m-Health to Increase Service Utilization in Recently Incarcerated Homeless Adults
Phase: PHASE3
Conditions: Substance Use Disorders, Mental Health Impairment, Health Behavior, Adherence, Patient
Sponsor: University of Oklahoma

Study Protocol
Protocol Title: m-Health to Increase Service Utilization in Recently Incarcerated Homeless Adults
Principal Investigators: Michael S. Businelle, Ph.D. and Jennifer Gonzalez, Ph.D.
Co-Investigators: Darla Kendzor, Ph.D.
Study Coordinator: James Barnes
Population: A total of 462 homeless men and women (>18 years old) who enroll in the Bridge Homeless 
Assistance Center’s Homeless Recovery Program after release from either the Dallas county jail or the Dallas 
City Jail will be recruited.
Number of Sites: Single site
Study Duration: This is a 5-year study
Subject Duration: Participants will complete assessments during 5 in-person visits (i.e., baseline visit, 
randomization visit [within 72 hours of the baseline visit], and 1-, 3- and 6-month follow-up visits). We will also 
examine arrest records to determine if participants are arrested within 12 months of the baseline visit. If in- 
person visits are not possible, follow-up visits may be completed in the community, by phone, or by sending a 
link through text or e-mail.
General Information:
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. Specifically, 462 homeless adults who enroll in a shelter based 
Homeless Recovery Program after release from county jail will be randomly assigned to one of three treatment 
groups: 1) usual shelter-based case management (UCM), 2) UCM plus a study provided smartphone 
(UCM+SP), and 3) UCM with a study provided smartphone that is preloaded with an innovative care 
management app (SPCM). The SPCM app is an extension of the research team’s previous successful work 
using mobile devices to assess and modify health behaviors in low income and homeless adults. Those 
assigned to SPCM will receive smartphones that will prompt (twice weekly) connections to shelter based case 
managers. The app will also offer direct links to care managers (available during normal business hours) and 
crisis interventionists (available 24 hours a day, 7 days a week), with the touch of a button. It is hypothesized 
that SPCM will increase utilization of case and crisis management services thereby addressing unmet needs 
(e.g., obtaining shelter, clothing, counseling, identification) and reducing homelessness and re-arrest. Another 
key focus of this study is to address gaps in the understanding of mechanisms that drive re-arrest and 
homelessness by using traditional in-person (i.e., baseline, 1, 3, and 6 months post-baseline) and smartphone 
based (i.e., daily for 6 months) assessment methods to identify distal and proximal predictors (e.g., affect, 
thoughts, behaviors, events) of continued homelessness and arrest. This research represents a step toward 
integrated service connection and healthcare service provision for one of the most undeserved, high need, and 
understudied populations in the United States. Smartphone 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).
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

Background Information:
At least 1.5 million people experience homelessness each year in the United States (US) and 6.2% of US adults 
have been homeless at some point in their lifetime.2 Homeless adults are more likely to be male, single, and African 
American,1 and have average life expectancies that are 8 (women) to 13 (men) years shorter than domiciled adults.3 
Homeless adults are more likely to spend time in jail than domiciled adults,4 and as many as 32% of jailed adults 
report being homeless in the year prior to their arrest.4,5 Further, homeless adults are more likely to return to jail 
after incarceration than domiciled adults.6 In Texas, more than half of adults released from county jails are re- 
arrested within one year,7 and many of those re-arrested are homeless.8 In the Dallas County
Jail alone, 5530 homeless adults were incarcerated in 2013 at an estimated cost of $12,557,406.9 
Incarcerated homeless adults have a variety of risk factors that increase the likelihood of re-arrest. For
instance, homeless inmates are more likely than domiciled inmates to have histories of mental illness and/or 
substance use disorders.4,8 Our own research has indicated that homeless adults released from jail in the past 
year were more likely than those not recently incarcerated to have a history of substance use and/or mental 
health problems.10 Thus, there is a strong need for mental health and substance abuse treatment among 
homeless adults following their release from incarceration. Studies have indicated that the link between 
homelessness and incarceration11 can be attenuated through the use of case management services.12-14 The 
overall significance and scope of this issue was eloquently stated by Kushel and colleagues in their evaluation 
of the “revolving door” of homeless incarceration,11 “High rates of imprisonment among homeless populations 
may be the end result of a system that does not provide access to timely services, including access to housing, 
health care, mental health care, and substance abuse treatment, and systems that have obstacles preventing 
receipt of these services by people exiting prison” (p. 1751). Thus, individuals who leave jail and return to the 
community without stable housing are at increased risk for premature mortality15,16 and re-arrest6,8 and are 
critically in need of interventions that increase access to services.
Case management is simply the professional coordination of individualized care.17 Specifically, case 
managers link individuals with relevant services and help them to overcome barriers to service utilization. In 
addition to linking clients with services, case managers engage in client assessment, practical support, service 
planning, advocacy, and monitoring of service utilization and progress.14,18,19 More intensive case management 
services (often employed with homeless adults) include a multi-dimensional approach with integrated 
counseling, independent living skills building, assertive outreach, and crisis intervention.20 Case management 
has been shown to be effective in improving housing stability, mental health, quality of life, and social 
functioning; while reducing substance use, hospitalization stays, and incarceration in at-risk populations21-23 
including homeless and recently incarcerated adult populations (see meta-analysis19).
Homeless individuals have many needs following release from incarceration including housing, 
employment, substance abuse and mental health treatment, medical care, medication, social support, proof of 
identification, and legal aid.4,5,24,25 Although public services often exist to address these needs, there are many 
barriers to service utilization and obtaining stable housing.26 For example, it is difficult for an individual to 
identify which services and housing placement programs are and are not available to those with histories of 
arrest, substance abuse, and serious mental illness.13,27-29 Furthermore, failure to provide valid identification 
(e.g., driver’s license or birth certificate) limits the ability to obtain employment assistance and disability 
services, and is often rationale for arrest by police.26 In addition, lack of access to transportation reduces the 
ability of this population to access free and available community services (e.g., food, clothing, temporary 
housing, obtaining identification).30 There are also many specific barriers to the utilization of case management 
among homeless adults, including lack of a permanent address, inconsistent access to phone service, lack of 
transportation to case management visits, and not having easy access the phone numbers of service 
providers.3,31-35 These factors reduce the ability of homeless adults to schedule appointments and limits the 
ability of providers to contact patients regarding appointments.36,37
Our own research in the summer of 2013 indicated that cell phone ownership is common among homeless 
adults, with 58.4% reporting that they had active cell phone service (there are government programs that pay 
for cell phone service for very low-income adults). Other studies have indicated that 70% of homeless adults 
who have cell phones use them to connect with peers and family members, 32% carry a phone for safety 
reasons (e.g., access to emergency services), and 23% use a phone to communicate with current or potential
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

