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April 29, 2020

Dr Lígia Teixeira

Using Evidence to End Homelessness – the book

For the past year I’ve been working on a collection of essays to help build the movement for evidence-based policy and practice in homelessness. Today we publish Using Evidence to End Homelessness in collaboration with Policy Press. The book contains contributions by an experienced group of leading thinkers from different sectors and across the political spectrum to provide a roadmap for how our sector can invest in ‘what works’. It’s an exciting moment for us, and I wanted to explain why.

Over 50 years on from Cathy Come Home and the creation of Crisis and Shelter, a lot of smart people and institutions have been trying to work out how to end homelessness in the UK and elsewhere. Billions of pounds were invested in different waves of policy reform and innovation that shaped the efforts of statutory and voluntary agencies in the intervening decades. While the situation improved significantly since the mid 1960s, too many people remained without a home.

But then on March 27, Westminster called for all of England’s rough sleepers to be housed by the weekend, and an ambition long-held by the entire homelessness sector was achieved almost overnight. 

Of course, rough sleeping is just one part of how we define homelessness, and if the Covid-19 crisis has revealed anything about our society, it is the importance of the social safety net to it. Many thousands of people are still at risk of experiencing homelessness, and it seems likely that the coronavirus pandemic will continue to hit the poorest in society hardest, potentially pushing greater numbers of people into homelessness than ever before. Although we are in the midst of a crisis, this move to protect our most vulnerable demonstrates just what we are capable of when we come together to affect change.

Nineteenth-century French physician Pierre-Charles-Alexandre Louis knew a good deal about affecting change. For centuries before his research, doctors believed that removing a few pints of a person’s blood would help cure all types of ailments. In the 1830s, doubting bloodletting’s alleged benefits, Louis carried out one of the first clinical trials. He compared the outcomes of 41 pneumonia victims who had undergone early and aggressive bloodletting to the outcomes of 36 pneumonia victims who had not. The results were clear: 44 per cent of the bled patients subsequently died, compared to only 25 per cent of the patients who remained leech-free. 

Louis’ discovery helped convince physicians to abandon bloodletting and his study became a touchstone of the modern movement in evidence-based medicine, which trains physicians to listen to patients and conduct, evaluate, and act according to research. 

When we first launched the Centre for Homelessness Impact and began work on Using Evidence to End Homelessness, the world looked very different to how it does today. But today, as then, the experimental, empirical approach matters, and Louis’ methodology is still as applicable to homelessness as it is to medicine. We have a lot to learn from other fields in this respect. The great leaps forward we have witnessed in fields like international development, education and policing show us that we could achieve significant results if we gradually shift attitudes and behaviour towards the  use of better data and evidence to guide vital investments. 

Homelessness has yet to find its revolutionary moment, and in many ways we’re still guilty of applying leeches where none are required. Rigorous evaluations of homelessness policy are exceedingly rare. As we highlight in Using Evidence to End Homelessness, the United Kingdom spends a tremendous amount on homelessness services, but very little of it learning which homelessness policies and interventions do and don’t work. 

The crisis in which we find ourselves offers a rare opportunity to transform the homelessness system for good. 2020 could mark a definitive turning point, but only if we use the coronavirus pandemic to step up the ambition to end rough sleeping and embrace the opportunity to tackle all forms of homelessness more effectively. 

At the moment, leaders at all levels of national and local government across the UK are rightly very much preoccupied with the pandemic and its consequences. But just as we know that the race to find a vaccine is as important as public health interventions and the availability of medical treatment, when it comes to homelessness, we know we must respond to the immediate emergency while maximising on this opportunity to achieve a step change in the longer term. 

The contributors to this volume envisage a future in which data and rigorous evidence is created efficiently, as a routine part of government operations and used to drive improvements to policies and services aimed at helping people access and maintain stable, affordable housing. The good news is that even pre-coronavirus pandemic governments across the UK had already taken important steps towards accomplishing this vision, but much work remains. And given that ‘business as usual’ would not be good enough post-pandemic, our agenda is now of even greater significance.

