Effectiveness of interventions to reduce homelessness: a systematic review and meta‐analysis

This Campbell systematic review examines the effectiveness of interventions to reduce homelessness and increase residential stability for individuals who are homeless, or at risk of becoming homeless. Forty‐three studies were included in the review, 37 of which are from the USA. Included interventions perform better than the usual services at reducing homelessness or improving housing stability in all comparisons. These interventions are: High intensity case management Housing First Critical time intervention Abstinence‐contingent housing Non‐abstinence‐contingent housing with high intensity case management Housing vouchers Residential treatment These interventions seem to have similar beneficial effects, so it is unclear which of these is best with respect to reducing homelessness and increasing housing stability. Plain Language Summary Interventions to reduce homelessness and improve housing stability are effective There are large numbers of homeless people around the world. Interventions to address homelessness seem to be effective, though better quality evidence is required. What is this review about? There are large numbers of homeless people around the world. Recent estimates are over 500,000 people in the USA, 100,000 in Australia and 30,000 in Sweden. Efforts to combat homelessness have been made on national levels as well as at local government levels. This review assesses the effectiveness of interventions combining housing and case management as a means to reduce homelessness and increase residential stability for individuals who are homeless, or at risk of becoming homeless. What is the aim of this review? This Campbell systematic review examines the effectiveness of interventions to reduce homelessness and increase residential stability for individuals who are homeless, or at risk of becoming homeless. Forty‐three studies were included in the review, 37 of which are from the USA. What studies are included? Included studies were randomized controlled trials of interventions for individuals who were already, or at‐risk of becoming, homeless, and which measured impact on homelessness or housing stability with follow‐up of at least one year. A total of 43 studies were included. The majority of the studies (37) were conducted in the United States, with three from the United Kingdom and one each from Australia, Canada, and Denmark. What are the main findings of this review? Included interventions perform better than the usual services at reducing homelessness or improving housing stability in all comparisons. These interventions are: High intensity case management Housing First Critical time intervention Abstinence‐contingent housing Non‐abstinence‐contingent housing with high intensity case management Housing vouchers Residential treatment These interventions seem to have similar beneficial effects, so it is unclear which of these is best with respect to reducing homelessness and increasing housing stability. What do the findings of this review mean? A range of housing programs and case management interventions appear to reduce homelessness and improve housing stability, compared to usual services. However, there is uncertainty in this finding as most the studies have risk of bias due to poor reporting, lack of blinding, or poor randomization or allocation concealment of participants. In addition to the general need for better conducted and reported studies, there are specific gaps in the research with respect to: 1) disadvantaged youth; 2) abstinence‐contingent housing with case management or day treatment; 3) non‐abstinence contingent housing comparing group vs independent living; 4) Housing First compared to interventions other than usual services, and; 5) studies outside of the USA. How up‐to‐date is this review? The review authors searched for studies published up to January 2016. This Campbell systematic review was published in February 2018. Executive summary Background The United Nations Universal Declaration of Human Rights (Article 25) states that everyone has a right to housing. However, this right is far from being realized for many people worldwide. According to the United Nations High Commissioner for Refugees (UNHCR), there are approximately 100 million homeless people worldwide. The aim of this report is to contribute evidence to inform future decision making and practice for preventing and reducing homelessness. Objectives To identify, appraise and summarize the evidence on the effectiveness of housing programs and case management to improve housing stability and reduce homelessness among people who are homeless or at‐risk of becoming homeless. Search methods We conducted a systematic review in accordance with the Norwegian Knowledge Centre's handbook. We systematically searched for literature in relevant databases and conducted a grey literature search which was last updated in January 2016. Selection criteria Randomized controlled trials that included individuals who were already, or at‐risk of becoming, homeless were included if they examined the effectiveness of relevant interventions on homelessness or housing stability. There were no limitations regarding language, country or length of homelessness. Two reviewers screened 2,918 abstracts and titles for inclusion. They read potentially relevant references in full, and included relevant studies in the review. Data collection and analysis We pooled the results and con

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