CoChat
Sign Up
Cited by 224Homelessness and Social IssuesUrban and Rural Development ChallengesHIV, Drug Use, Sexual Risk

Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review

Open access
Aubry, Tim, Bloch, Gary, Brcic, Vanessa, Saad, Ammar, Magwood, Olivia, Abdalla, Tasnim, Alkhateeb, Qasem, Xie, Edward +7 more·2020·The Lancet Public Health
DOI 10.1016/s2468-2667(20)30055-4
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Permanent supportive housing and income assistance are valuable interventions for homeless individuals. Homelessness can reduce physical and social wellbeing, presenting public health risks for infectious diseases, disability, and death. We did a systematic review, meta-analysis, and narrative synthesis to investigate the effectiveness and cost-effectiveness of permanent supportive housing and income interventions on the health and social wellbeing of individuals who are homeless in high-income countries. METHODS: We searched MEDLINE, Embase, CINAHL, PsycINFO, Epistemonikos, NIHR-HTA, NHS EED, DARE, and the Cochrane Central Register of Controlled Trials from database inception to Feb 10, 2020, for studies on permanent supportive housing and income interventions for homeless populations. We included only randomised controlled trials, quasi-experimental studies, and cost-effectiveness studies from high-income countries that reported at least one outcome of interest (housing stability, mental health, quality of life, substance use, hospital admission, earned income, or employment). We screened studies using a standardised data collection form and pooled data from published studies. We synthesised results using random effects meta-analysis and narrative synthesis. We assessed certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. FINDINGS: Our search identified 15 908 citations, of which 72 articles were included for analysis (15 studies on permanent supportive housing across 41 publications, ten studies on income interventions across 15 publications, and 21 publications on cost or cost-effectiveness). Permanent supportive housing interventions increased long-term (6 year) housing stability for participants with moderate support needs (one study; rate ratio [RR] 1·13 [95% CI 1·01-1·26]) and high support needs (RR 1·42 [1·19-1·69]) when compared with usual care. Permanent supportive housing had no measurable effect on the severity of psychiatric symptoms (ten studies), substance use (nine studies), income (two studies), or employment outcomes (one study) when compared with usual social services. Income interventions, particularly housing subsidies with case management, showed long-term improvements in the number of days stably housed (one study; mean difference at 3 years between intervention and usual services 8·58 days; p<0·004), whereas the effects on mental health and employment outcomes were unclear. INTERPRETATION: Permanent supportive housing and income assistance interventions were effective in reducing homelessness and achieving housing stability. Future research should focus on the long-term effects of housing and income interventions on physical and mental health, substance use, and quality-of-life outcomes. FUNDING: Inner City Health Associates.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/s2468-2667(20)30055-4

Cites

125 of 125 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Other harm reduction outcomes, including indicators of viral and sexual health, have been excluded in previous systematic reviews of Housing First.

    “Moreover, other harm reduction outcomes, including indicators of viral and sexual health, have been excluded in previous systematic reviews of Housing First (e.g., Aubry et al., 2020; Baxter et al., 2019; Woodhall-Melnik and Dunn, 2015).”

    From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Aubry et al., 2020

    The Interventions and outcomes section lists the review’s main outcomes without viral or sexual health indicators. But the Results report an estimate of HIV transmissions averted in an included cost-utility analysis, so saying such indicators were excluded altogether overstates what this review did. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • There is a robust evidence base demonstrating that Housing First is effective in stably housing a large majority of people experiencing chronic homelessness.

    “There is a robust evidence base demonstrating that Housing First is effective in stably housing a large majority of people experiencing chronic homelessness (Aubry et al., 2020; Collins et al., 2013; Padgett et al., 2016; Stergiopoulos et al., 2019a; Woodhall-Melnik and Dunn, 2015).”

    From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Aubry et al., 2020

    The Results and Discussion report that permanent supportive housing significantly improved housing stability compared with usual services, with benefits persisting at six years. But the review says most participants had severe mental illness and prior homelessness; the cited passages do not establish that Housing First stably housed a large majority of people experiencing chronic homelessness specifically. Page numbers are not available for these passages. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Hurlburt MS, Wood PA, Hough RL. Providing independent housing for the homeless mentally ill: a novel approach to evaluating long-term longitudinal housing patterns. J Community Psychol 1996; 24: 291-310.
  2. Gühne U, Stein J, Weinmann S, Becker T, Riedel-Heller SG. Housing interventions in severe mental illness-international evidence from RCTs. Psychiatr Prax 2017; 44: 194-205 (in German). 110
  3. Beaudoin I. Effectiveness of the "housing first" approach: a systematic review. Drog Santé Société 2016; 14: 43-69 (In French). 113
  4. Pawson R, Tilley N. Realistic evaluation. London: Sage Publications, 1997. 123

Cited by

Sorted by citations

Related

Authors
Aubry, T., Bloch, G., Brcic, V., Saad, A., Magwood, O., Abdalla, T., Alkhateeb, Q., Xie, E., Mathew, C., Hannigan, T., Costello, C., Thavorn, K., Stergiopoulos, V., Tugwell, P., & Pottie, K.
Affiliations
  • University of Ottawa (CA)
  • St. Michael's Hospital (CA)
  • University of British Columbia (CA)
  • Bruyère (CA)
  • University Health Network (CA)
  • McGill University Health Centre (CA)
  • Centre for Addiction and Mental Health (CA)
Corresponding author
Pottie, Kevin
ORCID
Venue
The Lancet Public Health
Publisher
Elsevier BV
Published
2020-06
Volume
5
Issue
6
Pages
e342-e360
ISSN
2468-2667 (ISSN-L)
DOI
10.1016/s2468-2667(20)30055-4
OpenAlex
W3033970593
Cited by
224
References
125
Citations by year
2026: 34 · 2025: 35 · 2024: 53 · 2023: 27 · 2022: 37 · 2021: 32 · 2020: 5 · 2019: 1
FWCI
4.79
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Public Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HRB National Drugs Library (Health Research Board) (submittedVersion, cc-by)
Topics
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
  • Social Sciences › Urban Studies › Urban and Rural Development Challenges
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
permanent supportive housing, income support, homelessness, housing stability, housing subsidies, case management, mental health, substance use, quality of life, employment, cost-effectiveness, high-income countries, social well-being, infectious disease risk, hospitalization, long-term outcomes, usual care comparison, usual care
MeSH terms
Ill-Housed Persons, Humans, Public Housing, Social Welfare, Program Evaluation, Randomized Controlled Trials as Topic, Developed Countries

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review