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November 2021
What Works Evidence Notes
02 Prevention
Evidence from across the world on solutions to homelessness

CENTRE FOR HOMELESSNESS IMPACT

WHAT WORKS EVIDENCE NOTES

What Works Evidence Notes
This series draws together research evidence from across the world of what we know about how best to relieve and prevent homelessness. The notes are deliberately short to provide a summary for busy people of findings of research from different fields. They will be updated regularly as our knowledge of what works advances.
About the Centre for Homelessness Impact
The Centre for Homelessness Impact champions the creation and use of better evidence for a world without homelessness. Our mission is to improve the lives of those experiencing homelessness by ensuring that policy, practice and funding decisions are underpinned by reliable evidence.
Written by Tim Gray, Sarah Argodale and Guillermo Rodriguez-Guzman
© 2021 | Centre for Homelessness Impact ISBN: 978-1-914132-08-7 CHI | Registered Charity Number: E&W1183026; SC049501 Company Number: 11732500 www.homelessnessimpact.org

November 2021
What Works Evidence Notes
Topics in this series:
01 Drugs and Alcohol 02 Prevention 03 Welfare and Single Homelessness 04 Immigration Status 05 Legislation 06 Institutional Discharge 07 Employment 08 Mental Health
Evidence from across the world on solutions to homelessness

CENTRE FOR HOMELESSNESS IMPACT

WHAT WORKS EVIDENCE NOTES

Background

Homelessness prevention has become an increasingly important part of addressing homelessness in the UK and a number of countries across the world, including the US, Finland, Canada, Australia and Germany. There is an argument that a good deal of the initial impetus for this came from the success of the housing options approach developed in England in the early 2000's, which very significantly reduced full duty homelessness acceptances. Housing options give people who benefit from higher support more choice and independence when trying to find suitable accommodation.

This move towards homelessness prevention is sometimes called the `Prevention Turn'.1 In Wales and England the requirement on Local Authorities to take steps to prevent homelessness has been formalised into legislation through the Housing

Wales Act 2014 and the Homelessness Reduction Act 2017, with a recent report to the Scottish Government recommending that it introduces an even stronger duty to prevent homelessness.2

The rationale for the move towards homelessness prevention is broadly twofold:

a. Preventing homelessness before it occurs shields people from the trauma and damage caused by experiencing homelessness
b. Preventing homelessness may save money to the public purse in a variety of ways including reduced use of expensive temporary accommodation, but also including reduced offending, improved mental and physical health, less loss of employment and less disruption to children's educational achievement.

The types of homelessness prevention can be categorised as shown in the typology in Figure 1, which emerged during the development of the Rough Sleeping Strategy for England.3 This includes `Universal' prevention measures aimed at the whole population, such as poverty reduction or increased housing supply, `Targeted' prevention for at-risk groups, such as care leavers, `Crisis' prevention where homelessness is likely to occur within 56 days, `Emergency' prevention where homelessness or rough sleeping is imminent and also `Recovery' prevention, which is essentially trying to prevent someone who has just experienced homelessness from doing so again in the future.

Treating `Universal' prevention as out of scope, what does the evidence say works in the other areas?

1 Culhane, .D et al. (2011). A prevention-centered approach to homelessness assistance: a paradigm shift? Housing Policy Debate, 21(2).

2 Reid, Beth. (2021). Preventing Homelessness in Scotland. Crisis.
3 Fitzpatrick, S. et al. (2019). Homelessness Prevention in the UK. UK Collaborative Centre for Housing Evidence.

02 PREVENTION

Identification of the issue

An obvious but important point is that homelessness can only be prevented if the body which is trying to prevent it becomes aware of the issue before a person or household actually becomes homeless.

