Presentation to the Homelessness and Support Division, Department for Communities and Local Government 27 June 2013 Maureen Crane, 1 Tony Warnes 2 and Louise Joly 1 1. Social Care Workforce Research Unit, King’s College London 2. School of Biological Sciences and Medicine, University of Sheffield Outcomes of the resettlement of single homeless people 1

Presentation  Brief overview of the aims of resettlement and resettlement practices  Design of the FOR-HOME study of resettlement outcomes  Findings from the FOR-HOME study  Introduction to the Rebuilding Lives study

Resettlement aims and practices  To assist homeless people to achieve independent living and rebuild their lives, and thus prevent repeat episodes of homelessness.  To avoid long-term or chronic homelessness and a reliance on hostels and homelessness sector services.  Resettlement practice varies greatly, i.e. its timing, help received before being rehoused, availability of support post- resettlement.  Lack of evidence in UK about outcomes over time for homeless people who are resettled. 3

Aims To collect information over time about: (a) the experiences of homeless people who are resettled, and (b) the factors that influence the outcomes. Study conducted at the University of Sheffield by Tony Warnes, Maureen Crane and Sarah Coward. Funded by the Economic and Social Research Council. 4

Partner organisations 5

Study design and data collection  The sample: 400 single homeless people resettled into independent accommodation by the six organisations. Two clusters: London, and Nottingham / Leeds / Sheffield (Notts/Yorks).  Semi-structured interviews conducted immediately before being resettled, and after 6 and 15/18 months. Key-worker also completed questionnaire at baseline.  Interviews from June 2007 to March Tracking exercise at 12 months (and when necessary) to check the participants’ whereabouts. 6

Principal lessons on methodology and execution  Importance of close collaboration with homelessness service- providers – partners in study and involved in design, recruitment, tracking, interpretation and dissemination of findings.  Important to have large sample to collect authoritative evidence and enable analyses of various circumstances and problems. Took 15 months to recruit sample.  Longitudinal studies are lengthy and time-consuming, but provide rich information about changes in people’s circumstances over time. Retrospective data less reliable.  FOR-HOME achieved low attrition rate – as a result of flexibility and consistency when interviewing, and an effective tracking system (essential for this client group). At end of study, the circumstances of 94% known. 7

The study participants, their achievements and housing outcomes

Profile of the participants  296 men and 104 women  24% aged years; 62% aged 25-49; 14% aged 50+ yrs  56% White British, 44% other ethnicity  Problems: 63% mental health, 33% alcohol, 57% drugs (38% mental health + drugs; 24% mental health + alcohol)  19% literacy difficulties  51% never previously lived alone  30% homeless more than 5 years; 39% homeless 2+ times  48% moved to local authority housing, 38% to housing association tenure, 14% to private-rented 9

Achievements since being rehoused  Most (78%) glad to have moved: gained independence and privacy; had control of their accommodation; able to start afresh and rebuild their life.  Many gradually acquired furniture and furnishings, and created ‘a home’.  Some obtained jobs, or started education or training courses. 9% working when resettled and 18% at 15/18 months. Another 16% worked at some time since being resettled.  Several renewed contact with family and children, or family relationships improved. By having own place, able to entertain family and friends and have their young children to stay. 10

Financial difficulties and debts Major difficulty was managing finances and paying bills – rent arrears and other debts increased over time. Common reasons for increase in debts:  Nearly one-half (46%) had debts at start of tenancy - 38% owed rent to pre-resettlement hostel / housing project  Old rent arrears and court fines resurfaced once rehoused  Loans from social security and elsewhere to furnish home  Difficulties understanding / paying utility bills  In and out of low-paid jobs affected HB and SS benefits  Poor budgeting skills; alcohol and drug misuse 11

Prevalence of debts over time by age groups 12

Those most affected by debts  Very young people – those aged least likely to have debts when resettled (29%) and most likely to have them by 15/18 months (79%)  People with mental health problems – experienced great difficulties budgeting and sorting out bills  People with more chaotic histories (drug problems or repeat episodes of homelessness)  Association between owing rent on pre-resettlement accommodation and defaulting with rent on new tenancy 13

Tenancy support  Only 51% had a tenancy support (TS) worker after being rehoused.  Those who had TS worker were less likely to have accrued rent arrears.  Those with mental health, alcohol or drug problems were more likely to be linked into mental health and substance misuse services if had TS worker.  Young people (17-24) least likely to have a TS worker yet most likely to have no experience of independent-living – 73% had no TS worker.  Some young people without TS worker sought help from former hostel staff – staff not have capacity to give substantial help if problems complex and required intense interventions. 14

Housing outcomes at 15/18 months by location Note: Excludes 4 people that died and 25 unknown if still in a tenancy 15

Housing outcomes at 15/18 months by age groups Note: Excludes 4 people who died and 25 unknown if still in a tenancy 16

Key influences on outcomes

The pre-resettlement accommodation Strong associations between type of accommodation before resettlement, duration of stay and housing outcomes. More likely to sustain a tenancy if:  Not slept rough during preceding 12 months  In semi-independent accommodation before being resettled  In last hostel / supported housing >6 months before being resettled. The likelihood of sustaining a tenancy increased with length of stay (up to 3 years) in the hostel / housing project. Additional months of stay beyond 3 years slightly increased the likelihood of tenancy failure. 18

Housing outcome at 15/18 months by length of stay in pre-resettlement accommodation 19

