Generating Evidence for a Support Package to Stabilize Youth Trajectories Out of Homelessness

Sponsor
Centre for Addiction and Mental Health (Other)
Overall Status
Completed
CT.gov ID
NCT03277794
Collaborator
(none)
65
1
2
21
3.1

Study Details

Study Description

Brief Summary

This project builds upon initial proof of concept work examining the optimal set of supports for youth who have recently exited homelessness - an intervention comprised of mental health and peer supports alongside transitional case management. This collaborative model will be tested as a proof-of-concept in Thunder Bay with Indigenous youth and a trial will be conducted in Toronto to optimize and determine the effectiveness of the existing model of support.

Condition or Disease Intervention/Treatment Phase
  • Behavioral: HOP-C
  • Behavioral: Transitional Case Management Only
N/A

Detailed Description

In response to the challenges outlined above, and with the support of a grant from the Ontario Ministry of Child and Youth Services, the investigators developed and tested a tertiary prevention strategy called the Housing Outreach Program Collaborative (HOP-C) which launched in the summer of 2015. In this approach the investigators focused on collaborations and interventions that have the greatest potential to be effective with this population. The investigators brought together partners from a number of sectors in the GTA and have tested a 3-pronged set of supports (intervention described in detail in the methods):

  • Transitional Case Management

  • Mental Health Interventions: Group, individual, family

  • Peer Support This is an intensive, 6-month critical time intervention - one that jointly addresses many points of vulnerability (mental health crises, housing instability, justice involvement) while fostering resilience and connection with resources in employment, education and training domains. It is unique in both content comprehensiveness and integrated process of delivery. Also important was the development of a collaborative and responsive partnering process, to facilitate effective organizational interfaces and seamless service integration so participants can experience a tailored and coherent set of supports. With CAMH, the Centre for Mindfulness Studies, Covenant House, LOFT, and SKETCH at the service level and the Wellesley Institute leading evaluation, the investigators have carefully attended to a collective impact framework.

This initiative has proven feasible and is demonstrating good outcomes - with excellent youth engagement, reports of lower social isolation, improved mental health, and engagement with resources, and spin-off benefits of closer collaboration between organizations. The investigators successfully met the target of youth engagement, with a total of 31 youth participating, minimal attrition (n=2), and the investigators observed no indications that HOP-C resulted in risk of any form, both with respect to the intervention itself and the mixed methods research methodology. This promising feasibility work formed the foundation from which the investigators were successful in obtaining a grant from the Local Poverty Reduction Fund to support the study described in this proposal.

Current Project Determine through a randomized trial in Toronto if the positive outcomes the investigators are observing are due solely or primarily to transitional case management and if the additional peer and mental health components are necessary.

Engaging in intensive, tertiary prevention shows clear promise in disrupting a cycle of poverty and marginalization at a critical time - if proven and scaled a key driver of chronic homelessness would be addressed.

Research Questions The objective of this two-part project is to examine the effectiveness and transferability of the Housing Outreach Program-Collaboration (HOP-C) transitional intervention. HOP-C has proven to be feasible with promising outcomes in the Toronto proof-of-concept work currently underway.

  1. Are the benefits of the complex HOP-C intervention with all components in place greater than transitional case management in isolation?

• It is hypothesized that the full model will provide benefit in domains of housing stability, mental health, and quality of life that are significantly greater than case management alone.

The investigators have data in hand from their recent national work in the area which provides data on 'treatment as usual' or the outcomes that attend typically available supports. The proposed trial will unpack benefit and be essential in economic and viability arguments to be made going forward.

Study Design

Study Type:
Interventional
Actual Enrollment :
65 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Single (Outcomes Assessor)
Primary Purpose:
Treatment
Official Title:
Generating Evidence for a Comprehensive Support Package to Stabilize Youth Trajectories Out of Homelessness: A Tertiary Prevention Strategy
Actual Study Start Date :
Apr 1, 2017
Actual Primary Completion Date :
Dec 31, 2018
Actual Study Completion Date :
Dec 31, 2018

Arms and Interventions

Arm Intervention/Treatment
Active Comparator: Transitional Case Management Only

Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth.