So how do we ensure that ‘business as usual’ doesn’t continue? How might we bring about a transformation of the homelessness sector? Our proposed methods are threefold:

  1. Improve the speed and quality of response by strengthening data foundations and data practices. The establishment of better data foundations around data collection, architecture and analysis would allow better insight into the phenomenon of homelessness and improve our ability to predict for whom, when, where and why homelessness may be an issue. It would enable us to respond faster and target efforts more effectively. We need to figure out what data is needed to support evaluation, research and development, and programme management, and advocate for collecting it.

In England, this work would build on the efforts that MHCLG (Ministry of Housing, Communities and Local Government) has made to improve the quality of homelessness data through the H-CLIC (Homelessness Case Level Information Collection) system, which creates opportunities for linking personal-level data with other administrative data to better understand the impact of policy interventions at a lower cost. 

Improving data foundations would go some way towards ensuring we don’t rush straight to solutions without gathering the necessary information about why a problem exists or whether it is the most pressing problem we should focus on. It is also a way to optimise decision making by encouraging leaders to explore different solutions before making decisions. 

  1. Enable smarter decision making by building evidence about the policies and interventions that will achieve the most effective and efficient results. Today there’s surprisingly little rigorous research on homelessness policy and programmes. Though some things we do and pay for are effective, there is a lot we don’t know. That’s inevitable. What isn’t inevitable — and where the real problems lie — is assuming, without evidence, that something works. In the UK, there has been very limited use of rigorous systematic reviews. Examples of evaluation using experimental and quasi-experimental methods, like the Troubled Families and Rough Sleepers Initiatives, are still rare.

An honest assessment of the state of ‘science’ behind homelessness practice and policy is humbling. But we are already seeing progress on this front by governments at both national and local levels across the UK. The big question now is: How do we make sure that evidence like this makes it into policy systematically? And here's the problem: there are currently limited resources for the evaluation of rigorous evidence, which too often is seen as an ‘extra’. This needs to change. 

We need more  and better systematic reviews, and more experiments to identify which interventions are effective and cost-effective in addressing homelessness. We know we can't go back to where we were before the crisis, but it's only through experimentation that we'll discover exactly how to prevent the multiple systemic factors that lead to homelessness.

  1. Upskill the workforce and nurture evidence-based leadership to strengthen our capacity to act on robust evidence and insight. It’s hard to rid ourselves of practices that are informed by little more than wishful thinking and to end policies that don’t work. But that is what we must do to ensure that our efforts are effective. The first step would be to do more rigorous policy evaluations. The next would be to heed them. This will require a shift in culture and mindsets; developing new behaviours around the use of data and evidence and a deep appreciation for learning.

Taking measured risks is an essential part of cultivating innovation but fear of uncertain outcomes is a barrier to creative confidence. Even before the crisis, leaders across the system lacked the tools to use data and evidence to improve how homelessness was tackled in their communities. Now more than ever people need support to think big, use evidence, be bold, and uncover and test inventive and shareable solutions. 

 

Shifting the homelessness system towards a ‘what works’ approach will not be easy or happen overnight. The crisis is almost certainly still deepening around us. Levels of homelessness may rise suddenly later on this year, and it’s possible that the numbers may be worse in a year’s time than they are today. But we have before us a very rare opportunity to reboot the entire homelessness system and revolutionise it for the better. The worst thing we could do now would be to simply to return to the way things were before.

 

The authors of the chapters in Using Evidence to End Homelessness and I believe that we can achieve something substantial for everyone in our society — not just those affected by or at risk of homelessness — if more and better data and evidence is used to guide the vital investments we make in children, their families, individuals and communities. 

 

This book is just the beginning. We must now come together to grow a ‘what works’ movement in homelessness with bipartisan support, informed by the best possible data, evidence and evaluation about what works. Buy the book and join us.


An earlier version of this article was originally published in Inside Housing on the 29th of April 2020.

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