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

Summary

Employment-Based Housing (EBH) is a novel model that helps unstably housed individuals obtain housing and on-site employment where they are housed. The long-term goal of this project is to examine how housing and vocational services can be integrated into hospital emergency departments (EDs) as a multi-sectoral intervention. The investigators central hypothesis is that EBH provides housing, employment, and health insurance which will reduce acute care use and ameliorate non-medical determinants of health more than standard care models. The rationale is that EBH addresses multiple upstream factors that can prevent recurring use of acute care, and the combination of housing with employment services will have positive synergistic effects. This project has three specific aims: 1) Conduct a three-arm randomized clinical trial comparing EBH to passive (resource list) and active control interventions (basic vocational services) on acute care use as the primary outcome and secondary outcomes related to housing, employment, and health-related quality of life; 2) Understand the experiences of subgroups of participants receiving EBH; and 3) Identify barriers and facilitators to adoption of EBH in public healthcare systems in other cities nationally. To achieve these aims, an EBH program will be integrated into the ED of the largest safety net hospital system in Houston, Texas- the 4th largest city in the United States. The project will include a three-arm randomized trial enrolling 750 participants (250 participants per arm). The three-arm trial allows for the investigation of the unique contribution of housing over other non-medical determinants of health (employment and insurance). Participants will be randomized to one of the three arms and followed for 12 months.

Conditions

• Emergency Department Visits
• Housing Stability
• Employment
• Sleep Quality
• Health-Related Quality-of-Life

Interventions

OTHER

Employment-Based Housing

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.

OTHER

Vocational Services

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.

OTHER

Resources

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.

Sponsors & Collaborators

• National Institute of Nursing Research (NINR)

  collaborator NIH

• The University of Texas Health Science Center, Houston

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-05-09

Primary Completion

2030-06-30

Completion

2030-06-30

Countries

• United States

Study Locations