The challenges of and returns from a longitudinal study of the resettlement of single homeless people Tony Warnes (University of Sheffield) and Maureen Crane (King’s College London) APHA meeting, Caucus on Homelessness Symposium Novel methods, priorities or challenges in conducting research with homeless populations 1 November 2011, Washington DC

Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Tony Warnes and Maureen Crane No relationships to disclose

Topics  Origins and aims of the FOR-HOME study  Main features of the methodology and of its execution  Returns from the longitudinal design and the large sample  Overcoming the difficulties of raising grants for large studies

A study in England designed to produce authoritative and longitudinal information about: (a) the experiences of homeless people who are resettled, and (b) the factors that influence the outcomes. Funded by the UK Economic and Social Research Council Aims of FOR-HOME

Partner organisations Leeds and Sheffield Nottingham

Study design and data collection  The sample: 400 single homeless people resettled into independent accommodation by the collaborating organisations. Sampled from London, and three provincial cities Nottingham / Leeds / Sheffield (Notts/Yorks).  Semi-structured interviews conducted immediately before being resettled, and after 6 and 15/18 months. Link Worker also completed questionnaire at baseline.  Interviews from June 2007 to March Tracking exercise at 12 months to check the respondents’ whereabouts, and at 9 and 15 months for some.

Scotland LEEDS * * SHEFFIELD Wales * NOTTINGHAM LONDON * The FOR-HOME survey areas

Final report available online at

Profile of the participants  296 men and 104 women  24% aged years; 39% aged 25-39; 23% aged 40-49; and 14% aged 50+ years.  56% White British, 44% other ethnicity  63% had mental health problems, 33% alcohol problems, 57% drug problems.

The rationale for a longitudinal study First, we set out to test a theoretical model, that resettlement outcomes are a function of : (i) the resettled person’s biographical and current attributes (ii) the help and support received before and after resettlement (iii) the condition and amenities of the accommodation (iv) the respondents’ experiences post-resettlement Second, previous studies had found a peak of abandonments in the early weeks of resettlement, and that early resettlement ‘failures’ had different causes than those after three months. We wished to establish the timing of abandonments and evictions. Both ambitions required a longitudinal design (three waves of interviews over 18 months)

Constructing a quasi-representative sample There have been few evaluations of the resettlement of homeless people in the UK, and most have been of single or special projects, e.g. the closure of Glasgow’s large outdated hostels. A representative sample raises the value and authority of evaluation findings, but was a major challenge because data on the characteristics of (single) homeless people have not been collated. Increasing the difficulty, we had resolved that the first interview would be just before the move from the hostel – only a few days to arrange. Moreover, homeless people and services in London differ from elsewhere in England. To build a quasi-representative sample: * Six organisations operating in four cities were signed up * Data on the residents they resettled in 2006 were collated, and age, sex and oooethnicity quotas computed * Each organisation appointed a Link Worker to co-ordinate the organisation’s ooorecruitment efforts. They were trained to apply the inclusion/exclusion criteria oooscrupulously.

Overcoming early recruitment problems In the first 3+ months, recruitment was much slower than required. Some residents being resettled by the six organisations were being missed. When investigated, the main reason was found to be defective communication – of the importance and value of the study, and of imminent resettlements to the Link Workers The problem was largely (but not entirely) overcome by a concerted ‘education program’ * researchers contacted hostel managers and attended staff meetings * management and Link Workers sent out reminders to staff. Lessons for future studies: work intensively on encouraging all staff and projects to take ‘ownership’ of the research, and appoint Link Workers for each resettling project, not just the organisation. Recruitment to FOR-HOME was extended for three months, so a minority of the sample were interviewed 15 months after resettlement, not 18 months

Minimising attrition Around one-third of the participants were difficult to engage – important to be persuasive and persistent. Interviews arranged through repeated phone calls and, for some, several visits (costs of unsuccessful visits/appointments has to be budgeted). Need to be flexible – some interviews conducted weekends, early morning or late evening, to fit in with both drinking and drug habits and the schedules of those in work or formal study/training With participants’ consent, collected detailed information about formal / informal contacts for tracking. These details updated at each interview. ‘Freepost’ cards to return if changed address / phone number, which several did. Helped re-establish contact with a few participants Trust with participants increased over time -- they were more willing to give contact details for family and friends later on in the study Intensive, frequent tracking of participants

Interviews that maximise the response rate and data quality Semi-structured approx. 75 minute interviews administered by first- class experienced / thoroughly-trained interviewers Many in-depth, open-ended questions Incentive payments and personal touch: most interviews in participants’ homes, Christmas cards sent to all participants, and same interviewers for second and third interviews Need for strict safety procedures code. Some interviews required two present for safety reasons. No serious problems encountered. *Key Worker self-completion questionairres at baseline (required intensive encouragement from researchers and from organisations’ management) Despite intensive search, no appropriate standard ‘housing satisfaction’ scale found. Developed own ‘Right Move Scale’ Verbatim transcription of responses to open-ended questions, and best practice, qualitative data analysis

