Trial Outcomes & Findings for Addiction Housing Case Management for Homeless Veterans (NCT NCT01346514)

NCT ID: NCT01346514

Last Updated: 2017-02-28

Results Overview

The primary aim is to determine whether the Addiction/Housing Case Management intervention increases percent days in long-term housing (permanent or long-term transitional) during the year following treatment entry relative to a Housing Support Group.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

181 participants

Primary outcome timeframe

12 months (18 to 24 month outcomes examined in secondary analyses)

Results posted on

2017-02-28

Participant Flow

Participants (n=181) were recruited from the VA Puget Sound, Seattle Division between October 2011 and November 2015.

Participant milestones

Participant milestones
Measure
Arm 1/Addiction Housing Case Management (AHCM)
AHCM intervention/ AHCM involves intensive case management for housing, substance use, and related issues. 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
Arm 2/Housing Support Group (HSG)
HSG/ The Housing Support Group is a time and attention control. Veterans assigned to HSG attend a weekly drop-in housing group where housing options are discussed and participants receive support from one another.
Overall Study
STARTED
91
90
Overall Study
3 Month Assessment
83
68
Overall Study
6 Month Assessment
74
61
Overall Study
9 Month Assessment
67
59
Overall Study
12 Month Assessment
62
53
Overall Study
COMPLETED
62
53
Overall Study
NOT COMPLETED
29
37

Reasons for withdrawal

Reasons for withdrawal
Measure
Arm 1/Addiction Housing Case Management (AHCM)
AHCM intervention/ AHCM involves intensive case management for housing, substance use, and related issues. 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
Arm 2/Housing Support Group (HSG)
HSG/ The Housing Support Group is a time and attention control. Veterans assigned to HSG attend a weekly drop-in housing group where housing options are discussed and participants receive support from one another.
Overall Study
Lost to Follow-up
19
30
Overall Study
Withdrawal by Subject
7
3
Overall Study
Death
3
4

Baseline Characteristics

Addiction Housing Case Management for Homeless Veterans

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Arm 1/Addiction Housing Case Management (AHCM)
n=91 Participants
AHCM intervention/ AHCM involves intensive case management for housing, substance use, and related issues. 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
Arm 2/Housing Support Group (HSG)
n=90 Participants
HSG/ The Housing Support Group is a time and attention control. Veterans assigned to HSG attend a weekly drop-in housing group where housing options are discussed and participants receive support from one another.
Total
n=181 Participants
Total of all reporting groups
Age, Continuous
50.8 years
STANDARD_DEVIATION 9.5 • n=5 Participants
50.9 years
STANDARD_DEVIATION 9.6 • n=7 Participants
50.9 years
STANDARD_DEVIATION 9.5 • n=5 Participants
Gender
Female
2 Participants
n=5 Participants
2 Participants
n=7 Participants
4 Participants
n=5 Participants
Gender
Male
89 Participants
n=5 Participants
88 Participants
n=7 Participants
177 Participants
n=5 Participants
Race/Ethnicity, Customized
White
55 participants
n=5 Participants
53 participants
n=7 Participants
108 participants
n=5 Participants
Race/Ethnicity, Customized
Black
32 participants
n=5 Participants
28 participants
n=7 Participants
60 participants
n=5 Participants
Race/Ethnicity, Customized
Native American
0 participants
n=5 Participants
6 participants
n=7 Participants
6 participants
n=5 Participants
Race/Ethnicity, Customized
Asian/Pacific Islander
2 participants
n=5 Participants
0 participants
n=7 Participants
2 participants
n=5 Participants
Race/Ethnicity, Customized
Hispanic
2 participants
n=5 Participants
3 participants
n=7 Participants
5 participants
n=5 Participants
Primary Substance of Use
Alcohol
57 participants
n=5 Participants
59 participants
n=7 Participants
116 participants
n=5 Participants
Primary Substance of Use
Cocaine
15 participants
n=5 Participants
15 participants
n=7 Participants
30 participants
n=5 Participants
Primary Substance of Use
Opioids
9 participants
n=5 Participants
8 participants
n=7 Participants
17 participants
n=5 Participants
Primary Substance of Use
Other
10 participants
n=5 Participants
8 participants
n=7 Participants
18 participants
n=5 Participants
Time Homeless, Current Episode
Less than 1 month
15 participants
n=5 Participants
10 participants
n=7 Participants
25 participants
n=5 Participants
Time Homeless, Current Episode
1-6 months
31 participants
n=5 Participants
27 participants
n=7 Participants
58 participants
n=5 Participants
Time Homeless, Current Episode
6-12 months
21 participants
n=5 Participants
15 participants
n=7 Participants
36 participants
n=5 Participants
Time Homeless, Current Episode
1-2 years
9 participants
n=5 Participants
10 participants
n=7 Participants
19 participants
n=5 Participants
Time Homeless, Current Episode
2 or more years
15 participants
n=5 Participants
27 participants
n=7 Participants
42 participants
n=5 Participants
Time Homeless, Current Episode
Unknown
0 participants
n=5 Participants
1 participants
n=7 Participants
1 participants
n=5 Participants
Episodes of Homelessness
1 episode
51 participants
n=5 Participants
55 participants
n=7 Participants
106 participants
n=5 Participants
Episodes of Homelessness
2 episodes
24 participants
n=5 Participants
17 participants
n=7 Participants
41 participants
n=5 Participants
Episodes of Homelessness
3 episodes
4 participants
n=5 Participants
10 participants
n=7 Participants
14 participants
n=5 Participants
Episodes of Homelessness
4 episodes
4 participants
n=5 Participants
4 participants
n=7 Participants
8 participants
n=5 Participants
Episodes of Homelessness
5 or more episodes
8 participants
n=5 Participants
3 participants
n=7 Participants
11 participants
n=5 Participants
Episodes of Homelessness
Unknown
0 participants
n=5 Participants
1 participants
n=7 Participants
1 participants
n=5 Participants

