Trial Outcomes & Findings for MISSION-Vet HUD-VASH Implementation Study (NCT NCT01430741)
NCT ID: NCT01430741
Last Updated: 2018-06-29
Results Overview
The fidelity index assesses the presence or absences of activities within MISSION-Vet - DRT, peer led sessions, self-guided exercises, referrals made, and/or delivery of the workbook, to each participating Veteran. We analyzed fidelity as the percent of adoption of MISSION-Vet. The threshold for fidelity to adopt MISSION-Vet is 1 contact between the case manager and each participating Veteran. There is no composite score, fidelity to MISSION-Vet is if the case manager conducted at least 1 session with a Veteran.This measure was embedded into the VA Electronic Medical Record System. The investigators will assess the impact GTO has in facilitating adoption and use with fidelity to the MISSION-Vet 12-month service delivery platform, in comparison to implementation as usual.
COMPLETED
NA
227 participants
12-months
2018-06-29
Participant Flow
All case managers were invited to participate and verbally consented before randomization into the IU or the GTO group. 10 refused to participate.
Participant milestones
| Measure |
MISSION-Vet - IU Case Management
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - standard training on the MISSION model via a 1.5 hour webinar
|
MISSION-Vet IU Veterans
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - staff receive standard training on the MISSION model via a 1.5 hour webinar and then deliver MISSION services to Veterans
|
GTO Case Management
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform.
|
GTO MISSION Veterans
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform, while delivering MISSION services to Veterans.
|
|---|---|---|---|---|
|
Overall Study
STARTED
|
22
|
87
|
47
|
81
|
|
Overall Study
COMPLETED
|
22
|
87
|
37
|
81
|
|
Overall Study
NOT COMPLETED
|
0
|
0
|
10
|
0
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
No baseline characteristics were collected on the case management population.
Baseline characteristics by cohort
| Measure |
MISSION-Vet - IU Case Management
n=22 Participants
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - standard training on the MISSION model via a 1.5 hour webinar
|
MISSION-Vet - IU Veterans
n=87 Participants
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - staff receive standard training on the MISSION model via a 1.5 hour webinar and then deliver MISSION services to Veterans.
|
Enhanced Implementation Approach GTO Case Management
n=37 Participants
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform.
|
GTO Veterans
n=81 Participants
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform, while delivering MISSION services to Veterans
|
Total
n=227 Participants
Total of all reporting groups
|
|---|---|---|---|---|---|
|
Age, Continuous
|
—
|
49.7 years
STANDARD_DEVIATION 10.8 • n=87 Participants • No baseline characteristics were collected on the case management population.
|
—
|
55.9 years
STANDARD_DEVIATION 9.5 • n=81 Participants • No baseline characteristics were collected on the case management population.
|
52.8 years
STANDARD_DEVIATION 10.6 • n=168 Participants • No baseline characteristics were collected on the case management population.
|
|
Sex/Gender, Customized
Unknown
|
22 participants
n=22 Participants
|
87 participants
n=87 Participants
|
37 participants
n=37 Participants
|
81 participants
n=81 Participants
|
227 participants
n=227 Participants
|
PRIMARY outcome
Timeframe: 12-monthsPopulation: Clinician fidelity to MISSION-Vet using IU or GTO. Only assessed Staff population.
The fidelity index assesses the presence or absences of activities within MISSION-Vet - DRT, peer led sessions, self-guided exercises, referrals made, and/or delivery of the workbook, to each participating Veteran. We analyzed fidelity as the percent of adoption of MISSION-Vet. The threshold for fidelity to adopt MISSION-Vet is 1 contact between the case manager and each participating Veteran. There is no composite score, fidelity to MISSION-Vet is if the case manager conducted at least 1 session with a Veteran.This measure was embedded into the VA Electronic Medical Record System. The investigators will assess the impact GTO has in facilitating adoption and use with fidelity to the MISSION-Vet 12-month service delivery platform, in comparison to implementation as usual.
Outcome measures
| Measure |
MISSION-Vet - IU Case Management
n=22 Participants
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - standard training on the MISSION model via a 1.5 hour webinar
|
MISSION-Vet IU Veterans
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - staff receive standard training on the MISSION model via a 1.5 hour webinar and then deliver MISSION services to Veterans
|
GTO Case Management
n=37 Participants
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform.
|
GTO Veterans
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform, while delivering MISSION services to Veterans.
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|---|---|---|---|---|
|
MISSION Fidelity Index
|
0 percentage of MISSION-Vet staff use
|
—
|
68 percentage of MISSION-Vet staff use
|
—
|
POST_HOC outcome
Timeframe: 12 monthsPopulation: All MISSION-Vet IU Veterans and GTO Veterans were analyzed from HUD-VASH data monitoring system HOMES (Homeless Operations, Management and Evaluation).