Returns from the methodology Social housing, Lenton, Nottingham

Direct returns * Low attrition rate. Interviews unable to be arranged or refused – 4.5% of sample at 6 months and 7.1% at 15/18 months. A few other participants had moved to institutions or died. * Reduced frequency of ‘missing data’ or values * Personal approach built trust with participants, who were then willing to share personal details and their opinions * Rich data set with >2,000 variables – including detailed information on personal finances, activities, aspirations and opinions... all of which increased the scope and power of feasible analyses and the reliability of the results, especially in comparisons of sub-groups

Examples of rich returns to understanding  Able to provide detailed descriptions and partial explanations of variations in access to ‘tenancy support’  New understanding about the radical impact of ‘resettlement’ – and of ‘life transitions’ once resettled – on personal finances  Able to detail the relationships between taking up and giving up paid work and change in personal finances – more serious impacts than gains/losses of earned income  Detailed evidence about the distinctive demands of moving into the private-rented sector

Tenancy support ‘Tenancy support’ is a form of low intensity ‘social work’ that focuses on managing a tenancy, including meeting rent payments and acquiring eligible social security benefits. It is provided in people’s homes: most clients have just a few visits, but some have multiple visits. It has been developing over 20+ years in the UK, particularly for vulnerable tenants, including those with learning difficulties, mental-health problems, vulnerability through old age and/or living alone, and recently has increasingly served people at risk of returning to homelessness. Most tenancy support services are funded through the central government Supporting People grant to every local authority, but some are supported by charitable funds. We learned during the study that some policy makers believed that every resettled person received tenancy support.

Tenancy support findings  Only 51% respondents had contact with a tenancy support (TS) worker after being rehoused.  Young people least likely to have a TS worker yet most likely to have no experience of independent-living. 27% aged compared to 59% above this age had a TS worker.  Strong difference in London – 93% rehoused through the ‘Clearing House’ compared to 37% rehoused in other ways had a TS worker. Only 12% in London aged had this help. Overall conclusion: The allocation of TS is as much a function of a person’s pathway through homelessness, particularly whether they have been a rough sleeper, as it is of the need for support

Resettlement and personal finances Resettlement involves moving from an institutional, supported setting to residential independence. In hostels, the management arranges rent and property-tax payments, and there are no energy, furnishing or domestic maintenance charges. Many hostels also provide subsidised hot meals. Becoming financially independent is a great challenge for many, particularly young people who have not been so before. The unemployed and those on low incomes are entitled to Housing Benefit, a rent subsidy. Among the respondents, 9% were employed at the time of resettlement, and 18% at 15/18 months. Most of the others had the majority of their rent paid by Housing Benefit. Nevertheless, when resettled many were short of money and, over time, debts increased.

Mean value (£) of debts by age group and time resettled

Policy and practice recommendations arising from the FOR-HOME evidence Resettlement preparation should give more attention to: a) The problem of being without basic furniture and equipment (particularly beds and cookers) when people first move in b) Training in the skills of not only weekly budgeting but also long-term personal financial planning. The allocation of tenancy support should be reformed in ways that place more emphasis on ‘support needs’ rather than the pathway prior to resettlement. Advice and support services for those who do not have tenancy support should be more widely available

Features of the FOR-HOME project that raised the impact of its evidence and recommendations The FOR-HOME evidence became available in May 2010 when the new UK Coalition government took power. The study shows that resettlement services in – all funded by central government (for revenue, principally Supporting People) – have successfully prevented returns to homelessness. The proposed cuts in Supporting People and rent subsidies threaten this success. As FOR-HOME was a collaboration with six service provider organisations, they were quick to distil the evidence for policy makers (see ) They/we have presented the findings to several national bodies (Homeless Link, the Homelessness Commission, Crisis Private-rented Sector project conference) and submitted evidence to Parliament’s scrutiny of the Localism Bill. The research findings have been rapidly disseminated and influential.

Securing grants for large, authoritative studies Study homeless people in at least two contrasting areas, or at least two different groups Design study and set aims in collaboration with service provider organisations Emphasise efficiency, effectiveness and cost-saving returns to service provision, and incorporate strong academic or theoretical objectives The proposal must also demonstrate that the research team is highly competent in the required skills and will be assiduous in following ethical research practice, minimising sample attrition, maximising data quality, and developing the findings in concert with service providers and users

Conclusions Large sample, area-stratified and longitudinal studies produce authoritative and original evidence about the effectiveness of interventions with homeless people. Such evidence is valued by service providers, public-service administrators and policy makers Studies designed in collaboration with service providers have a good chance of producing evidence relevant to currently contentious policy and practice issues Large sample, longitudinal studies tell us a great deal about the diversity of homeless people’s return to independence and conventional living – strong academic and theoretical returns Homelessness researchers should redirect their efforts towards large scale studies

Our warm thanks to … All the respondents who participated in the study Ruby Fu for her first-rate interviewing, data management and administrative support Camilla Mercer and Louise Joly who helped massively with administrative and coding tasks The freelance interviewers – Gary Bellamy, Ruby Fu, Paul Gilsenan, Louise Joly and John Miles Members of the Management Committee: David Fisher (Broadway), Caroline Day and Jennifer Barnes (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

Contact details Tony Warnes: Maureen Crane: