Table of Contents

Title page

Key points

Introduction

Homelessness, offending and prison

Key challenges

Accommodation

Complex needs

What is effective?

Advice and information

Support after release

Partnership working

Characteristics of practitioners and services

Practicalities first

Key messages for practice

References

Acknowledgements

IRISS Insights, no.29

Prison leavers and homelessness

Emma Dore (Shelter Scotland)

May 2015

www.iriss.org.uk | enquiries@iriss.org.uk

The Institute for Research and Innovation in Social Services (IRISS) is a charitable company limited by guarantee. Registered in Scotland : No 313740. Scottish Charity No: SC037882. Registered Office: Brunswick House, 51 Wilson Street, Glasgow, G1 1UZ.

This work is licensed under the Creative Commons Attribution-Non Commercial-Share Alike 2.5 UK: Scotland Licence. To view a copy of this licence, visit www.creativecommons.org/licenses/by-nc-sa/2.5/ scotland/ Copyright © 20154

Key points

- Scotland has a strong legal framework for protecting people from homelessness

- Many prisoners become homeless when they leave prison

- A lack of stable accommodation increases the risk of (re-)offending

- Four groups of prison leavers face particular barriers: remand prisoners / those on short sentences; women; young people; those who are homeless on entering prison

- Key challenges for prison leavers are: limited accommodation options, location of accommodation and the complexity of needs they may experience

- Effective approaches to supporting prison leavers include: proactively providing advice and information on housing needs well before release; support after release to help sustain tenancies; working with other agencies and offering practical support first

This Insight was written by Emma Dore (Shelter Scotland) and edited by Ellen Daly (IRISS).

Introduction

This evidence summary looks at the relationship between homelessness and offending, the impact of prison, key challenges and messages for practice. Not all offenders will spend time in prison, but there is evidence that both offending and imprisonment  increase the risk of homelessness.

Homelessness has a range of meanings. A person might be homeless if they are:

- Sleeping on the streets (referred to as ‘rough sleeping’ or ‘rooflessness’)

- Staying with friends or family (referred to as ‘sofa surfing’)

- Staying in a hostel or bed and breakfast hotel

- Living in overcrowded  conditions

- At risk of violence in their home

- Living in poor conditions  that affect their health

- Living in a house that is not suitable for them because they are sick or disabled

(Adapted from: http://scotland.shelter.org.uk/get_advice/advice_topics/homelessness/what_is_homelessness)

Since December 2012, local authorities have had a statutory duty to provide settled accommodation for all unintentionally homeless people in Scotland. There is also a duty to provide temporary accommodation for all homeless households that need it while an investigation into their homelessness application  is assessed. Scotland’s approach has been described as ‘possibly the strongest legal framework in the world in relation to protecting  people from homelessness’ (Anderson and Serpa, 2013, p14). Alongside these legislative provisions, in recent years there has been a strong focus on preventing homelessness through the ‘housing options’  approach. This involves exploring all accommodation possibilities for a household. The Homelessness Guidance (Scottish Executive, 2005) states that:

‘Local authorities should therefore work together with prisons, social work departments and voluntary organisations to put in place measures to prevent people from becoming homeless on release from prison’.

Homelessness, offending and prison

There is a well-evidenced  and complex relationship between homelessness and offending. Spending time in prison increases the risk of homelessness and a lack of stable accommodation increases the likelihood of (re-)offending. This can lead to a self-perpetuating negative cycle. The risk of homelessness for people leaving prison is recognised by the criminal justice sector. For example, the (then) Scottish Executive’s National Strategy for the Management of Offenders identified ‘the ability to access and sustain suitable accommodation’ as one of the nine offender outcomes (Scottish Executive, 2006).

Despite the legislative rights and strategic commitments in Scotland, many people leave prison without accommodation to go to. The most recent publicly available data shows that in 2011/12, 846 people were recorded as leaving prison to ‘no fixed abode’ (Scottish Government, 2012). However, these figures are likely to significantly under-report  the prevalence due to prisoners choosing not to disclose worries about accommodation or being unaware of the reality of their accommodation situation.

In 2013/14, statutory homelessness figures identify that 2,126 homeless applications (6% of total) came from people leaving prison (Scottish Government, 2014). This is also likely to be an underestimate, as individuals may choose not to cite leaving prison as their reason for homelessness, fearing that this could weaken their homelessness application.  They may, instead, cite another factor such as relationship breakdown.  For others,living arrangements may break down within a few weeks of release, leading to a delayed homeless presentation. Furthermore, not all those who are homeless will approach a local authority or be offered a homelessness assessment (Scottish Housing Regulator, 2014).