PRIMARY outcome

Timeframe: 12 months (18 to 24 month outcomes examined in secondary analyses)

Population: The percent of days in long-term transitional housing and/or own home was calculated for all patients using self-report and VA Homeless Operations Management and Evaluation System (HOMES) data. Individuals with no self-report or HOMES data were coded as not housed.

The primary aim is to determine whether the Addiction/Housing Case Management intervention increases percent days in long-term housing (permanent or long-term transitional) during the year following treatment entry relative to a Housing Support Group.

Outcome measures

Outcome measures
Measure
Arm 1/Addiction Housing Case Management (AHCM)
n=91 Participants
The AHCM condition provided individual case management, delivered at the VA and in the community, designed to assist homeless Veterans with SUD issues. Case management focused on : 1) support in obtaining/maintaining housing through education about resources, coordination with VA and community housing program providers, assistance in establishing housing program eligibility, and problem-solving around threats to housing stability; 2) support for SUD and related issues that affect housing status through treatment engagement/re-engagement, referrals for needed services (e.g. psychiatric, medical, vocational), and addressing substance use issues proactively; 3) promotion of residential stability through Life Skills Training, which was designed to improve key skills (room and self-care, money management, and community participation).
Arm 2/Housing Support Group (HSG)
n=90 Participants
The HSG condition involved a weekly drop-in housing support group. The HSG focused on gaining support from fellow study participants and learning from those who successfully obtained housing. Group facilitators provided education about housing resources and assistance with housing-related issues.
Percent Days Housed in AHCM vs. HSG, Baseline to 12 Months.
Percent Days Housed, Baseline
14.7 percent days housed
Interval 9.3 to 20.2
12.0 percent days housed
Interval 7.0 to 16.9
Percent Days Housed in AHCM vs. HSG, Baseline to 12 Months.
Percent Days Housed, 3 Month
25.0 percent days housed
Interval 18.1 to 31.8
14.1 percent days housed
Interval 8.9 to 19.4
Percent Days Housed in AHCM vs. HSG, Baseline to 12 Months.
Percent Days Housed, 6 Month
48.9 percent days housed
Interval 39.6 to 58.2
44.4 percent days housed
Interval 35.4 to 53.4
Percent Days Housed in AHCM vs. HSG, Baseline to 12 Months.
Percent Days Housed, 9 Month
53.9 percent days housed
Interval 44.3 to 63.5
48.5 percent days housed
Interval 38.9 to 58.2
Percent Days Housed in AHCM vs. HSG, Baseline to 12 Months.
Percent Days Housed, 12 Month
53.1 percent days housed
Interval 43.3 to 62.8
51.4 percent days housed
Interval 41.4 to 61.4

