Evaluation finds ‘Housing First’ pilots delivering “wide benefits” for clients coming into programme

The majority of ‘Housing First’ (HF) clients were in long-term accommodation a year after entering the pilot scheme and reported significantly better outcomes across a range of measures, an evaluation of the scheme has found.

The report published by the Department for Levelling Up, Housing and Communities said that while the absence of a comparison group of similar people not offered Housing First meant that changes in outcomes could not formally be attributed to the scheme, the changes in outcomes observed a year after clients entered the pilot were “very encouraging, with statistically significant improvements evident across a wide range of outcome measures”.

‘Housing First’ (HF) is a housing and support approach, first developed in New York by Pathways to Housing in 1992, which gives people who have experienced homelessness and chronic health/social care requirements a stable home from which to rebuild their lives and provides intensive, person-centred, holistic support that is open-ended. The practice places very few or no conditions on individuals apart from the individual must desire to have a tenancy.

It has since been widely adopted in the USA and become central to the national homelessness strategies in Canada, Denmark, Finland and France. In England, since 2010, a growing number of local areas have established HF services to meet and address need.

The three pilots have been running in the Greater Manchester, Liverpool and West Midlands combined authority regional areas. DLUHC is providing £28m in funding for the scheme.

The evaluation found that a year after entering HF, the majority of clients were living in long-term, largely social rented, accommodation. 84% were living in long-term accommodation at the point of the six-month interview and this rose to 92% after a year.

“This represented a significant shift in their living circumstances compared to prior to being part of HF,” the report said. The clients also rated highly their ‘satisfaction’ with various aspects of where they were living.

In relation to social connectedness, the evaluation found that a year after entering HF, there had been a significant reduction in the proportion of clients describing feeling lonely. When they entered HF, a third (35%) of clients reported ‘often or always’ being lonely, a percentage which had halved to 16% 12 months later. Similarly, the percentages saying they ‘never’ felt lonely doubled from 16% to 27% over the period.

Conversely, while three quarters (75%) of clients reported feeling at home where they lived, only half (48%) reported interaction with people locally.

“However, perhaps linked to support within HF, clients were significantly more likely at the 12-month point, compared to when they entered the program, to have people to turn to for support. Coming into HF, 70% of clients felt they had someone to listen to them, a figure which rose to 81% after a year.”

HF clients meanwhile were significantly more likely after a year in the program to feel safe and less likely to have been a victim of crime. At 12 months, half (49%) of clients felt safe all of the time, with a further fifth (22%) feeling safe most of the time. This was a significant improvement on the comparative figures of 11% and 18% before entering the program.

Prior to entering HF, the majority (70%) of clients had been a victim of crime over the previous six months. Six months on, two thirds (65%) reported not having been a victim of crime in the preceding six months.

“However, while exposure to crime after a year remain significantly better, there is tentative evidence of clients being more likely to be victims of crime at the 12-month follow-up stage than reported after six months, with just 55% reported not having been a victim of crime,” the report said.

The report found that a year after entering HF, there had been a significant positive shift in relation to clients’ wellbeing and health, particularly mental health, compared to their circumstances prior to entering the pilot.

However, a year after entering HF, there had been no statistically significant reduction in self-reported drug, overall drug use, or alcohol dependency.

There was, though, some evidence of a reduction in the usage of particular drugs (e.g., a fall in the percentage using crack cocaine in the previous three months from 37% before entering HF to 20% after a year) and in the frequency of drinking alcohol.

Substantial numbers of clients had reportedly taken action in relation to their substance dependency. Half of clients (51%) had received treatment for drug dependency since entering HF, and 17% had done so for alcohol dependency.

In relation to their contact with the criminal justice system, HF clients were significantly less likely than previously to report having been involved in antisocial behaviour (notices, orders, injunctions) or criminal behaviour.

The evaluation found little evidence, however, of clients having become closer to the labour market at the twelve-month point after entering HF. Only 4% of clients were in paid work and only a further 3% were looking for work or expecting to be in work in the next six months.

“This is in line with the HF theory of change, which would not predict an impact of HF on employment at this early stage, given the severity of disadvantage that clients have typically experienced,” the report said.

However, there was some suggestion that HF might have ensured that clients were claiming the disability benefits to which they were entitled. At the 12-month follow-up, 56% of clients were in receipt of disability benefits, compared to 33% before they entered HF.

When asked a series of statements about future plans a year after entering HF, substantial proportions of clients had positive plans.

Looking at outcomes for different subgroups, the report found improvements across the whole of the client population. “Analysis comparing changes in outcomes among different types of clients (split by gender, age, where they were living prior to HF, age they were first homeless, health, mental health, learning disability and substance dependency) showed a relatively consistent pattern of change.”

The most notable differences related to:

• Gender: women’s accommodation and health outcomes were less likely to improve than men;
• Age: younger people’s health and alcohol dependency outcomes were more likely to improve than older people’s;
• Age at which someone first became homeless: those first experiencing homelessness at a younger age had worse outcomes in relation to drug dependency;
• Mental health conditions: those with conditions had better outcomes in relation to drug dependency than those without.
• Cognitive impairment/disability: those with impairments had worse outcomes in relation to alcohol dependency.

The report concluded: “The vast majority of HF clients were in long-term accommodation a year after entering HF and reported significantly better outcomes across a range of measures, with sub-group analysis suggesting that, in the main, HF support had wide benefits across the different types of clients coming into the programme.”

Harry Rodd