Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION-HPACT)
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|ClinicalTrials.gov Identifier: NCT02942979|
Recruitment Status : Recruiting
First Posted : October 24, 2016
Last Update Posted : April 18, 2019
|Condition or disease|
|Co-Occurring Disorders Homelessness Substance Abuse Disorder Mental Illness|
Background: Homeless Veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop program" to address the Housing and Healthcare needs of Homeless Veterans. However, while 70% of HPACT's Veteran enrollees have co-occurring mental health and substance use disorders (COD), HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless Veterans with COD which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU).
Aims: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders' (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION.
Design: Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation across 7 HPACT teams in 3 sites in the greater Los Angeles VA system.
Discussion: Integrating MISSION-Vet within HPACT has the potential to improve the health of thousands of Veterans but, it is crucial to implement the intervention appropriately in order for it to succeed. The lessons learned in this protocol could assist with a larger roll-out of MISSION within HPACT.
|Study Type :||Observational [Patient Registry]|
|Estimated Enrollment :||200 participants|
|Target Follow-Up Duration:||12 Months|
|Official Title:||Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION) (QUE 15-284)|
|Actual Study Start Date :||February 12, 2016|
|Estimated Primary Completion Date :||June 30, 2020|
|Estimated Study Completion Date :||September 1, 2020|
MISSION Implementation as Usual
Passive implementation or, IU for MISSION-Vet is comprised of a two-hour webinar training, along with key information on how to access and use the MISSION-Vet Treatment Manual and Consumer Workbook. The manual is posted on the web and available inside the VA on the National Center for Homelessness Among Veterans website or at missionmode.org. This passive implementation strategy has been used in previous studies
Facilitation Implementation of MISSION
Facilitation is a comprehensive approach in which implementation experts partner with local staff to support implementation planning and to tailor adoption strategies to the local context. Facilitation gives attention to addressing individual- and organizational-level factors that can influence successful implementation of an evidence based practice with good fidelity.
- MISSION Fidelity [ Time Frame: 12 months ]The fidelity index consists of 78 items assessing the presence or absence of certain activities within MISSION-Vet, and will be captured in Veterans' electronic medical records. Together an overall fidelity to the model score will be computed for each Veteran. The presence or absence of the activities together produce the overall score.
- Inpatient Service Utilization [ Time Frame: 12 months ]The investigators will measure the number of medical, mental health and overall inpatient hospitalization days in each month of the study's observation period.
- VA National Homeless Registry [ Time Frame: 12 months ]Measures the number of days spent in VA specialized homeless programs (e.g. Grant and Per Diem, Domiciliary Care for Homeless Veterans, Supportive Services for Veteran Families rapid re-housing) for which Veterans meet the statutory definition of homelessness.
- Semi-Structured Interviews [ Time Frame: 12 months ]Semi-structured interviews will be conducted for a formative (FE). The FE interviews will elicit key stakeholders' experiences with, and perspectives on MISSION-Vet training, barriers and facilitators of implementing MISSION-Vet as well as to identify particular areas to target for Facilitation.
- Outpatient Service Utilization [ Time Frame: 12 Months ]The investigators will measure engagement in substance abuse services which will be measured by the number of outpatient visits in a VA substance abuse specialty clinic, which will be identified based on clinic stop codes, in each month of the study's observation period.
- VA National HOMES Registry [ Time Frame: 12 Months ]The investigators will measure of the number of days in VA permanent housing programs for which Veteran is considered housed.
- VA National HOMES Registry [ Time Frame: 12 Months ]The investigators will measure the number of days residing in the community (i.e. Veteran is in neither VA homeless or VA permanent housing programs) during each month of the study period.
- Semi-Structured Interviews [ Time Frame: 12 months ]Semi-structured interviews will be conducted for a summative evaluation (SE). Summative evaluation interviews will identify stakeholder's experiences with Facilitation and needed adaptations to MISSION-Vet as well as Veteran experiences with MISISON-Vet.
- Evidence-Base Practice Attitudes Scale [ Time Frame: 12 months ]The Evidence-Based Practice Attitudes scale and the Organizational Support for Evidence-Based Practices scale will provide information on potential mediating factors. We will administer this measure to all HPACT staff annually throughout the study period.
- Organizational Support for Evidence Based Practice Scale [ Time Frame: 12 months ]Will provide information on potential, organization mediating factors.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02942979
|Contact: David A Smelson, PsyD||(781) email@example.com|
|United States, Massachusetts|
|Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA||Recruiting|
|Bedford, Massachusetts, United States, 01730|
|Contact: David A Smelson, PsyD 781-687-7778 firstname.lastname@example.org|
|Principal Investigator: Allen L. Gifford, MD|
|Principal Investigator: David A. Smelson, PsyD|
|Principal Investigator:||David A. Smelson, PsyD||Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA|
|Principal Investigator:||Allen L. Gifford, MD||Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA|
|Principal Investigator:||Sonya Emi Gabrielian, MD MPH||VA Greater Los Angeles Healthcare System, West Los Angeles, CA|