Title: Evidence synthesis of two systematic reviews (1) effectiveness of psychosocial interventions for reducing problematic substance use, improving mental health, and improving housing stability for adults experiencing homelessness; and (2) barriers and facilitators accessing psychosocial interventions
Funder: Department of Health and Social Care

Abstract: Adults experiencing homelessness face severe and multiple disadvantages. They often experience major trauma in their childhood (such as physical, emotion, or sexual abuse), may have been in care, have low self esteem, find it difficult to trust other people, and have often had negative experiences of public services. As a result, they are more likely to have higher levels of physical and mental ill health than people who have not experienced homelessness. Despite this they face significant problems when trying to access health, social care, and housing services, often ‘falling between the cracks’._x000D_ _x000D_ While some evidence exists on what works to improve the mental health and housing of adults experiencing homelessness, for some interventions we do not know whether these work. One set of interventions where there are gaps in our understanding are psychosocial interventions. Psychosocial interventions can be individual or group based, and use therapy, motivation, rewards, and positive relationships to help people change their behaviour and how they feel about themselves. Examples include contingency management, behavioural therapy, and psychodynamic therapy. Contingency management uses rewards when individuals make positive changes to their behaviour (such as keeping appointments or not using drugs and alcohol). There are lots of different types of behavioural therapy, which explore how thoughts and beliefs affect actions and moods. These therapies help individuals understand their thoughts and beliefs, and help make them positive. Psychodynamic therapy helps individuals to find patterns in their thoughts, emotions, and beliefs so they can better understand themselves. There are other types of psychosocial interventions that are also used for people experiencing homelessness which will be considered in this review. _x000D_ _x000D_ This groundbreaking review will examine whether psychosocial interventions work for adults experiencing homelessness, and what issues they face when using psychosocial interventions. It will be the first review on this topic to synthesise both quantitative and qualitative synthesis of studies from across the globe. It will also be unique in that the voices of people with lived experiences of homelessness, health professionals and other stakeholders will be at the heart of the project from the very beginning, helping to ensure the findings are as useful as possible and result in improvements to the support available.

Lay abstract: Research question_x000D_ Are psychosocial interventions effective for, and what barriers and facilitators are faced by, adults experiencing severe and multiple disadvantage homelessness?_x000D_ _x000D_ Background_x000D_ Several studies have found that more visible and extreme forms of homelessness are associated with adverse childhood experiences, extreme social disadvantage, physical, emotional and sexual abuse, neglect, low self-esteem, poor physical and mental health, and much lower life expectancy compared to the general population. This group of people who experience homelessness have severe and multiple disadvantages (Bramley et al., 2020) and have complex needs (Dobson, 2019). They face significant barriers accessing services, and often fall through the cracks between different services they need to access (Dobson, 2019). They have repeated, but intermittent, contact with a range of publicly funded services, particularly health (Aldridge et al., 2018), criminal justice (Bramley et al., 2020), and local government (Dobson, 2019). For example, this population is five times more likely to attend accident and emergency, and three times more likely to be admitted to hospital, than their housed peers (Cornes et al., 2018). The evidence of effectiveness of interventions for this population is mixed (Luchenski et al., 2018), and there is a significant gap around the use of psychosocial interventions._x000D_ _x000D_ Aims and objectives_x000D_ 1)To produce two systematic reviews. The first review will use meta-analysis to examine the effectiveness of different psychosocial interventions in (1) reducing problematic substance use; (2) improving mental health; and (3) improving housing stability for adults experiencing homelessness; and of the barriers and facilitators experienced by homeless adults when using psychosocial interventions. (Housing is recognised as a significant social determinant of health, but is not addressed as such in the wider literature.) The second review will use thematic synthesis to examine the barriers and facilitators faced by adults experiencing homelessness accessing psychosocial interventions._x000D_ 2)to co-produce with professionals and individuals with lived experience of homelessness a series of policy and practice recommendations and mobilise the knowledge generated by the two reviews, to provide evidence-based insight for policymakers, commissioners, clinicians, and others involved in providing services._x000D_ _x000D_ _x000D_ Methods_x000D_ Two different approaches will be used to undertake systematic reviews. The first review will examine the effectiveness of psychosocial interventions for this population, and will use meta analysis to provide quantitative measures of effectiveness. The second review will examine the barriers and facilitators faced by adults experiencing homelessness when accessing psychosocial interventions. This review will use thematic synthesis to provide qualitative insights on the focus on the views and experiences of homeless adults._x000D_ _x000D_ Timelines for delivery_x000D_ xx_x000D_ _x000D_ Anticipated impact and dissemination_x000D_ - academic publications, including the review protocols and two systematic reviews_x000D_ - policy and practice papers addressing the relevant policy objectives from the NHS Long Term Plan (DHSC 2018). _x000D_ - a media programme led by experts by experience, to highlight ‘what works’ in tackling accessibility problems and the stigma._x000D_ - support local changemakers (embedded in CHI’s What Works Community).

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE