Experimental Trial of an Employment-Based Housing Program for Adults at Risk of Homelessness (Project HIRE)

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.

Study Overview

• Status: Enrolling by invitation
• Conditions: Sleep Quality; Employment; Emergency Department Visits; Health-Related Quality-of-Life; Housing Stability
• Intervention / Treatment: Other: Employment-Based Housing; Other: Vocational Services; Other: Resources

Detailed Description

Research Design/Study Arms. Patients discharged from the emergency department of the largest safety net hospitals in Houston, TX (N=750) will be enrolled in a three-arm pragmatic single-blind randomized controlled trial. Clients will be randomly assigned on a 1:1 ratio to one of the three arms: 1) Employment-Based Housing (EBH) facilitated by Entryway Houston; 2) Passive control intervention (PC) which will involve the provision of a list of available community resources; and 3) Active control intervention (AC) which will involve the provision of basic vocational services. The AC intervention will be modeled somewhat after existing community workforce development programs so there is ecological validity and having this additional treatment arm will strengthen the rigor of the trial. Ensuring that both EBH and AC consistently share key characteristics will allow them to directly compare the EBH model to AC.

Study materials will be available in English and Spanish. Individuals will be screened to determine whether they are at risk of homelessness and have an employment need, are 18+ years old, and report a willingness to pass an employer-mandated drug screening and criminal background checks if required by their employer.

• Study Type: Interventional
• Enrollment (Estimated): 750
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • UTHealth Houston

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• English and Spanish-speaking individuals
• Aged 18+
• Recently discharged from a Harris Health System emergency departments
• Screen positive for risk of homelessness and employment need per the Centers Accountable Health Communities Health-Related Social Needs Screening Tool.

Exclusion Criteria:

• Participants with a conservator
• Unwillingness to participate a background and drug test

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Employment-Based Housing; Experimental intervention	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.
Active Comparator: Vocational Services; Active control intervention	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.
Placebo Comparator: Resources; Passive control intervention	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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emergency Department (ED) Visits	The number of ED visits during the study period via administrative data and self-report	From enrollment to 12 months after enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Employment	The employment status of the participant will be assessed via an assessment of job acquisition during the follow-up period.	From enrollment to 12 months after enrollment
Housing stability	Housing assessment used in the Collaborative Initiative to End Chronic Homelessness, assessment of housing situation in previous 30 days, and assessment of housing situation the previous night.	From enrollment to 12 months after enrollment
Health-Related Quality of Life	Short From Health Survey-8 (SF-8) Health survey, a widely used tool which generates mental health and physical component scores with higher scores indicating more positive health.	From enrollment to 12 months after enrollment
Sleep Quality	Validated with the Mini Sleep Questionnaire, a widely used scale to assess sleep quality and daytime sleepiness with higher scores indicating reduced sleep quality.	From enrollment to 12 months after enrollment

Collaborators and Investigators

• Sponsor: The University of Texas Health Science Center, Houston
• Collaborators: National Institute of Nursing Research (NINR)

Study record dates

Study Major Dates

• Study Start (Actual): May 9, 2026
• Primary Completion (Estimated): June 30, 2030
• Study Completion (Estimated): June 30, 2030

Study Registration Dates

• First Submitted: March 3, 2026
• First Submitted That Met QC Criteria: March 9, 2026
• First Posted (Actual): March 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 18, 2026
• Last Update Submitted That Met QC Criteria: May 13, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Quality of Life; Employment; Housing; Emergency Department Usage; Employment-Based Housing
• Additional Relevant MeSH Terms: Nervous System Diseases; Mental Disorders; Sleep Wake Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Initiation and Maintenance Disorders; Delivery of Health Care; Health Care Quality, Access, and Evaluation; Health Care Economics and Organizations; Health Planning; Health Resources
• Other Study ID Numbers: HSC-SPH-25-0887; 1R01NR021997-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: After the end of the performance period, study data will be uploaded to the OpenICPSR data repository. OpenICPSR is a self-publishing repository for social, behavioral, and health sciences research data. De-identified data from our randomized controlled trial will be made available through this repository for others.
• IPD Sharing Time Frame: Data will be shared no later than the time of an associated publication or the end of performance period of the extramural award that generated the data, whichever comes first.
• IPD Sharing Access Criteria: Scientific data will be made available at the data repository OpenICPSR. Any identifying variables will not be deposited due to privacy and confidential concerns, but access to the deposited data will otherwise not be controlled.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No