DOI: 10.3886/icpsr39404.v1
title: Best Practices to Reduce COVID-19 in Group Homes for Individuals with Serious Mental Illness and Intellectual and Developmental Disabilities, Massachusetts, 2021-2022
title: Version 1

description: The overall goal for this project was to reduce the incidence of COVID-19, hospitalization, and mortality among adults with serious mental illness (SMI) and intellectual disabilities/developmental disabilities (IDD) in congregate living settings (i.e., group homes) in Massachusetts, as well as to reduce COVID-19 incidence among staff who work in these settings. The research team was guided by two comparative effectiveness questions:

With the goal of prioritizing and making actionable best practices available as resources, what is the comparative effectiveness of various types and intensities of preventative interventions (e.g., screening, isolation, contact tracing, hand hygiene, physical distancing, use of face masks) in reducing rates of COVID-19, related hospitalizations, and related mortality in this population?
With the goal of effectively implementing best practices, what is the most effective implementation strategy to reduce rates of COVID-19 in this population: using tailored best practices (TBP) with SMI/IDD residents and staff of group homes in mind, or general best practices (GBP) from state and federal standard guidelines for all congregate care settings?

The specific aims of this study were as follows:
<strong>Aim 1a. </strong>Synthesize existing baseline data collected by 6 state behavioral health agencies on COVID-19 rates, hospitalization, mortality, and use of infection prevention practices.
<strong>Aim 1b. </strong>Collect stakeholder input via surveys and virtual focus groups on staff and resident experiences and on barriers/facilitators to implementing recommended preventative practices.
<strong>Aims 2a and 2b. </strong>Determine the comparative effectiveness of various COVID-19 preventative practices by (Aim 2a) using a validated simulation model to estimate COVID-19 spread in group homes and (Aim 2b) obtaining stakeholder input on prioritizing and defining tailored best practices for implementation.
<strong>Aim 3. </strong>Compare the effectiveness of TBPs with GBPs by using a hybrid effectiveness-implementation cluster randomized controlled trial.
Data collected to answer Aims 1 and 2 served as the foundation for designing the Aim 3 trial. Data for the trial were collected in 3-month intervals beginning January 2021 (baseline) until October 2022 (15-month follow-up). Residents and staff were sampled from approximately 400 group homes. Primary implementation outcome measures were COVID-19 vaccination rates and fidelity scores. The primary effectiveness outcome measure was COVID-19 infection.
Notes: This collection contains only data from Aim 1a and Aim 3. Throughout the data and documentation, "intellectual and/or developmental disabilities" is abbreviated as both IDD and ID/DD.
description: The overall purpose of the study was to reduce the incidence of SARS-CoV-2 (COVID-19) and other infectious diseases, hospitalization, and mortality among adults with serious mental illness (SMI) and intellectual disabilities/developmental disabilities (IDD) in congregate living settings, and to reduce the incidence of COVID-19 among staff in congregate living settings.
description: <strong>Aim 1a. </strong>The research team performed a retrospective observation of COVID-19 incidence and hospitalization data. Resident-specific data were collected from group home managers (n=2,261 with serious mental illness (SMI); n=1,035 with intellectual disabilities/developmental disabilities (IDD)). Statewide information on total cases and hospitalizations per week were obtained from the Massachusetts Department of Public Health. Data were separated into wave 1 (March 1, 2020 to June 30, 2020) and wave 2 (July 1, 2020 to March 31, 2021) based on COVID-19 peaks and declines.
<strong>Aim 1b. </strong>The research team conducted a survey of group home staff who had physically worked in at least one of the initially sampled group homes as of January 2021. Data collection occurred between May and September 2021. Individuals were invited to participate via email invitation, receiving a paper copy of the survey at their workplace, or direct invitation from the study team. In addition to the survey, working groups consisting of group home residents, staff, and family/caregivers met every 1-2 months by video to discuss their experiences related to living in, working in, or having a loved one living in a group home during the COVID-19 pandemic. Working groups met from December 2020 to December 2022. The research team transcribed the working group meeting videos (n=23 transcripts) and performed qualitative coding in Dedoose.
