Adherence, Patient, Health Behavior, Mental Health Impairment, Substance Use Disorders
Conditions
Keywords
Case Management, Homelessness, Smartphone, Health Related Quality of Life, Mental Health, Substance Use Disorders
Brief summary
There is a significant revolving door of incarceration among homeless adults, a population with substantial health disparities. Homeless adults who receive the professional coordination of individualized care (i.e., case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be re-incarcerated. The proposed study will use mobile technology to address these barriers and fill gaps in the understanding of the causes of the revolving door of homeless incarceration. This research represents a step toward integrated service connection and healthcare service provision for one of the most underserved, high need, and understudied populations in the United States. Smart phone apps that increase the use of available healthcare services and identify predictors of key outcomes (e.g., homelessness, re-arrest, medication compliance) could be used to reach hard to reach populations with histories of significant and persistent health disparities (e.g., homeless adults).
Interventions
BEHAVIORALIn-Person Case Management at Homeless Recovery Program
In-Person Case Management at Homeless Recovery Program
BEHAVIORALUnlimited Smartphone
Smartphone with unlimited calls, texts, and data plan
BEHAVIORALSmartphone Based Case Management (SPCM) app
Smartphone Based Case Management app
Sponsors
The University of Texas Health Science Center, Houston
National Institutes of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
University of Oklahoma
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* released from Dallas County Jail in the past month * plan to reside in the Dallas area for the next year * enrolled in The Bridge Homeless Recovery Program * willing and able to attend the baseline visit, randomization visit, and the 1, 3, and 6-month follow-up visits * score ≥ 4 on the REALM-SF indicating \> 6th grade English literacy level * score \>24 on the Mini-Mental State Exam indicating no substantial cognitive impairment.
Exclusion criteria
* Cannot read English * Under the age of 18
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Case Management Sessions Completed | 6-month follow-up | Total number of sessions completed between the randomization visit and 6-month follow-up |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Homeless Nights | 6 months | Total number of self-reported homeless nights over the 6 month study period (via Timeline Follow Back Procedures). Participants with any missing are excluded. |
| Number of Re-arrests | 12 months | Total number of times each participant is booked into Dallas County Jail (using jail arrest records) |
| Alcohol Use | 6 months | Number of days of alcohol use (via Timeline Follow Back procedures). Any participant that missed any of the follow-ups are missing. |
| Drug Use | 6 months | Number of days of drug use (via Timeline Follow Back procedures). Any participant that missed any of the 3 follow-ups are missing. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Usual Case Management (UCM) Group receives standard case management at the shelter
In-Person Case Management at Homeless Recovery Program: In-Person Case Management at Homeless Recovery Program | 136 |
| UCM + Smartphone Group receives standard case management and an unlimited smartphone
In-Person Case Management at Homeless Recovery Program: In-Person Case Management at Homeless Recovery Program
Unlimited Smartphone: Smartphone with unlimited calls, texts, and data plan | 134 |
| Smartphone Based Case Management (SPCM) Group receives standard case management and an unlimited smartphone with the SPCM app
In-Person Case Management at Homeless Recovery Program: In-Person Case Management at Homeless Recovery Program
Unlimited Smartphone: Smartphone with unlimited calls, texts, and data plan
Smartphone Based Case Management (SPCM) app: Smartphone Based Case Management app | 133 |
| Total | 403 |
Baseline characteristics
| Characteristic | Usual Case Management (UCM) | Total | Smartphone Based Case Management (SPCM) | UCM + Smartphone |
|---|---|---|---|---|
| Age, Continuous | 39.68 years STANDARD_DEVIATION 10.63 | 40.34 years STANDARD_DEVIATION 10.93 | 40.46 years STANDARD_DEVIATION 10.84 | 40.88 years STANDARD_DEVIATION 11.37 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 17 Participants | 51 Participants | 17 Participants | 17 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 119 Participants | 352 Participants | 116 Participants | 117 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants | 7 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 4 Participants | 2 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 86 Participants | 240 Participants | 67 Participants | 87 Participants |
| Race (NIH/OMB) More than one race | 11 Participants | 40 Participants | 19 Participants | 10 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 18 Participants | 11 Participants | 5 Participants |
| Race (NIH/OMB) White | 33 Participants | 94 Participants | 32 Participants | 29 Participants |
| Region of Enrollment United States | 136 participants | 403 participants | 133 participants | 134 participants |
| Sex: Female, Male Female | 18 Participants | 56 Participants | 19 Participants | 19 Participants |
| Sex: Female, Male Male | 118 Participants | 347 Participants | 114 Participants | 115 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 136 | 0 / 134 | 0 / 133 |
| other Total, other adverse events | 0 / 136 | 0 / 134 | 0 / 133 |
| serious Total, serious adverse events | 0 / 136 | 0 / 134 | 0 / 133 |
Outcome results
Primary
Number of Case Management Sessions Completed
Total number of sessions completed between the randomization visit and 6-month follow-up
Time frame: 6-month follow-up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Usual Case Management (UCM) | Number of Case Management Sessions Completed | 9.39 number of sessions | Standard Deviation 11.4 |
| UCM + Smartphone | Number of Case Management Sessions Completed | 7.69 number of sessions | Standard Deviation 10.79 |
| Smartphone Based Case Management (SPCM) | Number of Case Management Sessions Completed | 8.46 number of sessions | Standard Deviation 11.17 |
Secondary
Alcohol Use
Number of days of alcohol use (via Timeline Follow Back procedures). Any participant that missed any of the follow-ups are missing.
Time frame: 6 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Usual Case Management (UCM) | Alcohol Use | 14.26 days | Standard Deviation 31.93 |
| UCM + Smartphone | Alcohol Use | 20.70 days | Standard Deviation 39.09 |
| Smartphone Based Case Management (SPCM) | Alcohol Use | 26.57 days | Standard Deviation 41.37 |
Secondary
Drug Use
Number of days of drug use (via Timeline Follow Back procedures). Any participant that missed any of the 3 follow-ups are missing.
Time frame: 6 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Usual Case Management (UCM) | Drug Use | 6.33 days | Standard Deviation 16.75 |
| UCM + Smartphone | Drug Use | 22.34 days | Standard Deviation 48.32 |
| Smartphone Based Case Management (SPCM) | Drug Use | 17.61 days | Standard Deviation 32.64 |
Secondary
Number of Homeless Nights
Total number of self-reported homeless nights over the 6 month study period (via Timeline Follow Back Procedures). Participants with any missing are excluded.
Time frame: 6 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Usual Case Management (UCM) | Number of Homeless Nights | 161.48 number of nights | Standard Deviation 41.64 |
| UCM + Smartphone | Number of Homeless Nights | 167.12 number of nights | Standard Deviation 31.19 |
| Smartphone Based Case Management (SPCM) | Number of Homeless Nights | 159.00 number of nights | Standard Deviation 39.09 |
Secondary
Number of Re-arrests
Total number of times each participant is booked into Dallas County Jail (using jail arrest records)
Time frame: 12 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Usual Case Management (UCM) | Number of Re-arrests | 0.55 number of arrests | Standard Deviation 0.82 |
| UCM + Smartphone | Number of Re-arrests | 0.64 number of arrests | Standard Deviation 1.01 |
| Smartphone Based Case Management (SPCM) | Number of Re-arrests | 0.61 number of arrests | Standard Deviation 1.06 |