employers.35-37 Another study demonstrated that although 62% of homeless youths possessed activated cell 
phones, only 17% were using their cell phone to connect to case managers.36 Thus, initial evidence indicates 
that cell phones are already being used in homeless populations, but few homeless adults are using their 
phones to contact case managers who have the primary role of linking individuals to care and coordinating care 
for those in need. Thus, a significant opportunity for novel interventions is being missed.
Smartphone apps may be a novel way to offer direct access to case management, and may be a practical and 
useful means by which to reduce barriers to service utilization in vulnerable and hard to reach populations. It is 
notable that smartphone service plans are no longer cost prohibitive to conducting intervention research. For 
instance, in our previous studies that have used smartphones, the cost for an activated smartphone with monthly 
talk, text, and internet has been under $30 per month (the cost for the phone is included in the monthly fee), which 
is equivalent to less than the cost of ½ of 1 day in the Dallas County Jail.
Aside from demographic variables and history of mental illness and/or substance use/abuse, very few 
predictors of re-arrest and sustained homelessness have been identified.4 To date, all studies that have 
examined predictors of incarceration, re-arrest, health, and continued homelessness among homeless adults 
have used traditional in-person assessment methods that are usually conducted retrospectively or 
months/years before the predicted outcome.4,11,33,38-41 Studies have indicated that traditional assessment 
methodologies provide biased and/or inaccurate estimates due to recall bias and errors in memory 
(e.g., assessing the number of drinks consumed or level of depression or anxiety over the past week or 
month).42,43 Ecological momentary assessment (EMA), in which handheld devices are used to capture “real 
time” experiences that vary daily (or from moment to moment), is currently the most accurate way to measure 
phenomena in real time in natural settings.42,44 Although EMA has been used in a variety of populations and 
with multiple health outcomes, only one study45 outside of our own work46 has collected EMA data in homeless 
adults. The proposed study will identify key variables, measured proximally (EMA data) and distally (traditional 
in-person assessments and EMAs), that predict re-arrest and homelessness. These rich data will address 
knowledge gaps that have limited our understanding of and ability to intervene in this marginalized population.
Overall, the significance of this trial will be to evaluate a technology-driven application to increase access 
to service providers in a highly vulnerable group of homeless adults and to thereby decrease the likelihood of 
re- arrest and homelessness. In addition, we hope to improve our understanding of the proximal and distal 
factors that contribute to homelessness and incarceration recidivism. This contribution is significant because it 
is a step towards the development of practical, inexpensive, and effective interventions for homeless adults.
Objectives:
Our long-term goal is to reduce health disparities among recently incarcerated homeless adults. 
The primary study objectives will be attained by pursuing the following specific aims:
a. To compare case management and crisis management service utilization among recently 
incarcerated homeless adults who are randomized to the UCM,UCM+SP, and SPCM 
conditions. It is hypothesized that homeless adults assigned to SPCM will utilize more
case management and crisis management services than those assigned to 
UCM or UCM+SP.
b. To compare the effect of treatment condition on alcohol use, drug use, and psychological 
distress. It is hypothesized that the SPCM group will demonstrate greater improvements in each 
outcome compared to UCM+SP or UCM
c. To identify key factors (alcohol and drug use, social support, psychological distress, 
quality of life) that predict re-arrest and nights spent homeless using traditional and smart 
phone-based assessment approaches. It is hypothesized that key variables that are 
measured in- person (e.g., alcohol/drug use, perceived social support, psychological 
distress, quality of life) and via daily phone-based assessments (e.g., affect, stress, 
discrimination, alcohol/drug use) will have direct effects on re-arrest and number of 
homeless nights. These key variables are also hypothesized to mediate the relation 
between treatment condition and number of homeless nights and re-arrest.
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