The latest publications show that in England
from 2020/2021, 42% of households were owed
a prevention duty. For Scotland in the same time
period, 3% of households were assessed as
being threatened with intentional or unintentional
homelessness. In Wales from 2019/2020, 31% of
those assessed for homelessness were eligible
for prevention services.4 From January-June
2021, 0.07% of households who submitted a
homelessness application in Northern Ireland were
prevented from becoming homeless.5
Figure 1. Homelessness Prevention Typology
UNIVERSAL
Preventing or minimising homlessness risks across the population at large e.g. poverty reduction across whole population
TARGETED
Upstream prevention focussed on high risk groups such as vulnerable young people, and risky
transitions, such as leaving local authority care, prison or mental health in-patient treatment e.g. transition pathways and support for prison leavers
CRISIS
Preventing homelessness likely to occur within 56 days, in line with legislation across Great Britain on threatened with homlessness
e.g. Housing Options approaches
EMERGENCY
Support for those at immediate risk of homelessness, especially sleeping rough e.g. provision of temporary accommodation
RECOVERY
Prevention of report homelessness and rough sleeping e.g. Housing First to
prevent recurrence of homelessness

In England for 2020/2021,5 60% of households were in secure accommodation after their prevention duty ended. For the same year in Scotland, 80% of those who were assessed as unintentionally homeless or threatened with homelessness were in settled accommodation.6 In Wales, from 2019/2020, 67% of those eligible for Section 66 assistance received support to successfully prevent homelessness from occurring.7 Northern Ireland currently does not publish outcomes for those who were prevented from becoming homeless, but is working on making that data available in future publications.8
This shows that Local Authority attempts to prevent homelessness are largely successful and suggests that a key factor in preventing more homelessness from occurring would be if more households approached Local Authorities earlier,9 and/or that more organisations, such as prisons and hospitals, working with people at risk of homelessness, referred them to Local Authorities while homelessness prevention is still possible.

4 StatsWales (2021). 5 Northern Ireland Homelessness Bulletin (2021). 6 Homelessness in Scotland (2021). 7 StatsWales (2021). 8 Northern Ireland Homelessness Bulletin (2021).

9 This does not, however, mean that if all those owed a relief duty approached Local Authorities before they became homeless, that prevention success rates would be the same, as relief cases may, on average, have resulted from circumstances where homelessness was more difficult to prevent.

CENTRE FOR HOMELESSNESS IMPACT

WHAT WORKS EVIDENCE NOTES

Review of the evidence on successful homelessness prevention

The 2019 University of York review of international evidence on preventing homelessness10 concludes that: "truly effective strategies to prevent and reduce homelessness are integrated and coordinated. An effective homelessness strategy incorporates a set of preventative, supported housing/hostel-based, Housing First, housing-led services, various hybrid and specialist models of support, such as dedicated services for groups who may have specific needs including women, vulnerable young people, ex-offenders, or families or other innovations such as critical time intervention (CTI), it also incorporates health, social work, social housing, social protection/welfare and other arms of the state."
It further concludes that an effective approach... "should include:
· Systems for preventing eviction by negotiation/working with landlords.
· Systems for preventing homelessness caused by unmet support and treatment needs, including resettlement for people discharged from institutional settings.
· Systems for detecting and intervening when domestic violence or abuse are present as triggers for individual/family homelessness.
· Systems for stopping unplanned moves when relationship or family breakdowns have occurred, including teenage runaways.
· Systems to ensure an unwanted move does not result in homelessness, but ensuring alternative housing is in place.
· Housing rights services where the risks of homelessness arises from illegal or inappropriate action by lenders or landlords.
· Rapid rehousing systems for when homelessness cannot be prevented or individuals or families present too late for assistance to be practical."

"Truly effective strategies to prevent and reduce homelessness are integrated and coordinated"

10 Please, Nicholas. (2019). Preventing Homelessness: A Review of International Evidence. Centre for Housing Policy, University of York.

