PHaCT
Research type
Research Study
Full title
Preventing Homelessness, improving health for people leaving prison: a pilot randomised controlled trial of a Critical Time intervention
IRAS ID
319937
Contact name
Jim Lewsey
Contact email
Sponsor organisation
University of Glasgow
ISRCTN Number
ISRCTN46969988
Clinicaltrials.gov Identifier
ISRCTN, ISRCTN46969988
Duration of Study in the UK
1 years, 11 months, 31 days
Research summary
Research Summary
People who have been in prison and are released into the community are at a high risk of homelessness. The life expectancy of people without a stable home is lower and they have a worse quality of life. Homelessness also has wider society impacts such as lower community wellbeing, more crime and higher healthcare and justice costs. Critical Time Intervention (CTI) is a type of intervention which aims to support those most in need in society during times of life changes and help people stabilise their housing situation. Homelessness services think that this type of intervention works best when it is ‘housing-led’ (where people are given housing quickly without conditions). There have been no studies which have looked at how good housing-led CTIs are at stopping homelessness and better the health of people leaving prison in the UK.
Working with Crisis we will carry out a ‘pilot Randomised Controlled Trial (RCT)’ in four prison populations in England and Wales to find out if the intervention and research methods are acceptable.
Working with Crisis (housing charity) we will carry out a ‘pilot Randomised Controlled Trial’ (RCT). We will recruit 80 adult males who are due leaving one of four prisons and at risk of homelessness. Participants will complete a survey asking about their health, housing, substance misuse, resource use etc. at baseline, 3-, 6-, 9- and 12months post randomisation. We will ask to access anonymous routinely collected health, educational and aggregated criminal justice information. Participants will then be randomly allocated to either get the CTI or usual care. Some participants and staff will also be asked to take part in interviews to find out more about their experiences of taking part. Some of their sessions with their CTI worker will also be observed to see how the intervention is being delivered.
Summary of Results
Two of the four progression criteria were rated green (recruitment and fidelity). The process evaluation was rated amber, with retention receiving a red rating. To progress to a full-scale trial all progression criteria needed to be rated green, as this was not achieved it is not recommended to progress to a full-scale trial.
1. Recruitment: only recruiting 34 out of the planned 80 participants. This was due to various reasons including early release, moving prisons, or being inaccessible within the prison. Of the 37 approached, 34 (92%) agreed to participate, surpassing the 'green' threshold of ≥50%. The three who refused cited distrust of research and mental health difficulties.
2. Retention: Out of the 34 participants recruited, there was one death before follow-up, three withdrawals, and eight returned to prison, leaving 22 for follow-up. Only six participants (18%) had follow-up data for at least one-time point, falling short of the 60% threshold. At 3 and 6 months, three participants were followed up (9% each), and at 9 months, only one participant was followed up (3%). No participants reached the 12-month follow-up due to delays in trial initiation.
Of the 22 participants eligible for follow-up, eight did not provide contact details. Many provided phone numbers that were disconnected when contacted (57%). The methodology involved maintaining contact through probation practitioners, but staffing issues and high caseloads in the probation service posed significant barriers. At baseline, 35% of participants had no details for their probation practitioner and 35% had only partial information. The strain on the Probation Service due to the ECSL and Probation Reset scheme resulted in many participants losing contact with probation staff.
3. Process evaluation: There was high acceptability of the CTI model (intervention). However, the randomisation within the trial process was viewed as unethical by CTI caseworkers, as it denied support to vulnerable individuals. It was difficult to maintain due to participants' complex needs and structural issues like accommodation shortages and changes in prison and probation services.
4. Fidelity: the intervention as found to be delivered with fidelity.Indicative Outcomes: The primary outcome was health-related quality of life (SF-12), but limited retention prevented meaningful reporting. Baseline data showed 73.5% of participants were not in settled accommodation before prison.
Exploratory Outcomes: All 34 participants consented to data linkage with healthcare and criminal justice sources. Matching results were unavailable at the point of publication.
Economic Evaluation: Small follow-up numbers prevented planned economic evaluations. The study demonstrated the feasibility of capturing CTI delivery costs despite limitations.REC name
Wales REC 3
REC reference
22/WA/0347
Date of REC Opinion
17 Jan 2023
REC opinion
Further Information Favourable Opinion