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The Journey to Social Inclusion Pilot
In November 2009, Sacred Heart Mission launched a three year pilot of the J2SI program. J2SI worked with 40 people experiencing long-term, chronic homelessness, delivering a highly intensive model of case management that supported participants across four integrated service delivery elements, working towards a common goal of social inclusion by addressing the pathways into homelessness and the dynamics that make it difficult to escape.
The experience of J2SI participants was measured against that of a control group, consisting of 44 comparable candidates who were accessing other homelessness services. The randomised control trial supported a rigorous, longitudinal evaluation that sought to demonstrate that a well-resourced, intensive and enduring service model can end a person’s long-term, chronic homelessness; and that there are significant social and economic benefits associated with doing so.
The circumstances of J2SI participants were extreme, even when compared to the homeless population:
•People had experienced on average five housing breakdowns in the last six months
•53% of participants first experienced homelessness at, or before, the age of 18
•87% reported a history of childhood trauma (with 52% experiencing sexual abuse)
•93% were suffering chronic mental or physical health conditions.
•56% had been imprisoned and 87% charged with a criminal offence
Social and economic outcomes achieved through the J2SI Pilot
At the conclusion of the J2SI pilot, 85% of J2SI participants were in stable housing, compared with 41% of those receiving existing homelessness services. Even after a small decline, following cessation of support, housing outcomes achieved through J2SI remained high at 75%.
The table below also demonstrates that J2SI outcomes are comparable with the best results reported by programs globally, in spite of the challenging cohort with which the program engaged.
Study / Proportion housed following service response (%)Months following service commencement / 0 months / 12 months / 24 months / 36 months / 48 months
J2SI Treatment Group,
48 Month Evaluation, 2015 / 12 / 78 / 86 / 85 / 75
J2SI Control Group,
48 Month Evaluation, 2015 / 2 / 29 / 53 / 41 / 58
Street to Home, Melbourne,
24 month Evaluation, 2015 / 0 / 78 / 70 / Not measured
Michael Project,
2007-2010 / 0 / 58 / Not measured
J2SI participants also reported substantial improvements in physical and mental health:
●Over 66% decline in usage rates for both emergency presentations and admission to psychiatric units
●J2SI participants reporting no bodily pain increased from 27% to 45%
●80% decline in emergency hospital services use (compared to 21% increase in control group)
●80% decline in average number of days hospitalised (compared to 33% reduction in control group)
●J2SI participant rates were half (2) those of control group (4)
In addition to housing and health the J2SI evaluation further demonstrated benefits in:
●Incarceration rates declined among participants, showing that J2SI helps stop people progressing to prison
●There was an increased use of employment services & willingness to work
●There was consistent improvement in the two key indicators of social inclusion
A cost-benefit analysis demonstrated that after 48 months the pilot delivered savings to government of between $14,978 and $32,080 per participant.[1] When the opportunity cost of public housing is stripped out of the analysis to reflect government cash flow, savings per participant were as high as $70,000 after 48 months.[2] Once future savings are taken into account the economic benefits of J2SI exceeded the cost of service delivery.
This rigorous independent evaluation of the J2SI pilot has shown the significant outcomes in people’s lives, positive community impact and cost savings for government. The pilot demonstrated that investing in the most disadvantaged members of our society is worth it, not only from a moral perspective but also from an economic perspective.
The J2SI Mark II Service Model: building on the success of the J2SI pilot
Having established the evidence base, SHM are now leveraging the success of the pilot through the delivery of J2SI Mark II. Through modifications to the J2SI model, SHM will increase its effectiveness and efficiency, while still recognising the long-term investment required to achieve outcomes with this complex needs group. Importantly Mark II will demonstrate scalability and replicability and set up a model for funding through government payment by results contracts and shared value initiatives with Corporates.
Proving these outcomes and the ability to scale will pave the way for Mark III, which will see J2SI adopted by service providers and governments across the country as the accepted, effective service response to chronic, long-term homelessness. Without Mark II evidence to prove required depth of savings and demonstrate scalability and replicability, the vision for J2SI to be implemented as a proven effective model, will not be possible.
