The proposed study entails a needs assessment to develop a program for Supporting Technology use and Harm Reduction (STaHR) among HF residents with lived experience of homelessness and substance use. This study will qualitatively explore HF residents’ technology literacy as well as their perspectives on barriers and facilitators to the use of technology, broadly, and for harm-reduction service provision. Then, with a community advisory board (CAB) made up of HF residents, staff, and management, we will inform and provide recommendations to HF management and leadership ways to improve HF resident technology use and engagement with online harm-reduction services.
Targeted Condition: Homelessness
eHaRT-A: adapting an in-person harm reduction for alcohol intervention into a telehealth platform
The unprecedented global pandemic has highlighted the digital divide and limited access to alcohol-related treatments among marginalized communities, specifically individuals with lived experience of homelessness. In line with the NIAAA health initiative seeking to integrate technology-based interventions among vulnerable populations, this study directly addresses this mission by proposing innovative methods (i.e., user-centered design + a community based participatory research framework) to adapt an in-person harm reduction for alcohol (HaRT-A) intervention into a telehealth platform (eHaRT-A) that can then be tested and successfully implemented into low-barrier Housing First settings. As healthcare continues to move more services online, it is essential to understand ways to successfully adapt and implement rigorously tested telehealth treatment services for marginalized communities to ameliorate alcohol-related harms.
eHaRT-A
The unprecedented global pandemic has highlighted the digital divide and limited access to alcohol-related treatments among marginalized communities, specifically individuals with lived experience of homelessness. In line with the NIAAA health initiative seeking to integrate technology-based interventions among vulnerable populations, this study directly addresses this mission by proposing innovative methods (i.e., user-centered design + a community based participatory research framework) to adapt an in-person harm reduction for alcohol (HaRT-A) intervention into a telehealth platform (eHaRT-A) that can then be tested and successfully implemented into low-barrier Housing First settings. As healthcare continues to move more services online, it is essential to understand ways to successfully adapt and implement rigorously tested telehealth treatment services for marginalized communities to ameliorate alcohol-related harms.
Housing stability for youth
The Housing Stability for Youth (H-SYNC) model was developed by the UW CoLab team in collaboration with Snohomish and Kitsap County workgroups and is intended to serve as a prevention tool for youth homelessness. Specifically, it’s designed to identify youth at risk of or currently experiencing homelessness within existing processes in juvenile court systems and refer youth and their families to appropriate prevention and housing services via a stepped-care navigation model. The court system serves as a pivotal resource for the identification of these populations in need due to the high frequency of police and court contact these populations experience. This model is being implemented in four counties in Washington State, including King, Snohomish, Kitsap, and Okanogan Counties and in collaboration with community-based organizations such as the YMCA of Greater Seattle, Cocoon House, and Kitsap Mental Health Services.
As of 2022, H-SYNC prevention program is coordinated by the Y Social Impact Center at the YMCA of Greater Seattle. H-SYNC now represents a state-wide partnership between juvenile courts and local social service providers across counties including King, Snohomish, Peirce, Spokane, Okanagan and Kitsap.
A cluster-randomized controlled trial testing the effectiveness of the Life Enhancing Alcohol-management Program (LEAP) for Housing First residents
| People experiencing chronic homelessness comprise a small yet high-morbidity, high-cost subset of the larger homeless population and are disproportionately impacted by alcohol-related harm. This study proposes a cluster randomized controlled trial of an innovative, community-based, and client-driven program known as the LEAP to explore its impact on substance use and quality of life outcomes among individuals with lived experience of homelessness and alcohol use problems living in Housing First settings. Analyses will test LEAP effectiveness in increasing engagement in meaningful activities, decreasing alcohol use, ameliorating both first- and secondhand alcohol-related harm, and improving quality of life for this population. |
Staying in Touch and Engaged Project (STEP)
The “Staying in Touch and Engaged Project” (STEP) aimed to support Housing First residents in staying in touch with researchers and in engaging in meaningful activities during the COVID-19 outbreak and social distancing directives. A 16-week, two-group randomized controlled pilot trial compared remote assessment of substance-use and health-related quality of life assessment paired with immediate versus delayed provision of remotely delivered meaningful activities. The aim of this project was to test whether the meaningful activities package (MAP) engages residents and improves their mood, substance-use outcomes, and physical and mental health-related quality of life.
The project team mailed study invitations to residents in five housing programs (estimated mailed N=538). To date, 32 Housing First residents reached out to consent to participate, responding via mailed consent forms, phone, video conferencing or online survey completion. Of those who consented, 26 have completed baseline assessments, and 11 have completed one-month follow-ups. The study highlighted the difficulties in reaching residents, partly due to the lack of communication technologies.
The team found that the technological divide has grown deeper and more consequential during the pandemic and must be bridged to facilitate social connection, physical and mental health, and basic communication for people marginalized by the lived experience of homelessness and psychiatric, medical and substance use disorder. The team is working to locate additional funds through the UW and WSU to continue participant recruitment and evaluation efforts, achieve the originally proposed sample size and further improve follow-up rates.
Disseminating a user-friendly guide: Advancing the science of intervention adaptation and improving access to evidence-based psychological treatment
Adaptation of evidence-based practices and programs (EBPs) is a necessary component of the implementation process. EBPs must be adapted to function with the constraints of real-world practice settings, providers’ expertise, and patients’ needs. The science of intervention adaptation is hungry for well-defined methods of EBP adaptation to guide decision making. A how-to guide for EBP adaptation titled MODIFI: Making Optimal Decisions for Intervention Flexibility during Implementation, is under development with NIMH funding (F32 MH116623). MODIFI will be disseminated via multiple strategies locally, nationally, and internationally. Dissemination of MODIFI will improve the practice of intervention adaptation by providing practitioners with a how-to guide that is (a) evidence-based, (b) usable, and (c) supported by the expert consensus of implementation practitioners and researchers.
The Doorway Project
The Doorway project is a University of Washington and YouthCare-led initiative focusing on addressing youth homelessness in the University District through continuous community-engaged collaboration with U District service providers and community members. The primary aim of the project is to center the voices of youth and young adults in the U-district who are experiencing homelessness in order to co-develop and evaluate a comprehensive and effective model that reduces youth homelessness and improves quality of life for all affected.
