20/46 Health impacts of housing led interventions for homeless people
Deadline for submission: 17 November 2020, 1pm
The Research Design Service representative supporting this commissioning brief is Janine Bestall. Email: firstname.lastname@example.org
- What are the health impacts of housing led interventions that provide housing plus intensive forms of support for people with histories of chronic/repeat homelessness?
Homelessness often results in, and from, ill health and can exacerbate existing health conditions. Homelessness increases the likelihood of mental or physical health problems and excessive alcohol and drug taking. The impact of long term and recurrent lone adult homelessness on health services, social services and the criminal justice system is significant. People with histories of chronic/repeat homelessness often have substantial and complex needs. People with histories of chronic/repeat homelessness can have severe and multiple disadvantages which act as barriers to engaging with health, social care, supported housing and social housing services, which makes the move into accommodation and sustaining tenancies more challenging. Alongside this, there is some evidence of long term and repeatedly homeless lone adults who are caught in ‘revolving door’ situations, frequently using emergency health, mental health, addiction, supported housing and emergency accommodation services without exiting homelessness.
A report from the Office for National Statistics suggests that in England, Wales and Northern Ireland, the number of people sleeping rough has risen substantially over the past decade. Each of the four UK nations has its own legislative framework for housing and housing strategy. England has recently undergone changes in housing legislation with the new Homelessness Reduction Act 2017. Policy responses include the Government’s Rough Sleeping Strategy which commits to end rough sleeping in England 2024 and sets out plans to invest in services and accommodation for homeless people. In the past year, Wales, Scotland and Northern Ireland have also made strategic and resource commitments to tackle homelessness.
Housing led interventions, such as Housing First, provide access to settled, independent housing which is not conditional on the person being ‘housing ready’. People receiving the intervention are not usually required to show changes in behaviour or compliance with treatment prior to being housed or afterwards. The housing is often provided along with a package of intensive support. Evidence suggests that housing led interventions are effective in supporting most people who have experienced chronic/repeat homelessness to sustain their tenancies.
The PHR Programme is aware that the causes and solutions of homelessness are many and varied. However, for this call, the Programme is interested specifically in the range of health and health inequality impacts of housing led interventions, such as Housing First, for people receiving the intervention, for the communities and societies in which they are housed and for the wider homelessness community. The Programme is interested in impacts for individuals and on local systems.
Research areas of interest could include, but are not limited to:
• Research that is focused on homeless population groups where there are evidence gaps or where evidence suggests there is particular need; for example, older people, care leavers, people with a severe mental illness and people with a personality disorder often in combination with an addiction, ex-offenders, people with long-term health conditions, lone adult women, gypsies and travellers, non-UK nationals including recent migrants, ex-service personnel, sex workers, refugees. Research could examine the differential health impacts of housing led interventions, such as Housing First, and whether these interventions are more likely to bring health benefits for some population groups than others.
• Research on long term health outcomes to establish whether observed short term improvements in wellbeing are sustained.
• Evaluations of the public health impacts of housing led interventions on the communities in which they occur, including community wellbeing, community and social integration.
• Evaluations of the health impacts that housing led interventions have on other services for homeless people. How interventions are best incorporated into homelessness, and health and wellbeing strategies to achieve health outcomes for all people experiencing homelessness.
• Research on how the local health, social and homelessness context affects the effectiveness of housing led interventions.
• Research on how the local physical environment e.g. access to green space, amenities, employment opportunities and public transport, affects the effectiveness of housing led interventions.
• Evaluations of natural experiments comparing the health impacts of different models of housing led interventions in different settings.
A range of study designs and outcome measures could be used. Researchers will need to identify and justify the most suitable methodological approach. Researchers will also need to specify key outcome measures and identify how these will be measured in short, medium and long term. Primary outcomes need to be health related and could include, for example, mortality rates, mental health, physical health, access to primary health care and other health services, retention of health care treatment and treatment plans such as substance misuse plans. Potential secondary outcomes could include social integration, access to support services such as domestic abuse services, engagement with the criminal justice system, housing stability, reduced Universal Credit sanctions.
Researchers are encouraged to consider the wider economic impacts, across whole community systems, of housing led interventions for people experiencing chronic/repeat homelessness compared with other types of homelessness interventions. Researchers could also consider how different models of housing led interventions inform the understanding and mitigation of the barriers and facilitators to improving wellbeing for people with histories of chronic/repeat homelessness.
Researchers are encouraged to involve people who are experts by experience in their studies along with experts in providing services to people experiencing homelessness. Researchers should demonstrate the relevance of their proposed research to evidence users. Researchers might want to consider how they will share their findings with relevant decision makers. They will be expected to be aware of other studies in this area and ensure their proposed research is complementary.
