Opinion: City Study on Pregnant People in Shelter Raises Serious Concerns

Instead of providing proven systems of patronage to pregnant people experiencing homelessness the city is choosing to delay help through an unnecessary evaluation failing to deliver what it already knows works Department of Homeless Services Prevention Assistance and Temporary Housing PATH intake center in the Bronx Photo by Adi Talwar This spring New York City proposed a new research investigation on pregnant people seeking shelter that raises crucial ethical and methodological concerns The review would randomly assign pregnant people arriving at the city s Prevention Assistance and Temporary Housing PATH intake centers to one of three groups one receiving monthly to stay with family or friends via the Pathway Home activity one instantly receiving CityFHEPS vouchers to move into permanent affordable housing and a control group that would remain in a shelter awaiting their turn to receive CityFHEPS vouchers The city s stated goal is to determine which intervention helps pregnant people avoid or shorten shelter stays While it s major that protocol be guided by research-backed evidence this analysis s design which withholds housing assistance from subjects based on chance raises considerable ethical concerns while failing to meet methodological standards While random assignment through a Randomized Controlled Trial RCT can help identify results of scientific intervention denying housing assistance to a group of pregnant people does not meet critical scientific and ethical standards We already know that housing insecurity during pregnancy is associated with increased pregnancy complications and adverse birth outcomes risks that cannot be justified in the name of scientific inquiry The Belmont Analysis issued by the federal executive in in response to egregious research practices like the Tuskegee Syphilis Analysis lays out three foundational principles for ethical research involving human subjects respect for persons beneficence and justice This proposed examination violates all three It undermines respect for persons by involving a highly vulnerable population pregnant people experiencing homelessness under circumstances that might challenge the validity of informed consent While the Department of Homeless Services DHS has stated that the venture is voluntary the prospective of immediate access to life-altering benefits like CityFHEPS or Pathway Home may make consent feel less like a choice and more like a necessity The investigation violates beneficence by exposing participants in the control group to prolonged housing instability rather than minimizing hazard and maximizing doable benefits Additionally it randomly assigns specific to Pathway Home even if they lack eligible hosts depriving pregnant people of meaningful help Furthermore Pathway Home fails to assess whether the host home may pose a exposure of interpersonal violence Ultimately the research also violates justice by placing the burden of research on a marginalized group while withholding proven housing benefits Under the proposal only those assigned to CityFHEPS would get immediate access without typical requirements leaving the control group unfairly denied quick access to stability based solely on chance a proposal that likely would not pass ethical review from any Institutional Review Board IRB a type of oversight body meant to protect vulnerable patients and ensure studies meet basic ethical standards Unfortunately the city has decided to move forward with the examination without seeking approval from an IRB Even setting aside serious ethical concerns the survey fails on scientific grounds RCTs require comparable groups and equal access to interventions but this investigation fails on both counts Pathway Home requires a willing host yet participants are assigned before verifying eligibility meaning that certain are placed in groups they cannot benefit from If someone placed in the Pathway Home group has no family or friends to stay with they are structurally excluded Treating these people as if they had access to the campaign skews evidence and distorts conclusions drawn from the records Beyond ethics and design flaws the survey s research goals are vague The city maintains its goal is to track the three groups over time measuring factors such as days in shelter and housing placements but these metrics are poorly defined The city regularly touts the success of the CityFHEPS campaign in helping people move from shelter to permanent housing Yet instead of providing proven systems of patronage to pregnant people experiencing homelessness the city is choosing to delay help through an unnecessary investigation failing to deliver what it already knows works Alison Wilkey is director of ruling body affairs and strategic campaigns for Coalition for the Homeless Rachel Swaner is vice president of plan research and advocacy at the District System Society The post Opinion City Examination on Pregnant People in Shelter Raises Serious Concerns appeared first on City Limits