Alongside these statutory figures, research consistently demonstrates that homelessness amongst prison leavers is a significant issue, although evidence varies as to the exact scale of the problem (Social Exclusion Unit, 2002; MacRae et al, 2006; Loucks, 2007). The most recent large-scale UK research was conducted  in 2005 by the Home Office. This found that 30% of those released from prison had nowhere to live (Niven and Stewart, 2005).

Lack of access to appropriate  accommodation on leaving prison has led to over-representation of this group within every section of the homeless population:  those who have made a statutory homelessness application;  those who are roofless; and those who are hidden, sleeping on friends’ sofas or in unsuitable places. For example, in Glasgow in 1999, 44% of people living in hostels or sleeping rough had been in prison at least once (Homelessness Task Force, 2002). More recently, a survey of 500 homelessness services in England in 2013, reported that an estimated 18% of service users were prison leavers (Homeless Link, 2013).

Research has established that securing adequate housing for prison leavers can significantly reduce re-offending.  For example, the Social Exclusion Unit (2002) found a reduction in relapses into criminal behaviour (or ‘recidivism’) of 20%. The Home Office, in a longitudinal follow-up  study of liberated prisoners identified that, while a third of those released to stable accommodation had re-offended, this rose to more than two thirds for those who were homeless or in unstable accommodation (cited in Reid Howie, 2004). Prisoners themselves are aware of this; 60% of prisoners are reported to believe that having a place to live would help them stop offending (Williams et al, 2012). Some prison leavers feel driven to re-offend to return to the secure ‘accommodation’ of prison (Loucks, 2007).

Surveying prisoner crime reduction was a longitudinal cohort study of 1,435 adult prisoners sentenced to between one month and four years in prison in England and Wales. It found that 15% of prisoners reported being homeless before custody (including 9% sleeping rough) compared to 3.5% of the general population  having ever been homeless. The cyclical nature of homelessness and re-offending  was also clearly demonstrated  by the survey, which found that 11% who had served a previous custodial sentence were sleeping rough prior to custody, compared to 3% of those who had not been in prison before (Williams et al, 2012).

While finding and sustaining accommodation can be problematic  for anyone leaving prison, evidence has highlighted four groups that face particular barriers:

- Remand prisoners and those on very short-term sentences (Loucks, 2007; Gojkovic et al, 2012)

- Women (Sapouna et al, 2011; Commission on Women Offenders, 2012)

- Young people (Glover and Clewett, 2011; Gojkovic et al, 2012)

- Those who were homeless on entering prison (Williams et al, 2012)

The families of prisoners are also affected by the imprisonment  and can find their housing situation at risk. In Scotland, imprisonment  affects an estimated 16,500 children annually (Families Outside, 2009). The children of prisoners are about three times more likely than their peers to engage in anti-social or delinquent behaviour, and more than twice as likely to have mental health problems during their life (SCIE, 2008).

Key challenges

This section explores some of the challenges associated with accommodation and the impact of complex needs which prison leavers might experience.

Accommodation

Local authorities will usually have a duty to provide prisoners who apply as homeless on release, with temporary accommodation. Most local authorities in Scotland have high demand on their temporary accommodation and many prisoners will be placed, at least short-term, in ‘bed and breakfast’ or hostel accommodation. Very few prison leavers want to live in a hostel, even temporarily; they may fear being drawn into re-offending by contact with other ex-offenders (Carlisle, 1996). Many get caught in a cycle of prison–hostel–prison (Homelessness Task Force, 2002). Although there is not conclusive evidence, research for the Scottish Government reports increasing consensus that rehousing prison leavers in mainstream rather than hostel accommodation will reduce re-offending (Sapouna et al, 2011). This is supported by McHardy (2010), whose research involved interviewing 10 homeless prison leavers from the west of Scotland about their experiences in temporary accommodation. The study concluded that unsuitable temporary accommodation impacts negatively on reintegration into the community and that hostel accommodation is rarely suitable for prison leavers, especially those with drug and alcohol problems.

