Experimental Trial of an Employment-Based Housing Program for Adults at Risk of Homelessness

Overview

Employment-Based Housing (EBH) is a novel model that helps unstably housed individuals obtain housing and on-site employment where they are housed. The long-term goal of this project is to examine how housing and vocational services can be integrated into hospital emergency departments (EDs) as a multi-sectoral intervention. The investigators central hypothesis is that EBH provides housing, employment, and health insurance which will reduce acute care use and ameliorate non-medical determinants of health more than standard care models. The rationale is that EBH addresses multiple upstream factors that can prevent recurring use of acute care, and the combination of housing with employment services will have positive synergistic effects. This project has three specific aims: 1) Conduct a three-arm randomized clinical trial comparing EBH to passive (resource list) and active control interventions (basic vocational services) on acute care use as the primary outcome and secondary outcomes related to housing, employment, and health-related quality of life; 2) Understand the experiences of subgroups of participants receiving EBH; and 3) Identify barriers and facilitators to adoption of EBH in public healthcare systems in other cities nationally. To achieve these aims, an EBH program will be integrated into the ED of the largest safety net hospital system in Houston, Texas- the 4th largest city in the United States. The project will include a three-arm randomized trial enrolling 750 participants (250 participants per arm). The three-arm trial allows for the investigation of the unique contribution of housing over other non-medical determinants of health (employment and insurance). Participants will be randomized to one of the three arms and followed for 12 months.

Research Design/Study Arms. Patients discharged from the emergency department of the largest safety net hospitals in Houston, TX (N=750) will be enrolled in a three-arm pragmatic single-blind randomized controlled trial. Clients will be randomly assigned on a 1:1 ratio to one of the three arms: 1) Employment-Based Housing (EBH) facilitated by Entryway Houston; 2) Passive control intervention (PC) which will involve the provision of a list of available community resources; and 3) Active control intervention (AC) which will involve the provision of basic vocational services. The AC intervention will be modeled somewhat after existing community workforce development programs so there is ecological validity and having this additional treatment arm will strengthen the rigor of the trial. Ensuring that both EBH and AC consistently share key characteristics will allow them to directly compare the EBH model to AC. Study materials will be available in English and Spanish. Individuals will be screened to determine whether they are at risk of homelessness and have an employment need, are 18+ years old, and report a willingness to pass an employer-mandated drug screening and criminal background checks if required by their employer.