Silicon Valley Guaranteed Income Project

Overview

The goal of this clinical trial is to learn about how unconditional cash payments equivalent to $1,000 for 24 months (also called 'guaranteed income') might help families experiencing homelessness and/or unstable housing in Santa Clara County, California. The main questions it aims to answer are: 1. What is the impact of guaranteed income on homelessness and housing stability among families experiencing homelessness or housing instability? 2. What is the impact of guaranteed income on the health and well-being of families experiencing homelessness or housing instability? 3. In terms of size and frequency of cash payments, do families prefer monthly recurrent payments ($1,000/month) vs a larger up front amount followed by smaller monthly payments ($6,500/month, then $500/month)? Is one payment strategy more helpful than the other in terms of achieving improved housing stability, health, or other measures of well-being?

Detailed description

Study design and overall objective: This is a mixed-methods randomized controlled trial (RCT) to assess the effectiveness of guaranteed income on improving housing stability, health, economic and overall well-being among 300 families experiencing homelessness in Santa Clara County.

The specific aims are:

Aim 1. Assess the effect of guaranteed income on housing stability and homelessness. The investigators will randomly select 150 households experiencing homelessness to receive guaranteed income equivalent to $1000 per month for 24 months in addition to usual care, with the remaining 150 households receiving usual care only (control group). The investigators will assess and compare measures of housing stability, housing services use and emergency shelter use at baseline, 6, 12, 18, 24, 27, 30, and 36 months after randomization. Hypothesis: Guaranteed income will improve housing stability and reduce the risk of continuing homelessness.

Aim 2. Assess the effect of guaranteed income on the health and well-being of families experiencing homelessness and their social networks. The investigators will assess and compare self-reported physical and mental health and well-being, health and social service use, employment and income volatility, financial assets and spending, food insecurity, agency, and network strain and support at baseline and then at 6, 12, 18, 24, 27, 30, and 36 months after randomization. The investigators will use a mixed methods approach, employing both validated survey instruments and qualitative interviews to assess measures of interest. Hypothesis: Families receiving guaranteed income will have improved health and well-being, and multiplier effects will accrue to their social networks.

Aim 3. Assess the effect of monthly vs a hybrid payment strategy (larger up-front lump sum plus a smaller monthly sum) on housing stability, health, and well-being. Individuals in the guaranteed income group (intervention group) will self-select whether they prefer to receive payments in a a) monthly ($1,000/month x 12 months) vs b) hybrid payment schedule ($6,500 x 1 month, then $500 x 11 month), with the option to change payment schedules after the first 12 months. Hypothesis: Individuals receiving a hybrid model of payments will obtain and sustain positive changes in stable housing and well-being more successfully over time compared to monthly payments.

Interventions

• Other Guaranteed Income
  Guaranteed income payments will be disbursed monthly for a total of 24 months to participants who are randomized to the guaranteed income intervention group. Participants will be given the choice to select from one of two different payment strategies (equal monthly payments of $1,000/month vs hybrid payment schedule with initial amount of $6,500 the first month followed by $500/month x 11 months); payment strategy preferences will be re-assessed after 12 months. The choice of payment strategy wi
• Other Public Benefits Information Session
  All participants (both the control and intervention groups) will be offered the option of attending a Public Benefits Information Session during which they will receive a comprehensive resource directory of public benefit, assistance, and social service programs available to residents of Santa Clara County, have the opportunity to ask questions about enrolling in those programs, and also have the opportunity to seek additional benefits navigation assistance from our community partner, Sacred Hea

Primary outcome measures

• Number of days experiencing homelessness [Time frame: At 24 months after randomization]

Secondary outcome measures (12)

• Number of days experiencing homelessness [Time frame: At 6 months after randomization]
• Number of days experiencing homelessness [Time frame: At 12 months after randomization]
• Number of days experiencing homelessness [Time frame: At 18 months after randomization]
• Number of days experiencing homelessness [Time frame: At 27 months after randomization]
• Number of days experiencing homelessness [Time frame: At 30 months after randomization]
• Number of days experiencing homelessness [Time frame: At 36 months after randomization]
• Time to stable housing from randomization [Time frame: Up to 24 months after randomization]
• Proportion of families who obtain stable housing [Time frame: At 6 months after randomization]
• Proportion of families who obtain stable housing [Time frame: At 12 months after randomization]
• Proportion of families who obtain stable housing [Time frame: At 18 months after randomization]
• Proportion of families who obtain stable housing [Time frame: At 24 months after randomization]
• Proportion of families who retain stable housing after the end of the 24-month intervention period [Time frame: At 27 months after randomization]

