Around 60,000 people with mental health problems in England live in supported accommodation, yet no one knows which models of care actually work or how much they cost. This five-year programme will create the first standardised quality assessment tool for these services, survey 300 accommodation providers, and track the five-year outcomes of 600 service users. The team will also test whether a randomised controlled trial is feasible by comparing two models: one that provides on-site staff with an expectation that residents move on within two years, and another that offers flexible floating outreach to people in permanent tenancies. Many clinicians assume that people should move through a system of decreasing support as they improve, but there is no evidence this is necessary or effective—and service users often dislike repeatedly moving home. If this research succeeds, it could give the NHS and local authorities the evidence they need to commission accommodation that actually improves outcomes, potentially saving millions of pounds currently spent on services of unknown quality.
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This programme of research AIMS to deliver: i) the first standardised, comprehensive quality assessment tool for supported accommodation services in England;ii) a detailed description of these services and those who use them;iii) evidence on the clinical and cost-effectiveness of these services;iv) information on the feasibility of a larger scale trial to test the clinical and cost-effectiveness of two models of supported housing. BACKGROUNDAround 60,000 people with mental health problems live in supported accommodation in England at a cost of millions of pounds to the NHS and Local Authorities. However, little is known about the quality and effectiveness of the supported accommodation models in operation or the content of care and support provided. Trials in this area have not been undertaken due to logistic difficulties in randomisation and the belief of many clinicians that service users should move through a system that provides decreasing levels of support as independent living skills improve. However, there is no evidence that this is necessary or effective and many service users dislike having to recurrently move home as they progress along this care pathway. The RESEARCH PLAN comprises four related workpackages (WP1-4) over five years. WP1: adapt an existing quality assessment tool, the Quality Indicator for Rehabilitative Care (QuIRC), for supported accommodation services. The QuIRC is completed by the unit manager and assesses seven domains of care. We will review its content through focus groups with staff and service users of the three main types of supported accommodation in England (residential care, supported housing and floating outreach) and expert panels. We will adapt the QuIRC accordingly and test its inter-rater reliability. WP2: national survey of supported accommodation services and retrospective cohort study to assess five year outcomes. We will describe and assess quality of care and costs of a representative sample of 300 supported accommodation services using the adapted QuIRC and interview 150 service users about their experiences of care. We will review case notes of 600 users of these services in 2009 to identify five year outcomes including whether they have moved on successfully. We will compare the costs and effectiveness of different approaches, taking account of differences in service type and service user characteristics.WP3: in-depth qualitative interviews with service users and staff to identify aspects of care that are most valued and the areas where there are challenges to providing effective support. We will gather views on the most appropriate measures of outcome in studies of supported accommodation. Along with the findings from WP2, we will incorporate the aspects of care that appear most beneficial into the models of supported housing that we will compare in WP4. WP4: test feasibility of a randomised controlled trial comparing two models of supported accommodation. One provides a constant level of staffing on-site to a number of flats with the expectation of move-on within two years (“Train and Place”). The other provides floating outreach of flexible intensity to individuals living in a time-unlimited independent tenancy (“Place and Train”). We aim to recruit 30 participants from across three regions and record the numbers referred to the trial, recruited, any attrition and the time from recruitment to moving into one of the two types of supported accommodation. We will assess outcomes suggested in WP3 12 months after randomisation and carry out in-depth qualitative interviews with trial participants and staff of the two types of service about their experiences of the trial. RESEARCH TEAM AND PROGRAMME MANAGEMENTThe team has the necessary academic and technical skills, the relevant clinical experience, links with services and appropriate service user representation to deliver this programme of research. Team members have proven track records in high quality mental health services
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