Engaging Homeless Veterans in Primary Care
Study Details
Study Description
Brief Summary
The objectives of this study are to test an evidence-based model for improving primary and preventive care engagement among homeless Veterans not currently receiving care and to demonstrate the additive benefit of primary care-based treatment engagement by this population.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
One out of three homeless men and nearly one quarter of all homeless adults are Veterans. This translates to almost 200,000 Veterans being homeless on any given night. The Department of Veteran Affairs (VA) is a major service provider to homeless persons and has developed several very successful and innovative programs that have been effective in securing housing, economic stability and needed services for these men and women. However, despite these efforts in many communities, Veterans are not accessing these services despite aggressive outreach and state-of-the art programming. The investigators are conducting a prospective randomized controlled trial to test the hypothesis that a personalized health assessment linked to community outreach is more likely to both engage the homeless Veteran in a primary care based chronic disease management model and to sustain that care and associated behavior changes necessary to exit homelessness. The key questions to be addressed in this study are: (1) Will a community-based health-oriented outreach increase health seeking behavior in the intervention group?; (2) can initial engagement be sustained in a continuity care model in this population?; (3) will this intervention facilitate changes/improvements in health seeking behavior that include participation in substance abuse treatment care, compliance with mental health care, and enrollment in VA-based employment/financial support programs?; and (4) can this intervention impact chronic disease management of key cardiovascular risk indicators that disproportionately affect homeless persons?; and (5) do any observed changes correlate with serial behavioral measures and qualitative assessments?
The investigators' working hypothesis is that a targeted outreach to homeless persons that capitalizes on either established or newly realized physical health concerns to affect both health seeking behavior and sustained behavior change. It is grounded in two complementary behavioral models: the Behavioral Model for Vulnerable Populations and the body of research describing intrinsic versus extrinsic motivators for sustained behavior change.
Two hundred and eighty homeless Veterans will be randomized to receive either a personalized health assessment based outreach or usual care (social work/housing focused) outreach. Baseline assessments will include demographics, medical, mental health and substance use co-morbidities, pre-intervention health seeking behavior, readiness for behavior change (URICA), motivation for health care. Serial assessments at months 1, and 6 will assess evolving readiness and motivation as well as changes in their homeless status (sheltering, employment/income, etc.) Actual utilization of services will be assessed using the CPRS electronic medical records.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Personal Health Assessment/RN Brief Intervention RN-based medical outreach, administration of a personal health assessment and brief intervention |
Behavioral: RN Brief Intervention
RN administered personal health assessment along with a brief intervention for behavior change administered to homeless veterans in the community
|
| Placebo Comparator: Social Work-Administered Outreach Social work based outreach (usual care) |
Behavioral: Social Worker Outreach
Social worker will encounter homeless veteran in the community and encourage to come to the VA for care
|
Outcome Measures
Primary Outcome Measures
- Receipt of Primary Care at the VA [within 4 weeks of intervention]
The primary aim of this study was to conduct a randomized controlled trial of different interventions aimed at increasing rates of treatment engagement among a community sample of treatment-naive homeless veterans.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
VA eligible
-
currently homeless
Exclusion Criteria:
-
cognitively impaired
-
not planning on staying in area for next 6 months
-
currently enrolled in VA primary care
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | VA Medical Center, Providence | Providence | Rhode Island | United States | 02908-4799 |
Sponsors and Collaborators
- VA Office of Research and Development
Investigators
- Principal Investigator: Thomas P O'Toole, MD, VA Medical Center, Providence