Studies should generate evidence to inform the implementation of single or multi-component interventions. Studies may include evidence syntheses, studies evaluating interventions, including trials, quasi- and natural experimental evaluations, and feasibility and pilot studies for these. We welcome applications for linked studies (e.g. pilot + main evaluation, evidence syntheses + modelling). Secondary analyses of existing epidemiological data and/or impact modelling studies may also be funded. We encourage the adoption of a systems perspective where appropriate to the study context. In all cases a strong justification for the chosen design and methods must be made.
The primary outcome measure of the research, if not necessarily the intervention itself, must be health-related. The positive or negative impacts of the intervention, including inequitable outcomes should be considered. Researchers are asked to indicate how long-term impacts will be assessed. All applications should identify underlying theory and include a logic model (or equivalent) to help explain underlying context, theory and mechanisms. Proposals should ensure adequate public involvement in the research.
The impacts of public health interventions are often complex and wide-reaching. Studies should acknowledge this by adopting a broad perspective, taking account of costs and benefits to all relevant sectors of society. An appropriate health economic analysis to inform cost effectiveness, affordability or return on investment should be included where appropriate. Sustainability - health, economic and environmental - is also of interest.
For all proposals, applicants should clearly state the public health utility of the outcomes and the mechanisms by which they will inform future public health policy and practice. Details about the potential pathway to impact and scalability of interventions, if shown to have an effect, should be provided, including an indication of which organisation(s) might fund the relevant intervention(s) if widely implemented
Remit of call
All proposals submitted under this call must fall within the remit of the NIHR Public Health Research (PHR) programme. Please go to http://www.nihr.ac.uk/phr for details. For the evaluation of time sensitive, policy driven, interventions applicants may wish to consider the fast-track work stream - http://www.nihr.ac.uk/phr
The PHR Programme funds research to generate evidence to inform the delivery of non-NHS interventions intended to improve the health of the public and reduce inequalities in health. Our scope is multi-disciplinary and broad, covering a wide range of interventions that improve public health.
The primary aim of the programme is the evaluation of practical interventions. We will fund both primary research (mainly evaluative, but also some preparatory research) and secondary research (evidence synthesis); precise methods will need to be appropriate to the question being asked and the feasibility of the research.
Our research serves a variety of key stakeholders including: decision-makers in local government; primary care organisations and other local public services; third sector organisations; relevant national agencies (e.g. NICE) concerned with improving public health and reducing health inequalities; researchers; public health practitioners and the public.
Applicants should consider how their findings will impact upon decision making in public health practice, whether results are generalisable to other populations and affordable, setting out a clear pathway to impact. The NIHR PHR programme recognises that there is a need for an evidence base for disinvestment and that the removal of an intervention from a population can be worthy of evaluation.
The affordability of the intervention, and at least an indication of the stakeholder(s) willing to fund the intervention, should be referenced within the stage 1 application. At the stage 2 application point, statements of support confirming stakeholder commitments to funding will be required. Applicants should be aware that the NIHR PHR programme is unable to fund intervention costs.
The NIHR PHR programme is open to the joint funding of research projects with other organisations such as those in the third sector. If you would like to explore the potential for joint funding, please contact us at email@example.com with details of your proposal and the other funder prior to submission.
All of our funded projects are eligible for publication in the NIHR Journals Library. This open access resource is freely available online, and provides a full and permanent record of NIHR-funded research.
Notes to applicants
The NIHR PHR programme is funded by the NIHR, with contributions from the CSO in Scotland, Health and Care Research Wales, and HSC R&D, Public Health Agency, Northern Ireland. Researchers in England, Scotland, Wales and Northern Ireland are eligible to apply for funding under this programme.
Applicants are recommended to seek advice from suitable methodological support services, at an early stage in the development of their research idea and application. The NIHR Research Design Service can advise on appropriate NIHR programme choice, and developing and designing high quality research grant applications. The Research Design Service representative supporting this commissioning brief is Janine Bestall. Email: firstname.lastname@example.org
The NIHR Clinical Research Network
(CRN) supports health and social care research taking place in NHS and non-NHS settings. The CRN provides expert advice and support to plan, set up and deliver research efficiently.
Clinical Trials Units are regarded as an important component of many trial applications however, they are not essential for all types of studies to the PHR programme. The CTUs can advise and participate throughout the process from initial idea development through to project delivery and reporting. NIHR CTU Support Funding provides information on units receiving funding from the NIHR to collaborate on research applications to NIHR programmes and funded projects. In addition, the UKCRC CTU Network provides a searchable information resource on all registered units in the UK, and lists key interest areas and contact information.
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