Using Evidence to End Homelessness

Teixeira, Lígia, Cartwright, James

• Publisher: Policy Press
• Year: 2020
• ISBN:
  9781447352877
• Edition: 1
• Topic: Politica e relazioni internazionali
• Subtopic: Politica sociale

Available open access under CC-BY-NC license. Homelessness is unequivocally devastating. In the UK, people affected by homelessness are ten times more likely to die than their peers in the general population, yet we still miss important opportunities to adequately address the issue. The Centre for Homelessness Impact brings together this urgent book gathering the insights and experiences of leaders in government, academia and the third sector to present new evidence-based strategies to end homelessness. Demonstrating why and how a new movement is needed that embraces data and evidence as integral to ending homelessness effectively, this book provides crucial methods to underpin future policy, practice and funding decisions.

1

The Impact Manifesto: doing the right things to end homelessness for good

Lígia Teixeira

The problem of extreme complexity

It is the challenge of our age: How do we end homelessness for good?

For the last 50 years, a lot of smart, well-resourced people and institutions have been trying to work out how to end homelessness in the UK and elsewhere. Billions of pounds have been invested in programmes and organisations with the mission of helping people who are at risk of or experiencing homelessness. They have studied issues like housing, social security, employment and asset-building, and then introduced or advocated for policies and programmes to support the most at-risk groups. They have written reports and columns and given passionate speeches, decrying the fact that the weakening of our social safety net is pushing more and more people into homelessness, even though we know that prevention is better than cure. These efforts have helped. But they are not enough.

Too many people remain without a home in the 21st century. They are not just sleeping rough on our streets, but also living in overcrowded housing, hostels and other temporary accommodation. Our best programmes do make a difference, but their impact has not changed significantly since homelessness first entered the national consciousness as a major concern in the mid-1960s.

In recent years, increased homelessness in many areas has again put a spotlight on the issue. At times like these, homelessness returns to the public’s attention, leading to renewed political action and the provision of more resources. As a result, the number of people experiencing homelessness goes down temporarily, but in time the cycle repeats. It is therefore no wonder that recent commitments to ending homelessness have been met with scepticism by the public – it is not enough to reduce the number of people affected by homelessness if we cannot sustain that change.

In this environment, what can government leaders and advocates do to make lasting change in ending homelessness? In the following chapters we argue that one way to break this cycle and rebuild the public’s trust is by focusing on ‘what works’ – by finding and funding solutions backed by evidence and data and by seeding experiments with the potential to produce outsized social returns. Existing approaches are proving insufficient to truly crack homelessness, so we need to experiment and find new approaches to create breakthrough change.

One simple idea: how can we use our resources to do the most good?

I was born and grew up in one of the poorest regions in Portugal. Although I did not grow up in poverty it was a close neighbour. It was not until I came to London as a young academic that I first came across destitution and street homelessness. I lived in Holborn at the time and, on my walk to the LSE each morning, I would often see people who were sleeping rough, especially in Lincoln’s Inn Fields. After a while I mustered sufficient courage to stop and talk to them, and that is how I began to learn about their journeys into homelessness. Hearing individual stories and looking at the wider figures, one would be forgiven for thinking that the UK is not a wealthy nation.

These early interactions made me pay attention. They made me want to do something to help the people I spoke with. I have now worked with and learned from people affected by or at risk of homelessness for more than ten years. I have campaigned for the strengthening of the social safety net, which protects individuals and families on low incomes from falling into homelessness. I have worked with individual people experiencing homelessness who manifest hope and promise, despite the complex challenges they sometimes face in Jobcentres, public spaces and specialist services. I have advocated for change in how we talk about homelessness so the public understand that it is an issue that can be solved because what is broken is our approach to solving homelessness, not the people who experience homelessness themselves.

I joined Crisis in 2008 because it was a great opportunity to place evidence at the heart of our efforts to help people at risk of, or experiencing, homelessness. While major forward strides have been made since then, I continue to be surprised by the limited use of evidence-based practices in policy-making in the UK and beyond. Only a small fraction of government spending is backed by reliable evidence that taxpayers’ money is being spent wisely.

Yet progress is within reach. We have more information than ever about the root causes and consequences of homelessness. Advances in legislation, research developments and the work of bold third-sector leaders and social entrepreneurs point the way to solutions. But too often we continue to do what we have always done in the past, without using evidence about what works (and perhaps most importantly, what does not) expecting that the same actions will yield different results. This is not a problem unique to homelessness.

This is why the time has come for a ‘what works’ movement in homelessness. What do we mean by this? ‘Homelessness impact’ is about using evidence and reason to figure out how to help people who are at risk of, or experiencing, homelessness as much as possible at a societal level, and taking action on that basis. It means acting promptly on the best available knowledge, while being aware of the limits of what we know. And, like evidence-based medicine, ‘homelessness impact’ can help us figure out what works and what does not, allowing us to reject the dangerous half-truths that can pass for wisdom.

Why are the ideas of ‘what works’ in homelessness important?

The 19th-century French physician Pierre-Charles-Alexandre Louis put a lot of leeches out of business. For centuries before his research, doctors believed that removing a few pints of a person’s blood would help cure all types of ailments. In the 1830s, doubting bloodletting’s alleged benefits, Louis carried out one of the first clinical trials. He compared the outcomes of 41 pneumonia victims who had undergone early and aggressive bloodletting to the outcomes of 36 pneumonia victims who had not. The results were clear: 44 per cent of the bled patients subsequently died, compared to only 25 per cent of the patients who remained leech-free (Morabia, 2006). Louis’ discovery helped convince physicians to abandon bloodletting and his study became a touchstone of the modern evidence-based medicine movement, which trains physicians to conduct, evaluate, and act according to research.

