Addiction Housing Case Management for Homeless Veterans (AHCM)

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by Department of Veterans Affairs
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT01346514
First received: April 29, 2011
Last updated: June 10, 2014
Last verified: June 2014
  Purpose

The study will examine intensive case management for homeless Veterans in addiction treatment by integrating addiction/housing case managers (AHCM), operating from a Life Skills Training perspective, into an addiction specialty program. The primary aim is to determine whether the AHCM intervention increases number of days housed during the year following treatment entry. Secondary aims are to compare costs and cost-effectiveness of AHCM vs. time and attention control, determine if AHCM improves addiction outcomes and functional status, and examine treatment process variables associated with improved outcomes.


Condition Intervention
Homelessness
Substance Abuse Disorders
Mental Disorders
Behavioral: LifeSkills Training/Intensive Case Management
Behavioral: Time and attention control

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Addiction Housing Case Management for Homeless Veterans Enrolled in Addictions Treatment

Resource links provided by NLM:


Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • Number of days housed during the year following treatment entry in AHCM vs. time and attention control [ Time Frame: 12 months (18 to 24 month outcomes examined in secondary analyses) ] [ Designated as safety issue: No ]
    The primary aim is to determine whether the Addiction/Housing Case Management intervention increases number of days housed during the year following treatment entry.


Secondary Outcome Measures:
  • Secondary aims are to compare costs and cost-effectiveness of AHCM vs. time and attention control, [ Time Frame: 12 months ] [ Designated as safety issue: No ]
    Secondary aims are to compare costs and cost-effectiveness of AHCM vs. time and attention control, determine if AHCM improves addiction outcomes and functional status, and examine treatment process variables associated with improved outcomes.

  • Functional, addiction, and mental health status in AHCM vs. time and attention control [ Time Frame: 12 months (18 and 24 outcomes examined in secondary analyses) ] [ Designated as safety issue: No ]
    Determine if Addiction/Housing Case Management compared to time and attention control significantly improves functional status, addiction, and mental health outcomes among homeless Veterans entering addiction specialty care over the 12-month study course.

  • Treatment process measures (number of treatment sessions, type of housing placement, and change in Life Skills) [ Time Frame: 12 months (18 and 24 outcomes examined in secondary analyses) ] [ Designated as safety issue: No ]
    Analyses will explore whether treatment process variables mediate differences in outcomes between Addiction/Housing Case Management and time and attention conditions.


Estimated Enrollment: 400
Study Start Date: October 2011
Estimated Study Completion Date: May 2016
Estimated Primary Completion Date: November 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm 1
AHCM intervention
Behavioral: LifeSkills Training/Intensive Case Management
Assertive community treatment / intensive case management. Veterans assigned to the AHCM condition will have a case manager who is integrated with the interdisciplinary treatment team. The AHCM will meet with the Veteran weekly, assist the Veteran with potential housing options, support the Veteran in continuing addiction treatment and psychiatric care, visit the Veteran in the community when appropriate, and obtain point of care urine toxicology testing to assess abstinence with the goal of addressing substance use issues proactively. The AHCM will educate the Veteran on needed basic life skills using existing manuals
Active Comparator: Arm 2
time and attention control (weekly housing group)
Behavioral: Time and attention control
Veterans assigned to the control condition will attend a weekly housing group where housing options are discussed.

Detailed Description:

Background: Homelessness, substance use, and co-occurring psychiatric disorders form a mutually perpetuating, downwardly spiraling triad that maintains a state of homelessness, increases morbidity and mortality and thereby escalates health care utilization and costs. Addiction treatment is one portal of health care entry accessed by many Veterans with this devastating triad, yet addiction treatment fails to address homelessness directly. Homeless Veterans entering addiction treatment have worse treatment outcomes and incur more costs than housed Veterans entering such treatment. Further, many homeless Veterans never obtain housing after treatment entry and substantial proportion of those who do may subsequently return to homelessness. Assertive community treatment / intensive case management shows promise in improving housing status, as well as substance use and mental health outcomes in this population. Life Skills Training, which has been shown to improve the likelihood of maintaining housing, may increase the effectiveness of this method of treatment. An approach to homelessness incorporating assertive community treatment / intensive case management and Life Skills Training has never previously been integrated into VA addiction specialty care.