Behavioral: Transitional Case Management Only
Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth.

Experimental: Full HOP-C Service

Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.

Behavioral: HOP-C
Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.

Outcome Measures

Primary Outcome Measures

  1. Housing [Change from Baseline to 6 months]

    Participants coded in a binary manner as having gained or sustained housing (binary positive) or lost (binary negative) based on assessment of the participant's trajectory from baseline to 6 months.

  2. Employment/Education [Change from baseline to 6 months]

    Participants coded in a binary manner as having gained or sustained education or employment (binary positive) or lost (binary negative) based on assessment of the participant's trajectory from baseline to 6 months.

  3. Mental Health [Change from baseline to 6 months]

    Participants coded in a binary manner as having gained or sustained mental health status without crises (binary positive) or experienced a crises that impacted major life domains (binary negative) based on assessment of the participant's trajectory from baseline to 6 months.

  4. Housing Security Scale [Change from Baseline to 6 months]

    The Housing Security Scale contains 12 items on a 5 point likert scale (Frederick et al., 2014). Scores range from "strongly disagree" (minimum = 1) to "strongly agree" (maximum = 5). Higher scores indicate better outcomes. Mean item range is 1-5 with pre-post difference reported.

  5. Housing Security Scale (Subjective Housing Stability Subscale) [Change from Baseline to 6 months]

    The Housing Security Scale contains a 4 item subscale that measures subjective housing satisfaction and perception of housing stability (Frederick et al., 2014). Scores range from "strongly disagree" (minimum = 1) to "strongly agree" (maximum = 5). Higher scores indicate better outcomes with a mean range of 1-5 with pre-post change reported.

Secondary Outcome Measures

  1. Mental Health Continuum - Short Form [Change from baseline to 6 month]

    Mental Health Continuum - Short Form assess mental health and addictions by measuring emotional, psychological and social well-being. It contains 14 items on a 6 point scale ranging from at minimum "never" (0) to, at maximum, "every day" (5). Higher scores indicate better outcomes. Range is 0-5 (means) with pre-post differences reported.

  2. Cognitive and Affective Mindfulness Scale [Change from baseline to 6 months]

    Cognitive and Affective Mindfulness Scale Revised was used to measure mindfulness and has demonstrated acceptable reliability (Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007). It contains 10 items. The minimum score is "rarely/Not at all" (1) and the maximum score is "almost always" (4). Higher scores indicate better outcomes with a mean item range from 1-4 with pre-post mean change reported.

  3. Community Integration Scale [Change from baseline to 6 months]

    Behavioural and psychological aspects of community integration was examined using Community Integration Scale The scale contains 7 dichotomous questions with higher scores indicating greater community integration (better outcomes). Mean item range is 0-1 with mean change reported.

  4. Community Integration Measure [Change from baseline to 6 months]

    Behavioural and psychological aspects of community integration were examined using the Community Integration Measure. The measure contains 6 items scored on a 5 point scale ranging from, at minimum, "always disagree" (1) to, at maximum, "always agree" (5). Higher scores indicating better outcomes with an item mean range from 1-5 with mean pre-post differences reported.

  5. Resilience Scale [Change from baseline to 6 months]

    Resilience will be measured using the 10-item Resilience Scale. Each item score ranges from, at minimum, "Not true at all" (0) to, at maximum, "True nearly all the time" (4) with higher scores indicating better outcomes. Mean item range is from 0-4 with pre-post change in means reported.

  6. Adults Hope Scale [Change from baseline to 6 months]

    Adult Hope Scale, a cognitive measure of hope, was employed. This self-report questionnaire contains 8 questions that are each scored on an 8 point Likert scale with scores ranging from "Definitely False" to "Definitely True". Higher scores indicate better outcomes. Mean item range is minimum 1 to maximum 8 with pre-post mean differences reported.

  7. GAIN Short Screener (CAMH Modified) [Change from baseline to 6 months]

    Mental health (and addictions) was measured using the Global Assessment of Individual Needs Short Screener, which includes 22 items scored on a 5 point scale ranging from "never" (0) as the minimum score and "past month" (4) as the maximum score. Higher scores indicate worse outcomes. Mean item range is 0-4 with pre-post mean change reported.

