Participatory Music Program for Homeless Veterans

Participatory Music Program for Homeless Veterans (Crossroads Orchestra): Pilot Evaluation

This pilot project evaluates the effectiveness of a participatory music program for Veterans cared for in the Domiciliary Care for Homeless Veterans (DCHV) Program (Indianapolis, IN) in terms of improving quality of life. A secondary goal of this study is to evaluate the effect of the participatory music program on community reintegration and healthcare utilization. The participatory music program entitled the "Crossroads Orchestra" includes both music education and an orchestra experience. The objective of this intervention program is to use an engaging music-based education and group orchestra experience to provide participants with an avocation that will improve their quality of life and facilitate their reintegration into the community. The Crossroads Orchestra pilot project protocol has been grounded on concepts from occupational therapy and recreational therapy; specifically, providing participants with a meaningful new activity that is enjoyable, that can be provided across a spectrum of skill levels (e.g., for participants with no musical training as well as for individuals who are proficient strings musicians), and that can provide participants with a new sense of self.

Study Overview

• Status: Completed
• Conditions: Quality of Life
• Intervention / Treatment: Behavioral: Crossroads Orchestra Participatory Music Program

Detailed Description

SPECIFIC AIMS:

Aim 1: To evaluate the effectiveness of the participatory music program in terms of improving quality of life.

Aim 2: To evaluate the effect of the participatory music program on community reintegration. Veteran members of the Crossroads Orchestra program may develop a sense of participating in something that "is bigger than oneself." They may develop a new sense of self, or identify with a new role. They may develop a sense of commitment to their stand-partner. These positive new perspectives may facilitate their transition from the Domiciliary to the community. Semi-structured interviews with participants will be conducted to understand participants' experiences to both improve the program and to assess its effects. The Military to Civilian Questionnaire (M2C-Q) measure will be used to assess community reintegration.

Secondary Aim: To evaluate the effect of the participatory music program on healthcare utilization. This pilot project is not powered to identify statistically significant differences in healthcare utilization but rather is designed to provide preliminary data to understand the potential role of a music education and orchestra participation experience for improving outcomes among Veteran participants.

INTERVENTION DESCRIPTION:

The intervention is a participatory music program where adults engage in music-making as members of a strings orchestra. As part of the Crossroads Orchestra, participants will receive an instrument (violin, viola, or cello). The intervention sessions will take place twice a week at the Domiciliary and once per week at either the Domiciliary or other Indianapolis community location. Each session will include: thirty minutes of group music instruction by an experienced music educator with skills in adult music education followed by thirty minutes of weekly adult ensemble experience. The choice of music pieces will be made by the interventionist in consultation with participants (to ensure that the choices represent selections that are most engaging for the majority of participants). The participants will be given a binder with sheet music and practice logs. The music educator will create Youtube videos demonstrating violin, viola, and cello techniques and providing helpful tips. Participants will be encouraged to practice and to attend all of the group sessions.

• Study Type: Interventional
• Enrollment (Actual): 180
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46216
      • VA Domiciliary

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Residents of the Indianapolis VA Domiciliary who are eligible to participate in elective activities (i.e., they have been Domiciliary residents for a minimum of two weeks and they have not committed any infractions that would place them on restriction status)

Exclusion Criteria:

• Visual impairment (blindness)
• Profound hearing impairment (deafness)
• Cognitive impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Program; Participants will receive an instrument (violin, viola, or cello). Intervention sessions will take place twice a week at the Domiciliary and once per week at the Domiciliary or at a community location (Richard L. Roudebush VA Medical Center or Regenstrief Institute). Each session will include: thirty minutes of group music instruction by an experienced music educator with skills in adult music education followed by thirty minutes of weekly adult ensemble experience.	Behavioral: Crossroads Orchestra Participatory Music Program; The intervention is a participatory music program where adults engage in music-making as members of a strings orchestra.
No Intervention: Usual Care Control; Usual care at VA Domiciliary including participation in Domiciliary recreational therapy electives (if eligible).
No Intervention: Retrospective Chart Review; Retrospective chart reviews case-matched to intervention participants for age and biological sex factors.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Life: 20-Item Short Form Health Survey (SF-20)	We will examine the trajectory of quality of life scores over time utilizing the SF-20. The total score ranges from 0-100, higher values indicate better functioning.	change from baseline to month-6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Community Reintegration: Military to Civilian Questionnaire (M2C-Q)	We will use the M2C-Q measure to assess perceived difficulties reintegrating into community life after leaving the Domiciliary. This is a 16 item scale where each item is scored on a 5-point Likert scale with 0 representing no difficulty and 4 representing extreme difficulty with reintegration.	1 month post-transition

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Healthcare Utilization: Chart Review	Healthcare utilization includes ED visits, inpatient admissions, and clinic missed appointments ("no shows")	One-year pre-enrollment versus the one-year post-enrollment period
Flow State (Experience of Total Absorption): Flow State Scale (FSS-2)	Flow state describes a participant's engagement with the intervention. The FSS-2 includes 9 items that are scored from 1 (disagree) to 5 (strongly agree). Higher scores indicate a greater degree of task absorption.	month-6

Collaborators and Investigators

• Sponsor: VA Quality Enhancement Research Intiative
• Investigators: Principal Investigator: Dawn M Bravata, MD, VA Quality Enhancement Research Initiative

Publications and helpful links

Helpful Links

• Keiper S, Sandene, B.A., Persky, H.R., and Kuang, M. . The Nation's Report Card: Arts 2008 Music & Visual Arts (NCES 2009-488). In: National Center for Education Statistics IoES, U.S. Department of Education, ed. Washington, D.C.2009.
• Ending Veteran Homelessness: A Community by Community Tally

Study record dates

Study Major Dates

• Study Start (Actual): July 18, 2018
• Primary Completion (Actual): June 18, 2019
• Study Completion (Actual): June 18, 2019

Study Registration Dates

• First Submitted: August 21, 2018
• First Submitted That Met QC Criteria: August 29, 2018
• First Posted (Actual): August 31, 2018

Study Record Updates

• Last Update Posted (Actual): September 10, 2019
• Last Update Submitted That Met QC Criteria: September 9, 2019
• Last Verified: September 1, 2019

More Information

Terms related to this study

• Keywords: Veteran; Occupational therapy; Music; community integration; homeless; recreational therapy; reintegration; housing insecurity; Domiciliary; Human Occupation
• Other Study ID Numbers: 1802361597

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No