine a world where every decision, every intervention, every policy is grounded in rigorous research, data analysis, and scientific inquiry. A world where we move beyond intuition and anecdote, embracing evidence as our North Star guiding us toward effective solutions and measurable impact.

This is the promise of evidence-led change—a promise that transcends ideology, politics, and geography. It's a commitment to truth, to reason, and to the pursuit of better outcomes for all.

Embracing evidence-led change also demands a fundamental shift in mindset.It requires us to embrace failure as a critical step on the path to success, to view setbacks as opportunities for growth and learning. 

This isn’t easy, which is why the Centre for Homelessness Impact was created. Ending homelessness for good requires more than just a band-aid solution. It demands a comprehensive, evidence-led and whole-systems approach that tackles the root causes head on. 

Our mission is to illuminate pathways from good to great. We set out to bridge the gap between research and practice, to transform data into actionable insights, and give policy-makers and practitioners the tools they need to make a lasting impact.  

By harnessing the power of data, research, and analysis, we can identify what works, what doesn't, and just as importantly, what can be improved upon. It's about moving beyond the status quo and striving for excellence in everything we do.

When we began, reliable evidence on what works to end homelessness was especially scarce. Our Effectiveness Evidence and Gap Map revealed that only ten ‘gold standard’ studies existed in the UK. In Australia, there were three. 

Despite this, confidence about our understanding of what works was strong. As historian Daniel J. Boorstin warned, ‘The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge’. 

This sentiment resonates deeply in the history of medicine. For much of history, doctors harmed patients rather than curing them, operating under the assumption of knowledge without sufficient evidence. However, in the last 200 years, since the first use of clinical trials, medicine has undergone a remarkable transformation. This journey mirrors the evolution of medical practices, transitioning from the speculative ideas of figures like Galen to the evidence-based marvels of gene therapy.

We also have a lot to learn from the private sector. One way that businesses continually improve is by testing different approaches to their work, constantly, in real time, without much fuss. Leading retailers like Tesco or Amazon constantly test ways of operating. An e-retailer, for instance, might ‘A/B test’ different messages - ‘Offer ends soon!’ and ‘Offer ends Sunday!’ – to randomly selected sample populations and see which perform better. Across education, criminal justice, children services, social welfare, and most other policy areas combined, the number of good quality trials is in the hundreds at best (though growing fast).

So, how can we take inspiration from other fields to improve our approach to homelessness?

Drawing from our experience and research into knowledge into practice initiatives in other fields, we've developed five principles.The first is to base interventions on evidence, avoiding ineffective practices.

Next, define success by setting clear goals and track progress with measurable metrics.

Third, learn, adapt and improve: embrace failure as a chance to grow and adjust strategies accordingly. Then, invest smart: fund programmes or innovations with ‘bolt on’ rigorous evaluations. And finally, have eyes on the future: invest in cost-effective and sustainable solutions for lasting impact.

Now, let's delve into each principle in turn to understand how they can inform and improve our approach to addressing homelessness.

Base interventions on evidence

First, base interventions on evidence and avoid ineffective practices. This seems easy, but it’s not. Rigorous evaluations of homelessness 
policy and programmes are still exceedingly rare, even though we know from other fields that better generation and use of evidence can unlock significant opportunities for improvement.

How do we know? Because when we started we did something that had never done before: systematically map the gold standard evidence available on the most common homelessness interventions so we could put it at people’s fingertips. And so it could serve as a baseline and to track progress.

The good news is there is evidence out there and many things appear to work. 

But most of the 
evidence comes from North America. We need more local studies.

We do know multicomponent interventions appear to be the most effective.
We need to understand better why this is. And we know that even if most things seem to work, we can’t do everything.
We need to be able to prioritise, based on what gives us most value for money.

Since the launch of the Centre, there has been a significant increase in causal evidence produced, with a 212% growth globally, and 490% growth in the UK. In Australia, there were only three rigorous studies when we launched the Centre.