  8. Medical Outcomes Study (MOS) Social Support Survey [Change from baseline to 6 month]

    We used a modified version of the Medical Outcomes Study Social Support Survey to measure social support. It is a 15-item 5-point Likert-type scale. The maximum score is "all of the time" (5) and the minimum score is "none of the time" (1). Higher score indicates better outcome. Item mean range is 1-5 with pre-post mean difference reported.

  9. World Health Organization Quality of Life Scale - BREF [Change from baseline to 6 months]

    The brief World Health Organization Quality of Life Scale - BREF contains 26 items, each scored from 1 to 5 with various labels for each score (e.g. 1= "very poor" for item 1 and 1= "very dissatisfied" for item 2). Higher scores indicate better outcomes with a mean item range of 1-5 with pre-post mean change reported.

Eligibility Criteria

Criteria

Ages Eligible for Study:
16 Years to 26 Years
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • between the ages of 16 and 26

  • have obtained secure housing in a time period up to 12 months previously

Exclusion Criteria:
  • none

Contacts and Locations

Locations

Site City State Country Postal Code
1 Centre for Addiction and Mental Health Toronto Ontario Canada M5T 1R8

Sponsors and Collaborators

  • Centre for Addiction and Mental Health

Investigators

  • Principal Investigator: Sean A Kidd, Phd, Centre for Addiction and Mental Health

Study Documents (Full-Text)

More Information

Additional Information:

Publications

Responsible Party:
Sean Kidd, Clinician Scientist, Centre for Addiction and Mental Health
ClinicalTrials.gov Identifier:
NCT03277794
Other Study ID Numbers:
  • 02/06/2017
First Posted:
Sep 11, 2017
Last Update Posted:
Mar 18, 2021
Last Verified:
Feb 1, 2021
Individual Participant Data (IPD) Sharing Statement:
No
Plan to Share IPD:
No
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No

Study Results

Participant Flow

Recruitment Details
Pre-assignment Detail
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Period Title: Overall Study
STARTED 31 34
COMPLETED 28 30
NOT COMPLETED 3 4

Baseline Characteristics

Arm/Group Title Transitional Case Management Only Full HOP-C Service Total
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. Total of all reporting groups
Overall Participants 31 34 65
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]
21.74
(2.03)
21.76
(2.14)
21.75
(2.07)
Sex/Gender, Customized (Count of Participants)
Female
14
45.2%
12
35.3%
26
40%
Other
17
54.8%
22
64.7%
39
60%
Race/Ethnicity, Customized (Count of Participants)
White - North American
5
16.1%
5
14.7%
10
15.4%
Black - African
5
16.1%
3
8.8%
8
12.3%
Black - Caribbean
3
9.7%
4
11.8%
7
10.8%
Mixed Heritage
2
6.5%
4
11.8%
6
9.2%
Other/Not Specified
16
51.6%
18
52.9%
34
52.3%
Sexual Orientation (Count of Participants)
Heterosexual
21
67.7%
22
64.7%
43
66.2%
Bi-Sexual
3
9.7%
4
11.8%
7
10.8%
Prefer not to answer
2
6.5%
2
5.9%
4
6.2%
Other/Not Specified
5
16.1%
6
17.6%
11
16.9%
Highest Education (Count of Participants)
Some High School
14
45.2%
7
20.6%
21
32.3%
Completed High School
7
22.6%
11
32.4%
18
27.7%
Transitional Program
6
19.4%
11
32.4%
17
26.2%
Other/Not Specified
4
12.9%
5
14.7%
9
13.8%
Homelessness - Lifetime Length (Count of Participants)
6-12 Months
7
22.6%
11
32.4%
18
27.7%
1-2 years
10
32.3%
6
17.6%
16
24.6%
2-3 years
1
3.2%
10
29.4%
11
16.9%
3+ years
13
41.9%
7
20.6%
20
30.8%
NEET - Not in Employment, Education or Training (Count of Participants)
Count of Participants [Participants]
14
45.2%
10
29.4%
24
36.9%

