Evaluating the Impact of Training for IHSS Workers

This trial investigates whether high-quality training for consumer-directed home health workers impacts health outcomes for care consumers and employment outcomes for care workers. The investigators are conducting this study in the context of the In-Home Supportive Services (IHSS) program, a consumer-directed, Medicaid-funded home care program in California serving elderly and disabled Medicaid recipients. The investigators will partner with the Center for Caregiver Advancement (CCA), a training provider based in California, to conduct a randomized evaluation of the impact of training for IHSS workers on labor and health care outcomes. The evaluation will enroll IHSS workers in San Bernardino County, where CCA will be expanding its program.

Participants will be randomized to either a group that receives CCA's training or a control group that does not receive training.

Participants randomized to the training group will complete a 30 hour online course that teaches fundamental caregiving skills. Training includes personal care, infection control, nutrition and body mechanics, medication adherence, and home safety.

Researchers will compare outcomes between IHSS providers in the two groups and between IHSS consumers who receive care from the IHSS providers in the two groups to see if training impacts health, health care, and labor market outcomes.

Study Overview

• Status: Recruiting
• Conditions: Home Care for Elderly or Disabled Individuals
• Intervention / Treatment: Other: IHSS Basic Training

• Study Type: Interventional
• Enrollment (Estimated): 2500
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jesse Gubb, Research Manager, PhD; Phone Number: 617-324-6995; Email: ihss.study@povertyactionlab.org

Study Locations

• United States
  • California
    • San Bernardino, California, United States, 92401
      • Recruiting
      • San Bernardino County
      • Contact: Research Manager; Email: ihss.study@povertyactionlab.org

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Current IHSS provider
• Live in San Bernardino County
• IHSS consumer lives in San Bernardino County

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: IHSS Basic Training; Individuals in the treatment group will be invited to participate in CCA's IHSS Basic training program. The program is a 30 hour online course for IHSS providers, which teaches fundamental caregiving skills. Training includes personal care, infection control, nutrition and body mechanics, medication adherence, and home safety.	Other: IHSS Basic Training; The intervention is the Center for Caregiver Advancements 30-hour IHSS Basic training course.
No Intervention: Control; No intervention is delivered to the control group. The control group will be unable to access CCA's training programs for two years following random assignment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of emergency department visits (for consumer)	1 year after training begins

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Any emergency department visits (for consumer)		1 year after training begins
Estimated annual health care spending (for consumer)	Estimated annual health care spending will be calculated by multiplying the number of inpatient admissions, emergency department visits, outpatient office visits, long term care stays, and prescription drugs by estimated average costs for those services among low income publicly insured adults.	1 year after training begins
Share of participants with falls resulting in a health care visit (for consumer)	The share of consumers with falls will be measured using diagnosis codes from medical claims	1 year after training begins
Share of participants with urinary tract infections resulting in a health care visit (for consumer)	The share of consumers with urinary tract infections will be measured using diagnosis codes from medical claims	1 year after training begins
Share of participants with pressure ulcers resulting in a health care visit (for consumer)	The share of consumers with pressure ulcers will be measured using diagnosis codes from medical claims	1 year after training begins
Share of participants with nursing facility utilization (for consumer)	The share of consumers who have a stay in a skilled nursing facility, rehab, or long term care facility during the year after training begins.	1 year after training begins
Share of participants still employed in IHSS (for provider)	The share of IHSS provider participants who remain as workers in the IHSS program 1 year after the start of training.	1 year after training begins
Caregiving knowledge (for provider)	Proportion of correct answers out of 18 true false knowledge questions	0-3 months after completion of training
Total length of stay in nursing facilities (for consumer)	The number of days spent per consumer in a skilled nursing facility, rehab, or long term care facility during the year after training begins.	1 year after training begins
IHSS earnings (for provider)	IHSS earnings for providers, measured weekly, quarterly, and annually, drawn from IHSS payroll data	1 year after training begins
IHSS hours worked (for provider)	IHSS hours worked for providers, measured weekly, quarterly, and annually, drawn from IHSS payroll data	1 year after training begins

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Any hospital admissions (for consumer)		1 year after training begins
Number of hospital admissions (for consumer)		1 year after training begins
Total length of stay in hospital (for consumer)		1 year after training begins
Depression (for provider)	Patient Health Questionnaire-2 (PHQ-2). Scores range from 0 to 6, with higher values indicating worse outcomes. A score of 3 or higher identifies possible cases of major depressive disorder.	0-3 months after completion of training
Anxiety (for provider)	Generalized Anxiety Disorder 2-item (GAD-2). Scores range from 0 to 6, with higher values indicating worse outcomes. A score of 3 or higher identifies possible cases of generalized anxiety disorder.	0-3 months after completion of training
Caregiver wellbeing (for provider)	18 question caregiver self assessment questionnaire developed by the American Medical Association (https://www.healthinaging.org/tools-and-tips/caregiver-self-assessment-questionnaire). Includes 16 Yes/No questions and 2 scale of 1 to 10 questions, with higher values indicating worse outcomes. 10 or more yes answers, having crying spells, feeling completely overwhelmed, a stress rating of >=6 out of 10, or health rating of >= 6 out of 10 all indicate distress.	0-3 months after completion of training
Caregiver job satisfaction (for provider)	Self-reported answer to "Overall, how satisfied are you with your IHSS job?" on a 5-point Likert scale from very dissatisfied to very satisfied	0-3 months after completion of training
Number of consumers served (for provider)	How many people the provider is paid to care for as part of the IHSS program	1 year after training begins

Collaborators and Investigators

• Sponsor: Abdul Latif Jameel Poverty Action Lab
• Collaborators: University of Chicago; Massachusetts Institute of Technology; Center for Caregiver Advancement
• Investigators: Principal Investigator: Amy Finkelstein, PhD, Massachusetts Institute of Technology; Principal Investigator: Matthew Notowidigdo, PhD, University of Chicago; Principal Investigator: David Autor, Phd, Massachusetts Institute of Technology; Principal Investigator: Anna Russo, Massachusetts Institute of Technology

Study record dates

Study Major Dates

• Study Start (Actual): January 9, 2024
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): June 30, 2029

Study Registration Dates

• First Submitted: December 14, 2023
• First Submitted That Met QC Criteria: January 3, 2024
• First Posted (Actual): January 16, 2024

Study Record Updates

• Last Update Posted (Actual): January 30, 2024
• Last Update Submitted That Met QC Criteria: January 29, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: 2308001081

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: To the extent allowed by our data use agreements with administrative data providers, we will share de-identified data and analysis code at the conclusion of the project.
• IPD Sharing Time Frame: Data will become available after publication and will be hosted on a public research data repository such as the Harvard Dataverse (dataverse.org).
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE

Drug and device information, study documents

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