Study Design:
This study is a 3-arm randomized controlled trial. Specifically, male and female homeless adults who enroll in a 
shelter based homeless recovery program following release from either the Dallas County Jail or the Dallas City 
Jail (N=462 will be randomized to one of three conditions: Usual Case Management (UCM); Usual Care plus 
Smartphone (UCM+SP); or Usual Care plus Smartphone based Case Management (SPCM). SPCM will be 
delivered through a modified version of the PI’s previously developed smartphone application (i.e., “app”) on a 
study provided smartphone. The app will not provide case management and crisis intervention services directly; 
rather, it will prompt twice weekly contact with their case manager and provide links to service providers 
through the touch of a button. Primary study outcomes are service utilization, number of homeless nights, and re- 
arrest. Another key focus of this study is to address gaps in our understanding of the factors that drive re- arrest 
and homelessness by using traditional in-person (i.e., baseline, 1, 3, and 6 months post- baseline) and 
smartphone based (i.e., daily for 6 months) assessment methods to identify distal and proximal predictors of 
continued homelessness and arrest. Arrest records will be examined to determine if participants are re-arrested 
within 12 months of study enrollment.
Participants who are randomly assigned to the UCM+SP or SPCM conditions will receive a 
smartphone at the randomization visit and they will be asked to carry it with them at all times for 6 
months (26 weeks). Date, time, location, and duration of SPCM app feature use (e.g., case manager calls) will 
be recorded by the app for future analysis. See Table 1 for a summary of study conditions.
Study Conditions
1.
Usual Case Management (UCM) group. The UCM group will receive the standard Homeless 
Recovery Program currently offered at The Bridge. In order to qualify for the standard homeless 
recovery program, individuals must complete The Bridge intake and substantiate homelessness 
(e.g., provide evidence that they spent the previous night in a shelter or jail). The Bridge intake 
includes a comprehensive needs assessment, and demographic information is obtained. Following 
intake, Bridge guests receive a day pass that grants them access to many of the services available 
at The Bridge (e.g., meals, showers, laundry, phone, mail, library, barber shop, and storage space 
for their belongings). Those who enroll in The Bridge Homeless Recovery Program receive an 
identification card and can gain access to additional services including case management, Metro 
Care (onsite mental health and substance abuse counseling), housing assistance, 
disability/veteran’s benefits assistance, job readiness training, legal aid, and bus passes. Although 
these services are freely available to all guests enrolled in The Bridge Homeless Recovery 
Program, many services are offered only during normal business hours and in-person visits are the 
norm.
Bridge case managers are licensed professional counselors and/or Master’s level clinicians who 
adhere to the Standard Case Management Model.19,47 Case managers assist homeless adults 
with: 1) developing care and housing plans; 2) making and maintaining linkages to on- and off-site 
service providers (e.g., mental health and substance abuse providers); 3) obtaining vital documents 
needed for housing and income (e.g., birth certificates, state identification, social security cards); 4) 
job readiness training and placement (if appropriate); 5) overcoming barriers related to criminal 
history; 6) development of and re-connection with support systems; and 7) transitioning from 
homelessness to appropriate housing. Case managers also advocate on behalf of homeless adults 
by serving as a connection between all agencies that will be assisting the guest, their families, and 
any other involved parties. Guests are encouraged to meet with their case managers weekly; 
however, Bridge data have indicated that those who enroll in the Bridge Homeless Recovery 
Program complete a total of 1.95 and 3.12 case management sessions in the first 1 and 6 
months of enrollment, respectively.
Bridge triage/intake specialists (i.e., Qualified Mental Health Professionals [QMHP]) are primarily 
responsible for completing the Bridge intake process with shelter guests, determining eligibility for 
the Bridge Homeless Recovery Program, and ensuring that guests are linked with onsite case 
management staff and the on/off-site service providers they need (e.g., mental health, substance
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

Table 1. SPCM group smartphone application features
abuse programs). The intake process includes behavioral/mental health and treatment history, 
substance abuse and treatment history, risk and safety assessment, medical history, criminal 
history, history of homelessness, and assessment of social support and other protective factors. 
Participants experiencing mental health crises will be directed to contact ADAPT Mobile Crisis at 
(866) 260-8000. The ADAPT phone number will be pre-programmed into the study app.
2.
UCM + Smartphone group. The UCM+SP group will receive UCM and an activated study 
smartphone. This smartphone only group (without the SPCM app) is necessary because homeless 
adults who have phones may have higher levels of social support, which may be related to mental 
health, quality of life, and their ability to obtain housing and avoid re-arrest.3,37,48 All smartphones 
will include standard cellular service that includes unlimited text messaging, unlimited minutes of 
domestic talk, and unlimited Internet access (speeds are throttled after monthly download limit is 
reached). Participants will be informed that they may use the phone to make calls, text, and use the 
internet as they wish during the 6-month course of the study. Participants randomized to the 
UCM+SP condition will receive phones with a very basic app that will only include the “Call Study 
Staff” and “Payment” functions (see Table 1) on the app home screen and will push daily. Links to 
treatment/case management resources will not be loaded onto phones for participants in UCM+SP 
condition.
3.
Smartphone Based Case Management (SPCM) group. Participants who are assigned to the
SPCM group will have access to UCM and will receive a smartphone that is preloaded with an 
innovative app that will provide direct links to services (see Table 1 for app features and Figure 1 
for a depiction of the app home screen). Smartphones and service plans will be identical to what 
is provided to the UCM+SP group. Participants in the SPCM and UCM+SP groups will be allowed 
to keep the phones as compensation at the end of the study.
Recent research has indicated that phone prompts can increase service utilization.49,50 For 
example, Lucht showed that twice weekly phone prompts increased phone-based counseling 
sessions in alcohol dependent patients.49 To increase the likelihood that SPCM group participants 
will use the resources available through the app, the phone will be programmed to automatically 
prompt/suggest a connection with their Bridge case manager twice per week.
Feature/Button
Description of feature
Call My Care 
Manager
Clicking this button will automatically call the participant’s assigned 
Bridge case manager. Individual Bridge case managers are 
assigned to all Bridge Homeless Recovery Program enrollees and 
they are available from 8:00am to 5:00pm Monday through Friday 
(see letter of support from Bridge CEO).
Call ADAPT 
Crisis Line
Clicking this button will call the free ADAPT mobile crisis line. The 
crisis line is available 24 hours a day, 7 days a week to help 
homeless individuals address and overcome crises.
Helpful 
Websites
Clicking this option will lead to a menu of websites that may be 
useful to participants (e.g., Dallas public transit routes, online 
support groups (e.g., Narcotics and Alcoholics Anonymous)
Call Study Staff
Clicking this option will connect participants to study staff if they 
encounter problems with the study phone and/or rescheduling 
missed follow-up appointments.
Payment
This button indicates the amount in gift cards that participants have 
earned for completing EMAs to date. These gift cards will be 
awarded when each participant presents at The Bridge to complete
1-,
6-month follow-up assessments (see EMA
Compensation in section 3.8.b.).
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

