Journey to Social Inclusion: the homelessness program changing lives and saving government money

By David Donaldson

Wednesday August 5, 2020

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Journey to Social Inclusion shows that investing in services and housing can save money in the long run. There are now hopes to expand it across Australia.

A Melbourne program that helps people exit homelessness by providing housing and long-term support has led to life improvements for participants and reduced costs to government.

Participants reported improvements in physical health, mental health, employment, housing stability, feelings of safety in accommodation, drug use, and time spent in hospital and drug services, according to the evaluation report published on Tuesday.

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Journey to Social Inclusion, run by Sacred Heart Mission, is a trauma-informed, strengths-based program that places people’s needs at the centre of service delivery. Intensive support and case management is provided to improve all areas of people’s lives. In addition to exiting homelessness, people are supported to improve their health and well-being, and to build the skills, independence and social connections required to experience and maintain a better quality of life.

This all means the costs of program delivery are higher — though the positive outcomes lead to lower costs for government overall.

Participants used around $32,000 less in public services over the three years of the program. A comparison group which did not access J2SI but were free to access other homelessness services increased consumption of public services by around $66,000 per person in that time. This meant the program was estimated to have saved almost $100,000 per person in expenditure.

“The program ‘pays’ for itself in less than six years,” argues the independent evaluation report.

“Simply put, J2SI works to end homelessness, rather than simply managing it,” explains Cathy Humphrey, CEO at Sacred Heart Mission.

“It works on the premise that when people are able to stay in their housing, and manage their complex health and social needs, people’s reliance on the service system is reduced.”

Providing adequate support can have a transformative impact on the lives of people experiencing homelessness, said Victorian Housing Minister Richard Wynne in a video address for the launch of the report.

“Once again, the evaluation has demonstrated that it’s far more cost effective to government to house people with the right supports, rather than allow them to remain homeless,” he says.

“The mix of housing and support can reduce the use of acute services, and, of course, ultimately, the cost to government and the community of both experiencing homelessness and the effect that has on all of the services such as our hospitals, police, ambulances, and of course, ultimately, for some people, the criminal justice system.”

Journey to Social Inclusion started as a successful pilot from 2009 to 2012 with 40 people from the inner south of Melbourne. It was Australia’s first randomised control trial study set up to capture and prove what solves chronic homelessness. Phase two — covered by the evaluation published on Tuesday — extended the program to 60 people in multiple locations across Melbourne and ran from 2016 to 2019.

Phase three, with 180 people, is currently underway, thanks to Victorian government social impact investment funding, and incorporates lessons from the first two waves.

After being “put through the wringer of Treasury”, the first two rounds of the program have shown that the social and economic benefits of social inclusion for people experiencing homelessness “far outweigh” the costs of the program, said Wynne, adding that he had “no doubt” the third phase will demonstrate the same.

There are now hopes these results will one day be achieved around the country.

“Our vision is to see a J2SI program across Australia,” Humphrey says.

“This vision will see J2SI expanded through licensing agreements with partnering agencies across multiple service sites in Australia. Licensing J2SI will ensure the retention of the program’s fidelity, create mechanisms for future research and continuous improvement. And this allows economies of scale to develop.

“A J2SI evaluation and learning centre has been established to manage the partnership, licensing, evaluation and continuous improvement of the model.”

The results

Participants had a high level of satisfaction with the program.

One participant described the positive impact of being provided with stable housing:

“If you know where you’re gonna lay your head every night, where you’re gonna get a feed from, it does take a lot of stress out of you. It takes a lot of stress out of your life.”

Participants also pointed to the value of having a case manager funded to spend larger amounts of time working with the client than usual:

“I actually had somebody that was an advocate for myself, rather than trying to have to do everything myself. I’d be back on the streets if that was the case.”

Outcomes at the end of the three-year program include:

64% of people in the J2SI group successfully maintained their housing for over a year, compared to 27% in the comparison group.

41% of people in J2SI reported feeling safe in their housing all of the time at the end of the program, compared to 13% at the start.

29% of people in the J2SI group reported their health as ‘better’ or ‘much better’ in the final year of the program. However, 39% of people in the program reported their health was ‘worse’ or ‘much worse’ in the final year. The evaluation finds this is likely due to the deterioration of chronic illnesses present at the start of the program — 91% of participants reported having at least one diagnosed physical or mental health condition at the start of the program, and 74% reported having three or more.

On average, nights spent in hospital reduced by 50% for the J2SI group compared to the start of the program, and increased by 100% for the comparison group.

Depression, anxiety, and stress levels fell by 30% for the J2SI group, and overall mental health satisfaction increased by 23%.

The number of people in J2SI reporting they hadn’t used illicit substances in the previous three months increased by 160% compared to the start of the program.

Nights required in drug and alcohol rehabilitation facilities fell by 67% for the J2SI group.

The percentage of the J2SI group in the labour force increased by 100% over the course of the program, and reduced by 25% for the comparison group. The percentage of the J2SI group able to work and looking for work increased by 67% over the course of the program, and reduced by 57% for the comparison group. Rates of labour force participation still remained low, the evaluation notes.

By the end of the program, J2SI participants said they were slightly lonelier and felt less supported than the comparison group. This may be as a result of moving away from social connections associated with homelessness.

The evaluation also suggests low levels of improvement in employment, physical health and social supports self-reported by participants may result from increased focus on those areas. As the program provided for security in the most basic needs, such as housing and food, the authors believe participants begin to spend more energy on things like health and social connection.

“Increasing focus on these priorities at this stage of support may make these areas seem worse than previously considered or may require more than three years to show measurable improvements,” they write.

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