Experimental Trial of an Employment-Based Housing Program for Adults at Risk of Homelessness
The University of Texas Health Science Center, Houston
Summary
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.
Description
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…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * English and Spanish-speaking individuals * Aged 18+ * Recently discharged from a Harris Health System emergency departments * Screen positive for risk of homelessness and employment need per the Centers Accountable Health Communities Health-Related Social Needs Screening Tool. Exclusion Criteria: * Participants with a conservator * Unwillingness to participate a background and drug test
Interventions
- OtherEmployment-Based Housing
Employment-based housing (EBH) is an innovative program that delivers housing and employment needs simultaneously. EBH will be delivered by an organization called Entryway which will provide training and employment opportunities in the apartment/multifamily housing industry. Since hires are required to live on-site, employees are provided with housing at the properties where they work at no or very low cost. There are a variety of entry-level positions in the industry (e.g., leasing agent, maintenance/apt technician, maintenance/apt supervisor) which pay well above Texas minimum wage and have opportunities for career advancement. Participants will receive job coaching, resume assistance, and extended training. Once trained, they are provided interview assistance (e.g., transportation) and, upon employment, continue to support through ongoing training and mentorship.
- OtherVocational Services
Active control intervention (AC) which will involve the provision of basic vocational services. Our in-house vocational specialists will offer basic hands-on vocational assistance and take advantage of various existing job support resources that already exist through the U.S. Department of Labor, the U.S. Department of Veterans Affairs (VA), and other federal and state agencies. This could include job search support, resume review, application support, job prep, and interview training.
- OtherResources
Passive control intervention (PC) which will involve the provision of a list of available community resources. Participants randomized to PC will receive a referral to resources via text, and can self-navigate to whichever resource seems best to them.
Location
- UTHealth HoustonHouston, Texas