Homelessness
Conditions
Keywords
Care Management, Homeless, Implementation, Mental Health Care, Quality Assurance, Improvement
Brief summary
The VA Grant and Per Diem (GPD) case management aftercare program provides six months of case management for homeless-experienced Veterans undergoing housing transitions. This Partnered Implementation Initiative (PII) proposes to implement and evaluate Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-in 32 GPD case management aftercare sites across the nation.
Detailed description
The VA Grant and Per Diem case management (GPD-CM) program provides six months of case management for homeless-experienced Veterans (HEVs) undergoing housing transitions. At present, no specific case management paradigm is required in the GPD-CM program, resulting in practice variation across sites. This Partnered Implementation Initiative (PII) implements Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-at 32 VA GPD-CM sites. The investigators will use the Replicating Effective Programs (REP) implementation bundle to support CTI implementation at all 32 sites. Half of these sites will also receive 9 months of external facilitation (enhanced REP) as additional support for CTI implementation. In a type 3 hybrid trial, the investigators will use mixed methods to examine the impacts of REP versus enhanced REP. Using trial data, the investigators will develop a business case analysis and implementation playbook for the investigators' program partners to support continued CTI spread and sustainment in the GPD-CM program.
Interventions
BEHAVIORALCritical Time Intervention
An evidence-based, structured, and time-limited case management practice
Site-specific support to help sites develop tailored plans to implement CTI.
A stakeholder-informed training and technical assistance implementation strategy
Sponsors
University of California, Los Angeles
Center for the Advancement of Critical Time Intervention
University of Southern California
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
The investigators are implementing Critical Time Intervention (CTI), an evidence-based, time limited case management practice for individuals experiencing homelessness. The investigators will be randomizing sites receiving CTI into one of two levels of implementation support (low vs. high intensity support).
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Grant and Per Diem (GPD) case management aftercare grantees in 7 Veterans Integrated Service Networks (VISN), all of whom provide 6-months of case management to Veterans who have experienced homelessness.
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fidelity to CTI | 12 months after implementation start | % of Sites with adequate fidelity to CTI at 12 months, as measured by the CTI fidelity scale |
| Sustainment of CTI | 18 months after implementation start | % of Sites with adequate fidelity to CTI at 18 months, as measured by the CTI fidelity scale |
| Dollars spent delivering CTI at each site | Between 6 and 18 months after implementation start | Case manager salary and benefits |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cost of Implementation Strategies | Through study completion, 4 years | Dollars spent on REP versus enhanced REP |
| Housing stability | Between 6 and 18 months after implementation start | Days between entry into the GPD case management program and indicator of housing instability |
| Outpatient service use | Between 6 and 18 months after implementation start | Number of outpatient appointments |
| Return on Investment (ROI) of CTI | 6-, 12-, and 18-months after GPD case management program enrollment | Dollars saved via improved housing stability and decreased hospitalizations among patients engaged in CTI versus control participants |
| Cost of CTI as Implemented | Between 6 and 18 months after implementation start | Mean monthly cost of CTI case management per GPD case management Veteran served, compared to the mean monthly cost in the non-CTI GPD case management programs. |
| Hospitalization rates | Between 6 and 18 months after implementation start | Number of days between entry into the GPD case management program and hospitalization, number of hospitalizations, number of bed days |
Countries
United States
Outcome results
None listed