Services provided by Case Managers OR Peers was computed by a count of the number of contacts between case managers OR peers and Veterans. This computed a total of all Veteran contacts, which was the sum of face-to-face contacts with Veterans and contacts on behalf of Veterans (described as Veteran contacts) with other stakeholders (e.g. family, medical providers). Assessed on a monthly basis for 12 months following study enrollment. These measures were obtained from the standardized monthly and quarterly status reports completed by case managers, which were extracted from HOMES. We used a linear-mixed effects model to calculate a Least-Squares Mean for each group at the study's end-point holding all variables in the model (Veteran age, Veteran sex, presence of an SMI diagnosis, employment) constant at their mean value.
Outcome measures
| Measure |
MISSION-Vet - IU Case Management
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - standard training on the MISSION model via a 1.5 hour webinar
|
MISSION-Vet IU Veterans
n=87 Participants
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - staff receive standard training on the MISSION model via a 1.5 hour webinar and then deliver MISSION services to Veterans
|
GTO Case Management
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform.
|
GTO Veterans
n=81 Participants
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform, while delivering MISSION services to Veterans.
|
|---|---|---|---|---|
|
Number of Services Provided by Case Managers and Peers to Veterans
|
—
|
3.466 Number of Service Contacts
Standard Error 2.824
|
—
|
3.469 Number of Service Contacts
Standard Error 3.051
|
POST_HOC outcome
Timeframe: 12 monthsPopulation: All MISSION-Vet IU Veterans and GTO Veterans were analyzed from HUD-VASH data monitoring system HOMES (Homeless Operations, Management and Evaluation).
Examined monthly alcohol and drug use by Veterans. Assessed on a monthly basis for 12 months following study enrollment. These measures were obtained from the standardized monthly and quarterly status reports completed by case managers, which were extracted from HOMES.
Outcome measures
| Measure |
MISSION-Vet - IU Case Management
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - standard training on the MISSION model via a 1.5 hour webinar
|
MISSION-Vet IU Veterans
n=87 Participants
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - staff receive standard training on the MISSION model via a 1.5 hour webinar and then deliver MISSION services to Veterans
|
GTO Case Management
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform.
|
GTO Veterans
n=81 Participants
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform, while delivering MISSION services to Veterans.
|
|---|---|---|---|---|
|
Drug and Alcohol Dependence
Drug Use
|
—
|
1.291 Monthly Substance Use
Standard Error 0.62
|
—
|
1.786 Monthly Substance Use
Standard Error 0.588
|
|
Drug and Alcohol Dependence
Alcohol Use
|
—
|
1.668 Monthly Substance Use
Standard Error 0.79
|
—
|
2.278 Monthly Substance Use
Standard Error 0.752
|
POST_HOC outcome
Timeframe: 12 monthsPopulation: All MISSION-Vet IU Veterans and GTO Veterans were analyzed from HUD-VASH data monitoring system HOMES (Homeless Operations, Management and Evaluation).
Number of inpatient hospitalization for medical and mental health conditions. Assessed on a monthly basis for 12 months following study enrollment. These measures were obtained from the standardized monthly and quarterly status reports completed by case managers, which were extracted from HOMES. A dichotomous measure of whether a veteran experienced an inpatient hospitalization for medical or mental health conditions , and not a count of number of hospitalizations. Specifically, we used a mixed-effects logistic regression model to calculate a predicted values (i.e. a Least-Squares Mean) for each group/arm at the study's end-point holding all variables in the model (Veteran age, Veteran sex, presence of an SMI diagnosis, employment) constant at their mean value. Predicted value reported in log-odds (logit) units.
Outcome measures
| Measure |
MISSION-Vet - IU Case Management
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - standard training on the MISSION model via a 1.5 hour webinar
|
MISSION-Vet IU Veterans
n=87 Participants
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - staff receive standard training on the MISSION model via a 1.5 hour webinar and then deliver MISSION services to Veterans
|
GTO Case Management
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform.
|
GTO Veterans
n=81 Participants
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform, while delivering MISSION services to Veterans.
|
|---|---|---|---|---|
|
Predicted Values of Veteran Inpatient Hospitalizations for Medical and Mental Health Conditions
Medical Inpatient Hospitalizations
|
—
|
-6.597 Inpatient Hospitalization Log Odds Units
Standard Error 1.903
|
—
|
-6.555 Inpatient Hospitalization Log Odds Units
Standard Error 1.498
|
|
Predicted Values of Veteran Inpatient Hospitalizations for Medical and Mental Health Conditions
Mental Health Inpatient Hospitalizations
|
—
|
-5.311 Inpatient Hospitalization Log Odds Units
Standard Error 6.008
|
—
|
-3.825 Inpatient Hospitalization Log Odds Units
Standard Error 5.802
|
POST_HOC outcome
Timeframe: 12 monthsPopulation: All MISSION-Vet IU Veterans and GTO Veterans were analyzed from HUD-VASH data monitoring system HOMES (Homeless Operations, Management and Evaluation).