Specifically, the phone will ring/vibrate on two occasions each week at random times between 9:00 am and 
5:00 pm, Monday through Friday to ask participants if they would like to contact their Bridge case manager. 
Participants will be able to select “No” (this will decline the connection), “Yes” (this will prompt the phone to 
automatically call their case manager), or “Maybe later today” (this will initiate the opportunity for another 
connection with their case manager 2 hours later). Participants will be instructed to leave a voice message 
or speak with an alternate case manager when their case manager cannot be reached. We decided against 
more frequent prompts to connect with case managers (e.g., daily) because of higher participant burden 
and concern for overwhelming the case management system.
 Sources of Materials
There will be 3 sources of data for the current study: 1) in-person data collected in private rooms at The 
Bridge, at a private location in the community, by telephone or online using the REDCap software system 
when in-person visits are not possible; 2) Ecological Momentary Assessment (EMA) data collected on study 
provided smartphones; and 3) arrest data for all arrests in the City of Dallas and Dallas County provided to 
Dr. Gonzalez by the Dallas County Jail. Dallas City Jail records are publicly accessible.
1.
In-person data. Demographic, psychosocial, environmental, and behavioral data will be collected from 
all participants via traditional self-report questionnaires during 5 in-person visits (i.e., baseline visit, the 
randomization visit [within 72 hours of the baseline visit], the 1, 3- and 6-month follow-up visits) on a 
laptop or tablet computer using Questionnaire Development System (QDS) software (see detailed 
description below). If in-person visits are not possible, interviews will be conducted over the telephone 
and manually entered into the QDS system by Link2Care staff. In addition, participants will complete 
timeline follow-back measures with study researchers to determine homeless nights, alcohol use, and 
other substance use. These in person visits will occur at The Bridge Homeless Shelter or at another 
location in the community if the participant is unable to attend their appointment at The Bridge. 
Additionally, these in-person visits may be conducted over the phone when in-person visits are not 
possible, or by texting or e-mailing a link to the REDCap survey. Information regarding residency status, 
social security number and if participants are employees of The University of Oklahoma Health 
Sciences Center (OUHSC), will be collected at baseline visit using a questionnaire. This information 
will not be utilized in data analysis and is being collected for Federal Tax purposes as required by The 
University of Oklahoma Health Sciences Center. If participants earn $600 or more, OUHSC will report 
the income to the IRS and mail a form 1099 to the participant’s address by January 31 of the following 
year. 
2.
EMA data. Individuals randomized into the 2 smartphone conditions (i.e., UCM+SP and SPCM) will 
receive a smartphone at the randomization visit and will be asked to carry the phone with them at all 
times for 6 months (26 weeks). All participants randomized to a smartphone condition will be trained to 
use the smartphone app for data collection and resource utilization purposes, and participants will be 
instructed to call study staff in the event that they are having difficulty with the phone. These participants 
will be asked to complete one EMA each day, administered through a secure smartphone application 
(i.e., app). Smartphones will be programmed to automatically cue an assessment each day 30 minutes 
after the participant’s self-reported usual waking time. The “usual waking time” is reported by the 
participant to the research staff at the randomization visit, and may vary by day of the week. If the 
participant does not acknowledge the EMA, it will be rescheduled for later that day to increase the 
likelihood that EMAs are completed. Participants will respond to EMA questions on the smartphone 
using the touch screen. Daily EMAs will inquire about the substance use, sleeping arrangements, 
stress, discrimination episodes, etc., from the previous day. In addition, EMAs will ask participants to 
rate their emotional state (e.g., affect, stress level,). The smartphone app will also collect geolocation 
data up to every five minutes of the study, regardless of app use.
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

3.
Arrest data. The Dallas County Jail collects and maintains a dataset that contains demographic 
characteristics (including homelessness status), and arrest data on all individuals who are arrested in 
the County. Dr. Gonzalez will have access to this dataset for the purposes of this study (see Director 
of Criminal Justice Letter of Support). Specifically, Dr. Gonzalez will receive a complete updated 
and encrypted dataset of all arrested study participants from a Dallas County employee every 6 months. 
Upon receipt, she will search the dataset for study participants and record whether a participant was 
arrested or not, the date(s) of arrest, and the class and type of the alleged crime (e.g., violent vs. non- 
violent, property crime, misdemeanor, felony) in a new study dataset. This arrest data will be used as 
one of the primary outcome variables for this study. Dallas City Jail records are publicly available online 
at https://www.municipalrecordsearch.com/dallastx/Cases. This database will augment County Jail 
records and be searched to determine eligibility and arrest.
 Study Population:
Consistent with our previous research with this population, we have limited exclusion criteria so that the sample is 
as broad and representative of the population as possible. Interested individuals (N=462 will be included in the 
study if they: 1) were released from Dallas County Jail in the past 60 days; 2) plan to reside in the Dallas area for 
the next year, 3) enroll in The Bridge Homeless Recovery Program, 4) are willing and able to attend the visit, 
randomization visit, and the 1, 3, and 6-month follow-up visits; 5) score ≥ 4 on the REALM- SF indicating > 6th 
grade English literacy level (i.e., a 7th grade reading level is necessary to complete assessments; 12% to 14% of 
those screened for Projects Advance and Aspire had REALM scores <7th grade reading level; <1% of Bridge 
guests are non-English speakers), 6) read aloud from the Informed Consent document to ensure understanding, 
and 7) score >24 on the Mini-Mental State Exam indicating no substantial cognitive impairment.
Participant Recruitment. Individuals who identify as homeless upon release from the Dallas County Jail will 
be given a 2-sided flier by jail re-entry staff (see flyer in Study Documents). One side of the flyer will provide 
information about services that may be useful to homeless adults in Dallas (e.g., directions to the Bridge and 
other nearby shelters where they may obtain meals, shelter, housing assistance and other services; this is 
current standard practice at the jail). We have received permission from the jail (see Director of Criminal Justice 
letter of support) to use the blank side of this flier to briefly describe this study. Each flyer will have a unique 
identification number and the individual’s name to allow us to track the response rate based upon the number 
of flyers distributed. This flyer will be considered a “ticket” for screening and potential participation into this 
study. If individuals misplace the flyer, they will be able to be screened for study inclusion if they can provide 
other evidence of recent (past 60 day) incarceration. See Recruitment Flyer attachment in Study Documents.
We considered recruiting participants and beginning case management while individuals were still 
incarcerated, but due to legal issues, jail policies, and the potential that incarcerated individuals may feel coerced 
into participating in this study, we decided to have jail pre-release staff only hand out flyers and provide a brief 
outline of the study during the jail discharge process.
Individuals who were released from the Dallas County Jail or the Dallas City Jail in the past 60 days and 
present at The Bridge will complete a shelter intake form, be given a Bridge identification badge, and enroll in 
the Bridge Homeless Recovery program if interested (this is the current standard of care at The Bridge). These 
individuals will receive information about this completely voluntary study and will be informed that Bridge 
services are not contingent upon study enrollment. Eligible adults who remain interested the study will be 
directed by The Bridge Triage/Intake Coordinator (see Bridge Subcontract) to the study research staff for 
screening. Only U.S Citizens will be allowed to participate in the study.
Participant Retention
All participants will be asked for in-depth locator information during the initial visit, which will be updated 
every 15 days by phone call or text. This information will be stored in a locked file cabinet, and we will 
not share this information with anyone outside of the study team. We will use all the information you 
provide, including phone calls, text messages, e-mails, and social media handles, to locate you and 
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

