Homeless Persons
Conditions
Brief summary
The objectives of this study are to test an evidence-based model for improving primary and preventive care engagement among homeless Veterans not currently receiving care and to demonstrate the additive benefit of primary care-based treatment engagement by this population.
Detailed description
One out of three homeless men and nearly one quarter of all homeless adults are Veterans. This translates to almost 200,000 Veterans being homeless on any given night. The Department of Veteran Affairs (VA) is a major service provider to homeless persons and has developed several very successful and innovative programs that have been effective in securing housing, economic stability and needed services for these men and women. However, despite these efforts in many communities, Veterans are not accessing these services despite aggressive outreach and state-of-the art programming. The investigators are conducting a prospective randomized controlled trial to test the hypothesis that a personalized health assessment linked to community outreach is more likely to both engage the homeless Veteran in a primary care based chronic disease management model and to sustain that care and associated behavior changes necessary to exit homelessness. The key questions to be addressed in this study are: (1) Will a community-based health-oriented outreach increase health seeking behavior in the intervention group?; (2) can initial engagement be sustained in a continuity care model in this population?; (3) will this intervention facilitate changes/improvements in health seeking behavior that include participation in substance abuse treatment care, compliance with mental health care, and enrollment in VA-based employment/financial support programs?; and (4) can this intervention impact chronic disease management of key cardiovascular risk indicators that disproportionately affect homeless persons?; and (5) do any observed changes correlate with serial behavioral measures and qualitative assessments? The investigators' working hypothesis is that a targeted outreach to homeless persons that capitalizes on either established or newly realized physical health concerns to affect both health seeking behavior and sustained behavior change. It is grounded in two complementary behavioral models: the Behavioral Model for Vulnerable Populations and the body of research describing intrinsic versus extrinsic motivators for sustained behavior change. Two hundred and eighty homeless Veterans will be randomized to receive either a personalized health assessment based outreach or usual care (social work/housing focused) outreach. Baseline assessments will include demographics, medical, mental health and substance use co-morbidities, pre-intervention health seeking behavior, readiness for behavior change (URICA), motivation for health care. Serial assessments at months 1, and 6 will assess evolving readiness and motivation as well as changes in their homeless status (sheltering, employment/income, etc.) Actual utilization of services will be assessed using the CPRS electronic medical records.
Interventions
BEHAVIORALRN Brief Intervention
RN administered personal health assessment along with a brief intervention for behavior change administered to homeless veterans in the community
BEHAVIORALSocial Worker Outreach
Social worker will encounter homeless veteran in the community and encourage to come to the VA for care
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* VA eligible * currently homeless
Exclusion criteria
* cognitively impaired * not planning on staying in area for next 6 months * currently enrolled in VA primary care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Receipt of Primary Care at the VA | within 4 weeks of intervention | The primary aim of this study was to conduct a randomized controlled trial of different interventions aimed at increasing rates of treatment engagement among a community sample of treatment-naive homeless veterans. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Arm 1: RN-based Medical Outreach, Administration of a Personal RN-based medical outreach, administration of a personal health assessment and brief intervention
Personal Health Assessment/brief intervention: RN administered personal health assessment along with a brief intervention for behavior change administered to homeless veterans in the community | 83 |
| Arm 2: Social Work Based Outreach (Usual Care) Social work based outreach (usual care)
Social work administered outreach: Social worker will encounter homeless veteran in the community and encourage to come to the VA for care | 101 |
| Total | 184 |
Baseline characteristics
| Characteristic | Arm 2: Social Work Based Outreach (Usual Care) | Arm 1: RN-based Medical Outreach, Administration of a Personal | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 4 Participants | 4 Participants | 8 Participants |
| Age, Categorical Between 18 and 65 years | 97 Participants | 79 Participants | 176 Participants |
| Age, Continuous | 48.5 years STANDARD_DEVIATION 10.2 | 48.8 years STANDARD_DEVIATION 11.6 | 48.6 years STANDARD_DEVIATION 10.8 |
| Region of Enrollment United States | 101 participants | 83 participants | 184 participants |
| Sex: Female, Male Female | 4 Participants | 6 Participants | 10 Participants |
| Sex: Female, Male Male | 97 Participants | 77 Participants | 174 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Receipt of Primary Care at the VA
The primary aim of this study was to conduct a randomized controlled trial of different interventions aimed at increasing rates of treatment engagement among a community sample of treatment-naive homeless veterans.
Time frame: within 4 weeks of intervention
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1: Outreach | Receipt of Primary Care at the VA | 50 participants |
| Arm 2: Usual Care | Receipt of Primary Care at the VA | 39 participants |