Resolving long-term homelessness

Evaluating an intensive intervention designed to end long-term homelessness, this report covers the 36 months outcomes of the Journey to Social Inclusion pilot program and follows on from two previous reports which examined outcomes after 12 and 24 months. The evaluation combined a traditional Randomised Controlled Trial (RCT) with in-depth interviews. • Executive Summary The Journey to Social Inclusion pilot program was designed to break the cycle of long-term homelessness. The pilot provided intensive support for three years to assist people who were long-term homeless to receive the range of services they need. This report presents the social and economic outcomes after the completion of the pilot. The evaluation used a randomised controlled trial to track and compare the outcomes of the J2SI participants (Group J) with those of an equivalent group of chronically homeless people (Group E) who were supported by existing services. After three years 80% of the original participants remained involved in the trial. The outcomes are promising. The evidence suggests that J2SI had a significant impact on the lives of most participants. After three years 85% of J2SI participants were housed compared to 41% of those who were receiving existing services. Over the course of the trial J2SI participants were housed for 67% of the time, or nearly twice as long as those in the control group (35%). The evidence confirms that given the right level of support people who have experienced long- term homelessness can maintain their housing. The outcomes data reveal ongoing improvements in other areas as well. The emotional health of the J2SI participants improved and they report lower levels of stress, anxiety and depression after three years compared to where they were at the start of the trial, and also compared to Group E. The physical health of Group J improved with the proportion reporting no bodily pain increasing from 27% to 41% over the three year period. However, four people passed away during the trial, a blunt reminder of how common premature death is among the long-term homeless. Three of those who passed away were from Group E. Although there is some variation in the use of health services with both groups showing greater improvements in some areas relative to the other group, the most important empirical finding is that Group J’s average use of emergency psychiatric services and their average number of days hospitalised in a general hospital and a psychiatric unit has declined both over time and relative to Group E. Group J’s need for emergency hospital treatment has also declined over time but less than Group E’s. This translates into a substantial health care impact and suggests that an intervention comprising stable housing and intensive case management can reduce the public burden associated with the over-utilisation of health services. While few people in either group were employed and the number looking for work in Group J declined in the last 12 months, twice as many people in Group J were looking for work compared to Group E. The report also shows improvements over time and relative to Group E in the use of welfare and homelessness services, and the amount of time incarcerated. There are a number of areas where there was little change. Most notably we found little change at any stage in the trial in the substance use behaviour of the participants. Similarly, the extent to which the participants felt connected to and supported by the community did not change a great deal over the three years. Further, we found the short-term economic benefit to be modest, with a return of between 0.15 and 0.22 for every dollar invested. Taking into account lives saved over a 10 year time frame the economic benefit was more substantial, with a $1.30 return for every dollar invested. Nonetheless, the evidence shows that breaking the cycle of chronic homelessness is possible and that intensive support coupled with stable housing can reduce demand on expensive health, justice and welfare services. However, the study also found the deep effects of social exclusion are much harder to address. The evaluation found, as have many other similar studies, that having a home does not necessarily lead to social acceptance and social inclusion. With limited employment options, few social networks outside of the homeless population, and few alternative social activities, opportunities for social inclusion are limited. In this context programs designed to permanently end long-term homelessness such as J2SI need to temper their expectations and accept that years immersed in homelessness not only have physical and emotional effects, but also long-term social and economic effects as well. When the long-term social impact of homelessness is understood by policy makers they will be in a better position to confront the fact that what constitutes social inclusion is a much thornier issue for the long-term homeless than is generally understood. J2SI has clearly made a difference in the lives of many of the participants, even if it is only a less stigmatised and safer day-to-day life. However, the true test of the J2SI pilot will be whether the improvements reported here are sustained over the longer term. In 12 months’ time we will report on how the trial participants are travelling 12 months after the program closed. Only then will we be in the position to say whether the J2SI approach provides lasting solutions to long-term homelessness and whether the benefits justify the costs