Outcome Measures

1. Primary Outcome
Title Housing
Description Participants coded in a binary manner as having gained or sustained housing (binary positive) or lost (binary negative) based on assessment of the participant's trajectory from baseline to 6 months.
Time Frame Change from Baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Count of Participants [Participants]
25
80.6%
28
82.4%
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only, Full HOP-C Service
Comments Full HOP-C Service (Treatment) vs. Transitional Case Management Only (Control)
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.354
Comments
Method Regression, Logistic
Comments
Method of Estimation Estimation Parameter Odds Ratio (OR)
Estimated Value 2.28
Confidence Interval (2-Sided) %
to
Parameter Dispersion Type: Standard Error of the Mean
Value: 0.89
Estimation Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only, Full HOP-C Service
Comments Full HOP-C Service (Treatment) vs. Transitional Case Management Only (Control)
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.465
Comments
Method Regression, Logistic
Comments
Method of Estimation Estimation Parameter Odds Ratio (OR)
Estimated Value 2.01
Confidence Interval (2-Sided) %
to
Parameter Dispersion Type: Standard Error of the Mean
Value: 0.95
Estimation Comments
2. Primary Outcome
Title Employment/Education
Description Participants coded in a binary manner as having gained or sustained education or employment (binary positive) or lost (binary negative) based on assessment of the participant's trajectory from baseline to 6 months.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Count of Participants [Participants]
18
58.1%
24
70.6%
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only, Full HOP-C Service
Comments Full HOP-C Service (Treatment) vs. Transitional Case Management Only (Control)
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.159
Comments
Method Regression, Logistic
Comments
Method of Estimation Estimation Parameter Odds Ratio (OR)
Estimated Value 2.31
Confidence Interval (2-Sided) %
to
Parameter Dispersion Type: Standard Error of the Mean
Value: 0.59
Estimation Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only, Full HOP-C Service
Comments Full HOP-C Service (Treatment) vs. Transitional Case Management Only (Control)
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.200
Comments
Method Regression, Linear
Comments
Method of Estimation Estimation Parameter Odds Ratio (OR)
Estimated Value 2.30
Confidence Interval (2-Sided) %
to
Parameter Dispersion Type: Standard Error of the Mean
Value: 0.64
Estimation Comments
3. Primary Outcome
Title Mental Health
Description Participants coded in a binary manner as having gained or sustained mental health status without crises (binary positive) or experienced a crises that impacted major life domains (binary negative) based on assessment of the participant's trajectory from baseline to 6 months.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Count of Participants [Participants]
20
64.5%
27
79.4%
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only, Full HOP-C Service
Comments Full HOP-C Service (Treatment) vs. Transitional Case Management Only (Control)
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.121
Comments
Method Regression, Logistic
Comments
Method of Estimation Estimation Parameter Odds Ratio (OR)
Estimated Value 3.18
Confidence Interval (2-Sided) %
to
Parameter Dispersion Type: Standard Error of the Mean
Value: 0.74
Estimation Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only, Full HOP-C Service
Comments Full HOP-C Service (Treatment) vs. Transitional Case Management Only (Control)
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.134
Comments
Method Regression, Logistic
Comments
Method of Estimation Estimation Parameter Odds Ratio (OR)
Estimated Value 3.63
Confidence Interval (2-Sided) %
to
Parameter Dispersion Type: Standard Error of the Mean
Value: 0.85
Estimation Comments
4. Primary Outcome
Title Housing Security Scale
Description The Housing Security Scale contains 12 items on a 5 point likert scale (Frederick et al., 2014). Scores range from "strongly disagree" (minimum = 1) to "strongly agree" (maximum = 5). Higher scores indicate better outcomes. Mean item range is 1-5 with pre-post difference reported.
Time Frame Change from Baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Mean (Standard Error) [score on a scale]
0.017
(0.129)
0.153
(0.098)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.899
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.128
Comments Unadjusted
Method Regression, Linear
Comments
5. Primary Outcome
Title Housing Security Scale (Subjective Housing Stability Subscale)
Description The Housing Security Scale contains a 4 item subscale that measures subjective housing satisfaction and perception of housing stability (Frederick et al., 2014). Scores range from "strongly disagree" (minimum = 1) to "strongly agree" (maximum = 5). Higher scores indicate better outcomes with a mean range of 1-5 with pre-post change reported.
Time Frame Change from Baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Mean (Standard Error) [score on a scale]
-0.259
(0.196)
0.422
(0.167)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.198
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.017
Comments Unadjusted.
Method Regression, Linear
Comments
6. Secondary Outcome
Title Mental Health Continuum - Short Form
Description Mental Health Continuum - Short Form assess mental health and addictions by measuring emotional, psychological and social well-being. It contains 14 items on a 6 point scale ranging from at minimum "never" (0) to, at maximum, "every day" (5). Higher scores indicate better outcomes. Range is 0-5 (means) with pre-post differences reported.
Time Frame Change from baseline to 6 month

