COVID-19 and rough sleepers: a randomised controlled trial to evaluate models of housing and support to reduce infection and homelessness
Lead Research Organisation:
Cardiff University
Department Name: Cardiff School of Planning and Geography
Abstract
As part of the government's response to COVID-19, 15,000 rough sleepers have now been offered self-contained temporary accommodation in England, mainly in hotels. This approach, which has involved the decanting of hostels, shelters and similar shared provision for rough sleepers, is a short-term response.
When the lockdown ends, decisions will need to be taken about how to house former rough sleepers in line with the UK government's commitment to prevent people from going back to the streets - including, potentially, through the re-opening of shelter-type accommodation. Existing temporary accommodation with shared facilities might make it impossible for people to comply with government social distancing advice. So these decisions will impact on the risk of a second wave of infection from COVID-19 and possibly any mutations.
This proposal outlines a unique time limited opportunity to conduct the first ever randomised controlled trial in the UK, to evaluate the effectiveness and cost-effectiveness of permanent housing on the risk of COVID-19 infection and housing stability for people experiencing homelessness.
That many homeless people are currently waiting to be housed means they can be randomly allocated to different housing solutions at scale quickly. The insights drawn from the short-term impacts of permanent housing can be used to inform other local authorities' responses to the challenges of COVID-19 and the cost-effectiveness of accommodation alternatives more broadly.
When the lockdown ends, decisions will need to be taken about how to house former rough sleepers in line with the UK government's commitment to prevent people from going back to the streets - including, potentially, through the re-opening of shelter-type accommodation. Existing temporary accommodation with shared facilities might make it impossible for people to comply with government social distancing advice. So these decisions will impact on the risk of a second wave of infection from COVID-19 and possibly any mutations.
This proposal outlines a unique time limited opportunity to conduct the first ever randomised controlled trial in the UK, to evaluate the effectiveness and cost-effectiveness of permanent housing on the risk of COVID-19 infection and housing stability for people experiencing homelessness.
That many homeless people are currently waiting to be housed means they can be randomly allocated to different housing solutions at scale quickly. The insights drawn from the short-term impacts of permanent housing can be used to inform other local authorities' responses to the challenges of COVID-19 and the cost-effectiveness of accommodation alternatives more broadly.
Organisations
- Cardiff University (Lead Research Organisation)
- Southend-on-Sea Borough Council (Project Partner)
- Oxford Community Foundation (Project Partner)
- Bloomberg Associates (Project Partner)
- Southwark Council (Project Partner)
- Comic Relief (Project Partner)
- Local Government Association (Project Partner)
- Greater London Authority (Project Partner)
- Ministry of Housing, Communities & L.Gov (Project Partner)
Publications
Peter, Mackie
(2020)
Moving on trial: COVID-19 and homelessness
Randell E
(2022)
Moving on trial: protocol for a pilot randomised controlled trial of models of housing and support to reduce risks of COVID-19 infection and homelessness.
in Pilot and feasibility studies
Rodriguez-Guzman, G.
(2022)
Accelerating learning - lessons and reflections from the first randomised controlled trials in homelessness in the UK
in European Journal of Homelessness
Thomas I
(2020)
A population level study of SARS-CoV-2 prevalence amongst people experiencing homelessness in Wales, UK.