Eligibility criteria

Inclusion criteria

• ≥18 years of age at baseline visit/assessment
• Experiencing homelessness, as defined by:

• The HEARTH Act; or
• Living in a public or private space intended for temporary (≤6 month) residence, such as residing in a hotel/motel;
• Residing in a space without a legal right to the space and therefore being at threat of being asked to leave at any time (i.e., no lease); and/or
• Being in a shared living situation intended to be temporary (i.e., being 'doubled up' due to lack of available and/or affordable housing).
• Vulnerability-Index Service Prioritization Decision Assistance Tool (VI-SPDAT) score within the eligibility range for referral to rapid rehousing assistance programs in Santa Clara County (score of 4-8 for households), if available at the time of study entry.

\- The VI-SPDAT score is commonly used by housing assistance service providers to prioritize households for housing assistance programs, where households with scores of 0-3 are lower priority for referral to programs, and households with scores of 9+ are recommended for referral to more intensive housing services such as permanent supportive housing (which combine affordable housing assistance with voluntary support services including health and mental health care, case management and other social supportive services). Households with a score of 4-8 are considered most appropriate for referral to housing assistance programs that may not offer additional supportive services.

• Living in a household with ≥1 dependent children (i.e., ≤17 years of age at the time of study entry)
• Written informed consent (and assent when applicable) obtained from participant or participant's legal representative and ability for participant to comply with the requirements of the study.

Exclusion criteria

• Substantial to severe level of problematic substance use as defined by the validated Drug Abuse Screening Test (DAST-10) (score of 6-8 or 9-10, respectively).
• Hazardous or harmful alcohol consumption, or active and severe alcohol use disorder as defined by the validated Alcohol Use Disorders Identification Test (AUDIT) (score of 8-14 and ≥15, respectively).

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

United States · 2 centers

• ¡Sí Se Puede! Collective — San Jose
• Santa Clara County Office of Supportive Housing — San Jose

Publications

• Gibson M, Hearty W, Craig P. The public health effects of interventions similar to basic income: a scoping review. Lancet Public Health. 2020 Mar;5(3):e165-e176. doi: 10.1016/S2468-2667(20)30005-0. PMID 32113520
• Bastagli F., Hagen-Zanker J., Harman L., Barca V., Sturge G., Schmidt T. (2019). The Impact of Cash Transfers: A Review of the Evidence from Low- and Middle-income Countries. Journal of Social Policy, 48(3), 569-594. doi:10.1017/S0047279418000715
• Aubry T, Bloch G, Brcic V, Saad A, Magwood O, Abdalla T, Alkhateeb Q, Xie E, Mathew C, Hannigan T, Costello C, Thavorn K, Stergiopoulos V, Tugwell P, Pottie K. Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review. Lancet Public Health. 2020 Jun;5(6):e342-e360. doi: 10.1016/S2468-2667(20)30055-4. PMID 32504587
• Pinto AD, Perri M, Pedersen CL, Aratangy T, Hapsari AP, Hwang SW. Exploring different methods to evaluate the impact of basic income interventions: a systematic review. Int J Equity Health. 2021 Jun 16;20(1):142. doi: 10.1186/s12939-021-01479-2. PMID 34134715
• Gubits D, Shinn M, Wood M, Brown SR, Dastrup SR, Bell SH. What Interventions Work Best for Families Who Experience Homelessness? Impact Estimates from the Family Options Study. J Policy Anal Manage. 2018;37(4):735-66. PMID 30272428
• Forchuk C, MacClure SK, Van Beers M, Smith C, Csiernik R, Hoch J, Jensen E. Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and 'No Fixed Address'. J Psychiatr Ment Health Nurs. 2008 Sep;15(7):569-75. doi: 10.1111/j.1365-2850.2008.01266.x. PMID 18768009
• Forget E.L. The town with no poverty: The health effects of a Canadian guaranteed annual income field experiment. Canadian Public Policy. 2011;37(3):283-305.
• Morton, M. H., Chavez, R., Kull, M. A., Carreon, E. D., Bishop, J., Daferede, S., Wood, E., Cohen, L., & Barreyro, P. (2020). Developing a direct cash transfer program for youth experiencing homelessness: Results of a mixed methods, multistakeholder design process. Chicago, IL: Chapin Hall at the University of Chicago.

Identifiers

NCT: NCT05698498 · 21-35573

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