There is evidence that settled and stable accommodation is vital for prison leavers. The National objectives for social work services in the criminal justice system: Standards throughcare (2004) highlight stable accommodation as a key factor for successful reintegration of long- term prisoners and sets out procedures for accommodation to be considered. However, at the root of the high levels of homelessness amongst those leaving prison is the difficulty they can face in gaining access to housing (Reid Howie, 2004; Communities and Local Government (CLG), 2009). Beyond temporary accommodation, the options for almost all are social housing or the private rented sector, both of which present barriers to access.

Although there is variation amongst areas, in general there is high demand in Scotland for social housing. According to the Scottish Government’s Housing Statistics for Scotland, (Housing and Regeneration datasets), there are currently 150,500 households waiting for social housing in Scotland and even those assessed as homeless can wait a long time for an appropriate property to become available.

The private rented sector has been looked to as an option for settled accommodation. However, there are often financial barriers to people leaving prison accessing private rented accommodation such as high rents, delays in benefits and the need for a deposit. For a few, help may be available through access to rent deposit guarantee schemes for people leaving prison, but these can be difficult to access (Reid Howie, 2004). Against a background of high demand, landlords can perceive people leaving prison as risky or undesirable tenants and those advocating for them can face a strong attitudinal challenge (Homeless Link, 2011). Also, if someone has been in custody they may have lost personal belongings including documentation that may be required by landlords to secure private rented accommodation.

The complex needs presented by some prison leavers can further limit accommodation options (CLG, 2009). For some particularly vulnerable groups, independent accommodation is unlikely to be successful even with support, and specialist supported accommodation may be needed for a period. For example, Barnardo’s has called for improved supported accommodation for young ex-offenders, arguing that this could save £67,000 per individual over a three-year period (Glover and Clewett, 2011). In 2004, Reid Howie identified a lack of semi and fully supported housing to accommodate the needs of this group in Scotland,although no more recent evidence has been found in this current brief review.

Of significant concern for people leaving prison is the location of accommodation, being away from negative, and being close to positive influences. Many want a ‘clean break’ when leaving prison, to move away from associates that have previously had a negative influence on them. Relationships with anti-social associates has been described as ‘one of the most potent predictors of re-offending’ (Andrews and Bonta, 2003). Often, prison leavers are offered social housing in what are perceived to be the ‘worst’ areas (Reid Howie, 2004). These are areas with the highest turnover of tenants, and where properties become available more regularly. However, they are often areas with the highest crime rates and can, therefore, increase the risk of re-offending.

Finding accommodation close to positive social networks can reduce offending behaviour (McHardy, 2010). The most frequently cited reason for change in Healy’s (2010) study of persistent adult offenders in Ireland was the formation of strong social bonds with parents, partners and children. Maintaining positive social networks is also key to preventing recurring homelessness (Tabner, 2013). Despite clear evidence that location is important, finding accommodation for prison leavers in an appropriate area can be difficult. There may be a requirement for a ‘local connection’ to an area, to access social housing. In addition, prison housing advisors often only have links with the local area of the prison. If a prisoner isn’t from that area, professionals in the receiving area may be required to assist (Gojkovic et al, 2012). This can be a challenge in many cases where prisoners are in custody away from their home area (Audit Scotland, 2012).

Complex needs

Evidence suggests that offenders often experience multiple challenges (Scottish Prisons Commission, 2008; Sapouna et al, 2011). Complex needs are also associated with experiences of homelessness. There is a strong overlap between experiences of more extreme forms of homelessness (eg multiple instances of homelessness, rough sleeping) and other support needs. McDonagh (2011) summarised findings from four key studies. One of these studies (Fitzpatrick et al, 2011) included a ‘census’ survey of users of ‘low threshold’ services (such as street outreach teams, drop-in services, day centres, direct access accommodation, soup runs etc.) in seven urban locations throughout the UK. Almost half of respondents to the survey reported experience of institutional care, substance misuse and street activities (like begging, sex work or shoplifting), as well as homelessness.

For many leaving prison, addiction, breakdown in relationships, poor physical or mental health and social isolation can perpetuate homelessness or make tenancies difficult to sustain. While any one of these could cause difficulties, evidence shows that for many prisoners, these issues are interlinked and often cumulative (Social Exclusion Unit, 2002; Reid Howie, 2004; Audit Scotland, 2011). For example, a study of transitional care in Scotland identified housing as one of the main challenges encountered by prisoners with drug problems on release, and that lack of stable housing made it more likely that they would resume drug misuse (MacRae et al, 2006).

