PHaCT

Preventing Homelessness, improving health for people leaving prison: a pilot randomised controlled trial of a Critical Time intervention.

Background

People who have been in prison and are released back into the community are at a high risk of homelessness. Nearly 1 in 2 who are released do not have a settled home and 1 in 3 are homeless or are in unsettled housing one year later. The life expectancy of people without a stable home is much lower and they have a worse quality of life. There are also wider society impacts of homelessness such as lower community wellbeing, more crime and higher healthcare and justice costs.

Crisis (a national charity for people experiencing homelessness) have calculated that on average the yearly cost of one person rough sleeping could cost £20,128. Although there are good interventions to stop homelessness, they are mostly from the US and we do not know how these work for people who have been in prison.

Critical Time Intervention

Critical Time Intervention (CTI) is the name of a type of intervention which aims to support those most in need in society during times of important life changes. They help people at risk of homelessness stabilise their housing situation, particularly those people who are leaving institutions (like prisons). Homelessness services think that this type of intervention works best when it is ‘housing-led’. This is where people are given housing quickly without conditions. There have been no studies which have looked at how good housing-led CTIs are at stopping homelessness and better the health of people with prison experience in the UK and if they are good value for money.

Pilot Randomised Controlled Trial

Working with Crisis we will carry out a ‘pilot Randomised Controlled Trial (RCT)’ in four prison populations in England and Wales. In the long term, we plan to test if a housing-led CTI is effective and cost-effective, but first we need to find out if the intervention and research methods are acceptable.

Recruitment

We will recruit 80 adult males who are due to be released from one of 4 prisons (HMP Liverpool, HMP Altcourse, HMP Risley and HMP Swansea) and at risk of homelessness. Participants will complete a survey asking about their health-related quality of life, housing stability, substance misuse, alcohol consumption, re-incarceration, support networks etc. at baseline, 3-, 6-, 9- and 12- months post randomisation.

Routine data

We will also ask their permission to access anonymous routinely collected health, educational and aggregated criminal justice information. Participants will then be randomly allocated to either get the CTI or usual care.

Public involvement

Some participants, their families, prison staff and intervention staff will also be asked to take part in interviews to find out more about their experiences of taking part to find out if they think the intervention and recruitment methods are feasible and acceptable to them. Some of their sessions with their CTI worker will also be observed to see how the CTI intervention is being delivered.