in International journal of population data science
| Description | The Moving On study is the first Pilot Randomised Controlled Trial in the homelessness field in the UK. The intention was to randomise the allocation of settled and temporary accommodation, to assess the effects on SARS-CoV-2 infection and housing stability. While the study provides some important empirical evidence, many of the key findings relate to the challenges of implementing trial methodologies in the homelessness field and these will provide an important basis for future research. 1] Methodological lessons - Of 144 local authorities approached, two local authorities in England consented to recruit individuals into the study. Key barriers to recruitment of local authorities included; a reluctance to cede control over housing allocation, the study design not fitting existing processes, and local authority capacity and resource limitations. - Of 154 people experiencing homelessness (PEH) who were approached and eligible to take part in the study, 50 (33%) consented and completed an initial interview. The study was able to undertake follow-up interviews with 67% of participants at three months, and 58% at six months. - The two participating local authorities faced considerable challenges adhering to the randomised allocation of temporary and settled accommodation. Local authorities adhered to randomisation in 25 (50%) cases. They faced two main challenges; first, landlords would not always accept the nominated tenant, and second, the local authorities sometimes ignored the randomisation and instead based allocations on their judgements of who should be housed, where, and when. These considerable methodological challenges provide fundamental lessons for the future of trials in the homelessness field in the UK. As in other areas of UK social policy (e.g. social care) and in North American homelessness research, future trials may need to be delivered alongside, and be a condition of, new funding for services. This approach is likely to have a positive impact on recruitment of local authorities and drive greater adherence to trial processes. 2] Lessons on the experiences of people experiencing homelessness during the COVID-19 pandemic - Key findings must be read cautiously due to the small sample size achieved (50 participants). At baseline interview, 15/50 (30%) PEH self-reported having experienced SARS-CoV-2 infection. At 6-month follow-up interview, 24/30 (77%) PEH reported receiving at least one vaccine. - Given study recruitment challenges, and the need to evidence the impacts of homeless experiences on SARS-CoV-2 infection, the Moving On study collaborated with ADR Wales, using linked health data, to identify and compare SARS-CoV-2 prevalence rates amongst PEH and a matched control group. Between March 2020 and March 2021, the prevalence of SARS-CoV-2 infection amongst 3,151 PEH was 5.0%, compared to a not-homeless exact matched population, for whom prevalence was 6.9%. It is likely that the Welsh Government policy response that moved away from communal accommodation may be partly responsible for the reduced SARS-CoV-2 infection amongst PEH. |
| Exploitation Route | The outcomes of this research will be of use to others in three main ways. First, homelessness policy makers and practitioners - including national and local governments, as well as third sector organisations - have an evidence base to inform future decisions. The research shows the protective impacts of ensuring access to suitable accommodation for all people experiencing homelessness, avoiding communal accommodation models. Second, UK homelessness scholars and trials specialists have the crucial foundations upon which to build and to design effective future trials in this important social policy area. Scholars have important new insights into recruitment and study adherence challenges, as well as retention rates. Third, funders have a much-improved understanding of the potential value in making robust service effectiveness trials a condition of new funding for services. This approach is likely to have a positive impact on recruitment of local authorities and drive greater adherence to trial processes. Ultimately, this then improves our understanding of what works, for whom, and in what contexts. |
| Sectors | Communities and Social Services/Policy,Other |
| Description | Through 29 engagement activities, the growing impact of the Moving On trial has been to bring this homelessness RCT to the attention of policy makers, politicians, local authorities, third sector organisations, and funders. The PI and the Centre for Homelessness Impact (CHI) have led an array of engagement activities ensuring international and UK-wide spread of awareness of the sector-leading work. They have engaged with key figures in both national and local government, charities and funders, creating awareness of the potential value and importance of trials research in the homelessness field and building important relationships for future work and dissemination. This has been hugely important in increasing the reach of this trial beyond academia and into sectors not used to this kind of research. Engagement has been with international audiences through the CHI International Homelessness Research Network, meetings with the Institute of Global Homelessness, and via the European Commission Platform on preventing homelessness. This has resulted in requests for further information and an increased awareness of the need for, and challenges of undertaking, trials in this field. We have opened national dialogue with policymakers and politicians through formal working groups, expert panels and presentations. This has also led to requests for further information and plans for future engagement. We have also engaged nationally with professional practitioners, third sector organisations and undergraduate students through workshops, presentations and social media bringing requests for further information and reports of changes in audience views and opinions. We have also used social media and press releases to engage with the general public. On a local level, we have delivered a report for delivery to a Local Authority Homelessness Reduction Board; and presented to policy advisor leads for development of policies intended to improve outcomes for people experiencing or at risk of rough sleeping. The study protocol has influenced the design and development of new trials in this area of public policy and has led to a successful funding bid to NIHR for a further pilot RCT in the homelessness field. More instrumentally, the preliminary findings of administrative data linkage were presented to the Welsh Government COVID-19 Technical Advisory Group subgroup on research and development. The findings were received favourably and seen as important evidence on the positive impacts of the homelessness policy response during the pandemic. The project outputs continue to generate interest and are helping to shape planned significant new investment in homelessness research. |