Why duration of stay in the pre-resettlement accommodation is influential Longer stays provide more opportunities:  to resolve or come to terms with personal problems (‘recovery time’) – through self-reflection, help from hostel staff and others, and accessing specialist help such as mental health or substance misuse services.  to become involved in lifeskills training and ETE (education, training, employment) and thus build or restore independent-living skills.  to develop or restore confidence and self-belief, and plan for the future. Shorter stays may characterise those with a more chaotic lifestyle – but not evident among FOR-HOME participants 20

Housing outcomes at 15/18 months by tenure Note: Excludes 4 people who died and 25 unknown if still in a tenancy 21

Why moves to the private-rented sector (PRS) had poorer outcomes  Less satisfaction with the accommodation as more likely to be bedsits – little space or privacy, and conflicts sharing kitchens / bathrooms.  Poor property maintenance – difficulties getting landlords to do repairs.  Shorter, less secure tenancy agreements – feelings of unsettledness and accommodation not being ‘home’.  Higher rents in PRS contributed to financial difficulties and debts, particularly when starting / stopping work and LHA stopped / reduced.  Among people who moved to a ‘managed’ PRS scheme, a higher tenancy sustainment rate was achieved (72% still in original tenancy at 15/18 months). 22

Percentages with debts by tenure 23

Average rent arrears (£s) by tenure 24

Other influences on outcomes More likely to remain housed if:  involved in ETE at time of resettlement  received training before resettlement on paying bills  liked neighbourhood and good transport links in area Less likely to remain housed if:  using illegal drugs at resettlement  in care as a child 24+ months No relationship between tenancy sustainment and:  mental health or alcohol problems at resettlement  previous experience of living alone  being employed (those consistently unemployed were ‘protected’ by welfare benefits)

Resettlement in the future: recommendations for policy-makers and service-commissioners in light of FOR-HOME’s findings

The work of hostel staff Given the imposition of shorter stays in many hostels and ‘supported accommodation’, there is an increasing need for more intensive work with hostel residents, particularly around:  Coming to terms with / resolving personal problems  Engaging in independent-living training programmes and ETE  The management of personal finances. Requires measures to avoid / tackle rent arrears while in hostels, and financial training for selected staff who can then advise on day-to-day money management, payment of household bills, financial implications of taking loans or making changes such as starting work or college, and tackling debts.  Having realistic expectations of available move-on housing – PRS rather than social housing; short rather than long or open-ended tenancies; no longer spacious accommodation for young people and a likely need to share some facilities. 27

Move-on accommodation and support  Given that the PRS is nowadays often the only resettlement option for many homeless people, it is essential that homelessness sector organisations have access to ‘managed’ PRS schemes that support the tenant and the landlord. The FOR-HOME findings suggest that these are more effective than other PRS arrangements.  There is a need for effective tenancy support for homeless people who are rehoused. Specialist tenancy support services should be targeted at those most in need. Other ways to provide advice and help post-resettlement should be explored, e.g. use of volunteers as peer supporters, ‘drop-in’ surgeries at day centres or other sites.

Rebuilding Lives Maureen Crane, Louise Joly and Jill Manthorpe Social Care Workforce Research Unit, King’s College London Study funded by School for Social Care Research, National Institute for Health Research The views expressed in this presentation are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health, NIHR or NHS.

Aims of Rebuilding Lives  To collect information about the circumstances of formerly homeless people five years after being rehoused, and their ability to sustain tenancies and achieve independent living.  To identify their longer-term social care and support needs, the characteristics of those who continue to require help, and whether their needs are currently met.  To identify the roles of different practitioners (social care, health and housing agencies) in providing longer-term support to formerly homeless people, effective ways of delivering the required help, and the challenges and difficulties of delivering this support.  To contribute to: (a) policy, public health and commissioning debates about the provision of longer-term support for formerly homeless people; and (b) practice debates about the support that is required to enable them to manage a tenancy and rebuild their lives. 30

Design of Rebuilding Lives  Involves 295 FOR-HOME participants who were still housed at 15/18 months (in the resettlement accommodation or another tenancy) and said we could contact them again.  The six FOR-HOME homelessness organisation partners are collaborating in the new study.  To achieve continuity and encourage participation, the same interviewers are involved.  Participants will be interviewed five years after they were resettled. For those who have received care and support in the last 12 months (other than treatment for health conditions) and who give consent, interviews will also be conducted with the support staff / practitioners.  Study started March 2013 and due to finish June Interviews started in April, and to date, **** interviews have been completed with resettled participants. 31

Contact details Maureen Crane: Louise Joly: Tony Warnes: FOR-HOME final report published 11 May 2011 Available at: forhomefinalreport.pdf Rebuilding Lives 32

Our warm thanks to … All the respondents who have participated in this study over a very long time. Ruby Fu, Camilla Mercer and Louise Joly who helped massively with running the project and coding the data. The freelance interviewers – Gary Bellamy, Paul Gilsenan, Louise Joly and John Miles. Members of the Management Committee: David Fisher (Broadway), Caroline Day and Jennifer Monfort (Centrepoint), Peter Radage and Rachel Harding (Framework), Julie Robinson and Tony Beech (St Anne’s), Simon Hughes and George Miller (St Mungo’s), and John Crowther and Debra Ives (Thames Reach), and to all their colleagues who have been Link Workers or have otherwise assisted with recruitment and tracking. 33