Housing Transitions QUERI

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

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.

Study Overview

• Status: Enrolling by invitation
• Conditions: Homelessness
• Intervention / Treatment: Behavioral: Critical Time Intervention; Other: Replicating Effective Programs; Other: External Facilitation

Detailed 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.

• Study Type: Interventional
• Enrollment (Estimated): 153
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • California
    • West Los Angeles, California, United States, 90073-1003
      • VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Replicating Effective Programs (REP); A stakeholder-informed training and technical assistance implementation strategy	Behavioral: Critical Time Intervention; An evidence-based, structured, and time-limited case management practice; Other Names: CTI; Other: Replicating Effective Programs; A stakeholder-informed training and technical assistance implementation strategy; Other Names: REP
Active Comparator: REP + External Facilitation (Enhanced REP); REP plus site specific weekly facilitation to support CTI implementation.	Behavioral: Critical Time Intervention; An evidence-based, structured, and time-limited case management practice; Other Names: CTI; Other: Replicating Effective Programs; A stakeholder-informed training and technical assistance implementation strategy; Other Names: REP; Other: External Facilitation; Site-specific support to help sites develop tailored plans to implement CTI.; Other Names: Coaching
No Intervention: Control Group; No CTI implementation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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
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
Dollars spent delivering CTI at each site	Case manager salary and benefits	Between 6 and 18 months after implementation start

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Housing stability	Days between entry into the GPD case management program and indicator of housing instability	Between 6 and 18 months after implementation start
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
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
Cost of Implementation Strategies	Dollars spent on REP versus enhanced REP	Through study completion, 4 years
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
Outpatient service use	Number of outpatient appointments	Between 6 and 18 months after implementation start

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Collaborators: University of California, Los Angeles; University of Southern California; Center for the Advancement of Critical Time Intervention
• Investigators: Principal Investigator: Sonya Emi Gabrielian, MD MPH, VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Publications and helpful links

General Publications

• Gabrielian S, Finley EP, Ganz DA, Barnard JM, Jackson NJ, Montgomery AE, Nelson RE, Cordasco KM. Comparing two implementation strategies for implementing and sustaining a case management practice serving homeless-experienced veterans: a protocol for a type 3 hybrid cluster-randomized trial. Implement Sci. 2022 Oct 3;17(1):67. doi: 10.1186/s13012-022-01236-1.

Helpful 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.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2021
• Primary Completion (Estimated): September 30, 2025
• Study Completion (Estimated): September 30, 2025

Study Registration Dates

• First Submitted: March 10, 2022
• First Submitted That Met QC Criteria: April 4, 2022
• First Posted (Actual): April 5, 2022

Study Record Updates

• Last Update Posted (Actual): February 26, 2024
• Last Update Submitted That Met QC Criteria: February 22, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Implementation; Care Management; Mental Health Care; Homeless; Quality Assurance, Improvement
• Other Study ID Numbers: PIX 22-001; PII 21-285 (Other Grant/Funding Number: QUERI)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No