There’s been an encouraging growth in the amount of rigorous studies conducted, in particular systematic reviews and meta-analysis. But with only about 40 rigorous studies in Australia and fewer than 100 in the UK, and many gaps in our understanding of what works remain. We have much work to do.

Why does this matter? Many attempts to do good fail. That’s why it’s so important to listen to the likes of W. Edwards Deming, was an American statistician -who is best known for his work in Japan after World War II, where he helped transform Japanese manufacturing practices - when he said, ‘ In God we trust, all others bring data’.

We do have a foundation to build on. Some key things we know.

One is that emergency financial assistance and more comprehensive interventions that provide a range of financial assistance, counselling, and legal support can prevent homelessness. More research is necessary on how best to deliver prevention programmes and target those most in need.

Another is that permanent supportive housing increases housing stability for individuals with severe mental illness and for ex-forces experiencing homelessness. But our understanding of their impact on other groups is limited.

We know that although rapid re-housing is a potentially cost-effective solution to provide immediate access to housing, there is limited rigorous evidence on the impacts of rapid re-housing on long-term housing stability.

Lastly, subsidised long-term housing support in the form of Housing Benefit helps low-income families avoid homelessness and stay stably housed.

What doesn’t work is just as important. Despite a plethora of evidence demonstrating their ineffectiveness, countless practices and policies persist unabated.

Common errors and blunders include the focus on short term ‘fixes’. For instance, despite overwhelming evidence demonstrating the harmful effects of temporary  accommodation, these practices persist worldwide. 

Another common error is the fragmented approach to complex social issues that require a joined up systems approach. A good example of this is recent actions by the UK’s Home Office, which committed to clearing a backlog of asylum decision cases. This led to a surge in unsheltered homelessness across several councils.

A third error or bad practice relates to how we talk about homelessness in the sector. There's a tendency to perpetuate stereotypes that stigmatise people who are homeless. For instance, fundraising strategies frequently depict people as helpless or emphasise unsheltered homelessness, reinforcing negative perceptions. This perpetuation of stereotypes can lead the public to believe that homelessness is inevitable, thus impeding efforts to address systemic issues and provide meaningful support to those in need. 

Set clear goals and track progress

My second guiding principle is to set clear goals and track progress with measurable metrics. Famously, what a government measures, matters. But as things stood, in England there was no agreed definition and metrics of the policy commitment to end rough sleeping or homelessness in any of the UK nations.

We successfully advocated for the government to adopt a clear definition of their commitment to end rough sleeping, alongside the creation and implementation of a comprehensive set of metrics to track progress towards this crucial goal. The defined commitment and metrics now form the cornerstone of the government's rough sleeping strategy, providing a robust framework for measuring progress and driving impactful interventions. It is now adopted in all 320 local areas. 

I can’t stress enough the importance of the government embracing not just a definition, but a clear set of metrics to track progress - one is nothing without the other.

Until recently, there was also a gap in data about women in the most extreme situations. In response, a new ‘women census’ is putting a much needed spotlight on the experiences of women. The census aims to bring visibility to the experiences of women who are rough sleeping and may not be represented in data, policy or services. The 2023 census in London saw more than double the number of women that were seen in the official point-in-time -count. Other areas in the UK that piloted the census in 2023 saw even sharper discrepancies.

Embrace failure as a chance to grow

My third guiding principle is to embrace failure as a chance to grow and adjust strategies accordingly. We have a lot to learn from aviation when it comes to learning from failure. 

For centuries, aviation was risky and marred by accidents. Yet, through data-driven methods like black box analysis, the industry underwent a remarkable shift. By analysing flight data and investigating incidents, it learned from mistakes, making aviation one of the safest modes of travel today. When an accident happens there is an investigation and the report is available to everyone. And crucially every pilot in the world has free access to the data when an accident happens.

What if the same meticulous approach was used to address the surge in homeless deaths? By systematically studying the circumstances surrounding each death and identifying root causes, we can develop evidence-based strategies to prevent preventable deaths among the homeless population. By adopting a proactive and data-driven approach, we have the potential to save countless lives and create a more compassionate and supportive society for those experiencing homelessness.