SECONDARY outcome

Timeframe: Baseline to 12 months

Population: These analyses were not completed due to the lack of differences seen in the primary study outcomes (percent days housed) and quality of life measures (SF-36).

Costs and cost-effectiveness of Addiction/Housing Case Management to the Housing Support Group condition.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline to 12 months

Determine if Addiction/Housing Case Management compared to a Housing Support Group control significantly improved functional status outcomes among homeless Veterans entering addiction specialty care over the 12-month study course. Functional status was measured by Medical, Employment, Family/Social, and Legal Composite Scores (range 0 to 1 with higher scores indicating greater severity) on the Addiction Severity Index (ASI) and the Physical Component Summary (PCS, range 0 to 100 with lower scores indicating greater severity) on the SF-36. Negative change on the ASI measures indicates improvement. Positive change on the SF-36 PCS indicates improvement.

Outcome measures

Outcome measures
Measure
Arm 1/Addiction Housing Case Management (AHCM)
n=91 Participants
The AHCM condition provided individual case management, delivered at the VA and in the community, designed to assist homeless Veterans with SUD issues. Case management focused on : 1) support in obtaining/maintaining housing through education about resources, coordination with VA and community housing program providers, assistance in establishing housing program eligibility, and problem-solving around threats to housing stability; 2) support for SUD and related issues that affect housing status through treatment engagement/re-engagement, referrals for needed services (e.g. psychiatric, medical, vocational), and addressing substance use issues proactively; 3) promotion of residential stability through Life Skills Training, which was designed to improve key skills (room and self-care, money management, and community participation).
Arm 2/Housing Support Group (HSG)
n=90 Participants
The HSG condition involved a weekly drop-in housing support group. The HSG focused on gaining support from fellow study participants and learning from those who successfully obtained housing. Group facilitators provided education about housing resources and assistance with housing-related issues.
Change in Functional Status in AHCM vs. HSG From Baseline to 12 Months
ASI Medical Composite, Change BL to Month 12
-0.05 units on a scale
Interval -0.16 to 0.05
0.04 units on a scale
Interval -0.06 to 0.14
Change in Functional Status in AHCM vs. HSG From Baseline to 12 Months
ASI Employment Composite, Change BL to Month 12
-0.05 units on a scale
Interval -0.1 to 0.0
0.00 units on a scale
Interval -0.05 to 0.04
Change in Functional Status in AHCM vs. HSG From Baseline to 12 Months
ASI Family Composite, Change BL to Month 12
-0.04 units on a scale
Interval -0.07 to 0.0
-0.04 units on a scale
Interval -0.07 to -0.01
Change in Functional Status in AHCM vs. HSG From Baseline to 12 Months
ASI Legal Composite, Change BL to Month 12
-0.07 units on a scale
Interval -0.11 to -0.03
-0.07 units on a scale
Interval -0.1 to -0.03
Change in Functional Status in AHCM vs. HSG From Baseline to 12 Months
SF-36 Physical Component Summ, Chg BL to Month 12
0.89 units on a scale
Interval -1.09 to 2.87
-1.07 units on a scale
Interval -3.04 to 0.91

SECONDARY outcome

Timeframe: Baseline to 12 months

Determine if Addiction/Housing Case Management compared to a Housing Support Group control significantly improved alcohol and drug outcomes, as measured by Alcohol and Drug Composite Scores (range 0 to 1, with higher scores indicating greater severity) on the Addiction Severity Index (ASI), among homeless Veterans entering addiction specialty care over the 12-month study course. Negative change on the ASI measures indicates improvement.