remind you of follow- up visits. In addition, these data will be updated during every subsequent visit. 
Our team will make every effort to locate participants to remind them of follow-up visits using all available 
information provided by the participant, including phone calls, text messages, e-mails, and social media 
handles. For social media contacts, the research team will create a closed study profile. Research 
participants will be contacted using private or direct messages on social media if they consent to be 
contacted using this mode on the locator form. No contact or ‘friend’ requests will be accepted in order 
to protect participant confidentiality. If participants do not complete 5 or more sequential EMAs and have 
not been responsive to the research    team after repeated contact attempts, a text message will be sent 
to the participant. This text message will alert the participant that their cell phone service will be 
terminated if they do not contact the research team within one week. If the participant’s phone service 
is terminated because he/she did not complete 5 or more sequential EMAs and was not responsive to 
the research team, then the participant will not be eligible to receive a replacement phone.
Study Procedures
Participants will complete assessments during 5 in-person visits (i.e., baseline visit, randomization visit 
[within 72 hours of the baseline visit], and 1, 3- and 6-month follow-up visits). Figure 2 demonstrates participant 
flow and a brief summary for each study visit is provided below:
Visit 1: During this visit, informed consent will be obtained, individuals will be screened, and interested 
individuals who meet the study inclusion criteria will complete the baseline study. This visit will take up to 2 
hours to complete (see Table 2 and the Appendix for assessment measures and actual assessment items).
Visit 2: This visit will take approximately 1 hour to complete. During this visit, participants will be randomized to one 
of three study conditions. All participants will complete additional study measures. Two-thirds of all participants will 
receive a smartphone. Those who are randomized to the smartphone groups will be shown how to use the phone 
to complete assessments, and how to use the app features. Researchers will utilize the participant’s Google Play 
Store account to download the Insight app. Those participants who are randomized to receive smart phones during 
visit 2 will have an app blocker installed on their phone to prevent phone loss. This app blocker will prevent the 
participant from access to the phone settings, the Google Play Store or allow deletion the Insight App. Only the 
research staff will have the password required to access those functions or delete the Insight App. At visits 3 or 
visit 4, the app blocker will be removed for participants who completed 50% or more of the daily EMA Surveys over 
the past 30 days as an additional incentive. At the conclusion of the study, the Insight app, and all app data will be 
removed from the phone, and the phone will be given to the participant to keep. The study data will be removed 
from the phone and all data collection through the Insight application will end. Researchers will delete the app from 
the phone and advise the participant the study has concluded. At visit 2, study participants will receive three 
referral coupons to pass on to others who are interested in the study. If a coupon recipient successfully completes 
visit 1, the participant who made the referral will be compensated $20 on the study credit card, for a maximum of 6 
successful referrals. Each coupon will include a random unique identification number that identifies the person who 
provided the coupon and will be valid for the 6 months the participant is active in the study. Participants will be 
given up to 6 coupons in total if the initial coupons have been distributed. The study team may replace lost or 
destroyed coupons at their discretion. Participants have a 14-day period to complete visit 2 and be randomized into 
one of the study conditions. Participants who are not randomized within the 14-day period will be terminated from 
the study.
Visits 3, 4, and 5: These visits will occur 1-, 3-, and 6-months after Visit 1. During these visits, participants will 
complete questionnaires. These visits will take about 1-2 hours to complete and may be completed in person or 
online using REDCap. Participants will be contacted prior to these visits via phone (call and/or text) and/or mail 
(see appointment letter in study documents). Participants have a 14-day window to complete visits 3 and 4 and 
a 30 day window to complete their visit 5, after their scheduled appointment date. After this visit window 
participants will not be allowed to attend the scheduled visit. For visits 3-5, participants may complete their visits 
up to 5 days prior to their scheduled appointment.
Figure 2. Participant flow
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

Screening/Baseline
Visit 1
Randomization 
Visit 2
1 Monthfollow-up
Visit 3
3 Monthfollow-up
Visit 4
6 Month 
follow-up 
Visit 5
Participants who are randomly assigned to the UCM+SP or SPCM conditions will receive a smartphone at 
the randomization visit and they will be asked to carry it with them at all times for 6 months (26 weeks).
Date, time, geolocation, and duration of SPCM app feature use (e.g., case manager calls) will be recorded by the app 
for future analysis.
Traditional Measures (in-person). Traditional assessment data will be primarily collected on laptop/tablet 
computers using Questionnaire Development System (QDS) software at baseline and follow-up visits. QDS 
utilizes a computer-administered self-interview format (i.e., ACASI), which reduces data entry errors
and the need to retain paper copies of raw data. Each item appears on the computer screen while the program 
simultaneously reads the item (participants may select their responses only after QDS reads each item).
Participants wear headphones so that others do not hear the survey items. .
Table 2. In-person assessment measures
Participants have reported few problems using the QDS program, including those 
with no computer experience. Staff will be available to help participants who may 
have difficulty. The amount of time needed to complete the QDS administered 
questionnaires varies by study visit. Based on our previous experience with 
collecting data in homeless adults we estimate that the baseline visit will require 
approximately 1-2 hours to complete and follow-up assessment visits will require 
approximately 1-2 hours. Note that although breaks have been encouraged in our 
previous studies that have used QDS assessments in this homeless population, 
none actually took breaks. Examples of traditional measures are listed in Table 2 
and include multiple constructs that are hypothesized to directly and indirectly (i.e., 
mediation of the treatment effect) affect the study outcomes. In addition, barriers to 
phone-based case management sessions and staff and participant perceptions of 
the SPCM app will be assessed.
See Appendix A for measure descriptions, assessment items, and a schedule 
that indicates which measures will be administered at each visit. In addition to the 
QDS System, assessment data may be collected through the REDCap system.
REDCap is a secure web application for building and managing online surveys and 
databases and is specifically tailored for the management and administration of 
online data collection for research studies.
Alcohol/drug use, re-arrest, and number of homeless nights will be collected 
using a Timeline Follow-back procedure (See Appendix) at all 1, 3, and 6-month follow-up visits. In addition, 
arrest data from the Dallas County Jail and the Dallas City Jail will be examined to identify participants who 
are re-arrested within 12- months of the randomization visit (see Director of Criminal Justice Letter of 
Support). This will provide an objective measure of the date and time of arrest as well as a description of the 
offenses that occurred. The research team will share participant’s name and date of birth to obtain this 
information, but no additional information that the participant provides to us over the course of the study will 
be shared with this Dallas County employee or the Jail. For participants who complete online surveys via 
REDCap, the participant will be instructed to call the research team to complete the Time Line Follow Back 
for location, drug and alcohol use.
Ecological Momentary Assessment Measures (EMA; phone based). EMA is currently the most accurate 
way to measure phenomena in near real-time in natural settings.42,44 Thus, EMA methodology will enable 
the identification of key variables that predict study outcomes with less bias than traditional in-person 
Demographics/Background
Demographic Information Questionnaire
Homelessness Questionnaire
Arrest History51
Health, Mental Health, & Health Behavior
Patient Health Questionnaire
52
(depression/anxiety/alcohol)
Mental Health Component from the SF-1253
Health Related Quality of Life54
Alcohol and Drug Timeline Follow Back55
88 COVID-19 Vaccine
Common Measures for Adult Well-Being89
Stress/Stressor Measures
Discrimination56
Urban Life Stressors Scale57
Personal Victimization58
Perceived Stress Scale – Short Version59
Negative Affect
Aggression60
Positive and Negative Affect Schedule61
Loneliness Scale62
Interpersonal/Intrapersonal Resources
Interpersonal Support Evaluation List-1263
Religious Participation
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