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Mean (Standard Error) [score on a scale]
0.276
(0.157)
0.077
(0.141)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.091
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.591
Comments Unadjusted.
Method Regression, Linear
Comments
7. Secondary Outcome
Title Cognitive and Affective Mindfulness Scale
Description Cognitive and Affective Mindfulness Scale Revised was used to measure mindfulness and has demonstrated acceptable reliability (Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007). It contains 10 items. The minimum score is "rarely/Not at all" (1) and the maximum score is "almost always" (4). Higher scores indicate better outcomes with a mean item range from 1-4 with pre-post mean change reported.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Mean (Standard Error) [score on a scale]
0.226
(0.099)
0.176
(0.058)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.030
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.005
Comments Unadjusted.
Method Regression, Linear
Comments
8. Secondary Outcome
Title Community Integration Scale
Description Behavioural and psychological aspects of community integration was examined using Community Integration Scale The scale contains 7 dichotomous questions with higher scores indicating greater community integration (better outcomes). Mean item range is 0-1 with mean change reported.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Mean (Standard Error) [score on a scale]
-0.108
(0.075)
0.008
(0.045)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.163
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.865
Comments Unadjusted.
Method Regression, Linear
Comments
9. Secondary Outcome
Title Community Integration Measure
Description Behavioural and psychological aspects of community integration were examined using the Community Integration Measure. The measure contains 6 items scored on a 5 point scale ranging from, at minimum, "always disagree" (1) to, at maximum, "always agree" (5). Higher scores indicating better outcomes with an item mean range from 1-5 with mean pre-post differences reported.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Mean (Standard Error) [score on a scale]
-0.006
(0.239)
-0.051
(0.163)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.980
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.758
Comments Unadjusted.
Method Regression, Linear
Comments
10. Secondary Outcome
Title Resilience Scale
Description Resilience will be measured using the 10-item Resilience Scale. Each item score ranges from, at minimum, "Not true at all" (0) to, at maximum, "True nearly all the time" (4) with higher scores indicating better outcomes. Mean item range is from 0-4 with pre-post change in means reported.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Mean (Standard Error) [score on a scale]
0.252
(0.159)
0.093
(0.065)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.124
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.168
Comments Unadjusted.
Method Regression, Linear
Comments
11. Secondary Outcome
Title Adults Hope Scale
Description Adult Hope Scale, a cognitive measure of hope, was employed. This self-report questionnaire contains 8 questions that are each scored on an 8 point Likert scale with scores ranging from "Definitely False" to "Definitely True". Higher scores indicate better outcomes. Mean item range is minimum 1 to maximum 8 with pre-post mean differences reported.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Mean (Standard Error) [score on a scale]
0.218
(0.276)
-0.038
(0.099)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.436
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.706
Comments Unadjusted.
Method Regression, Linear
Comments
12. Secondary Outcome
Title GAIN Short Screener (CAMH Modified)
Description Mental health (and addictions) was measured using the Global Assessment of Individual Needs Short Screener, which includes 22 items scored on a 5 point scale ranging from "never" (0) as the minimum score and "past month" (4) as the maximum score. Higher scores indicate worse outcomes. Mean item range is 0-4 with pre-post mean change reported.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Internalizing
-0.124
(0.236)
-0.265
(0.191)
Externalizing
-0.151
(0.15)
-0.212
(0.171)
Substance Use
-0.308
(0.184)
-0.291
(0.147)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Internalizing
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.604
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Internalizing
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.177
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 3
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Externalizing
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.325
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 4
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Externalizing
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.227
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 5
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Substance Use
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.106
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 6
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Substance Use
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.058
Comments Unadjusted.
Method Regression, Linear
Comments
13. Secondary Outcome
Title Medical Outcomes Study (MOS) Social Support Survey
Description We used a modified version of the Medical Outcomes Study Social Support Survey to measure social support. It is a 15-item 5-point Likert-type scale. The maximum score is "all of the time" (5) and the minimum score is "none of the time" (1). Higher score indicates better outcome. Item mean range is 1-5 with pre-post mean difference reported.
Time Frame Change from baseline to 6 month

