Emergency Department Visits, Housing Stability, Employment, Sleep Quality, Health-Related Quality-of-Life
Conditions
Keywords
Emergency Department Usage, Housing, Employment, Employment-Based Housing, Quality of Life
Brief summary
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.
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.
Interventions
OTHEREmployment-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.
OTHERVocational 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.
OTHERResources
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.
Sponsors
The University of Texas Health Science Center, Houston
National Institute of Nursing Research (NINR)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergency Department (ED) Visits | From enrollment to 12 months after enrollment | The number of ED visits during the study period via administrative data and self-report |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Employment | From enrollment to 12 months after enrollment | The employment status of the participant will be assessed via an assessment of job acquisition during the follow-up period. |
| Housing stability | From enrollment to 12 months after enrollment | 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. |
| Health-Related Quality of Life | From enrollment to 12 months after enrollment | 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. |
| Sleep Quality | From enrollment to 12 months after enrollment | Validated with the Mini Sleep Questionnaire, a widely used scale to assess sleep quality and daytime sleepiness with higher scores indicating reduced sleep quality. |
Countries
United States
Contacts
CONTACTVanessa Schick, PhD
CONTACTJack Tsai, PhD
Outcome results
None listed