Short-term impacts of housing first on homeless families: a pragmatic randomized controlled trial in Brno, Czechia

ABSTRACTThis article examines whether Housing First for homeless families reduces homelessness and use of emergency health services and improves security of tenure and caregivers’ mental health. We present the quantitative data from a mixed-methods design. Homeless families with at least one child under 18, residing in Brno, Czechia were recruited for an open-label pragmatic randomized controlled trial. Families were stratified by number of children and randomized by lottery. Fifty treatment families received intensive case management, housing in municipal flats, and a risk-fund. One hundred control families received services as usual. Structured interviews were conducted at baseline, and six and twelve months after move‒in. For statistical analysis, we used a non-parametric Fisher's exact test for binary variables, a Mann–Whitney U test for categorical and continuous variables, and a parametric negative binomial model for count variables. Treatment families had less homelessness (0, 2 months vs. 11 months) in the year after move-in, were twice as likely to have secure tenure, and showed lower psychological distress. The treatment cut annual emergency room visits in half, ambulance use by three fourths, and hospitalizations by two thirds. This intervention led to greater improvements in health outcomes than previous interventions involving families experiencing homelessness.KEYWORDS: Housing firstfamily homelessnesshealth‌randomized controlled trialshort-term impacts Data availability statementThe data that support the findings of this study are available from the corresponding author, [ŠR], upon reasonable request and will be stored in the Czech Social Science Data Archive (ČSDA) indefinitely at: http://archiv.soc.cas.cz/en. ČSDA's data are stored in the data catalogue based on the Nesstar system. Data requests are processed by the ČSDA.Disclosure statementNo potential conflict of interest was reported by the author(s).Notes1 The Czech system provides two types of housing subsidy: a general housing allowance covering housing costs above 30% of income with an income cap and no asset test, which can be used only in standard housing, and a poverty‒focused housing supplement used to pay for shelters, hostels, and substandard housing and to supplement the general allowance in standard housing. The second is severely restricted by both income and assets.2 To test possible differences between the treatment and the control group, we used baseline data from the questionnaires, specifically length of homelessness, age of becoming homeless for the first time, number of household members, employment in the last month, self-evaluation of work opportunities, number of hours spent at work in the last month, income, how much money a family lacks monthly to cover their basic needs, how many days before a paycheck a family lacks money; health condition, Srole anomie index and K6 index.Additional informationFundingThis work was funded by Directorate-General for Employment, Social Affairs and Inclusion under [CZ.03.3.60/0.0/0.0/15_024/0002729].Notes on contributorsŠtěpán RipkaŠtěpán Ripka studied Sociology and Social Anthropology in Prague and Bayreuth. In his research he is dedicated to the topics of housing exclusion, housing politics and religion. He, as an expert, addresses issues of ending homelessness and social housing and housing of Roma minority. As an activist he initiated creation of Platform for Social Housing that he also chaired for a few of years. In Brno he led a research team who evaluated first randomized controlled trial of Housing First project for families. Currently he is employed at Ministry of Regional Development.Eliška ČernáEliška Černá is a social worker by profession. Since 2016 she has worked at the Department of Social Work at the University of Ostrava. As an academician and an activist, she elaborated on topics of participation, housing inequalities and homelessness. In 2018/2019 she was a US Fulbright scholar at University of California in Berkeley. She is one of the founding members of Platform for Social Housing that advocates for implementation of Housing First programmes in Czechia. She published in British Journal of Social Work, Critical Housing Analysis or European Journal of Homelessness.Ondřej KrčálOndřej Krčál studied Economics at the Faculty of Economics and Administration at Masaryk University in Brno, where he currently works in the position of an associate professor. He focuses on experimental and behavioural economy, and also transport economy. He published in the journals Journal of Behavioural and Experimental Economics, Applied Economics Letters and Economics of Transportation.Petr KubalaPetr Kubala studied Sociology at the Faculty of Social Studies at Masaryk University in Brno. Currently he works at the department of Socioeconomics of Housing in Institute of Sociology of Czech Academy of Sciences. He focuses on housing research, specifically housing for young adults, inequalities in housing, housing exclusion and Housing first approach. He published in the journals Time and Society, Housing Studies, Critical Housing Analysis or European Journal of Homelessness.Marybeth ShinnMarybeth (Beth) Shinn is a Cornelius Vanderbilt Chair and Professor in the Department of Human and Organizational Development, Vanderbilt University. She studies how to prevent and end homelessness, especially for families. She co-led the first two rounds of the 12-site Family Options study showing that housing vouchers end homelessness for families and have radiating benefits for other aspects of family well-being. She has also worked with New York City to target their prevention efforts to people with greatest need.Rostislav StaněkRostislav Staněk studied Economics at the Faculty of Economics and Administration at Masaryk University in Brno, where he currently works in the position of an associate professor. He is interested in experimental and behavioural economy, theory of games and empirical micro-economy. He published in the journals of Journal of Industry, Competition and Trade, Judgment and Decision Making and Research in Economics.