How an innovative, evidence-based initiative in Melbourne reduced long-term homelessness

Phase two of Sacred Heart Mission’s Journey to Social Inclusion program, which supports those experiencing long-term, chronic homelessness to exit homelessness rather than simply manage it, has been rigorously evaluated. Here, Professor Paul Flatau shares the findings.

Building on the strong housing outcomes of the Journey to Social Inclusion (J2SI) pilot program, Melbourne’s Sacred Heart Mission designed the J2SI Phase two program with the primary aim to address chronic homelessness in Melbourne. It did so by facilitating rapid access to housing through collaborative partnerships with housing providers and sustaining that housing over time. 

In addition, the program sought improved health and wellbeing outcomes, increased economic participation, and improved social connectedness. In short, the J2SI Phase two program aimed to improve social inclusion outcomes for those experiencing chronic homelessness.

The final research reports of the J2SI Phase two program have been launched this week. They outline the results of the three-year, mixed methods randomised control trial J2SI Phase two program research study led by the Centre for Social Impact at The University of Western Australia (CSI UWA) in partnership with Swinburne University. The research represents one of the most rigorous research studies undertaken in Australia in respect of a homelessness program.

The quantitative study found improvements across a range of domains of socioeconomic wellbeing across the three years. 

In line with the program’s primary aim of providing sustained housing, the findings revealed that relative to 28.3 per cent of the control group, 62.2 per cent of J2SI program participants surveyed at Year 3 reported that they were in permanent housing.

Access to housing was rapid and then sustained over time. An analysis of public housing linked administrative data also revealed high differential access to public housing and Sacred Heart Mission’s records indicated a relatively high number of transitions among J2SI Phase two clients into community housing. 

Some key findings include: 

• Among J2SI program participants, labour force participation increased, substance use decreased and particularly high-risk use of substances, and self-reported anxiety, depression and stress decreased relative to the beginning of the program.
• While only 13.5 per cent of J2SI clients felt safe in their current housing circumstance at the start of the study, by Year 3, 40.5 per cent reported feeling safe in their housing all of the time and high levels of satisfaction were associated with the housing services provided by Sacred Heart Mission. 
• J2SI Phase two clients’ feelings of loneliness decreased, and experience of social support increased between Baseline and Year 3. 
• There were improvements in quality of life outcomes using the World Health Organisation Quality of Life instrument across most domains for the J2SI Phase two client group. 
• Between Baseline and Year 3, we also found general improvement in a number of mental health and alcohol and other drug measures among those not recruited to the J2SI Phase two program which may have reflected in part the significant increase in support provided by the Victorian government in these domains.
• Health service utilisation and associated costs were markedly lower among J2SI program participants than the control group, with most of the difference accounted for by fewer nights spent in hospital by J2SI program participants. 
• Justice system interaction and costs were also lower among J2SI program participants than control group participants. 

Overall, the evaluation found that for every $1 invested in J2SI Phase two (relative to support as usual), $1.84 of health and justice net savings were returned. The qualitative study, led by Swinburne University’s Associate Professor Monica Thielking, revealed four hierarchical priorities that clients sought to achieve: 

• ensuring survival; 
• obtaining safe, secure and appropriate housing;
• working to resolve physical health, mental health, social inclusion and/or relational issues; and
• labour force participation and other independence goals.

J2SI Phase two clients in the qualitative study reported that the particular strengths of the J2SI Phase two program were its ability to meet immediate client needs, its strong linkages to permanent housing and provision of continued support once clients were housed, and its effective and efficient referral pathways to wraparound services. 

The time and commitment of case managers, facilitated by the intensive case management approach, allowed the development of a positive client-case manager relationship, built on authenticity and trust.

“They’ve helped me get into housing… and to make sure that I’ve got set up, they helped me with a washing machine, vacuum cleaner, just some bits and pieces.” – J2SI client

The J2SI Phase two qualitative report includes a number of key recommendations guided by the voice of those with lived experience of chronic homelessness for future rollout of the J2SI Phase two program. 

Speaking at the virtual launch event earlier this week, Sacred Heart Mission CEO Cathy Humphrey said that strong relationships with partners, particularly housing partners, were integral to the success of the J2SI Phase two program. Also at the launch, J2SI program participant Fred* recounted that J2SI case managers felt less overburdened, and that this resulted in a more personalised, caring service user experience.

The J2SI model continues with J2SI Phase three, funded by a Social Impact Investment (SII) with the Victorian government. Beginning in August 2018 and supporting 60 people per year for three years, Phase three seeks to demonstrate the scalability of the service delivery model and pave the way for the replication of the model in other states and territories across Australia.

About the author: Professor Paul Flatau is the lead researcher on the report and is the director of Centre for Social Impact at the University of Western Australia (CSI UWA).