| First Year Of Impact | 2021 |
| Sector | Communities and Social Services/Policy |
| Impact Types | Policy & public services |
| Description | 2021.05.21 Welsh Government Technical Advisory Cell meeting |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | PHaCT Trial: Preventing Homelessness improving health for people leaving prison: a pilot randomised controlled trial of a Critical Time intervention |
| Amount | £744,145 (GBP) |
| Funding ID | NIHR134281 |
| Organisation | National Institute for Health Research |
| Sector | Public |
| Country | United Kingdom |
| Start | 06/2022 |
| End | 05/2024 |
| Title | Development of the Moving On survey tool |
| Description | A tool to measure outcomes of housing-led interventions with homeless people. The tool compiles a number of existing scales and augments these with additional questions |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2020 |
| Provided To Others? | No |
| Impact | None yet |
| Description | 2020.09.08 Announcing a new study |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Twitter post announcing the study, who it will be delivered by, funding source and the focus of evaluation |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.09.08 Centre for Homelessness Impact and Cardiff University lead new major trial |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Blog post announcing that the study is being conducted, by whom and its aims, considerations and methodology. Including timeframe and which organisations had committed support to the projects |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.09.09 Presentation at CHI International Homelessness Research Network |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | Invited to present on COVID and homelessness at Centre for Homelessness Impact International Homelessness Research Network meeting. |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.09.14 Media article: Council steps up efforts to help homeless on Brighton streets |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Original CHI press release/announcement about the study picked up by The Argus (local news outlet for Brighton and Hove) provides readers with insight into the aims of the study |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.09.24 Welsh Government Housing Information Group attendance and update |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Attendance and presentation on ESRC funded studies to the Welsh Government Housing Information Group. |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.10.13 Media article: Newham takes part in major study to improve Covid-19 outcomes for the homeless |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Original CHI press release/announcement about the study picked up by the Newham Recorder provides readers insight into the importance of the study and its aims |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.10.16 Presentation to policy advisor colleagues at MHCLG |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Presentation to policy advisor leads for development of policies intened to improve outcomes for people experiencing or at risk fo rough sleeping - summary reminder of study, its focus, intended aims, methodology and progress with recruiting participating LAs. MHCLG are supporting the study and this was an update |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.11.18 Presentation to Cambridge University students of Social Policy |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Undergraduate students |
| Results and Impact | Presentation to social policy students at Cambridge University explaining the importance of the study, its, methods and what it aims to understand - growing a robust evidence base for tackling homelessness based on what works |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.11.19 Presentation to Support Better Futures |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presentation to the Supporting Better Futures for All (Scotland) group covering the study as an example of the types of evidence needed to grow our understanding of what works to tackle homelessness most effectively. |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2020.12.02 A Randomised Controlled Trial Testing Models of Housing and Support to Reduce Risks of COVID-19 Infection and Homelessness |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Other audiences |
| Results and Impact | Invited talk at the Concordat Launch Event, Cardiff University. |
| Year(s) Of Engagement Activity | 2020 |
| Description | 2021.01.05 Progress update to MHCLG |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Progress update on the study to the Director of Rough Sleeping and Homelessness at MHCLG - engagement with LAs and pending start to fieldwork |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.01.06 Summary to Institute for Global Homelessness |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Third sector organisations |
| Results and Impact | Summary of the study, its aims and intended benefits to the work of the Centre to end homelessness with a focus on understanding what works/ growing the evidence of what works |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.01.11 Summary to Bob Blackman MP |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Summary of the study, its aims and intended benefits to the work of the Centre to end homelessness with a focus on understanding what works/ growing the evidence of what works |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.01.12 Overview to the Greater Manchester Mayor's Charity |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Third sector organisations |
