Housing Transitions QUERI

Homelessness Clinical Trial

Official title:

Implementing and Sustaining Critical Time Intervention (CTI) in Case Management Programs for Homeless-experienced Veterans (PII 21-285)

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT05312229
• Other study ID #: PIX 22-001
• Secondary ID: PII 21-285
• Status: Enrolling by invitation
• Phase: Phase 1
• Start date: October 1, 2021
• Est. completion date: September 30, 2025

Study information

• Verified date: February 2024
• Source: VA Office of Research and Development
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The VA Grant and Per Diem (GPD) case management aftercare program provides six months of case management for homeless-experienced Veterans undergoing housing transitions. This Partnered Implementation Initiative (PII) proposes to implement and evaluate Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-in 32 GPD case management aftercare sites across the nation.

Description:

The VA Grant and Per Diem case management (GPD-CM) program provides six months of case management for homeless-experienced Veterans (HEVs) undergoing housing transitions. At present, no specific case management paradigm is required in the GPD-CM program, resulting in practice variation across sites. This Partnered Implementation Initiative (PII) implements Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-at 32 VA GPD-CM sites. The investigators will use the Replicating Effective Programs (REP) implementation bundle to support CTI implementation at all 32 sites. Half of these sites will also receive 9 months of external facilitation (enhanced REP) as additional support for CTI implementation. In a type 3 hybrid trial, the investigators will use mixed methods to examine the impacts of REP versus enhanced REP. Using trial data, the investigators will develop a business case analysis and implementation playbook for the investigators' program partners to support continued CTI spread and sustainment in the GPD-CM program.

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 153
• Est. completion date: September 30, 2025
• Est. primary completion date: September 30, 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Grant and Per Diem (GPD) case management aftercare grantees in 7 Veterans Integrated Service Networks (VISN), all of whom provide 6-months of case management to Veterans who have experienced homelessness.

Exclusion Criteria:

• None

Related Conditions & MeSH terms

• Homelessness

Intervention

Behavioral:
• Critical Time Intervention
An evidence-based, structured, and time-limited case management practice

Other:
• External Facilitation
Site-specific support to help sites develop tailored plans to implement CTI.
• Replicating Effective Programs
A stakeholder-informed training and technical assistance implementation strategy

Locations

Country	Name	City	State
United States	VA Greater Los Angeles Healthcare System, West Los Angeles, CA	West Los Angeles	California

Sponsors (4)

Lead Sponsor	Collaborator
VA Office of Research and Development	Center for the Advancement of Critical Time Intervention, University of California, Los Angeles, University of Southern California

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Fidelity to CTI	% of Sites with adequate fidelity to CTI at 12 months, as measured by the CTI fidelity scale	12 months after implementation start
Primary	Sustainment of CTI	% of Sites with adequate fidelity to CTI at 18 months, as measured by the CTI fidelity scale	18 months after implementation start
Primary	Dollars spent delivering CTI at each site	Case manager salary and benefits	Between 6 and 18 months after implementation start
Secondary	Housing stability	Days between entry into the GPD case management program and indicator of housing instability	Between 6 and 18 months after implementation start
Secondary	Cost of CTI as Implemented	Mean monthly cost of CTI case management per GPD case management Veteran served, compared to the mean monthly cost in the non-CTI GPD case management programs.	Between 6 and 18 months after implementation start
Secondary	Hospitalization rates	Number of days between entry into the GPD case management program and hospitalization, number of hospitalizations, number of bed days	Between 6 and 18 months after implementation start
Secondary	Cost of Implementation Strategies	Dollars spent on REP versus enhanced REP	Through study completion, 4 years
Secondary	Return on Investment (ROI) of CTI	Dollars saved via improved housing stability and decreased hospitalizations among patients engaged in CTI versus control participants	6-, 12-, and 18-months after GPD case management program enrollment
Secondary	Outpatient service use	Number of outpatient appointments	Between 6 and 18 months after implementation start

External Links

•   Resources for VA Grant and Per Diem (GPD) case management aftercare grantee sites to implement and sustain Critical Time Intervention (CTI) at their sites.