Another important opportunity area is to combat long-standing attitudes and stigma surrounding homelessness. 

Fund programmes with evaluations

My fourth guiding principle for doing good, better is to fund programmes or innovations with 'bolt ono' rigorous evaluations. Our advocacy for evidence-based approaches in homelessness led to a landmark achievement: the UK government’s investment in a groundbreaking trials programme, The programme includes a portfolio of eight projects, on areas such as individual placement and support, to a project assisting non-residents, to another on using council data for preventing people from becoming homeless and another on personalised budgets.

Here are two examples. Our ‘Staying Close’ project is supporting young people transitioning from residential care to independent living, funded by the Department for Education in the UK. 

Staying Close aims to promote housing stability and prevent homelessness. It facilitates a managed and gradual transition by developing essential skills and enhancing overall wellbeing outcomes. The ‘bolt-on’ evaluation includes three elements: an impact evaluation, an implementation and process evaluation, and a cost-benefit analysis. 

And we have a pilot to test our unconditional cash transfers. Unconditional cash transfers have one of the strongest existing evidence bases among anti-poverty interventions, with many high-quality evaluations available across the globe. Despite this their use in homelessness has been limited. In response, CHI and partners have launched a pilot, including a randomised controlled trial, in Swansea, Glasgow, Manchester and Oxford, with 180 people.

Cost-effective, sustainable solutions

My final guiding principle is to invest in cost effective and sustainable solutions for lasting impact. This matters greatly. Why? In the UK, there has been a broad trend of an increasing proportion of budgets being spent on acute services at the expense of preventative services since 2010.

Housing is a service that exemplifies the trend of local government spending increasing amounts on acute services at the expense of preventative services throughout the 2010s. Spending on homelessness services – which are generally acute – almost doubled between 2009-10 and 2022-23. In contrast, spending on housing welfare fell by 76%.

Scotland has some of the UK’s strongest homelessness protections, including rapid rehousing rules meant to cut the use of transitional and crisis accommodation. Yet, last financial year, Scottish councils spent over £160m on temporary accommodation – a rise of 50% in only three years. In England local areas spent around £2bn on temporary accommodation in 2022-23. 

The reported cost of this accommodation has never been as high as it is today. As we are increasingly seeing, this cost has the potential to threaten the financial sustainability of some local authorities. 

Despite this, the information that exists on the costs of TA is, at best, patchy. In response, we've launched a value-for-money programme aimed at aiding both local and national governments throughout the UK in transforming the use of transitional and crisis accommodation. This initiative begins with a thorough examination of the value for money derived from their placements. With significant interest already generated, we are currently collaborating with the Northern Ireland Housing Executive and various local areas across Scotland, England, and Wales. Together, we're developing tools designed to facilitate the shift toward best practices.

Another opportunity in this space is the imperative for more and better cross-sector collaboration is needed to improve outcomes. There are already good examples of collaboration across sectors to tackle the most severe cases. While this is commendable, focusing primarily on extreme situations doesn’t go far enough. 

In summary, to do good, better in homelessness, we must constantly evaluate and refine our efforts. By adopting a mindset of continuous improvement and learning, we can ensure that every action we take brings us closer to our goal.

The rising tide of homelessness is a formidable challenge. But each and every one of us has a role to play in efforts to end homelessness for good. Whether you're a policymaker crafting legislation, a social worker on the front lines, or a concerned citizen lending a helping hand, your actions matter.

When things are bleak, I take comfort in the idea that small things make a big difference. In The Tipping Point, Malcolm Gladwell talks about the ‘Law of the Few’ – how any successful ‘social epidemic’ is actually spread by a handful of people with a particular and rare set of social gifts. The point is that this can be any one of us.

As we face the formidable task of turning the tide on homelessness, let's draw inspiration from the fact that each of us has the ability to make real change happen. 

Let this moment be a tipping point in our collective efforts to end homelessness in Australia. And remember the aboriginal saying: “Footprints on the sand are not made by sitting down."

* Dr  Ligia Teixeira is Chief Executive of the Centre for Homelessness Impact

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