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

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.

• Employment-Based Housing (Other): 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.
• Vocational Services (Other): 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.
• Resources (Other): 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.

Primary outcomes

• Emergency Department (ED) Visits [From enrollment to 12 months after enrollment]: The number of ED visits during the study period via administrative data and self-report

Secondary outcomes

• Employment [From enrollment to 12 months after enrollment]: The employment status of the participant will be assessed via an assessment of job acquisition during the follow-up period.
• Housing stability [From enrollment to 12 months after enrollment]: Housing assessment used in the Collaborative Initiative to End Chronic Homelessness, assessment of housing situation in previous 30 days, and assessment of housing situation the previous night.
• Health-Related Quality of Life [From enrollment to 12 months after enrollment]: Short From Health Survey-8 (SF-8) Health survey, a widely used tool which generates mental health and physical component scores with higher scores indicating more positive health.
• Sleep Quality [From enrollment to 12 months after enrollment]: Validated with the Mini Sleep Questionnaire, a widely used scale to assess sleep quality and daytime sleepiness with higher scores indicating reduced sleep quality.

Sex: All, ages: 18 Years to any

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

NIH grants: R01NR021997