Applying a Case Management Model in a VA Homeless Program
Implementierung und Aufrechterhaltung von Critical Time Intervention (CTI) in Fallmanagementprogrammen für obdachlos erfahrene Veteranen (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.
Studienübersicht
Status
Bedingungen
Detaillierte Beschreibung
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.
Studientyp
Einschreibung (Tatsächlich)
Phase
- Phase 1
Kontakte und Standorte
Studienorte
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California
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West Los Angeles, California, Vereinigte Staaten, 90073-1003
- VA Greater Los Angeles Healthcare System, West Los Angeles, CA
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Teilnahmekriterien
Zulassungskriterien
Studienberechtigtes Alter
- Kind
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
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
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Sonstiges
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Keine (Offenes Etikett)
Waffen und Interventionen
Teilnehmergruppe / Arm |
Intervention / Behandlung |
|---|---|
|
Experimental: Replicating Effective Programs (REP)
A stakeholder-informed training and technical assistance implementation strategy |
An evidence-based, structured, and time-limited case management practice
Andere Namen:
A stakeholder-informed training and technical assistance implementation strategy
Andere Namen:
|
|
Aktiver Komparator: REP + External Facilitation (Enhanced REP)
REP plus site specific weekly facilitation to support critical time intervention (CTI) implementation. |
An evidence-based, structured, and time-limited case management practice
Andere Namen:
A stakeholder-informed training and technical assistance implementation strategy
Andere Namen:
Site-specific support to help sites develop tailored plans to implement critical time intervention (CTI)
Andere Namen:
|
|
Kein Eingriff: Control Group
No critical time intervention (CTI) implementation |
Was misst die Studie?
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Fidelity to critical time intervention (CTI)
Zeitfenster: 12 months after implementation start
|
% of Sites with adequate fidelity to CTI at 12 months, as measured by the CTI fidelity scale |
12 months after implementation start
|
|
Sustainment of critical time intervention (CTI)
Zeitfenster: 18 months after implementation start
|
% 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 critical time intervention (CTI) at each site
Zeitfenster: Between 6 and 18 months after implementation start
|
Case manager salary and benefits |
Between 6 and 18 months after implementation start
|
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Housing stability
Zeitfenster: Between 6 and 18 months after implementation start
|
Days between entry into the GPD case management program and indicator of housing instability |
Between 6 and 18 months after implementation start
|
|
Cost of critical time intervention (CTI) as Implemented
Zeitfenster: Between 6 and 18 months after implementation start
|
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
Zeitfenster: Between 6 and 18 months after implementation start
|
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
Zeitfenster: Through study completion, 4 years
|
Dollars spent on REP versus enhanced REP |
Through study completion, 4 years
|
|
Return on Investment (ROI) of critical time intervention (CTI)
Zeitfenster: 6-, 12-, and 18-months after GPD case management program enrollment
|
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
Zeitfenster: Between 6 and 18 months after implementation start
|
Number of outpatient appointments |
Between 6 and 18 months after implementation start
|
Mitarbeiter und Ermittler
Mitarbeiter
Ermittler
- Hauptermittler: Sonya Emi Gabrielian, MD MPH, VA Greater Los Angeles Healthcare System, West Los Angeles, CA
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- 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.
- Cummings C, Rawal M, Tan G, Finley E, Cordasco KM, Herman D, Edwards L, Gabrielian S. Assessing fidelity to Critical Time Intervention (CTI) for homeless-experienced persons. BMC Health Serv Res. 2026 Jun 16. doi: 10.1186/s12913-026-14939-8. Online ahead of print.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Primärer Abschluss (Tatsächlich)
Studienabschluss (Tatsächlich)
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Andere Studien-ID-Nummern
- PIX 22-001
- PII 21-285 (Andere Zuschuss-/Finanzierungsnummer: QUERI)
- 1I50HX003501-01 (US NIH Stipendium/Vertrag)
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