Objectives: The proposed study will examine intensive case management for homeless Veterans in addiction treatment by integrating addiction/housing case managers (AHCM), operating from a Life Skills Training perspective, into an addiction specialty program. The primary aim is to determine whether the AHCM intervention increases number of days housed during the year following treatment entry. Secondary aims are to compare costs and cost-effectiveness of AHCM vs. time and attention control, determine if AHCM improves addiction outcomes and functional status, and examine treatment process variables associated with improved outcomes.

Methods: The proposed study is a, parallel design, intention to treat, randomized clinical trial comparing the AHCM intervention to a time and attention control (weekly housing group) among homeless Veterans (N=400) newly entering addiction treatment. Following baseline assessment, Veterans will be randomly assigned, stratified by gender and primary substance problem, to one of the two treatment conditions and followed for 12 months. All Veterans will receive addiction treatment as usual. Veterans assigned to the AHCM condition will have a case manager who is integrated with the interdisciplinary treatment team. The AHCM will meet with the Veteran weekly, assist the Veteran with potential housing options, support the Veteran in continuing addiction treatment and psychiatric care, visit the Veteran in the community when appropriate, and obtain point of care urine toxicology testing to assess abstinence with the goal of addressing substance use issues proactively. The AHCM will educate the Veteran on needed basic life skills using existing manuals. Veterans assigned to the control condition will attend a weekly housing group where housing options are discussed. Participants will complete research assessments every 3 months through one year and then every 6 months for up to 2 years post-randomization to assess housing status and other outcomes. The Northwest Regional Data Warehouse and Decision Support System data sources will be used to determine outpatient and inpatient VA health care services and costs for the 1 year before and 2 years after study enrollment.

Impact: If the AHCM model interrupts the mutually perpetuating triad of homelessness, substance use, and co-occurring psychiatric disorders by increasing days stably housed, reducing costs and excessive health care utilization, and improving functional status, the model could be feasibly and rapidly replicated in VA addiction programs nationwide thereby decreasing homelessness among Veterans and preserving precious health care resources.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Veterans newly presenting or returning to specialty treatment for substance dependence at VA Puget Sound Seattle Division who, after an initial evaluation, are scheduled for a treatment appointment in the Addiction Treatment Center
  • Currently homeless (unsheltered, staying in temporary emergency shelter, or doubled up with friends/family)

Exclusion Criteria:

  • Not planning to stay in the Puget Sound area during the next 12 months
  • Unable to provide informed consent
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01346514

Contacts
Contact: Koriann Brousseau, MEd (206) 764-2763 Koriann.Brousseau@va.gov
Contact: Bergetta Dietel, BA (206) 277-4015 Bergetta.Dietel@va.gov

Locations
United States, Washington
VA Puget Sound Health Care System Recruiting
Seattle, Washington, United States, 98109
Contact: Koriann Brousseau, MEd    206-764-2763    Koriann.Brousseau@va.gov   
Contact: Bergetta Dietel, BA    (206) 277-4015    Bergetta.Dietel@va.gov   
Principal Investigator: Andrew J. Saxon, MD         
Sponsors and Collaborators
Investigators
Principal Investigator: Andrew J. Saxon, MD VA Puget Sound Health Care System
  More Information

No publications provided

Responsible Party: Department of Veterans Affairs
ClinicalTrials.gov Identifier: NCT01346514     History of Changes
Other Study ID Numbers: SDR 11-231
Study First Received: April 29, 2011
Last Updated: June 10, 2014
Health Authority: United States: Federal Government

Keywords provided by Department of Veterans Affairs:
Homeless Persons
Housing
Case Management
Veterans
Substance Related Disorders
Mental Disorders
Social Adjustment

Additional relevant MeSH terms:
Mental Disorders
Psychotic Disorders
Behavior, Addictive
Substance-Related Disorders
Schizophrenia and Disorders with Psychotic Features
Compulsive Behavior
Impulsive Behavior
Chemically-Induced Disorders

ClinicalTrials.gov processed this record on September 14, 2014