Preventing homelessness, improving health for people leaving prison
| ISRCTN | ISRCTN46969988 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN46969988 |
| IRAS number | 319937 |
| Secondary identifying numbers | NIHR 134281, IRAS 319937 |
- Submission date
- 10/10/2022
- Registration date
- 14/10/2022
- Last edited
- 10/01/2025
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English Summary
Background and study aims
People who have been in prison and are released back into the community are at a high risk of homelessness. Nearly 1 in 2 who are released do not have a settled home and 1 in 3 are homeless or are in unsettled housing one year later. The life expectancy of people without a stable home is much lower and they have a worse quality of life. There are also wider societal impacts of homelessness such as lower community wellbeing, more crime and higher healthcare and justice costs. Crisis (a national charity for people experiencing homelessness) has calculated that on average the yearly cost of one-person rough sleeping could cost £20,128. Although there are good interventions to stop homelessness, they are mostly from the US, and we do not know how these work for people who have been in prison. Critical Time Intervention (CTI) is the name of a type of intervention which aims to support those most in need in society during times of important life changes. They help people at risk of homelessness stabilise their housing situation, particularly those people who are leaving institutions (like prisons). Homelessness services think that this type of intervention works best when it is ‘housing-led’. This is 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 with prison experience in the UK and if they are good value for money. Working with Crisis we will carry out a pilot randomised controlled trial (RCT) (where people are randomly allocated to one of two groups: CTI or usual care) in four prison populations in England and Wales. In the long term, we plan to test if a housing-led CTI betters people’s health-related quality of life and housing (‘effectiveness’) and is ‘cost-effective’ (i.e., its good value for money), but first, we need to find out if the intervention and study design (research methods) are acceptable.
Who can participate?
Adult males who are ready to leave one of four prisons (HMP Liverpool, HMP Altcourse, HMP Risley and HMP Swansea) who are at risk of subsequent homelessness
What does the study involve?
Participants will be asked to complete a survey asking about their health-related quality of life, housing stability, substance misuse, alcohol consumption, re-incarceration, and support networks etc. We will also ask their permission 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. We will follow up with participants at 3, 6, 9 and 12 months. Some participants, prison staff and intervention staff will also be asked to take part in face-to-face interviews to find out more about their experiences of taking part to find out if they think the intervention and recruitment methods are feasible and acceptable to them. Some of their sessions with their CTI worker will also be observed to see how the CTI intervention is being delivered.
What are the possible benefits and risks of participating?
By taking part researchers can work out how best to support this kind of research. This means in the future we will look at which type of support can help people who are leaving prison and who are at risk of being homeless settle into the community better. By taking part in an interview, participants might find it helpful to talk to someone about their experiences. If in the intervention group, the experiences shared will help us make the intervention better for people in the future. We hope that the results will help CRISIS to improve how they work with people who are leaving prison and are at risk of being homeless.
Taking part will take some of your time. In total there will be 5 appointments over the next 12 months, and they will take around 30 minutes. The first appointment will take around 45 minutes. If you also take part in an interview this will take 30 minutes.
If you take part in an interview, some people find it helpful to think or talk about their experiences, but you may find talking about this upsetting.
Where is the study run from?
School of Health & Wellbeing at the University of Glasgow (UK)
When is the study starting and how long is it expected to run for?
June 2022 to September 2024
Who is funding the study?
The National Institute for Health and Care Research (NIHR) (UK)
Who is the main contact?
1. Prof Jim Lewsey (Chief Investigator), jim.lewsey@glasgow.ac.uk (UK)
2. Adam Williams (PHaCT Trial Manager), phact@cardiff.ac.uk (UK)
Contact information
Principal Investigator
Institute of Health & Wellbeing
1 Lilybank Gardens
Glasgow
G12 8RZ
United Kingdom
 ORCID ID |
0000-0002-3811-8165 |
|---|---|
| Phone | +44 (0)141 3303260 |
| jim.lewsey@glasgow.ac.uk |
Scientific
Neuadd Meirionydd
University Hospital of Wales
Cardiff
CF14 4YS
United Kingdom
| ORCID ID |
0000-0002-4825-8997 |
|---|---|
| Phone | +44 (0)2920 879989 |
| williamsad7@cardiff.ac.uk |
Study information
| Study design | Pilot randomized controlled study |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Randomised controlled trial |
| Study setting(s) | Community, Prison/detention |
| Study type | Other |
| Participant information sheet | Not available in web format, please use contact details to request a participant information sheet |
| Scientific title | Preventing Homelessness, improving health for people leaving prison: a pilot randomised controlled trial of a Critical Time intervention - PHaCT |
| Study acronym | PHaCT |
| Study hypothesis | To conduct a pilot randomised controlled trial of housing-led critical time intervention (CTI) for male prison leavers at risk of homelessness to determine if a full-scale randomised control trial is warranted |
| Ethics approval(s) | Approved 11/01/2023, Wales REC 3 (postal address not available; +44 (0)2922 941107, +44 (0)2922 940954, +44 (0)2922 940963; wales.rec3@wales.nhs.uk), ref: 22/WA/0347 |
| Condition | Preventing homelessness among prison leavers. |
