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4.1.3 Changes in service use from pre-support to Housing First
All Housing First customers were also recorded as VOICES customers; some received VOICES support for at least 12 months prior to a Housing First referral (n=10) and others were referred directly to Housing First. As above, some were housed (n=13) and others were not (n=5). The following descriptive statistics are presented for the overall sample, and with some subgroup comparisons.
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• Whole sample
Analysis for all 18 Housing First participants revealed large reductions in service use from pre-support to the first 12 months of VOICES, followed by increases in service use during the first 12 months in Housing First (Figure 1). This pattern was similar for most outcomes, but most marked for A&E attendances, which rose during the period of Housing First support to higher levels than those recorded prior to support.
Figure 1. Changes in service use from 12 months before any support (pre-support), to the first 12 months of VOICES, to the first 12 months of Housing First (n=18)
• Housed vs. not housed
However, patterns were different when the sample was split to compare these changes over time for Housing First customers that had been accommodated through Housing First with those who did not start a tenancy.
Figure 2a illustrates that for criminal justice system outcomes, the reduction from pre-support to VOICES was continued during Housing First for those who were housed, i.e., Housing First appeared
to lead to even greater reductions in criminal justice system service use than those afforded by VOICES.
Patterns were less clear for health service use outcomes. A&E episodes increased during VOICES support, then reduced during Housing First to pre-support levels. Number of hospital in-patient episodes increased during Housing First support. Whilst this has resource implications, it could reflect those housed through Housing First were taking a better planned care of their health (with concurrent reduction in A&E attendance). Both of these patterns could also indicate that VOICES customers referred to Housing First were particularly complex, which greater health needs that were better met once in Housing First.
In those not housed, changes in criminal justice system outcomes over time showed that demand was not lower than when supported by VOICES (Figure 2b). A&E attendances were markedly higher (more than double pre-support levels), as were the number hospital in-patient episodes. Again, the latter could be a marker of improved care and/or a cohort of VOICES customers with particularly high health need. However, these are based on small customer numbers, which included two that accounted for 48 A&E episodes, three customers accounting for 79 in-patient episodes).
Figure 2a. Changes in service use from 12 months pre-VOICES, to 12 months in VOICES and 12 months of Housing First in those who were housed (n=11)