assessments. At the randomization visit, those assigned to the UCM+SP and SPCM conditions will be 
trained on how to use the smartphone to complete EMAs and how to use the “Call Study Staff” and 
“Payment” button/options. Those assigned to the SPCM condition will be trained to use the features of the 
full smartphone app. All participants who receive smartphones will be prompted by the phone to complete 
one EMA 30 minutes after waking each day for 6 months beginning the day after the randomization 
visitAfter completion of the EMA, a joke or link to a joke will presented to the participant via the smartphone. 
EMA data, collected over a 6-month period, will be used to identify key risk and protective factors that 
significantly impact substance use, re-arrest (i.e., re-arrest rates tend to peak within 6-12 months of jail 
discharge67), and continued homelessness (homeless episode duration peaks at 180-190 days;68,69 see Aim 
3).
Table 3. EMA measures.
EMA Assessments. The EMA methodology that will be used in this study is similar to 
that developed by Shiffman and colleagues43,70,71 and was used in our previous studies. 
EMA items will assess multiple constructs that are hypothesized to be related to the 
study outcomes (see examples in Table 3). The phone will audibly and visually cue 
EMAs for 5 minutes, 30 minutes after each participant’s self-reported usual waking 
time. If the participant does not respond to the EMA prompt, the EMA will be recorded 
as missed and another prompt will be pushed later that day (this will reduce the 
likelihood of missed EMAs). EMAs will take approximately 2-4 minutes to complete. All 
EMAs will be date and time stamped for future analyses. Daily EMA items will ask 
about current affect and stress. In addition, participants will be asked a number of 
questions about the prior day that are hypothesized to be related to study outcomes 
(see Table 3). On Mondays, the daily EMA items and additional items will be assessed. 
Additional Monday items will cover topics/variables that have less day to-day variability 
(e.g., arrest; witnessing crimes or violence; emergency room visits; hospitalization; 
quality of life). Examples of EMA constructs that will be assessed are listed in Table 3 
and actual EMA items are included in table
Compensation. Participants will receive compensation for completing each in person 
visit (i.e., Visits 1 and 2 = $30; Visits 3-5 = $50) in the form of gift cards (via 
Greenphire). Participants who receive study phones will also be compensated based
upon the percentage of EMAs completed. Participants who are randomized to receive a smartphone, will have 
the opportunity to earn additional payment every 15 days for completing daily surveys on the phone. Participants 
will not receive payment for EMA surveys until they confirm or update the locator information (research staff will 
attempt to contact participants every 15 days). The level of payment for these daily surveys will depend upon the 
number of EMA surveys that are completed within each 15-day period. If participants complete at least 13 EMA 
surveys within a 15-day period, they will receive $50, if they complete at least 11 EMA surveys within a 15-day 
period, they will receive $30, and if they complete at least 7 EMA surveys within a 15-day period, they will 
receive $20. Participants will be able to track the number of EMA surveys they have completed by clicking a 
button on the phone. Payments or completing QDS questionnaires will be issued at scheduled in-person visits 
only.
Data and Safety Monitoring:
The study poses minimal risk to participants; therefore, the co-Principal investigators (Drs. Businelle and Gonzalez) will 
continuously monitor and report any adverse events. Review of the data and safety monitoring plan (e.g., procedures for 
screening and consenting participants, computer and phone-based data storage) will occur during the monthly research 
team meetings. Adverse events are not expected. Although unlikely given our experience, any unanticipated problems 
(adverse events, protocol deviations, other problems) will be promptly reported to the IRB. The NIH will be informed of 
any actions taken by the IRB as a result of its continuing review.
Daily Assessments
Positive and Negative Affect66
Sleeping Arrangements
Social Support and 
Interactions
Perceived Stress & Current 
Stressors
Discrimination
Prescription Medication Use
Alcohol Consumption
Other Illicit Substance Use
Meal Consumption
Weekly – Monday 
Assessments
Arrest
Employment
Crime/Violence
Emergency Room Visits
Hospitalization
Quality of Life Items
Pandemic Stress Index (PSI)
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

