Effectiveness of Supportive Housing on COVID-19 Related Outcomes for People Experiencing Homelessness

This study aims to understand the comparative effectiveness of two PSH models (PB-PSH and SS-PSH) on quality of life and COVID-19 related health behaviors by following for 6 months a cohort of 800 PEH who have been placed in either PB (n=400) or SS (n=400). In a natural observational experiment, participants will complete 6 monthly mobile-based questionnaires exploring quality of life including physical, mental, social, and housing/environmental health, COVID-19 prevention practices (i.e., handwashing, social distancing, face covering), and past-30-day healthcare utilization. A sub-sample of 40 participants living in both PB-PSH and SS-PSH will be qualitatively interviewed longitudinally to help contextualize quantitative findings. Focus groups will also be conducted with providers of PSH and qualitative interviews will be conducted with other key stakeholders to understand perspectives on the challenges of implementing and sustaining COVID-19 related prevention practices while maintaining a continuity of care.

Study Overview

• Status: Active, not recruiting
• Conditions: Covid19; Mental Health; Social Interaction; Housing; Physical Health; Healthcare

Detailed Description

This study will aim to understand the comparative effectiveness of PB-PSH and SS-PSH on patient-centered quality of life, health care utilization, and health behaviors that will reduce COVID-19 risk by following a diverse sample of 800 PEH who are placed in PB-PSH (n = 400) or SS-PSH (n = 400) for 6 months. Barriers and facilitators will also be identified that may affect PSH implementation during the pandemic and its aftermath. The specific aims are:

Aim 1: To test the comparative effectiveness of PB-PSH and SS-PSH on COVID-19-related health behaviors (COVID-19-related personal health practices including social distancing) for PEH over time.

Aim 2: To test the comparative effectiveness of PB-PSH and SS-PSH on patient-centered quality of life (i.e., general life satisfaction; physical, mental, social, and environmental health) for PEH over time.

Aim 3: To test the comparative effectiveness of PB-PSH and SS-PSH on health care utilization health behaviors and unmet need for care for physical health, mental health, substance use disorders, for PEH over time.

Aim 4: To contextualize quantitative findings through longitudinal qualitative inquiry with 40 participants, purposively sampled from PB-PSH and SS-PSH, based on whether they are following social distancing guidelines.

Aim 5: To understand service providers, policy makers, and other stakeholders perspectives on challenges of implementing and sustaining COVID-19-related prevention practices and continuity of care in PSH.

• Study Type: Observational
• Enrollment (Actual): 563

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 91303
      • Los Angeles Homeless Services Authority (LAHSA)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

800 adults experiencing homelessness who have been approved for permanent supportive housing (PSH) in Los Angeles

Description

Inclusion Criteria:

• adults (aged 18+) with recent (past 12 months) lived experience with homelessness
• approved for PSH
• proficient in English
• able to provide informed consent

Exclusion Criteria:

• aged younger than 18
• not approved for PSH
• not proficient in English
• unable to provide informed consent

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Life Satisfaction	The NIH Toolbox item Bank v2.0 contains 10 items and will be utilized for participants to self-rate their life satisfaction	Change of Life satisfaction from baseline to 6 months
Quality of physical health	Self-rated physical health and frequency/quantity of health-related activities will be assessed with the PROMIS Global Health Scale Version 1.2. Scores range from 1-10, with higher scores reflecting better functioning.	Change in quality of physical health from baseline to 6 months
Degree of mental health symptomatology	The PROMIS will also be utilized to assess self-rated frequency the participant is bothered by mental health symptoms. The lowest possible score is 8 and the highest possible score is 40. Higher scores reflect more problematic symptomatology.	Change in symptomatology from baseline to 6 months
Social Isolation	The PROMIS will be utilized to assess social isolation including perceptions of being avoided, excluded, detached, disconnected from, or unknown by, others. Scores range from 6 to 40 with higher scores representing increased perceptions of isolation.	Change in social isolation from baseline to 6 months
Housing Environment	The Housing Environment Scale will assess residential satisfaction and neighborhood quality/safety. There are 5 subscales assessing the following: physical quality of the home, perceived quality of the neighborhood, perceived social climate in neighborhood, physical quality of home, and the physical quality of the neighborhood. Scales contain a range of 14 to 17 items with scores that range from 14 to 85 with higher scores representing increased satisfaction with environment.	Change in satisfaction with housing environment from baseline to 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
COVID-19 Prevention practices	The NIH Disaster Research Response Platform will assess participant frequency of handwashing, social distancing, and use of face covering.	Change in use of prevention practices from baseline to 6 months
Healthcare Utilization	Participants will record their past 30-day use of physical and mental health treatment, social services, and support provided by the permanent supportive housing program	Change in utilization from baseline to 6 months

Collaborators and Investigators

• Sponsor: University of Southern California
• Collaborators: University of California, Los Angeles
• Investigators: Principal Investigator: Benjamin Henwood, University of Southern California

Study record dates

Study Major Dates

• Study Start (Actual): January 29, 2021
• Primary Completion (Anticipated): June 1, 2023
• Study Completion (Anticipated): August 30, 2023

Study Registration Dates

• First Submitted: February 9, 2021
• First Submitted That Met QC Criteria: February 23, 2021
• First Posted (Actual): February 24, 2021

Study Record Updates

• Last Update Posted (Actual): April 20, 2023
• Last Update Submitted That Met QC Criteria: April 18, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19
• Other Study ID Numbers: UP-20-01081

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