Homeless people are also significantly more likely to be victims of crime, which can leave them traumatised and living in fear, affecting both their physical and mental health. Compared to the general public, rough sleepers are 13 times more likely to have experienced violence and 47 times more likely to be victims of theft. Almost one in 10 of 336 homeless people interviewed by the London School of Economics had experienced sexual assault in the previous year and around half had experienced damage to property (Newburn and Rock, 2005).

What is effective?

This section highlights some examples of effective approaches and identifies associated challenges.

Advice and information

The availability of appropriate specialist information, advice and support on housing issues is critical in preventing homelessness amongst prison leavers. However, there is evidence that this has challenges. For example, a survey of 680 offenders found that only 21% of respondents reported awareness of any housing organisations operating in their prison and no more than 4% reported engagement with them (Gojkovic et al, 2011). Prisoners need to know how to give up their tenancy, what will happen to their belongings and how they can find a new home (Audit Scotland, 2012). A House of Commons Library review (2014) highlighted the UK Government’s recommendation that all prisons should have a specialist housing advice centre, or, at least, ready access to specialist housing advice. In Scotland, many prisons have link centres, which will often include some element of access to housing advice from either local authorities, who have Prison Liaison Officers, or voluntary sector providers. However, there are inconsistent levels of provision in Scottish prisons (Audit Scotland, 2012). Reid Howie Associates, in their evaluation of the Rough Sleeper Initiative (2004), found that prison-based housing advice and assistance projects were of benefit to prisoners facing difficulties with housing upon release. This is in line with the focus on advice and information within the Code of Guidance on Homelessness (Scottish Executive, 2005). For example, since the introduction of Shelter Scotland’s housing advice project to HMP Perth, the number of prisoners being assessed for homelessness by Dundee City Council has halved.

Housing issues need to be given prominence. Housing advice must be proactively publicised in ways that are accessible to prisoners, many of whom have poor literacy skills. Innovative approaches are emerging to address this issue; for example, the West of Scotland Housing Options Hub is producing a short video to be shown in prison link centres while prisoners are receiving their induction. Another example is the Supporting Prisoners Advice Network (SPAN) Insiders Programme which trains and accredits chosen prisoners in giving housing advice, in line with Scottish National Standards to raise awareness about housing and homelessness amongst fellow inmates.

There is general acknowledgement that the assessment of housing need should start in prison at entry and also be undertaken at review points to enable a more planned approach to resettlement (James et al, 2004). In Scottish prisons a Core Screen assessment interview within the first 72 hours of custody should ask about housing needs. However, some prisoners are reluctant to disclose this information or within the first three days of custody are not in the right emotional or mental state to answer all questions fully (Anderson et al, 2014). Early assessment of housing need identifies those requiring assistance in maintaining or closing down tenancies in order to prevent unplanned accommodation loss. It also can give early warning of those who will need help in finding accommodation and sustaining accommodation on release (CLG, 2009). The Improving Offenders Housing Outcomes initiative, part of the Scottish Government’s Reducing Reoffending Programme, is currently trialling the inclusion of a more detailed housing needs social questionnaire within the Core Screening process in HMP Perth. The aim is to identify and act on housing issues at the earliest possible opportunity.

Plans for finding new accommodation should also start early (Anderson et al, 2014). In Scotland, prisoners sentenced to under four years should have a pre-release interview, which should include identifying housing issues. However, evidence suggests that this is not always effective. For example, in McHardy’s study, interviewees reported being unable to gain access to appropriate staff and only being given phone numbers to contact on release (2010).

Pre-release planning can be hampered by uncertainty about prisoner transfers and timing of release, such as for remand prisoners or through inclusion in the Home Detention Curfew scheme (where short-term prisoners assessed as low risk are released on licence). Challenges to early assessment and planning include variations in local authority practices, their willingness to consider applications for housing assistance prior to release and the ability of other social and private sector housing providers to assess applications for assistance from offenders in custody (CLG, 2009). The Reid Howie (2004) evaluation of projects giving housing advice to prisoners, demonstrated the benefits of conducting housing and homelessness assessments prior to release in Glasgow and Dumfries and Galloway, so that support packages could be put in place and appropriate accommodation arranged.

