Effectiveness of a Functional Literacy Program for Formerly Homeless Adults

Study Overview
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Brief Summary
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The purpose of this study is to assess a functional literacy program for formerly homeless adults now residing in supported housing who have difficulty performing daily life skills requiring functional literacy (e.g., bill paying, medication management, community transportation) needed to maintain housing placements. The hypothesis is that intervention group participants will improve in functional literacy compared to the control group that does not receive the intervention.

Detailed Description
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Sixty-five percent of homeless adults are reported to be illiterate or marginally literate. The lack of literacy in a high technological society negatively impacts this population's ability to participate in daily life activities including finding and maintaining employment, renting and maintaining an apartment, seeking health care, using public transportation, and managing finances. Poor literacy marginalizes this population from societal participation and maintains this group in a state of lack and deficiency. A literacy program will be delivered to participants who are formerly homeless and now residing in supported shelter. Participants will be randomly assigned to an intervention (n=20) or control (n=20) group. The intervention group will receive the functional literacy intervention over 8 weeks, twice weekly. Intervention sessions will allow participants to learn literacy skills within the context of real-life daily activities like grocery shopping, preparing a meal, and purchasing subway cards. Control group participants will not receive intervention.

Official Title
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Effectiveness of a Functional Literacy Program for Formerly Homeless Adults

Conditions
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Literacy

Intervention / Treatment
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* Behavioral: Functional Literacy Program
* Behavioral: Usual Care Management Services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Resident of a supported shelter environment (after homelessness) Self-reported difficulty with basic reading skills needed to participate in desired daily life activities English-speaking Exclusion Criteria: Severe behavioral management disorder that would make cooperation and direction following problematic

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Approximately 10 participants will be randomly assigned to an intervention group; another 10 will be randomly assigned to a control group.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Functional Literacy Intervention<br>The intervention group will receive the functional literacy program in which, in small groups, participants learn literacy skills in the context of daily life activities such as shopping, meal preparation, and transportation use. | Behavioral: Functional Literacy Program<br>* The intervention will be provided twice weekly in 2-hour sessions, over 8 weeks. The 16 intervention sessions will provide the opportunity for participants to learn functional literacy skills to (1) manage an apartment, (2) access community resources, (3) manage finances, (4) access free recreational activities. All sessions will address literacy skills needed to complete basic daily life activities in the home and community environments. Literacy skills will first be learned and practiced within the supported shelter, and then extended to the community.<br>Behavioral: Usual Care Management Services<br>* The control group will receive the usual housing services without additional intervention.<br>|
| Active Comparator: Functional Literacy Control<br>The control group will not receive intervention but the Usual Care Management Services. | Behavioral: Usual Care Management Services<br>* The control group will receive the usual housing services without additional intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Canadian Occupational Performance Measure (COPM) score | The Canadian Occupational Performance Measure (COPM) is a 5-item, 10-point rating scale (1=most important, 10=least important) designed to be completed conjointly by a therapist and participant, and requires approximately 30 minutes to administer. The scale allows participants to identify and prioritize the most important problems impacting daily function and can be used with clients of all ages and diagnoses. Participants are asked to identify the five most critical problems impeding functional performance in the areas of self-care, productivity, and leisure. After the identification of five problems, participants are asked to rate both performance and satisfaction levels of the identified activities on a 10-point scale (1=not satisfied; 10=extremely satisfied). An open-ended narrative section is provided to allow therapists to record participant comments. The COPM is intended to be used pre- and post-intervention. | 1-week post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inventory of Reading Occupations (IRO) score | The IRO-Adult identifies reading materials from a list of 14 categories (e.g., financial records, federal/state aid documents, food and nutrition labels) that participants access as part of daily occupations. Two sections include Reading Categories (having 14 items) and Dimensions of Reading Participation (consisting of 5 dimensions with two open-ended questions and three 5-point Likert scale items; scores of 10+ = higher reading proficiency). For each client-identified reading category, participants are asked a series of questions about the 5 dimensions of reading participation: (1) reading material type; (2) frequency of access; (3) effectiveness, efficiency, and satisfaction; (4) importance of reading material in daily life; and (5) strategies and supports needed to access). The IRO-Adult descriptively assesses participants' relative mastery (effectiveness, efficiency, satisfaction) in functional literacy in relation to occupational participation. | 1-week post-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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functional literacy, homelessness, daily life activities