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Emotional Supports
0.043
(0.247)
0.174
(0.196)
Tangible Supports
0.110
(0.264)
-0.003
(0.194)
Affectionate Supports
-0.115
(0.297)
0.333
(0.227)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Emotional Supports
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.862
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Emotional Supports
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.382
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 3
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Tangible Supports
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.680
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 4
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Tangible Supports
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.988
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 5
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Affectionate
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.701
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 6
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Affectionate
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.154
Comments Unadjusted.
Method Regression, Linear
Comments
14. Secondary Outcome
Title World Health Organization Quality of Life Scale - BREF
Description The brief World Health Organization Quality of Life Scale - BREF contains 26 items, each scored from 1 to 5 with various labels for each score (e.g. 1= "very poor" for item 1 and 1= "very dissatisfied" for item 2). Higher scores indicate better outcomes with a mean item range of 1-5 with pre-post mean change reported.
Time Frame Change from baseline to 6 months

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
Measure Participants 28 30
Physical Health
0.201
(0.552)
0.717
(0.484)
Psychological
-0.117
(0.432)
0.086
(0.355)
Social
0.308
(0.869)
0.099
(0.376)
Environment
0.124
(0.596)
0.843
(0.407)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Physical Health
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.719
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Physical Health
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.150
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 3
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Psychological
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.789
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 4
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Psychological
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.811
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 5
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Social
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.726
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 6
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Social
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.795
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 7
Statistical Analysis Overview Comparison Group Selection Transitional Case Management Only
Comments Environment
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.837
Comments Unadjusted.
Method Regression, Linear
Comments
Statistical Analysis 8
Statistical Analysis Overview Comparison Group Selection Full HOP-C Service
Comments Environment
Type of Statistical Test Other
Comments
Statistical Test of Hypothesis p-Value 0.048
Comments Unadjusted.
Method Regression, Linear
Comments

Adverse Events

Time Frame 6 months
Adverse Event Reporting Description
Arm/Group Title Transitional Case Management Only Full HOP-C Service
Arm/Group Description Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd.
All Cause Mortality
Transitional Case Management Only Full HOP-C Service
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/31 (0%) 0/34 (0%)
Serious Adverse Events
Transitional Case Management Only Full HOP-C Service
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/31 (0%) 0/34 (0%)
Other (Not Including Serious) Adverse Events
Transitional Case Management Only Full HOP-C Service
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/31 (0%) 0/34 (0%)

Limitations/Caveats

Variability in youth service need resulting in variable effectiveness of treatment. In attempt to normalize the control group, it became less generalizable. RCT challenges with engagement and trust.

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 Dr. Sean Kidd
Organization Centre for Addiction and Mental Health
Phone 416-535-8501 ext 36295
Email sean.kidd@camh.ca
Responsible Party:
Sean Kidd, Clinician Scientist, Centre for Addiction and Mental Health
ClinicalTrials.gov Identifier:
NCT03277794
Other Study ID Numbers:
  • 02/06/2017
First Posted:
Sep 11, 2017
Last Update Posted:
Mar 18, 2021
Last Verified:
Feb 1, 2021