Support after release

Accessing appropriate accommodation is only the beginning of the resettlement process. Although not all prison leavers will require support, some will have poor basic skills and high levels of need, which can impact on their ability to sustain accommodation (Scottish Prisons Commission, 2008). Evidence from the literature suggests that ensuring tenancy sustainment for prison leavers requires holistic assessment processes that identify the full range of housing-related and wider support needs (CLG, 2009; Audit Scotland, 2011).

Alongside evidence regarding prison leavers, there is also strong evidence that appropriate support and advocacy is vital to successfully maintain tenancies for all vulnerable people who have been homeless (Civis, 2008; Shelter Scotland, 2009). This has led to the recent introduction of the Housing Support Duty to Homeless Households for local authorities in Scotland to ensure that anyone receiving a settled tenancy is supported to sustain it. The need for life skills in order to reduce re-offending and homelessness should not be underestimated (Homeless Link, 2011). The support delivered can range from budgeting to cooking skills, and organisations that deliver this support can be crucial in enabling someone to stabilise in independent accommodation.

Engaging with housing providers around tenancy support can also be effective as providers are more likely to accept prison leavers as tenants when appropriate tenancy support is available. Such support can reduce anxieties about actual and perceived risks associated with housing this group and thus increase offenders’ housing options (CLG, 2009).

Partnership working

Partnership working is central to increasing capacity and diversity in the housing options accessible to prison leavers (CLG, 2009; Gojkovic et al, 2012). Criminal justice agencies alone are not able to provide or guarantee effective resettlement for prison leavers. Multiple stakeholders may need to be involved including: housing advice services, local authorities, social housing providers, the Scottish Prison Service, support agencies and criminal justice social work services (Local Government Association, 2005). Although there are examples of positive multi-agency practice in prisons, for instance the Integrated Case Management process (Scottish Prison Service, 2007), there is room for this to be built on both locally and systemically.

Prisoners themselves have emphasised the need for prisons to have better links with housing organisations throughout the country, especially those which cover areas outside large cities (Gojkovic et al, 2011). In prisons which reported the existence of partnership arrangements with housing providers, prisoners were often more positive and less concerned about their prospects on release (Gojkovic et al, 2012).

When relationships between statutory and third sector agencies are strong, service provision appears to be more effective and more likely to ensure consistency of support for service users (Malloch et al, 2013). However, challenges to partnership working are well documented. For example, in their evaluation of the Community Reintegration Project, Anderson and colleagues found that inter-agency relationships are often under-developed and over-reliant on personal links between individual staff (2014).

The integration of health and social care in Scotland following the Public Bodies (Joint working) Act (2014), may encourage improvement of partnership working to support people with complex needs, including those leaving prison.

Homeless Link’s (2011) Better Together research into links between the homelessness and criminal justice sectors surveyed 400 homelessness professionals and 75 people supported by them. The following components of successful partnership working were identified:

1. Cross-sector working driven at a strategic level, e.g. jointly owned strategies, working groups or partnership frameworks

2. Shared understanding of mutual goals

3. Co-location explored as an option

4. Personal networks of contacts are valued

5. Multi-agency panels and support planning

6. Cross-sector learning about how each sector can complement the other’s client support

7. All staff empowered to proactively share information wisely for the benefit of the client

Building on point 7 in the previous list, the Scottish Government’s Prevention of homelessness guidance (2009) highlights the benefits of establishing clear protocols for sharing information between housing advice services, the Scottish Prison Service, local authority housing and providers/registered social landlords. Such protocols not only provide clarity about the procedures and context for information sharing, they also assist the assessment and pre-release planning process. For example, The Tayside Inter Agency Prison Discharge and Homelessness Prevention Protocol was developed during 2008-09 in partnership with Perth and Kinross Council, Angus Council and Shelter Scotland. The protocol details background information, overall objectives, the roles and responsibilities of each partner, the homelessness prevention pathway and requirements for information sharing. Perth and Kinross Council reported that emergency homeless applications from prisoners leaving custody dropped from 75 in 2008/9 to three in 2010/11. However, the Homelessness and substance misuse: Services needs assessment in Tayside (2013) reports that despite the protocol, some people may have not received the service they want, potentially due to literacy barriers. This suggests that protocols need to be regularly monitored, reviewed and have proactive buy-in from all partners in order to be fully effective.

