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August 20, 2019

Our first three systematic reviews

Dr Sarah Miller

This summer I had the great pleasure of attending the Impact Forums hosted by the Centre for Homelessness Impact (CHI) across the four UK nations. The commitment of everyone who attended was evident through the many conversations I had with other attendees – a commitment to provide effective support for those who are experiencing homelessness but also, importantly, to prevent homelessness from occurring at all. 

CHI asked me to talk about the work that they are doing in partnership with us at Campbell UK & Ireland to synthesise the available evidence, through three systematic reviews, to answer some important questions about particular homelessness interventions. We (Campbell UK & Ireland) are based in Queen’s University Belfast. We not only produce systematic reviews but also advocate for their use and strive to find ways to put this evidence into the hands of those who need it to make decisions about service provision. For more information on what a systematic review is and why they are important read this blog post.

For some homelessness policies and practices, there are many high-quality studies conducted, from all around the globe, but not enough quality syntheses of these studies. In the context of scarce resources, we need to be careful that we are not misled by single studies or a small number of studies when there is a larger body of literature out there. It is important we understand what the weight of evidence says in relation to certain, important questions. We need to know what works, who it works best for and under what conditions – systematic reviews can answer these questions. 

So, what reviews are we doing?

CHI’s two evidence and gap maps (EGMs) include studies on the effectiveness and implementation of homelessness interventions. The EGMs revealed the extent of the evidence base for each intervention category. Where the evidence is sparse, the only option is to strategically fill the most pressing gaps with new primary research. For the more densely populated areas of the maps it makes more sense to conduct systematic reviews to improve the syntheses of the existing knowledge.

Our first review is focussed on the effectiveness of accommodation-based interventions. There are lots of different types of accommodation-based interventions, many of which are diverse in their approach for example: Housing First, hostels, shelters, supported housing, temporary accommodation, Rapid Re-Housing. The primary aim of this review is to ask: are accommodation-based interventions effective in improving housing stability and decreasing the occurrence of homelessness? If yes, then which type of intervention is the most effective? 

Our second review is exploring the effectiveness of discharge programmes (i.e. services which support people leaving institutions). Discharge from institutions is recognised as a major cause of homelessness and there are different types of institutions from which individuals might be discharged, such as prison, in-patient treatment (for physical or mental health care, addiction treatment), the military and youth aging out of foster care. From this review, we want to find out how effective discharge programmes are for improving housing stability and decreasing homelessness for individuals experiencing or at risk of experiencing homelessness. Does effectiveness vary according to the type of institution a person is being discharged from?

The third and final review focuses on the accessibility of health and social care services for individuals experiencing homelessness. Accessing services when experiencing homelessness is extremely difficult for lots of reasons, and those experiencing homelessness may have multiple needs requiring support from a range of services. This review asks whether interventions aimed at improving access to services by addressing barriers are effective in doing so. 

For all three reviews, we are also interested to know whether such interventions also improve other outcomes including: capabilities and wellbeing; cost effectiveness; crime and justice; employment and income; health; public attitudes and engagement. We are also asking other important questions including: who does the intervention work best for? What implementation and process factors impact intervention delivery? And is implementation fidelity related to the effectiveness of the intervention?

When will the reviews be available?

The findings from the reviews will be published by the Centre for Homeless Impact starting with the accommodation review in November 2019. The discharge programmes review will be released in January 2020, and the access to services review in March 2020.

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