Clinical trial NCT05312229: Housing Transitions QUERI
Official title: Implementing and Sustaining Critical Time Intervention (CTI) in Case Management Programs for Homeless-experienced Veterans (PII 21-285)
Study type: INTERVENTIONAL
Overall status: ENROLLING_BY_INVITATION
Phase: PHASE1
Conditions: Homelessness
Keywords: Care Management
Homeless
Implementation
Mental Health Care
Quality Assurance, Improvement
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
Collaborators: name: University of California, Los Angeles
name: Center for the Advancement of Critical Time Intervention
name: University of Southern California
First posted: 2022-04-05
Enrollment: 153
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: The investigators are implementing Critical Time Intervention (CTI), an evidence-based, time limited case management practice for individuals experiencing homelessness. The investigators will be randomizing sites receiving CTI into one of two levels of implementation support (low vs. high intensity support).
Primary purpose: OTHER

Brief summary: The VA Grant and Per Diem (GPD) case management aftercare program provides six months of case management for homeless-experienced Veterans undergoing housing transitions. This Partnered Implementation Initiative (PII) proposes to implement and evaluate Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-in 32 GPD case management aftercare sites across the nation.

Detailed description: The VA Grant and Per Diem case management (GPD-CM) program provides six months of case management for homeless-experienced Veterans (HEVs) undergoing housing transitions. At present, no specific case management paradigm is required in the GPD-CM program, resulting in practice variation across sites. This Partnered Implementation Initiative (PII) implements Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-at 32 VA GPD-CM sites. The investigators will use the Replicating Effective Programs (REP) implementation bundle to support CTI implementation at all 32 sites. Half of these sites will also receive 9 months of external facilitation (enhanced REP) as additional support for CTI implementation. In a type 3 hybrid trial, the investigators will use mixed methods to examine the impacts of REP versus enhanced REP. Using trial data, the investigators will develop a business case analysis and implementation playbook for the investigators' program partners to support continued CTI spread and sustainment in the GPD-CM program.

Eligibility criteria: Inclusion Criteria:

* Grant and Per Diem (GPD) case management aftercare grantees in 7 Veterans Integrated Service Networks (VISN), all of whom provide 6-months of case management to Veterans who have experienced homelessness.

Exclusion Criteria:

* None

Primary outcomes:
measure: Fidelity to CTI
timeFrame: 12 months after implementation start
measure: Sustainment of CTI
timeFrame: 18 months after implementation start
measure: Dollars spent delivering CTI at each site
timeFrame: Between 6 and 18 months after implementation start
Secondary outcomes:
measure: Housing stability
timeFrame: Between 6 and 18 months after implementation start
measure: Cost of CTI as Implemented
timeFrame: Between 6 and 18 months after implementation start
measure: Hospitalization rates
timeFrame: Between 6 and 18 months after implementation start
measure: Cost of Implementation Strategies
timeFrame: Through study completion, 4 years
measure: Return on Investment (ROI) of CTI
timeFrame: 6-, 12-, and 18-months after GPD case management program enrollment
measure: Outpatient service use
timeFrame: Between 6 and 18 months after implementation start
Other outcomes:
Locations:
city: West Los Angeles
country: United States
facility: VA Greater Los Angeles Healthcare System, West Los Angeles, CA
state: California
Study officials:
affiliation: VA Greater Los Angeles Healthcare System, West Los Angeles, CA
name: Sonya Emi Gabrielian, MD MPH
role: PRINCIPAL_INVESTIGATOR
References:
citation: Gabrielian S, Finley EP, Ganz DA, Barnard JM, Jackson NJ, Montgomery AE, Nelson RE, Cordasco KM. Comparing two implementation strategies for implementing and sustaining a case management practice serving homeless-experienced veterans: a protocol for a type 3 hybrid cluster-randomized trial. Implement Sci. 2022 Oct 3;17(1):67. doi: 10.1186/s13012-022-01236-1.