By Howard White, CEO, Campbell Collaboration
At the What Works Global Summit in London in 2016, I was approached by Ligia Teixeira, at that time Research Director for the UK homelessness charity CRISIS, who said, “we need to do this for homelessness”. ‘This’ meant developing the evidence ecosystem – or what I call building the evidence architecture – to end homelessness.
The best approaches to tackling homelessness are debated. Assertive outreach has become more common. This replaces traditional outreach programmes which make facilities – such as meals available to those sleeping rough – with an approach which seeks out rough sleepers and connects them to services. Whilst it used to be thought best to first deal with mental health and substance abuse issues before putting someone in accommodation, the increasingly popular Housing First model puts people straight into accommodation. Discharge programmes for people leaving prison often fail to prevent former prisoners from being discharged into homelessness.
What Ligia set out to do was to create a What Works Centre for Homelessness. As David Gough and I describe in our chapter in the new book Using Evidence to End Homelessness, the What Works model has become common in the US and UK. It started with the foundation of the UK National Institute for Health and Care Excellence (NICE) and is now a growing number of centres for education, well-being, ageing, crime and justice and so on.
However, the Centre for Homelessness Impact is unique in that it was not created out of a central government initiative. Rather, it has grown from one women’s vision, and using money from philanthropic donations, not public funds.
I am pleased to say that Campbell was amongst the partners to whom Ligia reached out, to make the Centre for Homelessness Impact happen. The centrepiece of CHI is its intervention tool. This is what I call an evidence portal – an online, evidence-based guide to what works for decisionmakers.
The tool has to be based on existing evidence. With CHI, we took an approach I would recommend for all builders of evidence-based decisionmaking products. We built a homelessness evidence map. In fact, we made two maps: the effectiveness map of impact evaluations and the implementation issues map of process evaluations.
There were three striking findings from the effectiveness map. First, there is a lot of evidence out there. The first edition of the map had around 220 studies, and we are about to publish the third edition with over 300 primary studies. Second, very little of this evidence comes from the UK. The vast majority of studies are from North America, both USA and Canada. This was important since it couldn’t be argued that homelessness interventions are not amenable to impact evaluation, including random assignment. They clearly are, as the experience of North America shows. Finally, it is an ‘under-reviewed’ topic. Only about 10% of included studies are reviews. In some areas of health research, there are more reviews than primary studies! And, indeed, the reviews in the map are focused around health.
The map demonstrates the need for more reviews, and identifies areas where there are the studies to do them. The next step was that CHI commissioned three reviews from Queen’s University Belfast – these reviews use the studies in the two maps. The review findings are being used to inform the content of the intervention tool. These evidence portals, like the intervention tool, are a global public good. The tool can be used by decisionmakers around the world.
We should be grateful that one woman took it upon herself to build the evidence ecosystem for homelessness and found a funder with the vision to realise that funding the global public good of evidence is “the most good you can do”. But it should not be that way. Multilateral organisations should be supporting these efforts. And governments across the world should be pooling funds to jointly support further development of the evidence base for homelessness: more primary studies and more reviews.
So, buy the book. But more importantly, lobby for an international effort to use evidence to end homelessness.
At-a-glance evidence of what works to end homelessness
Summaries of existing research into how to relieve and prevent homelessness are to be published in a series of short papers by the Centre for Homelessness Impact.
Money spent on housing support could be used more effectively, new joint report finds
A new report by the Chartered institute of Housing (CIH) and the Centre for Homelessness Impact highlights that money spent on housing support could be used more effectively.
An evidence-based approach to tackling homelessness health inequalities
The COVID-19 pandemic highlighted how social inequality has implications for public health: rates of infection were much higher in communities where overcrowded households were more common. We know that the most extreme form of housing inequality is homelessness and it is here that health inequalities have, for decades, been greatest.