Characteristics of practitioners and services

Characteristics of services and practitioners shown to be effective in assisting prisoners on liberation include: continuity, flexibility and a respectful relationship. These characteristics will be more important when working with people with complex needs and can be central to supporting someone to access and maintain accommodation (Malloch et al, 2013). The voluntary sector is perceived to have a good record for maintaining contact with prisoners on release, often having more time and flexibility than statutory services and overcoming traditional barriers that emerge when working across multiple agencies (McLaughlin, 2012; Malloch et al, 2013). Of the programmes identified in the National directory of services, 107 third sector organisations provide 30% of the criminal justice services listed in Scotland (Audit Scotland, 2012). A revised and updated directory is currently being developed as part of the second phase of the Scottish Government’s Reducing Reoffending Programme.

Practicalities first

If practical needs remain unmet on leaving prison, progress in reforming behaviour and other areas of development such as employment or addressing mental health issues are unlikely to be successful (Malloch et al, 2013). Other studies of how and why people stop offending (also known as the desistance process) report that offenders value practical support more than any other type of intervention (Sapouna et al, 2011). The Housing First Model approaches accommodation as a practical need. Modelled on the Pathways to Housing in the United States (Tsemberis, 2010), the Housing First pilot was led by Turning Point Scotland in response to high levels of repeat homelessness amongst people with active substance misuse problems in Glasgow. Homeless people with complex needs are placed directly into independent tenancies without first having to undergo treatment or go through transitional housing programmes. People supported are offered flexible, non-time-limited support in their homes and communities. It has been evaluated as reducing service users’ involvement in criminal activity (Johnsen, 2013). In a review of approaches to complex needs, Evans (2015) reports two case studies of achieving success with Housing First, stating that it can give people with complex needs a long-term option that builds stability, self-worth and social connections.

Key messages for practice

Several messages for practice can be drawn from the evidence summarised here including:

• Intervening early by addressing housing needs before prisoners are released is important, can help protect existing tenancies and avoid unplanned loss of accommodation.

• Those supporting  people who have been sentenced to under four years need to be aware of the increased likelihood of housing problems on release for this group. Short-term  prisoners can request voluntary social work assistance, but traditionally there has been very low take-up of this (Malloch et al, 2013).

• It is important for professionals involved with those at risk of imprisonment  to consider the impact on families and to ensure that appropriate  support is in place (Loucks, 2004).

• Respectful relationships between prison leavers and services / practitioners  are effective in supporting  prisoners after release.

• Support on release from prison can be vital to help prison leavers sustain tenancies. Support might focus on life skills such as budgeting and cooking and other practical help. This support can be crucial in enabling someone to stabilise in independent  accommodation.

• Effective partnership working can help ensure consistent support for prison leavers, which can be particularly important when supporting  those with complex needs.

• Many prisoners do not consider issues such as housing during their time in custody, or may not think that they need help so it is important to be proactive in addressing housing needs. Some prisoners may choose not to access help, being unaccustomed to actively seeking support from outside agencies (Loucks, 2007; Shapland et al, 2011). Research amongst women prisoners suggests that unless issues such as housing are proactively raised, few will seek out help (Reid Howie, 2004). It is also worth considering alternative ways of conveying advice and information to suit those with limited literacy skills.

• The order in which support is provided is important and needs to be ‘appropriately sequenced: for example, employment, while critical in the longer term, is often not a realistic short-term  goal until other issues and needs have been addressed’  (Sapouna et al, 2011, p13).

• A professional’s local knowledge about housing related support in prisons, and agencies providing support and accommodation in the community, plays an important role. Referrals to the right agencies, including knowing how to access appropriate support and accommodation providers, largely depends on a professional’s local knowledge.

• Due to inconsistency in provision of housing advice across Scotland (Audit Scotland, 2011) and constraints on criminal justice social work resources, often there is no-one whose specific job it is to do this negotiating or to hold specialist knowledge about housing options for offenders (Gojkovic et al, 2012). Professionals who come into contact with prison leavers can help significantly if they are willing to engage with housing providers to increase their clients’ housing options, even if this is outside their normal area of expertise.

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Acknowledgements

This Insight was reviewed by Helen Allbutt and colleagues from NHS Education for Scotland, Claire Frew (Glasgow Homelessness Network), Neil Macleod (Scottish Social Services Council), Brian McAteer and Audrey McGuinness (North Lanarkshire Council), David Orr (Edinburgh City Council), and colleagues from the Scottish Government Homelessness Team. IRISS would like to thank reviewers for taking the time to reflect and comment on this Insight.