| Intervention | The intervention group will receive the Critical Time Intervention (CTI) delivered by Crisis charity case workers to improve an individual’s engagement with treatment and community services through developing problem-solving skills. The stages of the intervention are: 1. Pre-CTI (in-prison): this stage focuses on relationship building, understanding housing and support needs and agreement on the areas for focus and support 2. Phase 1 Transition (0-3 months after release from prison): Intense period of forming the links and relationships, shared goal setting and deciding on the areas of focus for each person 3. Phase 2 Try out (3-6 months post-prison): Testing out of the links, agreeing on other areas for support and focus, facilitating and trying out participants' problem-solving skills 4. Phase 3 Transfer (6-9 months post-prison): Reducing support until full termination of CTI services once support is in place. The control arm would receive standard care provided during this time. Participants will complete a survey at baseline and follow up at 3, 6, 9 and 12 months post-randomisation. A subsample of intervention participants (n=12 (x 2 interviews)), control participants (n=16) prison staff (n=6) and interventionists (n=6) will be sampled to maximise variability (based on age, prison, caseworker, differing levels of engagement with the trial (and the intervention specifically), and phases of delivery) to take part in repeated (intervention participants only)/one-off interviews. Consent will be sought to link with participants routinely collected electronic health records via SAIL and NHS digital as well as augmented Criminal Justice data via the Ministry of Justice DataLab. Participants will be randomised to receive CTI or usual care following gaining informed consent and completion of the baseline assessment by the CRN/R&D staff. Randomisation will be on a 1:1 ratio and stratified by prison, using random blocks, and generated by the trial statistician and checked by the senior statistician. Allocation will be revealed to participants by the CRN/R&D staff by opening a sequential sealed envelope and communicated to the participant by the CRN/R&D staff (using a prepared script). Owing to the nature of the intervention, it will not be possible to blind participants, CRN/R&D Staff or CTI staff to the treatment allocation. |
| Intervention type | Behavioural |
| Primary outcome measure | Meeting progression criteria to run a full-scale trial: 1. Recruitment of 50% of those approached at baseline measured using the enrolment/withdrawal logs at 12 months post-randomisation 2. Retention of 60% of those enrolled measured using the enrolment/withdrawal log at 12 months post-randomisation 3. Acceptability of intervention delivery to participants and staff explored through interviews at 3 and 12 months 4. Intervention delivered with fidelity explored through interviews at 3 and 12 months |
| Secondary outcome measures | 1. Health-related quality of life measured using questionnaires SF-12 (total, physical and mental health scores), EQ-5D and ICECAP-A at 3, 6, 9, and 12 months 2. Housing stability (i.e., number of days in a stable accommodation) measured using ad-hoc questions at 3, 6, 9, and 12 months 3. Substance use and hazardous alcohol consumption measured using the AUDIT-C and ad-hoc questions of drug use at 3, 6, 9, and 12 months 4. Deaths (including the cause of death) measured using data linkage records at 12 months |
| Overall study start date | 01/06/2022 |
| Overall study end date | 30/09/2024 |
Eligibility
| Participant type(s) | Other |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Sex | Male |
| Target number of participants | 92 |
| Total final enrolment | 40 |
| Participant inclusion criteria | 1. Aged 18 years old and over 2. Released into the Swansea or Liverpool local authority areas and have a local connection (e.g., lived their previously; close relatives living in these areas) 3. Recourse to public funds 4. Have experienced prison and homelessness at least once 5. Mental health or substance use support needs |
| Participant exclusion criteria | 1. Individual under the Multi-Agency Public Protection arrangements 3 (MAPPA 3) 2. Those benefitting from Housing First |
| Recruitment start date | 13/10/2023 |
| Recruitment end date | 30/07/2024 |
Locations
Countries of recruitment
- England
- United Kingdom
- Wales
Study participating centres
Liverpool
L9 3DF
United Kingdom
Fazakerley
Liverpool
L9 7LH
United Kingdom
Risley
Warrington
WA3 6BP
United Kingdom
Swansea
SA1 3SR
United Kingdom
Sponsor information
University/education
University Avenue
Glasgow
G12 8QQ
Scotland
United Kingdom
| Phone | +44 (0)141 330 5519 |
|---|---|
| emmaJane.gault@glasgow.ac.uk | |
| Website | https://www.gla.ac.uk/schools/healthwellbeing/news/headline_851379_en.html |
"ROR" |
https://ror.org/00vtgdb53 |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
- Location
- United Kingdom
Results and Publications
| Intention to publish date | 01/05/2025 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not expected to be made available |
| Publication and dissemination plan | Planned publication in a high-impact peer-reviewed journal |
| IPD sharing plan | The datasets generated during and/or analysed during the current study are not expected to be made available. This is because consent does not cover the sharing of datasets. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol file | version 2.2 | 11/04/2024 | 10/01/2025 | No | No |
Additional files
Editorial Notes
10/01/2025: The following changes were made to the study record:
1. Protocol uploaded.
2. The recruitment start date was changed from 01/03/2023 to 13/10/2023.
3. The overall study end date was changed from 30/11/2024 to 30/09/2024.
4. Total final enrolment added.
09/07/2024: The following changes were made to the study record:
1. Ethics approval details added.
2. The recruitment end date was changed from 30/07/2023 to 30/07/2024.
3. The overall study end date was changed from 30/05/2024 to 30/11/2024.
24/01/2023: The study setting has been updated from ‘Other’.
10/01/2023: The following changes were made to the trial record:
1. The target number of participants was changed from 80 to 92.
2. The recruitment start date was changed from 01/12/2022 to 01/03/2023.
3. The recruitment end date was changed from 30/04/2023 to 30/07/2023.
13/10/2022: Trial's existence confirmed by NIHR (UK).