Statistics
All randomized participants will be included in the analyses and the trial will end once 462 participants are 
randomized and complete all study components. Preliminary data analyses, manuscript preparation, and 
conference presentations will begin in Year 2.
Aim 1. The number of participants (n = 144 in each group) was estimated based on the following 
assumptions: 1) random allocation of participants between 3 conditions; 2) type I error rate set to 0.05; 3) a 
30% dropout rate for each condition;23 4) targeted minimum power of 0.9, and 5) a conservative increase of
4.5 case management sessions between the UCM and SPCM conditions across the 6-month study period. 
The estimated increase in in case management sessions is based on Lucht et al.,49 which showed that 20% 
of all phone-based prompts to connect with an alcohol treatment counselor resulted in actual treatment 
sessions. Mondays, the daily EMA items and additional items will be assessed. Additional Monday items will 
cover topics/variables that have less day-to-day variability (e.g., arrest; witnessing crimes or violence; 
emergency room visits; hospitalization; quality of life). Examples of EMA constructs that will be assessed are 
listed in Table 3 and actual EMA items are included in the Appendix.
Compensation
Compensation
(Usual Care)
(Smartphone Groups)
Visit 1 (Today)
Questionnaire
$30
$30
Visit 2 (Within 3 Days)
$30
$30
Visit 3 (1-Month Follow-Up)
Questionnaire
$50
$50
Phone Assessments
N/A
Up to $50 every 15
days for survey
completion
Visit 4 (3-Month Follow-Up)
($100)
Questionnaire
$50
$50
Phone Assessments
N/A
Up to $50 every 15
days for survey
completion
($200).
Visit 5 (6-Month Follow-Up)
Questionnaire
$50
$50
Phone Assessments
N/A
Up to $50 every 15
days for survey
completion
($300).
TOTAL:
Up to $210
Up to $810
Analyses. Primary analyses for this aim will compare counts of the total number of case and crisis 
management sessions that occurred between the randomization visit and the 6-month follow-up across the 3 
conditions using analysis of covariance (ANCOVA). Covariates may include race/ethnicity, age, sex, lifetime 
months homeless, type of arrest (e.g., violent vs. non-violent), substance abuse or mental health diagnoses, 
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

and education. The Tukey-Kramer adjustment will be used to examine all pairwise comparisons across 
conditions. We will also determine if the intervention has similar effects across races, gender, and ageAim 2. 
Based on the available data in criminal justice and homeless populations, we expect a 30% reduction in 
alcohol and drug use days in SPCM and a 15% reduction in alcohol and drug use days in UCM+SP 
compared with UCM.3,126 Given these expected differences, the proposed sample size of 462 participants 
(144 per condition) will yield 90% minimum power for comparing the frequency of alcohol and drug use days 
across conditions. Furthermore, the proposed sample size of 462 participants has 80% minimum power to 
detect a 24% greater decrease in psychiatric symptoms127 in the SPCM group and 10% greater decrease in 
the UCM+SP group relative to UCM).
Analyses. Multi-level models, also known as mixed models will assess the impact of condition on alcohol and 
drug use and psychological distress. This method considers the auto correlated nature of this data, and 
‘unstructured’ covariance may be specified to account for the unequal spacing of observations (in-person and 
EMA data). Covariates for analyses will include baseline characteristics that are known predictors of each 
outcome, including age, race/ethnicity, employment status, criminal history, and periods of lifetime 
homelessness. We will also test for interactions between treatment and key demographic variables (e.g., 
race, ethnicity, gender, and age).
Aim 3. The detectable effects for analyses based on a complete EMA sample size of 201 participants (allowing for
30% study drop-out; see Gonzalez and Rosenheck3 for follow-up rates in a sample of homeless adults with both 
serious mental illness and substance abuse), 2-sided tests, alpha=.05, and power=.80 are presented in Table 8. 
Where appropriate, these estimates account for the fact that repeated observations from the same person will be 
correlated. The most conservative detectable effects for the GLMM EMA analyses will be presented. Thus, 
calculations are based on an N of 201 individuals completing 80% of 183 assessments during the 6-month EMA 
study period for a total of 29,426 EMAs across all participants. Since few EMA studies have been conducted in 
this population, we computed detectable effects using a reasonable range of intraclass correlation coefficient 
(ICC) values. Detectable effects estimates depend on the variance inflation factor (VIF)134 which is based on both 
the size of the ICC and the average number of observations per person. The VIFs used to calculate the effective 
sample size are displayed in Table 8. Thus, using the EMA data, we will be able to detect factors that predict 
reductions in homeless nights by as little as 3.1 percentage points.
Analyses. Logistic Regression of traditional in-person assessments (e.g., substance use, social support, 
psychological functioning, quality of life; see Table 7 for other key constructs) and summarized EMA data (e.g., 
affect, stress, discrimination, alcohol and drug use) will be conducted to identify significant demographic, 
psychosocial, environmental, and behavioral predictors of re-arrest in the 12 months following the 
randomization visit (binary outcome). Covariates may include treatment group, age, gender, race/ethnicity, 
education, type of crime, and other variables as appropriate. Change scores (e.g., change in social support 
from baseline to the 1-month follow-up visit) will also be examined as potential predictors of re-arrest.
Generalized Linear Mixed Model Regression Analyses (GLMM) will be used to examine the longitudinal effect 
of key risk and protective factors on number of homeless nights (measured repeatedly using a timeline follow- 
back procedure at in-person follow-up visits). GLMM can handle fixed and random effect model parameters, 
nested designs, and repeated measures with various correlation structures.128,129 GLMM can also handle 
different variance functions, unbalanced designs where the number of repeated observations varies across 
individuals, and the situation where assessments within a week are more highly correlated than assessments 
separated by multiple weeks or months. We will assess the best way to model the correlation of the repeated 
measures using the methods of Wolfinger130 and statistics such as Akaike's and Schwarz's information 
criteria. Adjustments for multiple comparisons will be made according to Westfall and Young.131
GLMM will also be used to identify proximal predictors of homeless nights (assessed each day) using 
EMA data. EMAs generate an enormous amount of data; therefore, we will be able to address multiple within 
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