Outcome measures

Outcome measures
Measure
Arm 1/Addiction Housing Case Management (AHCM)
n=91 Participants
The AHCM condition provided individual case management, delivered at the VA and in the community, designed to assist homeless Veterans with SUD issues. Case management focused on : 1) support in obtaining/maintaining housing through education about resources, coordination with VA and community housing program providers, assistance in establishing housing program eligibility, and problem-solving around threats to housing stability; 2) support for SUD and related issues that affect housing status through treatment engagement/re-engagement, referrals for needed services (e.g. psychiatric, medical, vocational), and addressing substance use issues proactively; 3) promotion of residential stability through Life Skills Training, which was designed to improve key skills (room and self-care, money management, and community participation).
Arm 2/Housing Support Group (HSG)
n=90 Participants
The HSG condition involved a weekly drop-in housing support group. The HSG focused on gaining support from fellow study participants and learning from those who successfully obtained housing. Group facilitators provided education about housing resources and assistance with housing-related issues.
Change in Alcohol and Drug Outcomes in AHCM vs. HSG From Baseline to 12 Months
ASI Alcohol Composite, Change BL to Month 12
-0.06 units on a scale
Interval -0.13 to 0.01
-0.20 units on a scale
Interval -0.26 to -0.13
Change in Alcohol and Drug Outcomes in AHCM vs. HSG From Baseline to 12 Months
ASI Drug Composite, Change BL to Month 12
-0.04 units on a scale
Interval -0.07 to -0.02
-0.05 units on a scale
Interval -0.07 to -0.03

SECONDARY outcome

Timeframe: Baseline to 12 months

Determine if Addiction/Housing Case Management compared to a Housing Support Group control significantly increase the percent of participants abstinent from alcohol and drugs over the past 30 days among homeless Veterans entering addiction specialty care over the 12-month study course. Positive change indicates improvement.

Outcome measures

Outcome measures
Measure
Arm 1/Addiction Housing Case Management (AHCM)
n=91 Participants
The AHCM condition provided individual case management, delivered at the VA and in the community, designed to assist homeless Veterans with SUD issues. Case management focused on : 1) support in obtaining/maintaining housing through education about resources, coordination with VA and community housing program providers, assistance in establishing housing program eligibility, and problem-solving around threats to housing stability; 2) support for SUD and related issues that affect housing status through treatment engagement/re-engagement, referrals for needed services (e.g. psychiatric, medical, vocational), and addressing substance use issues proactively; 3) promotion of residential stability through Life Skills Training, which was designed to improve key skills (room and self-care, money management, and community participation).
Arm 2/Housing Support Group (HSG)
n=90 Participants
The HSG condition involved a weekly drop-in housing support group. The HSG focused on gaining support from fellow study participants and learning from those who successfully obtained housing. Group facilitators provided education about housing resources and assistance with housing-related issues.
Change in Percent of Participants Abstinent From Baseline to 12 Month Follow-up
27.0 precentage of participants
Interval 12.2 to 41.7
30.5 precentage of participants
Interval 16.2 to 44.8

SECONDARY outcome

Timeframe: Baseline to 12 months

Determine if Addiction/Housing Case Management compared to a Housing Support Group control significantly improved mental health outcomes, as measured by the Psychiatric Composite Score (range 0 to 1, with higher scores indicating greater severity) on the Addiction Severity Index (ASI) and the Mental Component Summary (MCS, range 0 to 100 with lower scores indicating greater severity) of the SF-36, among homeless Veterans entering addiction specialty care over the 12-month study course. Negative change on the ASI Psychiatric Composite Score indicates improvement. Positive change on the SF-36 MCS indicates improvement.

