Silicon Valley Guaranteed Income Project

The goal of this clinical trial is to learn about how unconditional cash payments equivalent to $1,000 for 24 months (also called 'guaranteed income') might help families experiencing homelessness and/or unstable housing in Santa Clara County, California.

The main questions it aims to answer are:

1. What is the impact of guaranteed income on homelessness and housing stability among families experiencing homelessness or housing instability?
2. What is the impact of guaranteed income on the health and well-being of families experiencing homelessness or housing instability?
3. In terms of size and frequency of cash payments, do families prefer monthly recurrent payments ($1,000/month) vs a larger up front amount followed by smaller monthly payments ($6,500/month, then $500/month)? Is one payment strategy more helpful than the other in terms of achieving improved housing stability, health, or other measures of well-being?

Study design and overall objective: This is a mixed-methods randomized controlled trial (RCT) to assess the effectiveness of guaranteed income on improving housing stability, health, economic and overall well-being among 300 families experiencing homelessness in Santa Clara County.

The specific aims are:

Aim 1. Assess the effect of guaranteed income on housing stability and homelessness. The investigators will randomly select 150 households experiencing homelessness to receive guaranteed income equivalent to $1000 per month for 24 months in addition to usual care, with the remaining 150 households receiving usual care only (control group). The investigators will assess and compare measures of housing stability, housing services use and emergency shelter use at baseline, 6, 12, 18, 24, 27, 30, and 36 months after randomization. Hypothesis: Guaranteed income will improve housing stability and reduce the risk of continuing homelessness.

Aim 2. Assess the effect of guaranteed income on the health and well-being of families experiencing homelessness and their social networks. The investigators will assess and compare self-reported physical and mental health and well-being, health and social service use, employment and income volatility, financial assets and spending, food insecurity, agency, and network strain and support at baseline and then at 6, 12, 18, 24, 27, 30, and 36 months after randomization. The investigators will use a mixed methods approach, employing both validated survey instruments and qualitative interviews to assess measures of interest. Hypothesis: Families receiving guaranteed income will have improved health and well-being, and multiplier effects will accrue to their social networks.

Aim 3. Assess the effect of monthly vs a hybrid payment strategy (larger up-front lump sum plus a smaller monthly sum) on housing stability, health, and well-being. Individuals in the guaranteed income group (intervention group) will self-select whether they prefer to receive payments in a a) monthly ($1,000/month x 12 months) vs b) hybrid payment schedule ($6,500 x 1 month, then $500 x 11 month), with the option to change payment schedules after the first 12 months. Hypothesis: Individuals receiving a hybrid model of payments will obtain and sustain positive changes in stable housing and well-being more successfully over time compared to monthly payments.

Eligibility Criteria:
Inclusion Criteria:

1. ≥18 years of age at baseline visit/assessment
2. Experiencing homelessness, as defined by:

   1. The HEARTH Act; or
   2. Living in a public or private space intended for temporary (≤6 month) residence, such as residing in a hotel/motel;
   3. Residing in a space without a legal right to the space and therefore being at threat of being asked to leave at any time (i.e., no lease); and/or
   4. Being in a shared living situation intended to be temporary (i.e., being 'doubled up' due to lack of available and/or affordable housing).
3. Vulnerability-Index Service Prioritization Decision Assistance Tool (VI-SPDAT) score within the eligibility range for referral to rapid rehousing assistance programs in Santa Clara County (score of 4-8 for households), if available at the time of study entry.

   - The VI-SPDAT score is commonly used by housing assistance service providers to prioritize households for housing assistance programs, where households with scores of 0-3 are lower priority for referral to programs, and households with scores of 9+ are recommended for referral to more intensive housing services such as permanent supportive housing (which combine affordable housing assistance with voluntary support services including health and mental health care, case management and other social supportive services). Households with a score of 4-8 are considered most appropriate for referral to housing assistance programs that may not offer additional supportive services.
4. Living in a household with ≥1 dependent children (i.e., ≤17 years of age at the time of study entry)
5. Written informed consent (and assent when applicable) obtained from participant or participant's legal representative and ability for participant to comply with the requirements of the study.

Exclusion Criteria:

1. Substantial to severe level of problematic substance use as defined by the validated Drug Abuse Screening Test (DAST-10) (score of 6-8 or 9-10, respectively).
2. Hazardous or harmful alcohol consumption, or active and severe alcohol use disorder as defined by the validated Alcohol Use Disorders Identification Test (AUDIT) (score of 8-14 and ≥15, respectively).