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- IIR 07-184
Study Results
Participant Flow
| Recruitment Details | |
|---|---|
| Pre-assignment Detail |
| Arm/Group Title | Arm 1: RN-based Medical Outreach, Administration of a Personal | Arm 2: Social Work Based Outreach (Usual Care) |
|---|---|---|
| Arm/Group Description | RN-based medical outreach, administration of a personal health assessment and brief intervention Personal Health Assessment/brief intervention: RN administered personal health assessment along with a brief intervention for behavior change administered to homeless veterans in the community | Social work based outreach (usual care) Social work administered outreach: Social worker will encounter homeless veteran in the community and encourage to come to the VA for care |
| Period Title: Overall Study | ||
| STARTED | 105 | 116 |
| COMPLETED | 83 | 101 |
| NOT COMPLETED | 22 | 15 |
Baseline Characteristics
| Arm/Group Title | Arm 1: RN-based Medical Outreach, Administration of a Personal | Arm 2: Social Work Based Outreach (Usual Care) | Total |
|---|---|---|---|
| Arm/Group Description | RN-based medical outreach, administration of a personal health assessment and brief intervention Personal Health Assessment/brief intervention: RN administered personal health assessment along with a brief intervention for behavior change administered to homeless veterans in the community | Social work based outreach (usual care) Social work administered outreach: Social worker will encounter homeless veteran in the community and encourage to come to the VA for care | Total of all reporting groups |
| Overall Participants | 83 | 101 | 184 |
| Age (Count of Participants) | |||
| <=18 years |
0
0%
|
0
0%
|
0
0%
|
| Between 18 and 65 years |
79
95.2%
|
97
96%
|
176
95.7%
|
| >=65 years |
4
4.8%
|
4
4%
|
8
4.3%
|
| Age (years) [Mean (Standard Deviation) ] | |||
| Mean (Standard Deviation) [years] |
48.8
(11.6)
|
48.5
(10.2)
|
48.6
(10.8)
|
| Sex: Female, Male (Count of Participants) | |||
| Female |
6
7.2%
|
4
4%
|
10
5.4%
|
| Male |
77
92.8%
|
97
96%
|
174
94.6%
|
| Region of Enrollment (participants) [Number] | |||
| United States |
83
100%
|
101
100%
|
184
100%
|
Outcome Measures
| Title | Receipt of Primary Care at the VA |
|---|---|
| Description | The primary aim of this study was to conduct a randomized controlled trial of different interventions aimed at increasing rates of treatment engagement among a community sample of treatment-naive homeless veterans. |
| Time Frame | within 4 weeks of intervention |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Arm 1: Outreach | Arm 2: Usual Care |
|---|---|---|
| Arm/Group Description | RN-based medical outreach, administration of a personal health assessment and brief intervention Personal Health Assessment/brief intervention: RN administered personal health assessment along with a brief intervention for behavior change administered to homeless veterans in the community | Social work based outreach (usual care) Social work administered outreach: Social worker will encounter homeless veteran in the community and encourage to come to the VA for care |
| Measure Participants | 83 | 101 |
| Number [participants] |
50
60.2%
|
39
38.6%
|
Adverse Events
| Time Frame | ||||
|---|---|---|---|---|
| Adverse Event Reporting Description | Per IRB designation as 'minimal risk' and approval of safety monitoring plan, non-serious AEs were not assessed. Serious Adverse Events were not monitored/assessed. | |||
| Arm/Group Title | Arm 1: Outreach | Arm 2: Usual Care | ||
| Arm/Group Description | RN-based medical outreach, administration of a personal health assessment and brief intervention Personal Health Assessment/brief intervention: RN administered personal health assessment along with a brief intervention for behavior change administered to homeless veterans in the community | Social work based outreach (usual care) Social work administered outreach: Social worker will encounter homeless veteran in the community and encourage to come to the VA for care | ||
All Cause Mortality |
||||
| Arm 1: Outreach | Arm 2: Usual Care | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | / (NaN) | / (NaN) | ||
Serious Adverse Events |
||||
| Arm 1: Outreach | Arm 2: Usual Care | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/0 (NaN) | 0/0 (NaN) | ||
Other (Not Including Serious) Adverse Events |
||||
| Arm 1: Outreach | Arm 2: Usual Care | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/0 (NaN) | 0/0 (NaN) | ||
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Thomas O'Toole, MD |
|---|---|
| Organization | Providence VA Medical Center |
| Phone | 4012737100 |
| thomas.otoole@va.gov |
- IIR 07-184