Number of emergency department visits for medical and for mental health. Assessed on a monthly basis for 12 months following study enrollment. These measures were obtained from the standardized monthly and quarterly status reports completed by case managers, which were extracted from HOMES. A dichotomous measure of whether a veteran experienced an emergency department visit for medical or mental health conditions , and not a count of number of emergency department visits. We used a mixed-effects logistic regression model to calculate a predicted values (i.e. a Least-Squares Mean) for each group/arm at the study's end-point holding all variables in the model (Veteran age, Veteran sex, presence of an SMI diagnosis, employment) constant at their mean value. Predicted value reported in log-odds (logit) units.
Outcome measures
| Measure |
MISSION-Vet - IU Case Management
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - standard training on the MISSION model via a 1.5 hour webinar
|
MISSION-Vet IU Veterans
n=87 Participants
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - staff receive standard training on the MISSION model via a 1.5 hour webinar and then deliver MISSION services to Veterans
|
GTO Case Management
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform.
|
GTO Veterans
n=81 Participants
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform, while delivering MISSION services to Veterans.
|
|---|---|---|---|---|
|
Predicted Values of Veteran Emergency Department Visits for Medical and Mental Health Concerns
Medical Emergency Dept Visits
|
—
|
-4.663 Log Odd Units of Emergency Dept. Visits
Standard Error 3.063
|
—
|
-3.983 Log Odd Units of Emergency Dept. Visits
Standard Error 2.923
|
|
Predicted Values of Veteran Emergency Department Visits for Medical and Mental Health Concerns
Mental Health Emergency Dept Visits
|
—
|
-7.96 Log Odd Units of Emergency Dept. Visits
Standard Error 2.312
|
—
|
-6.792 Log Odd Units of Emergency Dept. Visits
Standard Error 1.779
|
POST_HOC outcome
Timeframe: 12 monthsPopulation: All MISSION-Vet IU Veterans and GTO Veterans were analyzed from HUD-VASH data monitoring system HOMES (Homeless Operations, Management and Evaluation).
We obtained information on negative housing exits from the HUD-VASH Exit form, which is available in HOMES and tracks the dates and reasons for all exits from the program. We measured whether and when a Veteran experienced a negative housing over the period from study enrollment (i.e. the first date of MISSION-Vet for those served by case managers in the GTO group and the date of the first MISSION-Vet session provided to any Veteran at the appropriate study site for this in the comparison group) until the end of the study observation period; the maximum follow-up time was 2.4 years, but only for HUD-VASH Exits. A negative exit was defined as an exit from HUD-VASH that occurred due to non-compliance with case management, eviction, Veteran dissatisfaction with housing, inability to locate Veteran and incarceration. Kaplan-Meier survival curves to calculate an estimate of the proportion of Veterans in each arm/group not experiencing a negative exit from housing at the study's endpoint.
Outcome measures
| Measure |
MISSION-Vet - IU Case Management
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - standard training on the MISSION model via a 1.5 hour webinar
|
MISSION-Vet IU Veterans
n=87 Participants
Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (Veterans Edition):MISSION-Vet has been developed to target mental health, substance abuse and related issues faced by homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based resources.
Implementation as Usual (IU) - staff receive standard training on the MISSION model via a 1.5 hour webinar and then deliver MISSION services to Veterans
|
GTO Case Management
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform.
|
GTO Veterans
n=81 Participants
Getting To Outcomes (GTO) is used to strengthens the knowledge, attitudes, and skills practitioners need to carry out evidence based programs. In GTO, staff receive ongoing technical assistance using the GTO implementation platform, while delivering MISSION services to Veterans.
|
|---|---|---|---|---|
|
Estimated Proportion of Veterans Without Negative Housing Exits
|
—
|
0.808 Proportion of Veterans
Interval 0.694 to 0.883
|
—
|
0.884 Proportion of Veterans
Interval 0.737 to 0.952
|
Adverse Events
MISSION-Vet - IU Case Management
MISSION-Vet - IU Veterans
GTO Case Management
GTO Veterans
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place