Outcome measures

Outcome measures
Measure
Arm 1/Addiction Housing Case Management (AHCM)
n=91 Participants
The AHCM condition provided individual case management, delivered at the VA and in the community, designed to assist homeless Veterans with SUD issues. Case management focused on : 1) support in obtaining/maintaining housing through education about resources, coordination with VA and community housing program providers, assistance in establishing housing program eligibility, and problem-solving around threats to housing stability; 2) support for SUD and related issues that affect housing status through treatment engagement/re-engagement, referrals for needed services (e.g. psychiatric, medical, vocational), and addressing substance use issues proactively; 3) promotion of residential stability through Life Skills Training, which was designed to improve key skills (room and self-care, money management, and community participation).
Arm 2/Housing Support Group (HSG)
n=90 Participants
The HSG condition involved a weekly drop-in housing support group. The HSG focused on gaining support from fellow study participants and learning from those who successfully obtained housing. Group facilitators provided education about housing resources and assistance with housing-related issues.
Change in Mental Health Status in AHCM vs. HSG From Baseline to 12 Months
ASI Psychiatric Composite, Change BL to Month 12
-0.11 units on a scale
Interval -0.17 to -0.04
-0.13 units on a scale
Interval -0.19 to -0.07
Change in Mental Health Status in AHCM vs. HSG From Baseline to 12 Months
SF-36 MCS, Change BL to Month 12
1.08 units on a scale
Interval -1.92 to 4.08
3.09 units on a scale
Interval 0.63 to 5.55

SECONDARY outcome

Timeframe: Baseline to 12 months

Population: Due to the lack of differences seen in the primary housing outcomes between the AHCM and HSG conditions, tests of mediation were not completed.

Analyses will explore whether treatment process variables mediate differences in outcomes between Addiction/Housing Case Management and time and attention conditions.

Outcome measures

Outcome data not reported

Adverse Events

Arm 1/Addiction Housing Case Management (AHCM)

Serious events: 39 serious events
Other events: 18 other events
Deaths: 0 deaths

Arm 2/Housing Support Group (HSG)

Serious events: 31 serious events
Other events: 13 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Arm 1/Addiction Housing Case Management (AHCM)
n=91 participants at risk
AHCM intervention/ AHCM involves intensive case management for housing, substance use, and related issues. 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
Arm 2/Housing Support Group (HSG)
n=90 participants at risk
HSG/ The Housing Support Group is a time and attention control. Veterans assigned to HSG attend a weekly drop-in housing group where housing options are discussed and participants receive support from one another.
General disorders
Death
3.3%
3/91 • Number of events 3 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
4.4%
4/90 • Number of events 4 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
General disorders
Medical Hospitalization
20.9%
19/91 • Number of events 36 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
17.8%
16/90 • Number of events 27 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
Psychiatric disorders
Suicide attempt
2.2%
2/91 • Number of events 2 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
3.3%
3/90 • Number of events 6 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
Psychiatric disorders
Psychiatric Hospitalization
22.0%
20/91 • Number of events 35 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
8.9%
8/90 • Number of events 21 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
Psychiatric disorders
Inpatient Detoxification
12.1%
11/91 • Number of events 17 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
13.3%
12/90 • Number of events 22 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.

Other adverse events

Other adverse events
Measure
Arm 1/Addiction Housing Case Management (AHCM)
n=91 participants at risk
AHCM intervention/ AHCM involves intensive case management for housing, substance use, and related issues. 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
Arm 2/Housing Support Group (HSG)
n=90 participants at risk
HSG/ The Housing Support Group is a time and attention control. Veterans assigned to HSG attend a weekly drop-in housing group where housing options are discussed and participants receive support from one another.
Social circumstances
Incarceration
19.8%
18/91 • Number of events 34 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.
14.4%
13/90 • Number of events 17 • Baseline to 12 months.
Data on hospitalizations and suicide attempts were collected from participant self-report and from VA medical record review at every assessment. Information on death was collected from medical record review and from the Vital Status file. Information on cause of death was not available. Information on non-serious adverse events were not collected.

Additional Information

Carol Malte

VA Puget Sound

Phone: 206.277.3780

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place