Today, as then, the experimental, empirical approach matters. It matters because many attempts to do good fail – even those with a high profile. Scared Straight is a good example of misguided intuition passing for wisdom: a programme that takes kids who have committed misdemeanours to visit prisons and meet criminals to confront their likely future if they continue to offend. The concept proved popular not just as a social programme but as entertainment; it was adapted for both an acclaimed documentary and a TV show on A&E, which broke ratings records for the network upon its premiere. There is just one problem with Scared Straight: multiple studies have found that the programme actually increases rates of offending among its participants (see, for example, Washington State Institute for Public Policy, 2004).

More recently, teenage pregnancy prevention programmes that use ‘magic dolls’ to simulate the needs of a new baby have been found not to work, according to a study in The Lancet (Brinkman, S. et al, 2016). More than 1,000 teenage girls who took part in programmes in Western Australia were more likely to become pregnant than girls who did not. Similar programmes are still used in schools in 89 countries, including the US.

Research shows that many attempts to do good are like Scared Straight and Magic Dolls. When tested with rigorous randomised controlled trials, nearly 80 per cent of individual interventions do not work. Between 1 and 10 per cent have negative effects.¹

But while many attempts to do good fail, some succeed, and the best examples of success are exceptional. Consider the evidence-informed provision of bed nets in sub-Saharan Africa, where malaria is one of the leading killers of children. Long-lasting insecticide-treated nets (LLINs) effectively prevent deaths and many other non-fatal cases of malaria. They are also relatively inexpensive – about $5 per net.² The charity evaluator GiveWell estimates that a donation of $7,500 to the Against Malaria Foundation will save someone’s life.

In other areas of policy, giving cash grants to people living in poverty in low-income countries has the strongest track record of success. Cash transfers – directly transferring money to poor individuals – are a priority programme of GiveWell as they allow individuals to purchase the things most necessary to them. Strong evidence indicates that cash transfers lead recipients to spend more on their basic needs (such as food) and may allow recipients to make investments with high returns, with no evidence of large increases in spending on items like alcohol or cigarettes, in spite of what many unhelpful stereotypes would lead us to assume.³

Homelessness has yet to find its direct cash transfers or insecticide-treated mosquito nets. Housing First is one of the few interventions to have rigorous evidence behind it, but even here there are not enough studies to provide reliable cost-effectiveness data. People are not aware of the best ways to help end homelessness for good, and so miss opportunities to make a tremendous difference. No wonder then that in lieu of evidence, leaders often base their decisions on dearly held ideologies, the actions of others and strategies they have used in the past. As a result, we inadvertently risk causing harm in the manner of Louis’ bloodletting doctors.

What are the origins of the movement?

None of these challenges are unique to homelessness. As David Halpern remarks in Inside the Nudge Unit (Halpern, 2016): ‘The dirty secret of much government policy and professional practice is that we don’t really know whether it is effective at all.’

To counteract this and help find more ways to link research to practice, a whole movement has emerged in health, international development, education and policing. From the 1990s onwards, whole ecosystems of organisations, individuals and networks have grown around this movement. Some of them are wide-ranging like the Cochrane and Campbell Collaborations, the National Institute for Health and Care Excellence (NICE) or the Africa Evidence Network. Others are grassroots, like the Society for Evidence-Based Policing, researchEd, Evidence for the Frontline and the Coalition for Evidence-Based Education. In the UK, there has been a push for new organisations to synthesise actionable research for decision-makers through the What Works Network.

Also positive is the fact that, until recently, none of these organisations, at home or internationally, had a focus on homelessness. But we now have the Centre for Homelessness Impact (CHI) – one of the nine-strong What Works Centres – to act as a catalyst for evidence-led change in the field and recognise that a new approach is needed.

What past social movements does this echo? The What Works movement in the UK bears a number of similarities to evidence-based medicine, and in homelessness we have combined this with some insights from the movements of effective altruism and design thinking.

One of the strengths of evidence-based medicine is that it realises the limits of our rationality. It acknowledges that we are in fact very bad at working out how to maximise expected utility through abstract reasoning. We should therefore test things empirically to find out what works.

An important lesson from the effective altruism movement is an awareness of the importance of prioritising the most pressing challenges if we are to magnify impact (‘the multiplier effect’). Design thinking provides a powerful tool to understand fully the challenge we are trying to address and whether it is the right challenge to address, putting a spotlight on the importance of diversity and creativity to achieve breakthrough solutions.

What has been the journey in homelessness?

On the first day of class, the deans of many medical schools greet their first-year medical students with this sobering statement: ‘Half of what we know is wrong. The problem is, we don’t know which half.’ Why is this an important message for us all to bear in mind? Because to achieve step change in homelessness, we too must act with knowledge while simultaneously doubting what we know. This entails striking a balance between arrogance (assuming you know more than you do) and insecurity (believing that you know too little to act). With this attitude, those working in or around homelessness can take action now but continue to learn along the way.

In homelessness, modesty is often in short supply and absolutes abound – in recommendations as to what to do, in conclusions about what affects performance and in beliefs about what works. Interestingly, it seems that the less developed the evidence infrastructure is in a particula...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• List of figures
• Notes on contributors
• Foreword
• 1. The Impact Manifesto: doing the right things to end homelessness for good
• 2. A new approach to ending homelessness
• 3. Reform in the private rented sector
• 4. Houses, not homelessness
• 5. Loosening poverty’s grip
• 6. A cross-party approach to homelessness
• 7. Contrasting traditions in homelessness research between the UK and US
• 8. Why evidence matters
• 9. A public health approach to homelessness
• 10. Data and evidence: what is possible in public policy?
• 11. Using evidence in social policy: from NICE to What Works
• 12. Charities and donors in evidence systems
• 13. Why transparency matters to knowledge mobilisation
• 14. Afterword