02 PREVENTION

The review and CHI's work to date also suggests that the following more specific interventions can be successful:

· Rent deposit schemes.
· Housing advice and housing rights services.
· Local lettings agencies/housing access schemes.
· Housing/tenancy support services that offer case management/service brokering with health, mental health, social protection/welfare support, debt management/counselling, addiction, other support and treatment services.
· Specialist support services, such as tenancy support services for people leaving prison, young people leaving child protection/social work services, women at risk of homelessness, families at risk of homelessness and potentially at-risk individuals such as people with a history of addiction or severe mental illness whose housing situation is precarious.
However, details on which specific interventions are more successful or more cost effective than others are currently very limited because:
· There are very few randomised control trials of homelessness prevention measures outside the US (and the situation in the US is very different due to the absence of welfare benefit provision to pay for housing costs).
· Local Authorities have a statutory duty to accommodate some types of households experiencing or at risk of homelessness in England and the rest of the UK, which sets prevention measures in a different context to other countries where this is not the case.
· The success of different measures depends on the reasons underlying the risk of homelessness. For example, homelessness due to the lack

of affordable accommodation for people on low incomes needs a different solution to homelessness as a result primarily of mental health problems or substance use, so which measures are most needed locally depends on the breakdown of reasons for homelessness in a particular geographical area.
· The type of homelessness being prevented is important. Prevention of rough sleeping is different from prevention of homelessness when defined as living in unsuitable accommodation, for example.
With this important caveat, two international recent reviews of international (mainly US) evidence are worth highlighting:
1. A US evidence review: "Reducing and preventing homelessness: lessons from randomized evaluations" published in 2019 by JPAL11 reviews the existing literature on the impact of programs and policies in North America that aim to reduce and prevent homelessness and outlines a research agenda for additional evaluation based on existing gaps in the literature. Unlike the University of York review, JPAL's focuses mainly on questions that can be answered through rigorous impact evaluation methods and draws primarily from randomised evaluations and quasi-experimental studies. The review summarises forty studies evaluating eighteen distinct programs. The key lessons drawn from the review are that:

11 Binder, J. (2019). Reducing and Preventing Homelessness: Lessons from Randomized Evaluations. J-PAL Evidence Review.

CENTRE FOR HOMELESSNESS IMPACT

WHAT WORKS EVIDENCE NOTES

· Emergency financial assistance and more comprehensive interventions that provide a range of financial assistance, counselling, and legal support can prevent homelessness among families at risk of losing their homes, but more research is necessary on how best to deliver prevention programs and target those most in need.
· Legal representation for tenants facing eviction holds promise for improving court-related outcomes for tenants and reducing evictions, although more research is needed on which types of legal tactics and programs are effective.
· Permanent supportive housing increases housing stability for individuals with severe mental illness and for veterans experiencing homelessness. There is limited rigorous evidence on the impact of permanent supportive housing for other groups of people. The profile of service veterans in the US is also different from, for example, the UK.
· Although rapid re-housing is a potentially costeffective solution to provide immediate access to housing, there is limited rigorous evidence on the impacts of rapid re-housing on long-term housing stability.
· Subsidised long-term housing assistance in the form of Housing Choice Vouchers helps lowincome families avoid homelessness and stay stably housed.
· Additional research on the effectiveness of other strategies to reduce homelessness is needed. This review identifies gaps in the literature and poses several new questions to be considered when conducting evaluations of homelessness prevention or assistance programs.

2. The 2018 Campbell systematic review and meta-analysis of the effectiveness of interventions to reduce homelessness12 was based on 43 studies, 37 of which were from the US, with three from the United Kingdom and one each from Australia, Canada, and Denmark. The review concluded that "the following interventions perform better than the usual services at reducing homelessness or improving housing stability in all comparisons. These interventions are:
· High intensity case management
· Housing First
· Critical time intervention
· Abstinence-contingent housing
· Non-abstinence-contingent housing with high intensity case management
· Housing vouchers
· Residential treatment
The review concludes: "These interventions seem to have similar beneficial effects, so it is unclear which of these is best with respect to reducing homelessness and increasing housing stability." This also highlights the problem that, for example, most of these measures would have little relevance to family homelessness in England or the rest of the UK.

12 Munthe-Kaas, H. et al. (2018). Effectiveness of interventions to reduce homelessness: a systematic review and meta-analysis. Campbell Systematic Reviews, 14(1).

