Effectiveness of intensive support programs for the chronically homeless: A randomized controlled trial in Australia
Last registered on January 31, 2020

Pre-Trial

Trial Information
General Information
Title
Effectiveness of intensive support programs for the chronically homeless: A randomized controlled trial in Australia
RCT ID
AEARCTR-0005235
Initial registration date
January 27, 2020
Last updated
January 31, 2020 12:57 PM EST
Location(s)
Region
Primary Investigator
Affiliation
RMIT University
Other Primary Investigator(s)
PI Affiliation
University Duisburg-Essen
PI Affiliation
University of Melbourne
Additional Trial Information
Status
Completed
Start date
2009-08-20
End date
2016-04-12
Secondary IDs
Abstract
Research shows that the homeless population is made up of various subgroups that have different biographical experiences, characteristics and needs. This trial focuses on the group of ‘chronically homeless’ individuals, who have posed an enduring challenge for policy makers and practitioners alike. In Australia, responses to homelessness are typically based on high case loads and short-term assistance. While this can help the short-term homeless to regain their housing, it struggles to meet the more complex needs of the long-term homeless.

Journey to Social Inclusion (J2SI) is a pilot program designed to break the cycle of long-term homelessness. The program provides intensive support for up to three years to assist long-term homeless people receive the range of services they need. The J2SI model contrasts with existing services that tend to the short-term responses which do not address the underlying issues causing long-term homelessness.

The goal of this study is to evaluate the efficacy of the J2SI intervention using a randomized experiment. The evaluation involves implementing the J2SI pilot program as a randomized control trial where participants are randomly assigned into two groups: those receiving J2SI services and those receiving existing services. A longitudinal survey will be conducted to examine how the two groups of study participants are travelling at ten points-in-time over a six-year period. While such an approach can provide robust insights into the short, intermediate, and long-term impacts of J2SI, tracking two cohorts of long-term homeless people over a six-year period is not an easy task and requires significant resources and commitment. Nonetheless, in the context of the shift towards evidence-based policies here and overseas, the benefits of using this ‘gold standard’ approach to evaluation outweigh the costs.

We will identify the causal effect of the intervention by comparing differences between the two groups in terms of housing, economic participation, health outcomes and health services usage, other service usage, problematic drug use, and measures of social acceptance and support.
External Link(s)
Registration Citation
Citation
Johnson, Guy, Daniel Kuehnle and Yi-Ping Tseng. 2020. "Effectiveness of intensive support programs for the chronically homeless: A randomized controlled trial in Australia." AEA RCT Registry. January 31. https://doi.org/10.1257/rct.5235-1.1.
Experimental Details
Interventions
Intervention(s)
The J2SI model was borne out of the recognition by Sacred Heart Mission that existing approaches were usually failing the long-term homeless.

The J2SI service model differs significantly from existing approaches in five important ways:

First, J2SI provides long-term support. The median length of support provided by traditional agencies in 2007/2008 was 10 days. J2SI supports each client for up to three years. Second, J2SI provides intensive support. The client case load is 1:4 for the three year period. Existing funded case loads in NAHA services are around 1:48 over a 12 month period. Third, J2SI focuses on the rapid housing of participants in safe, secure, affordable, long-term housing. Fourth, J2SI responds to the specific mental health and psychological needs of participants, with a specific focus on the impact that trauma has played in people’s lives. Fifth, J2SI includes integrated training and skills development that aims to enhance self-esteem and provide participants with interpersonal, practical, tenancy and vocational skills.

The J2SI pilot commenced in November 2009 with the aim of assisting 40 long-term homeless people to make a permanent exit from homelessness. To achieve this aim, J2SI practices are explicitly designed to focus on services that improve:
• residential stability;
• physical and mental health outcomes; and
• social and economic participation.
Intervention Start Date
2009-11-01
Intervention End Date
2012-10-31
Primary Outcomes
Primary Outcomes (end points)
housing stability
Primary Outcomes (explanation)
If individuals are housed at follow-up surveys.
Secondary Outcomes
Secondary Outcomes (end points)
employment, physical and mental health, drug use, social support and social acceptance
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
J2SI was implemented as a randomized experiment. Most potential participants were referred by Sacred Heart Mission with a small number from other homelessness agencies in inner city Melbourne. Of the 99 people initially referred, 88 people satisfied the admission criteria which was people who:
- had slept rough continuously for more than 12 months; and/or
- had been in and out of homelessness for at least three years (including people who have been housed in the last six months and are at risk of further homelessness); and
- were aged between 25 and 50 (within 12 months of their 25th birthday or 50th birthday at commencement of the program).

The 88 individuals were informed about the evaluation and gave informed consent to participate. They were then randomly assigned into two groups: 40 people were assigned to Group J which received J2SI services (the treatment group); and the remaining 48 were assigned to Group E (the control group) which received existing services.
Experimental Design Details
Randomization Method
Randomization done in office by a computer.
Randomization Unit
Randomization was at the individual level and stratified by family status such that both members of a couple were either allocated to the treatment or control group.
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
100 individuals
Sample size: planned number of observations
100 individuals
Sample size (or number of clusters) by treatment arms
48 treated, 56 control.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
RMIT University Human Research Ethics Committee
IRB Approval Date
2009-10-19
IRB Approval Number
HREC B-2000197-07/09
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is data collection complete?
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports and Papers
Preliminary Reports
Relevant Papers