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August 2, 2019

Impact Forums 2019: The Prevention Imperative

Large numbers of people are affected by homelessness. Shelter estimates more than 300,000 people to be experiencing homelessness across Britain. Although this number is contested, what is certain is that it represents only a fraction of the problem. 

There are many people living in unsafe or precarious situations. Crisis estimates there are 160,000 households experiencing the most acute forms of homelessness including rough sleeping, sofa surfing and sleeping in cars and tents. Added to this are people living in unstable housing or at risk of homelessness.

The social costs and consequences of homelessness are substantial. People affected by homelessness are ten times more likely to die than those of a similar age in the general population. Spending to reduce homelessness has been estimated to save the public purse nearly £10,000 per person experiencing homelessness.

These calculations assume that programmes to reduce homelessness are effective. Yet, to date, relatively few interventions have been rigorously evaluated and fewer still have shown positive results.

By 2024 it is our intention that more people who are at risk of, or experiencing homelessness are housed in suitable homes quickly, are financially secure and have strong social connections and a sense of agency. These are the objectives that underpin all of the work that we do and formed the basis of our 2019 Impact Forums Programme.

In order to achieve this, it is imperative that society as a whole pays more attention to prevention. “It’s not enough to focus on emergency and crisis prevention,” said Julie James, Welsh Minister for Housing and Local Government, at our Cardiff Impact Forum. “We need to focus on universal prevention. We’re not going to have a significant impact unless there’s a greater focus on this. Of course we need to help people we see struggling on the street, but we also need to create systemic change.”

Developing preventative policy while maintaining the acute services on which thousands depend demands that we take a bird’s-eye view of homelessness, a comprehensive approach to generating and translating evidence and a better understanding of how to interpret and use this in policymaking and practice. This is why we developed our SHARE framework, to outline comprehensively what needs to be done to end homelessness.

“Gathering the evidence to support preventative services will mean we’re less stretched,” said Julie. “Without that evidence, the obvious thing is to put money into acute services to ease the current strain on the NHS and other public services. The more evidence we have about preventative services, the more money policymakers can put back into public services.”

So how do we achieve this? First, by understanding that homelessness is influenced by a variety of complex factors like the strength of the social safety net and the health of our families and communities. In the past, a myopic understanding of homelessness and its causes has prevented efforts to end it for good and exacerbated problems for those people experiencing homelessness whose needs do not appear to be acute.

In Utah, in 2005, the state and its capital started providing no-strings-attached apartments to the “chronically” homeless — people who had lived on the streets for at least a year and suffered from mental illness, substance abuse or a physical disability. Over the next 10 years, Utah built hundreds of housing units, hired dozens of social workers and reduced chronic homelessness by 91%.

The results were a sensation, but masked a far more complex truth. While Salt Lake City targeted a small subset of the homeless population, the overall problem got worse. Between 2005 and 2015, while the number of drug-addicted and mentally ill homeless people fell dramatically, the number of people sleeping in the city’s emergency shelters more than doubled. Since then, unsheltered homelessness has continued to rise. According to 2018 figures, the majority of unhoused families and single adults in Salt Lake City are experiencing homelessness for the first time.

Across the country, in the midst of a deepening housing crisis and widening inequality, homelessness has concentrated in America’s most prosperous cities. So far, municipal leaders have responded with policies that solve a tiny portion of the problem and fail to account for all the ways their economies are pushing people onto the streets. We can’t afford to make the same mistakes.

Second, we must gather the evidence. Our Evidence and Gap Maps already highlight the many areas in which evidence is lacking, prevention being one of them. The next step is to amass high-quality evidence to fill them.

Third, we must be open to acknowledging how little we actually know about what interventions are effective in preventing homelessness. The story above emphasises the damage that can be done when we assume that an intervention is working without testing its effectiveness. Rigorously testing and synthesising evidence will enable us to work out how best to proceed, ensuring we are using appropriate methods to answer the questions we need answers to. 

Of course, testing the effectiveness of policies and interventions means admitting when things aren’t working. “There are some interventions that sound like they’re great, but it turns out they’re not.” said Giving Evidence’s Caroline Fiennes at our London Impact Forum. “Why does it take so long to turn evidence into practice? Because it’s hard to admit that your work might be ineffective.”

This shouldn’t deter us. “Only about one in four of the interventions done by the Education Endowment Foundation have been effective,” said David Halpern of the Behavioural Insights Team, “but it’s really important for us to know that. It’s likely to be the same in the case of homelessness.”

Work is already underway to build the infrastructure that allows us to take a truly preventative approach to homelessness. The Centre’s work with the Campbell Collaboration in sifting the evidence base has already enabled us to update our Intervention Tool and Effectiveness Map and gain a much better understanding of our knowledge base, creating a more robust foundation to build on. The new set of homelessness indicators underpinned by the SHARE framework currently under development in partnership with the ONS will make it easier than ever to track success at population level, while the work on harmonising a definition of homelessness will further strengthen the evidence infrastructure and inform efforts to prevent homelessness more effectively.

Of course, there is still an acute homelessness crisis to address, but the focus of the Centre and its partners and peers in the What Works Network is to drive prevention upstream.

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