The independent evaluation of Mark II, like the pilot, will employ a longitudinal Randomised Control Trial (RCT) methodology, as did the pilot. Its aim is to demonstrate that J2SI is more cost effective than leaving long-term homelessness in the hands of the criminal justice, health and crisis homelessness service systems.
The Mark II service response will be provided to 60 people, with services offered to 30 people at two sites, one program operating in the inner south of Melbourne based at Sacred Heart Mission in St Kilda and the other site operating in the inner north from VincentCare.
As the lead, Sacred Heart Mission will source necessary funding, contribute its own income, as well as implement and deliver the J2SI response. We will do this in partnership with VincentCare and St Mary’s House of Welcome who share an approach of open welcome and hospitality through their drop in services to communities in the inner north and provide critical access to the client group who are notoriously difficult to access. Partnerships with these two organisations are critical to the projects ability prove scalability across locations.
Key elements of J2SI Mark II Service Model
The five key elements that comprise the J2SI Mark II response are described in the table below. The integration of these elements allows key workers to establish a meaningful and trusting relationship with participants. The key workers are able to leverage this relationship to support and challenge clients to address the underlying causes of homelessness in a way that increases resilience, leading to long-term improvements in health and wellbeing and reducing expensive service use. It is this integrated response, which is relationship based, using a trauma informed practice model that makes J2SI unique to other programs of this nature.
Cost benefit
Just as we plan to achieve improved social outcomes through refining the J2SI service model, we also aim to demonstrate that these outcomes can be achieved with a less intensive and therefore lower cost service model. This will in turn deliver higher cost savings to government and society.
In Mark II, an increased client to worker ratio of 6:1 for the first two years and 10:1 for the last year will reduce the average cost from $27,900 to just over $20,000 per client, per annum. Once overhead around establishment, evaluation and management are excluded the costs of service delivery are just over $18,000 per client, per annum ($54,000 over the three years).
Assuming that the same or better outcomes of the J2SI pilot can be delivered under the lower cost service model, and once future savings are taken into account, we will quickly see a return on the investment required to deliver the intensive J2SI program (see table below). This allows Sacred Heart Mission to prove the appropriateness of the program for a payment by results or social impact bond.
Measures / Indicative data points to be validated through Mark IIJ2SI Mark II unit cost / $54,000 ($18,000 per year)
Annual savings to government per participant ($), based on alternative analysis of Mark II data[3] / $19,641
Years of future savings[4] / 11.09
Savings to government per participant / $217,818
Return on government’s investment / $4 savings for every $1 spent on program costs
In addition to proving the case to government to support the program, Sacred Heart Mission will work with Commercial Corporations in employment and construction in order to develop Shared Value projects which see economic benefit for the organisation as well as the social outcomes that are being achieved that will be unlocked in Mark III.
Service Delivery and Evaluation
The program will commence service delivery in late 2015 and will run for three years. Recruitment of clients and staff will occur in October and November this year from across the three sites and with the two other service delivery partners.
As soon as service delivery commences, evaluation commences. A randomised control trial will be used to assess the effectiveness of J2SI Mark ll in achieving housing and quality of life outcomes including social and economic inclusion through the University of Western Australia and the Centre for Social Impact. This will commence with a baseline survey being conducted in November/ December 2015 followed by post baseline surveys every six months throughout the life of the project by both treatment and control group participants. A profile & comparative report of J2SI project participants will be prepared at six months based on baseline survey findings (mid 2016). A final report will also be provided post project completion (post December 2018)
An economic evaluation will occur and findings provided at the end of the project (post December 2018.
A process evaluation will be conducted by Sacred Heart Mission for the three year project.
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[1] The lower figure accounts for justice costs accrued in connection with criminal activity which predominantly occurred prior to the program’s commencement.
[2] For more details see the independent evaluation of J2SI 1 year after service delivery ‘Sustaining Exits from Long-term Homelessness’, Guy Johnson et al 2015
[3] Cost savings generated through a comparison of the treatment group at baseline and the treatment group at 48 months; assumes that, despite reduced unit cost, social and financial outcomes can be maintained.
[4] Calculated by subtracting the average age of J2SI participants (36.4), from the life expectancy of homeless men according to a 2013 study conducted by Bethlehem House in Tasmania (47.49):