and between subject questions. For example, we will examine key EMA variables (e.g., negative affect, 
stress) and parameters (e.g., intercept, slope, quadratic term, volatility) as potential predictors of homeless 
nights. This invaluable information may be used to detect high-risk situations that may be targeted in future 
“smart interventions.” EMA data will also allow us to address other important exploratory questions like: 1) 
what psychosocial changes occur as an individual moves from homelessness into housing, and 2) what effect 
do events like exposure to discrimination, violence, or hospitalization have on homeless nights.
Mediation. The PROCESS macro for SPSS/SAS (described in Hayes, 2013;132 and available online133) will be 
used to conduct exploratory mediation analyses to identify variables that mediate the relation between 
condition and homeless nights and re-arrest outcomes. This method uses an ordinary least squares path 
analytic framework to estimate direct and indirect effects in single and multiple mediation models with 
bootstrapped confidence intervals. The macro can also be used to evaluate moderated mediation models 
including those with dichotomous outcomes (e.g., arrest vs. no arrest).
Ethics:
Approval for this study is being sought from the Committee for the Protection of Human Subjects (CPHS) of 
the University of Texas Health Science Center at Houston. Individuals who were released from the Dallas 
County Jail or the Dallas City Jail in the past month and present at The Bridge will complete a shelter intake 
form, be given a Bridge identification badge, and enroll in the Bridge Homeless Recovery program if interested 
(this is the current standard of care at The Bridge). These individuals will receive information about this 
completely voluntary study and will be informed that Bridge services are not contingent upon study enrollment. 
Eligible adults who remain interested the study will be directed by The Bridge Triage/Intake Coordinator (see 
Bridge Subcontract) to the study research staff for screening. Informed consent will be obtained prior to 
screening for this study.
Data handling and record keeping:
General Procedures. Each participant will be assigned an identification number that will be utilized in place 
of names in all electronic and print data files. The sheet containing the links between participant names and 
identifiers will be kept in locked filing cabinet when not in use and will be destroyed 12 months after data 
collection has been completed. All print information, including informed consent and screening questionnaires, 
will be stored in a separate locked filing cabinet in Dr. Gonzalez’s office. All electronic data (with names 
omitted) will be maintained on the investigator’s computers, and all computers and electronic files will be 
password protected. Because sensitive data will be collected, a Certificate of Confidentiality has been 
obtained to ensure that data cannot be subpoenaed and used against participants in court, and this 
information will be explained to all participants during the informed consent process.
In-person data. Participants will complete questionnaire data on a laptop or tablet computers using the 
Questionnaire Development System (QDS) program. Participants will wear headphones and the computer will 
read each question aloud. Participants will be instructed that they may elect to not answer questions that they 
choose not to answer. When in-person visits are not possible, follow-up visits may occur by phone. QDS does 
not allow participants to exit without a password. Thus, participants will not have access to other programs or 
files on the computer. In addition, all questionnaire data is automatically saved and password protected. At the 
end of each day, participant data will be removed from the laptop/tablet computers and saved into a password 
protected database. To ensure that research staff are adequately trained in data collection, confidential, and 
the protection of human subjects, all project staff will complete extensive training focused on each of the 
following topics: 1) project rationale and objectives; 2) the informed consent process; and 3) general data 
collection procedures (e.g., computer data collection, privacy). They will also complete all confidentiality, 
conflict of interest, and HIPAA training programs bi-annually as required by the University of Texas School of 
Public Health. To maintain the integrity of the data, participants will be required to show identification at each 
IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

follow-up visit prior to completing the study assessments.
 EMA data. Participant responses to study questions will be encrypted and stored on the study smartphone. 
Encrypted data will be automatically uploaded to our secure server multiple times each day. The following 
features are designed to ensure the security of EMA data: 1) the data stored on the smartphone device is in a 
SQLite database in a sandbox environment, where read/write operations are only available through the 
programming application (i.e., no file or output is readable to end users); 2) a 10 character password (only 
known to researchers) is required to authenticate the current user before data can be manually accessed or 
manually downloaded from the smartphone to the server; 3) the web browser application linking the 
investigator’s computer to the database is on HTTPS protocol (SSL certificate with encryption) which will 
guarantee the data transfer from web browser to the backend database is well protected; and 4) the backend 
database is hosted by Microsoft Azure servers and the University of Oklahoma Health Sciences Center in a 
secure setup. These steps will ensure the security of EMA data.
Arrest data. A list of participant names will be shared with a single Dallas County employee. As stated in 
the letter of support, the Dallas County Jail (Ron Stretcher, Director of Criminal Justice) will send Dr. Gonzalez 
an encrypted database every 6 months that contains a list of arrested participants, dates of arrest, and charges 
filed in Dallas County. Dr. Gonzalez will use this database to identify study participants who were re-arrested 
within the 12 months following the date of randomization. Dr. Gonzalez will create a new database that includes 
the participant identification number, date of re-arrest, and class/type of alleged crime. Participant names will 
not be included in this newly created dataset. This re-arrest data will eventually be merged into the master 
dataset. Each iteration of the Dallas County Jail dataset will be deleted/destroyed after Dr. Gonzalez extracts 
relevant information. The Dallas City Jail database will be searched to augment arrest data from the Dallas 
County Jail.
Certificate of Confidentiality. Participants will be asked to answer questions about private information that 
may have legal consequences if it were disclosed. Therefore, before data collection is initiated, researchers will 
obtain a Certificate of Confidentiality to protect participants from the mandated release of study data. All 
participants will be informed that this Certificate has been obtained, and what protections it affords them during 
the informed consent process. Participant data will not be released to any party outside the research team.
Quality control and assurance:
Drs.Gonzalez and Businelle will develop data management and quality assurance procedures for the 
study data, which will continue through all years of this project. Quality assurance procedures will include a 
data collection protocol documented in a protocol manual and regular meetings between Drs. Gonzalez, 
Businelle, Kendzor, and other project staff. The QDS data entry system provides field checks, range checks 
for continuous variables, valid value checks for categorical variables, checks for legitimate dates and times, 
and logical consistency. All EMA data and jail provided arrest data will be encrypted and secured on the 
researcher’s password protected computers at the moment of receipt and through all years of the project.
Preliminary analyses will be initiated shortly after data collection begins to assess data quality. Dr. Cannell will 
be primarily responsible for overseeing data cleaning and data preparation (e.g., combining of EMA, QDS, 
REDCap and Arrest datasets) for analyses.
Publication Plan
Data analyses, manuscript preparation using preliminary data, and conference presentations will begin in Year
All participants will be mailed a brief summary of the main study findings within 12 months of study 
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IRB NUMBER: HSC-SPH-15-0632
IRB APPROVAL DATE: 03/03/2022

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