<strong>Aims 2a and 2b. </strong>The research team used the Clinical and Economic Analysis of COVID-19 Interventions, a publicly available and validated microsimulation model (Aim 2a), to assess new COVID-19 infections among group home residents, group home staff, and the surrounding community, as well as resident hospitalization days. Data to inform the model inputs were derived from published literature and data previously collected for Aims 1a and 1b. The simulation was used in late 2020 and early 2021 for all 415 participating group homes to determine the most effective strategies to mitigate infections. The results of the simulations informed subsequent work with stakeholders to finalize the tailored best practices intervention (Aim 2b) in February 2021.
<strong>Aim 3. </strong>The research team conducted a hybrid effectiveness-implementation cluster-randomized trial to assess the effectiveness of COVID-19 prevention practices tailored to adults with SMI and IDD (tailored best practices, or TBP), the intervention condition, compared to the standard of care (general best practices, or GBP), the control condition. TBP included 4 core components: motivational interviewing, interactive education, trusted messengers, and a house plan for COVID-19 prevention practices (including measurement and feedback). GBP included standard recommended best practices for preventing COVID-19 based on CDC guidelines and Massachusetts Executive Office of Health and Human Services policies. Implementation outcomes at the group home level were assessed at baseline (May 2021) and every 3 months after randomization up to 15 months post-baseline (June 2022) from administrative records on residents and staff. Fidelity was assessed via program director web-based surveys distributed at baseline (May 2021) and every 3 months up to 15 months post-baseline (October 2022). Additional vaccination data was assessed between April 2021 and June 2022.
description: Primary outcome measures were COVID-19 positive test result (resident or staff) and COVID-19 related hospitalization (resident only).
Demographic variables included age, sex, race, ethnicity, and spoken language. Staff demographics also included length of tenure and education level.
Needs assessment surveys included information seeking and trust in information sources, access to health care, unmet needs, vaccination status, impacts of COVID-19 on work and personal life, and if extra help was needed in various areas (e.g., mental health, finances, social life).
Fidelity and adoption measures focused on frequency of COVID-19 screening, testing, mitigation (e.g., masking, social distancing, handwashing, cleaning, use of protective equipment), vaccination, and education/training. Staff were also surveyed about the acceptability, appropriateness, and feasibility of their site's COVID-19 prevention practices.
description: Response Rates: Staff survey (Aim 1b) had a 44 percent response rate.
description: Presence of Common Scales: Coronavirus Impact Scale
description: About 400 group homes were recruited from 6 public-sector community-based organizations throughout Massachusetts that provide group assisted living and 24-hour support services. Randomization occurred at the group home level. Clusters were stratified on population served (serious mental illness vs. intellectual disabilities/developmental disabilities), race and ethnicity of group home residents/staff, and a COVID-19 infection risk score that was based on ranking group homes (i.e., low, medium, high) by prior COVID-19 infections and vaccination uptake among residents/staff. Approximately 200 group homes were randomized to each condition, and approximately 3,330 staff and 2,600 residents were included in the trial.
description: Datasets: 
DS0: Study-Level Files
DS1: Aim 1a Data: IDD Resident COVID-19 and Hospitalization Rates
DS2: Aim 1a Data: IDD Resident COVID-19 Cases
DS3: Aim 3 Data: SMI Resident COVID-19 and Hospitalization Rates
DS4: Aim 3 Data: COVID-19 Cases
DS5: Aim 3 Data: COVID-19 Hospitalization
DS6: Aim 3 Data: Preventative Practices Adoption (Analytic)
DS7: Aim 3 Data: Preventative Practices Adoption (Source)
DS8: Aim 3 Data: Implementation Fidelity (Analytic)
DS9: Aim 3 Data: Implementation Fidelity (Source)
DS10: Aim 3 Data: Vaccinations (Residents)
DS11: Aim 3 Data: Vaccinations (Staff)
DS12: Aim 3 Data: Needs Assessment Wave 1 (Staff)
DS13: Aim 3 Data: Needs Assessment Wave 2 (IDD Resident)
DS14: Aim 3 Data: Needs Assessment Wave 2 (SMI Resident)
DS15: Aim 3 Data: Needs Assessment Wave 2 (Staff)
DS16: Source Data: Needs Assessment Wave 1 (Staff)
DS17: Source Data: Group Home Structure
DS18: Source Data: Resident COVID-19 Cases
DS19: Source Data: Resident COVID-19 Vaccinations
DS20: Source Data: Resident Deaths
DS21: Source Data: Resident Demographics
DS22: Source Data: Resident Hospitalizations
DS23: Source Data: Resident Group Home Intake/Discharge
DS24: Source Data: Staff COVID-19 Cases
DS25: Source Data: Staff COVID-19 Vaccinations
DS26: Source Data: Staff Demographics
DS27: Source Data: Staff Payroll
description: Staff and adult residents with serious mental illness (SMI) or intellectual/developmental disabilities (IDD) of group homes.
description: web-based survey