Feasibility of Mobile and Technology Assisted Aftercare Services for Crisis Stabilization Units

Study Overview
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Brief Summary
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In this study investigators are examining the feasibility and acceptability of an expanded and technology-assisted aftercare program with persons released from a crisis stabilization unit (CSU) who were brought to the CSU by choice of law enforcement. Investigators are assessing the critical elements of CSUs, examining the feasibility and acceptability of pairing mobile and technology-assisted aftercare to improve treatment access and retention; and developing a study protocol to be used in a future multisite randomized controlled trial (RCT). Crisis stabilization units provide law enforcement officers an alternative to jail for individuals experiencing a substance use or mental health disorder crisis contributing to criminalized behavior. This study is designed to assist with the diversion of individuals toward treatment and away from subsequent contact with law enforcement through piloting mobile and technology assisted aftercare services to persons released from a CSU. One of the largest barriers to the effectiveness of CSUs is retaining the individual in treatment after discharge. Logistical factors including transportation, stable housing, and long waitlists for community-based treatment decrease treatment access. These factors may also be complicated by an individual's understanding of the importance of remaining in treatment as well as their motivation to continue. To overcome these barriers and enhance the impact of CSUs, investigators are developing an expanded model which includes mobile and technology-assisted modalities that address psychological, behavioral, and medication-assisted treatment.

Detailed Description
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This study is a mixed methods design, combining a randomized controlled trial and qualitative interviews into the feasibility of the pilot program, mobile and technology assisted aftercare. The randomized controlled trial consists of a 1:1 comparison of the pilot CSU aftercare services and the treatment as usual (TAU) services for persons releasing from a CSU. Participants (n=24) are recruited into the study prior to their discharge from a CSU. Research team members are alerted of potential eligible participants who meet study criteria and are soon-to-be discharged by CSU staff. At this point, research team members approach the eligible participants to conduct the recruitment and consent process. Due to the short length of stay in a CSU, the research team does one-to-one randomization and pre-randomize of the pool of participants prior to recruitment. For example, the pre-randomization may results in Tx Tx Ctrl Tx Ctrl Ctrl assignments for each sequential enrollment in the study. Or it may result in a different pattern Ctrl Txt Ctrl, etc. Participants are notified of their randomization status at the end of the consent and baseline data collection interview. The pilot program of mobile and technology assisted aftercare service connects participants with a Community Support Specialist (CSS) who provides mobile aftercare (i.e., meet the client in their homes or other community settings) up to once a week for 6 months. Participants also have 24/7 access to behavioral health mobile applications on a smart phone. Mobile apps recommended to participants include, moodtools-depression aid, virtual hope box, recovery path, and intellicare hub. All mobile apps have undergone one or a combination of RCTs, clinical trials, and/or developed with mental health professionals. Data is collected through participant interviews and collection of health and administrative records from agency collaborators. Participants will complete a total of 4 interviews over a period of 6 months. Baseline interviews will be conducted at study enrollment. Time 1 (T1) interviews will be conducted 2 weeks post-discharge from the CSU. Time 2 (T2) interviews will be conducted 3 months post-discharge from CSU. Time 3 (T3) will be conducted 6 months post-discharge from the CSU. The investigators are monitoring trends in participants during their participation in the pilot program and all consented participants for the treatment and control groups will complete a series of interviews. The assessed trends include readmission to a CSU, employment stability, financial stability, criminal justice involvement, perception of social support, use of acute and long-term services, and multiple psychosocial measures listed below. Data assessing the feasibility and acceptability of the mobile and technology-assisted aftercare is also assessed through qualitative interviews and focus groups with our community mental health partner. This qualitative data will be used to create a protocol for CSU aftercare that can respond to diverse jurisdictional characteristics leading to CSU aftercare services that are feasible and scalable.

Official Title
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Multi-Site Feasibility Evaluation of Crisis Stabilization Units Across Three Jurisdictions With High Opioid Use Disorders and a Proposed Follow-Up RCT

Conditions
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Substance Abuse, Criminal Behavior, Mental Disorder

Intervention / Treatment
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* Behavioral: mobile and technology assisted aftercare
* Other: Treatment as usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: brought to Meridian Behavioral Health CSU by the choice of law enforcement over 18 years of age self-report to be residing in Alachua, Columbia, or Levy county for at least 6 months following their discharge from the CSU. conversational in English being able to cognitively consent Exclusion Criteria: younger than 18 years old not cognitively able to consent not conversational in English not releasing from the CSU to Alachua, Columbia, or Levy County, Florida not brought to the CSU by choice of law enforcement

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A total of 24 adults releasing to one of the three participating counties in Florida will be randomly assigned to participate in the mobile and technology assisted aftercare or a treatment-as-usual (TAU) control group. Participants assigned to the treatment-as-usual control group will remain eligible to participate in all agency specific services offered to persons discharging the CSU as well as, any community resources they normally would have access to.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mobile and technology assisted aftercare<br>participants randomized to this condition will receive up to 26 sessions with a community support specialist aftercare provider and 6 months of access to behavioral health mobile applications. | Behavioral: mobile and technology assisted aftercare<br>* The mobile and technology assisted aftercare consists of mobile mental health professionals who travel to participants to provide mental health services including counseling, navigation of community referrals, motivational interviewing, solution focused therapy, psycho-education, and social support. Participants randomized to this condition will also receive 24/7 access to evidence-based behavioral health mobile applications that are recommended based on the participant's diagnostic status, learning style, and goals. Frequency of app use is up to the participant's discretion. However, during weekly aftercare sessions, the CSS may assist the participant with creation of an app use schedule that is realistic for the participant's needs and treatment goals.<br>|
| Active Comparator: Treatment as usual (TAU)<br>Participants randomized to this condition receive standard treatment services available to persons discharging from a CSU. | Other: Treatment as usual<br>* Treatment as usual services include a personalized discharge plan, a follow up appointment within a month of discharge for evaluation and connection to other agency services if applicable. Some of these services may include outpatient counseling for behavioral and emotional problems, psychiatric services, group therapy, case management, rehabilitation services, homeless recovery services, employment services, medication-assisted treatment, group-based team building activities, primary care clinic, and forensic services. Individuals may also receive ancillary referrals for applicable healthcare services, access to residential and outpatient substance abuse treatment services, and access to a tablet.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants recruited | Number of eligible participant who agree to participate out of total number of eligible participants | up to 6 months | 
| Retention of participants | Retention of participants is tracked by the number of recruited participants who complete the intervention | up to 6 months | 
| Number of intervention sessions completed | Number of intervention sessions completed is tracked by the number of sessions participants complete over 6 months | up to 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in arrest rates | Change in arrest rates will be tracked by the number of arrests participants incur over a 6-month period beginning at baseline | up to 6 months | 
| Frequency of acute service use | Frequency of acute service use is tracked by the number of acute services participants partake in over a 6-month period beginning at baseline | up to 6 months | 
| Frequency of long-term treatment use | Frequency of long-term treatment use if tracked by the number of long-term treatment services participants partake in over a 6-month period beginning at baseline | up to 6 months | 
| Admission into a crisis stabilization unit | Admission into a crisis stabilization unit is tracked by the number of times a participant is admitted into a crisis stabilization unit over a 6-month period beginning at baseline | up to 6 months | 
| Acceptability of intervention specific aftercare services | Acceptability of intervention specific aftercare services is assessed through qualitative interviews with mental health stakeholders and CSU staff | up to 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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crisis stabilization, psychological well-being, law enforcement, mental health treatment, substance use disorder treatment