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May 24, 2021

The UK's first pilot Randomised Controlled Trial in homelessness

Guillermo Rodríguez-Guzmán

Guillermo Rodríguez-Guzmán is the Head of Evidence and Data at the Centre for Homelessness Impact. Dr Peter Mackie is an Associate at the Centre for Homelessness Impact and Reader at the School of Geography and Planning at Cardiff University. Together they are working on a URKI funded Randomised Controlled Trial that is exploring which housing options are most likely to provide positive outcomes for people moving on from COVID-19 emergency accommodation.

In early 2020, the UK government made the commitment to an unprecedented programme to house street homeless people and prevent them from going back to the streets, known as bringing ‘Everyone In’. The success of this and similar initiatives across the UK nations meant that people experiencing homelessness were much better protected than they would have been under previous arrangements. However, these time-bounded measures posed questions for local authorities about what to do next: moving people to long-term housing or other types of temporary accommodation. 

Existing temporary accommodation with shared facilities would have made it impossible for people to comply with government social distancing advice and thus could have had an impact on COVID-19. Councils also lacked information about which models, particularly housing-led models (such as Rapid Rehousing and Housing First in the UK context), might be effective in reducing both COVID-19 infections and improving housing stability. 

Large numbers were housed in emergency accommodation waiting to be moved, offering an opportunity to conduct the first ever randomised controlled trial in the UK in homelessness policy. This galvanised us to forge a partnership between Centre for Homelessness Impact and Cardiff University to develop a first-of-its-kind study to begin to explore the relative effectiveness and cost-effectiveness of longer term accommodation in preventing COVID-19 infection and improving housing stability for single-person households waiting to move on from emergency or temporary accommodation provided during the pandemic.

We moved quickly, and have approached local authorities in England to identify partners keen to take this opportunity to contribute to this groundbreaking study as well as to understand the impact of their own approaches to supporting move on options.

To do so, we are exploring some of the accommodation options made available through Next Step Accommodation Programme or pre-existing homelessness accommodation pathways.  We have recruited our first local authorities and participants to take part in the trial which is an important milestone and have started to collect information on how people are moved. 

We are delighted to take this step forward, as it brings us closer to truly helping not only the people experiencing homelessness who take part in the trial, but many more people experiencing homelessness in the UK, both now and in the future. 

We have learnt a great deal along the way, even if it has not been easy. We know that local authorities and people working in the sector are increasingly interested in using evidence to support their decisions and practices. This came across in our multiple discussions with local authorities but was also one of the key findings from polling we did with IPSOS Mori showing that a  majority would like to see important decisions about homelessness made based upon evidence of what works (57% choose this from a list) as well as the views of those affected by or at risk of homelessness (55%). These feature ahead of expert’s views, the cost/amount of money needed, and decisions driven by public opinion.

Why a Randomised Controlled Trial?

Randomised Controlled Trials (RCTs) are considered the “gold standard” when it comes to evaluation. Randomisation is a process by which individuals recruited to a study are given a 50:50 chance of being allocated into one of two groups: some would receive a new type of programme or support, while the other would continue receiving whatever support was available before that. This is a robust way to evaluate the effectiveness of an intervention because, by randomising, we can create two groups that are very similar to each other, which means that any differences observed at the end are a consequence of the intervention, and not any other underlying characteristics. 

Put simply, it helps us to compare one housing option against another in order to determine which one gives better outcomes for people who need to be housed. In this instance, we’re comparing a longer term housing placement against temporary accommodation. To see which is more effective, some of the participants will be offered longer term accommodation, and the others temporary accommodation as usually offered by their local authority. We will then evaluate the outcomes relating to housing stability, health and the financial impact of each type.  

This study will not only try to shed light on the relative effectiveness of housing models but, also, help us understand how to run more robust evaluation in this space - one of the key ingredients needed to identify effective practice and accelerate impact towards ending homelessness for good. 

We look forward to sharing more insights with you in the coming months after initial data collection is closed by the early Summer 2021. We will publish results by Spring 2022. If you’d like to learn more or you have any questions about the study contact us on hello@homelessnessimpact.org 

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