02 PREVENTION

9
UK evidence
The interventions highlighted as being promising in all of the above evidence reviews are already commonly used in all UK nations, though to date their effectiveness and cost-effectiveness hasn't been tested. So a natural next step would be to ensure we understand the relative effectiveness of these interventions in our context so that we can make limited resources go further.
The evidence from the homelessness statistics in England13 shows that in terms of the numbers of successful homelessness preventions achieved by Local Authority homelessness services between March 2020 to April 2021: · 64% moved to alternative accommodation and 36% were able to
remain in their current accommodation · The accommodation secured (for the total of those who moved
and those who remained) was about 41% private rented, 39% social rented and 15% staying with family or friends The main activities that secured a successful homelessness prevention in England are shown in Figure 2. For the 67% who moved to alternative accommodation, clearly providing or helping households to secure accommodation `works' as a prevention measure. However, there are constraints on the ability of Local Authorities to be able to help secure accommodation based on the cost and availability of accommodation in an area, and on the willingness of both private and social sector landlords to let accommodation to households experiencing homelessness. There may also be painful compromises for the households for whom homelessness is prevented in terms of the size, location, affordability and security of tenure of the accommodation in which they have to move in order to avoid homelessness.

13 Detailed published information on homelessness prevention outcomes does not exist in the same way in the other UK nations or internationally.

CENTRE FOR HOMELESSNESS IMPACT

WHAT WORKS EVIDENCE NOTES

02 PREVENTION

Figure 2. Main activity that resulted in accommodation secured to end a prevention duty in England between October and December 2020 Source Homelessness Live tables14

Main activity that resulted in accommodation secured for households: Accommodation secured by Local Authority or organisation delivering housing options service Helped to secure accommodation found by applicant, with financial payment Helped to secure accommodation found by applicant, without financial payment Negotiation / mediation / advocacy work to prevent eviction / repossession Negotiation / mediation work to secure return to family or friend Supported housing provided Discretionary Housing Payment to reduce shortfall Other financial payments (e.g. to reduce arrears) Other15 No activity advice and information provided

20,340
8,570
4,780
3,490
6,910 5,590 2,590 1,220 5,180 10,480

29.4%
12.4%
6.9%
5.0%
10.0% 8.1% 3.7% 1.8% 7.5% 15.2%

For the 36% who were able to remain in accommodation, negotiation or mediation work to secure return to a family or friend is the most successful single activity, at 10% of all preventions, followed by similar work to prevent eviction/ repossession by a landlord, at 5%. However, these are very broad descriptions, and there may be some overlap between these categories and the DHP or other financial payments, as such payments may have formed part of a negotiation to prevent eviction, for example. There may also be similar overlap with some of the `other' categories which make up 8% of preventions. Work to prevent illegal evictions is not differentiated and would presumably fall under negotiation or mediation. It is thus difficult to determine more granular measures of success from these statistics, especially as we do not know in how many cases negotiations of various kinds

were attempted and failed.
It is therefore possible that more effective negotiation, following best practice, or with more households approaching Local Authorities earlier, it would be possible to increase the percentage of households who remain in their own home as opposed to those who move to alternative accommodation.
Scotland does not separate out its outcomes for those who were assessed as unintentionally homeless or threatened with homelessness, so it is harder to compare. Of those whose contact was maintained by the Local Authority from 2020-2021, 6% stayed in their current accommodation and the majority, 41%, went to Local Authority tenancies,16. Scotland does not indicate how accommodation was secured.

14 England Statutory Homelessness Data. (2021). 15 Other includes: Debt advice, resolved benefit problems,
sanctuary or other security measures to home, not known, housing related support to sustain accommodation

16 Homelessness in Scotland (2021).

Concluding remarks
Much greater use of empirical methods to assess the relative effectiveness and cost effectiveness of different approaches is needed. This would accelerate learning as well as help to understand the circumstances in which it is better for the household in the medium term to remain in existing accommodation, move into new private rented accommodation or to move into temporary accommodation (if homelessness prevention fails), with a subsequent move into social housing. The answers to all these questions are likely to be quite nuanced depending on individual and local circumstances, and not necessarily to follow a simple pattern of `prevention good, main duty acceptance bad' or vice versa.

References

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