| Results and Impact | Summary of the study, its aims and intended benefits to the work of the Centre to end homelessness with a focus on understanding what works/ growing the evidence of what works |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.01.18 Overview to Scottish government policy leads |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Summary of the study, its aims and intended benefits to the work of the Centre to end homelessness with a focus on understanding what works/ growing the evidence of what works |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.01.25 Summary to Neil Coyle MP |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Summary of the study, its aims and intended benefits to the work of the Centre to end homelessness with a focus on understanding what works/ growing the evidence of what works |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.01.29 Summary to Steve Reed MP |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Summary of the study, its aims and intended benefits to the work of the Centre to end homelessness with a focus on understanding what works/ growing the evidence of what works |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.02.09 Overview to Welsh government policy leads |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Summary of the study, its aims and intended benefits to the work of the Centre to end homelessness with a focus on understanding what works/ growing the evidence of what works |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.02.22 Presentation at IPPO roundtable on homelessness policy and COVID |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Brief presentation and roudntable discussion on the key homelessness policy challenges in the UK. |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.02.26 Summary to Centrepoint |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Third sector organisations |
| Results and Impact | Summary of the study, its aims and intended benefits to the work of the Centre to end homelessness with a focus on understanding what works/ growing the evidence of what works |
| Year(s) Of Engagement Activity | 2021 |
| Description | 2021.03.08 Bournemouth Local Authority Homelessness Reduction Board report |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Third sector organisations |
| Results and Impact | Report produced by the study team to be delivered to the Bournemouth Local Authority Homelessness Reduction Board |
| Year(s) Of Engagement Activity | 2021 |
| Description | Blog: The UK's first pilot Randomised Controlled Trial in homelessness - 2021.05.24 |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | This blog by the Centre for Homelessness Impact and the PI provides an overview of the trial and its potential value to social sciences and homelessness research. |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://www.homelessnessimpact.org/post/first-pilot-rct |
| Description | ESRC/UKRI/GSR: Actionable Insights Seminar Series - Homelessness and Covid-19 - 2022.03.17 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | A presentation on findings of research into Covid-19 and homelessness, drawing upon findings from research undertaken through three ESRC investments, including Moving On. the presentation raised awareness of the impacts of the Covid-19 response and raised questions about future trials in this field in the future. |
| Year(s) Of Engagement Activity | 2022 |
| Description | European Commission Mutual Learning Platform Presentation - 2022.10.20 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | An invited plenary presentation on preventative measures against homelessness and housing exclusion, delivered to the European Commission Mutual Learning Platform. The presentation explored effectiveness of homelessness prevention efforts and included some consideration of the limited robust evidence base, drawing upon lessons from the Moving On study. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Funders roundtable presentation - 2023.03.02 |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Supporters |
| Results and Impact | A plenary presentation and roundtable discussion exploring homelessness prevention interventions and including a reflection on the limited robust trials-based evidence base on what works to prevent homelessness, including key learning from the Moving On study. The intention is to inform further intervention and robust evaluation in this area. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Homeless Link Prevention into Action Conference - 2022.06.09 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Third sector organisations |
| Results and Impact | An invited plenary presentation reflecting on the collective efforts to prevent homelessness in the UK. Drawing upon available evidence from the UK and internationally, it pointed towards key successes and challenges, whilst also focusing on possibilities to act earlier and to be more effective in meeting our goal of making homelessness rare, brief, and unrepeated. The presentation included some consideration of the need for more robust evidence on effective interventions, drawing on lessons from the Moving On study. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Homelessness Data England Stakeholder meeting - 2021.10.12 |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Invited attendance at the homelessness data England stakeholder meeting to discuss developments and opportunities relating to homelessness data collection and analysis in England. This virtual roundtable provided an opportunity to discuss the linked administrative data component of the trial. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Meeting with researchers at the Senedd to discuss homelessness research priorities in Wales - 2021.06.11 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | A meeting with researchers at the Senedd to discuss homelessness research priorities in Wales. The meeting provided an opportunity to reflect on learning across several research projects involving the PI. The meeting is intended to inform potential future lines of inquiry by the Senedd. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Policy That Works: Innovation and evaluation in practice - homelessness - 2022.03.03 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | A presentation at the Cabinet Officer organised 'Policy That Works' event on innovation and evaluation in practice in the homelessness sector. This presentation reflected o the key findings of the Moving On study. |
| Year(s) Of Engagement Activity | 2022 |