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Home > Evidence review: adults with complex needs (with a particular focus on street begging and street sleeping).

Seria-Walker, Emma (2018) Evidence review: adults with complex needs (with a particular focus on street begging and street sleeping). London: Public Health England.

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Public Health England South East Centre was asked by Portsmouth and Southampton City Councils to provide an independent review of the literature around homelessness. With particular reference to those who are street homeless and those who street beg to support efforts to prevent and reduce homelessness and the adverse outcomes associated with this. The purpose of this document is, therefore, to provide an overview of the national picture in relation to homelessness and provide insights into the current evidence base to support action in preventing and reducing homelessness, particularly with those who are street sleeping and street begging.

Sections 2, 5, 6 and 7 explore the data, risk factors and reasons why people street beg, street sleep and/or experience homelessness and indicate that it is a highly complex mix of issues that combine, stemming from early childhood experiences through to the development of substance misuse and mental health problems. This, coupled with the significant social exclusion faced by these adults with complex needs, serves to make the provision of interventions and services to reduce and prevent homelessness incredibly difficult.

Section 9 explores promising interventions from the literature that may support efforts to prevent and reduce homelessness. Some of the key interventions include:
• No Second Night Out
• Housing First
• Psychologically Informed Environments
• Personalised Services
• MEAM

There was little primary research looking at interventions specifically to prevent or reduce street begging or street sleeping. Much of the literature relating to this is found in grey literature, policy or strategy papers, or informal news pieces. However, there are some key themes that have emerged, including:
• early intervention in the context of homelessness
• integrated working
• interventionist approaches Vs non-interventionist approaches

In addition, there has been a recent review of the evidence in relation to interventions for inclusion health, which highlight a number of areas where there is good evidence to support intervention, including:
• pharmacological interventions
• psychosocial interventions
• case management
• disease prevention
• housing and social determinants
• other interventions
• interventions tailored to women
• interventions tailored to young people

What is clear is that no one single intervention on its own will reduce or prevent homelessness. A system wide, integrated approach is needed to ensure that there a range of linked services available to meet the needs of those with highly complex needs. A home is one of the key things required to support this group. Evidence suggests that simply having appropriate long-term accommodation can have a significant impact on those with complex needs, who are often the most socially isolated and excluded people within our communities.

Sections 8, 10 and 11 explore some of the impacts associated with homelessness and particularly street begging and street sleeping, where evidence exists and highlights some of the potential savings that could be made through tackling this complex issue. There are a lack of return on investment tools to provide a robust judgement on the extent of those savings, but there is likely to be substantial gains to health and social services as well as benefits to the criminal justice system of addressing this issue.


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