Homeless Youth Study - Stepping Stone 2.0

Housing instability is both a cause and consequence of mental health problems. As such youth experiencing housing instability (e.g., homeless or marginally housed) have higher rates of mental health problems.Because of their circumstances, these youth also face significant barriers to mental health care and are therefore less likely to receive the treatment that they need. Mobile technology may offer a novel platform for increasing access to mental health care in this population. The primary goals of this pilot study are to (1) establish the feasibility and acceptability of delivering automated mental health interventions via smartphone technology, (2) examine the extent to which automated mental health interventions delivered via mobile technology improve mental health in homeless, marginally-housed, and exiting foster youth.

Study Overview

• Status: Completed
• Conditions: Mental Health Issue (E.G., Depression, Psychosis, Personality Disorder, Substance Abuse)
• Intervention / Treatment: Behavioral: Mobile self-help intervention

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Rush University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 25 years (Child, Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 16-25 years
• English-speaking

• Youth must meet one of the following risk criteria

  • Experiencing housing instability as defined by:

    • lacking a fixed, regular, and adequate nighttime residence OR whose primary nighttime residence is a shelter, institution, or a "public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings"
    • sharing the housing of other persons due to loss of housing [or] economic hardship.
    • frequent moves, poor housing quality (e.g., living in severely overcrowded housing).
  • Imminently leaving the foster care system
• Willingness and ability to comply with requirements of the study protocol

Exclusion Criteria:

* Inability to understand study procedures and participate in the informed consent process.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Mobile self-help intervention; This study uses automated self-help interventions designed as a kit of smartphone tools.

Behavioral: Mobile self-help intervention; Participants receive several apps on their phone including IntelliCare apps, which are based on principles of cognitive-behavioral therapy. Participants also receive the Pocket Helper app, which has been designed for this study. The tools within the Pocket Helper app include a crisis text line that is available 24/7, the Illinois Warm Line which is available Monday through Friday from 8am to 5pm, directions to call 911 in the case of an emergency, the Koko web app that provides crowdsourced emotional support, brief cognitive-behavioral interventions, daily tips, and daily surveys. Phones will also include the StreetLight Chicago app, which provides homeless individuals with up-to-date information on shelters, health clinics, emergency contacts, mental health services, and more.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Program adherence	Program adherence will be assessed based on usage data determining how often participants utilized the study applications, and how often they completed daily surveys and rated daily tips.	Baseline to Endpoint (6 months)
Program satisfaction	Program satisfaction will be assessed using a self-report questionnaire that participants will be asked to complete at the midpoint and endpoint of the study. Participants will be asked to report the extent to which they benefited from the study, how helpful the mobile applications were, and if they would recommend the study to others. These responses are recorded on 5-point likert type scales with higher ratings indicating higher satisfaction.	Midpoint (3 months) and Endpoint (6 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anxiety symptoms	Anxiety symptoms will be assessed using the adaptive PROMIS Bank v1.0 for anxiety.	Baseline (0 months), Midpoint (3 months), Endpoint (6 months)
Depression symptoms	Depression symptoms will be assessed using the adaptive PROMIS Bank v1.0 for depression.	Baseline (0 months), Midpoint (3 months), Endpoint (6 months)
Alcohol use	Alcohol use will be assessed using the Alcohol Use Disorders Identification Test (AUDIT-C).	Baseline (0 months), Midpoint (3 months), Endpoint (6 months)
Cannabis use	Cannabis use will be assessed using the Cannabis Use Disorder Identification Test - Revised (CUDIT-R).	Baseline (0 months), Midpoint (3 months), Endpoint (6 months)
Risky sexual behavior	Risky sexual behaviors will be assessed using the sexual behavior items from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey (2011).	Baseline (0 months), Midpoint (3 months), Endpoint (6 months)
PTSD symptoms	PTSD symptoms will be assessed using the The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5).	Baseline (0 months), Midpoint (3 months), Endpoint (6 months)
Satisfaction with life: Satisfaction with Life Scale (SWLS)	General satisfaction with life will be assessed using the Satisfaction with Life Scale (SWLS). This measure is 5 items, with each item rated on a scale from 1-7. All 5 items are summed to achieve a total score of 5-35. Higher scores indicate higher satisfaction with one's life circumstances.	Baseline (0 months), Midpoint (3 months), Endpoint (6 months)
Psychosocial flourishing	Psychological resources and strengths will be assessed using the Flourishing Scale (FS). This measure is 8 items, with each item rated on a scale from 1-7. All 8 items are summed to achieve a total score of 8-56. Higher scores indicate that an individual has more psychological resources and strengths.	Baseline (0 months), Midpoint (3 months), Endpoint (6 months)

Collaborators and Investigators

• Sponsor: Rush University Medical Center
• Collaborators: Illinois Department of Human Services; Sparrow Mobile
• Investigators: Study Director: Alyson K Zalta, PhD, University of California, Irvine

Publications and helpful links

General Publications

• Straka K, Blacketer AR, Martinez RL, Glover A, Winiarski DA, Karnik NS, Schueller SM, Zalta AK. Rates and correlates of well-being among youth experiencing homelessness. J Community Psychol. 2022 Sep;50(8):3746-3759. doi: 10.1002/jcop.22869. Epub 2022 Apr 23.
• Glover AC, Schueller SM, Winiarski DA, Smith DL, Karnik NS, Zalta AK. Automated Mobile Phone-Based Mental Health Resource for Homeless Youth: Pilot Study Assessing Feasibility and Acceptability. JMIR Ment Health. 2019 Oct 11;6(10):e15144. doi: 10.2196/15144.

Study record dates

Study Major Dates

• Study Start (Actual): December 21, 2017
• Primary Completion (Actual): July 8, 2019
• Study Completion (Actual): July 8, 2019

Study Registration Dates

• First Submitted: December 12, 2018
• First Submitted That Met QC Criteria: December 12, 2018
• First Posted (Actual): December 14, 2018

Study Record Updates

• Last Update Posted (Actual): September 27, 2019
• Last Update Submitted That Met QC Criteria: September 26, 2019
• Last Verified: September 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders; Personality Disorders
• Other Study ID Numbers: 17072403

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