Housing First Combined with Suicide Treatment Education and Prevention (HOME + STEP): study protocol for a randomized controlled trial

Abstract Background Youth experiencing homelessness are at high risk for suicide, yet few studies have evaluated risk reduction interventions targeting suicidal ideation in this vulnerable population. A comprehensive approach to risk-reduction is needed that addresses basic needs and provides targeted interventions for those at highest risk. The protocol described builds on the design of the first randomized trial of Housing First (HF) for homeless youth. The primary objective is to determine whether housing combined with supportive services that include suicide screening and targeted psychotherapy (Cognitive Therapy for Suicide Prevention) is effective for reducing suicidal ideation and other secondary outcomes (depression and suicide attempts). Additionally, we will explore mediators of the treatment effect (housing stability and substance use) and determinants of implementation. Methods Youth recruited to the HF trial will be randomized to HF + supportive services (n = 120), or supportive services alone (n = 120). The “Suicide Treatment Education and Prevention” (STEP) protocol will additionally screen youth in both arms at baseline and 3 months for suicidal ideation (SSI-W). Those who screen as moderate risk for suicide (SSI-W ≥ 10) will be offered CTSP, which includes up to 9 sessions over the first 6 months following enrollment. CTSP will be delivered in one-on-one sessions by a trained advocate. Research assessments will be collected to assess outcomes (including suicidal ideation) at baseline, 3, 6, 9 and 12 months. Qualitative interviews with subjects receiving CTSP and other stakeholders will explore implementation determinants. Discussion The study will fill an important gap in the literature about the added benefit of HF combined with supportive services including suicide screening and treatment for reducing suicidal ideation in homeless youth. With the urgent need to address both homelessness and suicide risk, evidence is needed about services that can be integrated into delivery settings for youth experiencing homelessness. Trial registration NCT04135703. Date of registration: October 23, 2019.

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3.22 HOUSING FIRST FOR HOMELESS YOUTH WITH MENTAL ILLNESS: ANALYSIS FROM A RANDOMIZED CONTROLLED TRIAL

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2016.09.154 ◽

2016 ◽

Vol 55 (10) ◽

pp. S149

Author(s):

Nicole Kozloff ◽

Vicky Stergiopoulos ◽

Amy Cheung ◽

Paula N. Goering

Keyword(s):

Mental Illness ◽

Randomized Controlled Trial ◽

Homeless Youth ◽

Controlled Trial ◽

Housing First ◽

Randomized Controlled

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Housing first, connection second: the impact of professional helping relationships on the trajectories of housing stability for people facing severe and multiple disadvantage

BMC Public Health ◽

10.1186/s12889-021-10281-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rebeca D. Sandu ◽

Frederick Anyan ◽

Vicky Stergiopoulos

Keyword(s):

Controlled Trial ◽

Housing First ◽

Helping Relationships ◽

Targeted Interventions ◽

Housing Stability ◽

Disadvantaged Populations ◽

Class 1 ◽

The Impact

Abstract Background Despite the accumulating evidence on the role of professional helping relationships for highly disadvantaged populations, methodological shortcomings have made it difficult to establish a robust relationships-outcomes link. This study sought to establish the impact of professional helping relationships on the trajectories over 24 months of housing stability for 2141 people facing severe and multiple disadvantage using data from the Housing First controlled trial in Canada. Method The study used a mixed method design. Latent growth curve and growth mixture models assessed the impact of working alliance across the sample as a whole and within subgroups with different patterns of housing stability. Thematic analysis explored the factors that may affect the quality of working alliances within different subgroups. Results Three distinct trajectories of housing stability emerged (i.e., Class 1: “sharp rise, sustained, and decline housing”; Class 2: “hardly any time housed”; Class 3: “high rise, sustained, and decline housing”) with professional helping relationships having different effects in each. The analysis revealed structural and individual circumstances that may explain differences among the classes. Conclusions The findings underscore the role of professional helping relationships, as distinct from services, in major interventions for highly disadvantaged populations, and draws new attention to the temporal patterns of responses to both the quality of relationship and targeted interventions.

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Housing First, Connection Second: The Impact of Professional Helping Relationships on the Developmental Trajectories of Housing Stability for People Facing Severe and Multiple Disadvantage

10.21203/rs.3.rs-15643/v1 ◽

2020 ◽

Author(s):

Rebeca Denisa Sandu ◽

Frederick Anyan ◽

Vicky Stergiopoulos

Keyword(s):

Developmental Trajectories ◽

Controlled Trial ◽

Housing First ◽

Gradual Decline ◽

Helping Relationships ◽

Targeted Interventions ◽

Housing Stability ◽

Class 1 ◽

The Impact

Abstract Background . This study sought to establish the impact of professional helping relationships on the developmental trajectories over 24 months of housing stability for 2,141 people facing severe and multiple disadvantage using data from the Housing First controlled trial in Canada. Method: The study used a mixed method design. Latent growth curve and growth mixture models assessed the impact of working alliance across the sample as a whole and within subgroups with different patterns of housing stability. Thematic analysis explored the factors that may affect the quality of working alliances within different subgroups. Results: Three distinct trajectories of housing stability emerged (i.e., Class 1: “sharp, sustained, gradual decline”; Class 2: “hardly any time housed”; Class 3: “high, sustained, and gradual decline”) with professional helping relationships having different effects in each. The analysis revealed structural and individual circumstances that may explain differences among the classes. Conclusions: The findings underscore the role of the relationships, as distinct from services, in major interventions for highly disadvantaged populations, and draws new attention to the temporal patterns of responses to both the quality of relationship and targeted interventions. Keywords: relationships, Housing First, sub-groups, housing stability, severe and multiple disadvantage

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Housing, opportunities, motivation and engagement (HOME) for homeless youth at-risk for opioid use disorder: study protocol for a randomized controlled trial

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00237-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Natasha Slesnick ◽

Laura Chavez ◽

Alicia Bunger ◽

Ruri Famelia ◽

Jodi Ford ◽

...

Keyword(s):

Substance Use ◽

Homeless Youth ◽

Controlled Trial ◽

Opioid Use Disorder ◽

Risk Prevention ◽

Housing First ◽

Opioid Use ◽

Prevention Services ◽

Randomized Controlled ◽

Related Risk

Abstract Background Homeless youth experience high rates of substance use disorders, exposures to violence, mental and physical health conditions, and mortality. They have been particularly affected by the opioid crisis. However, no study to date has used a randomized controlled design to test preventive interventions of opioid and other drug use among this vulnerable population. Resolution of youth homelessness through housing and supportive services including prevention services, often referred to as “Housing First,” has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. Housing First has been tested through randomized trials among homeless adults with mental health and substance use disorders, but has not been empirically tested for opioid prevention among homeless youth. Methods Homeless youth will be recruited from a drop-in shelter site frequented by disconnected youth; they will be screened for eligibility, including current homelessness, age 18–24 years, and not currently meeting criteria for opioid use disorder (OUD). In a controlled trial, 240 youth will then be randomized to one of two conditions, (1) housing + opioid and related risk prevention services, or (2) opioid and related risk prevention services alone. This project utilizes existing efficacious models of prevention to address opioid-related risks, including motivational interviewing, strengths-based outreach and advocacy, and an HIV risk preventive intervention. Follow-up will be conducted at 3, 6, 9 and 12-months post-baseline. The economic cost of each intervention will be determined to support implementation decisions with other providers and their funders. Discussion This study will provide essential information for researchers and providers on the efficacy of housing + opioid and related risk prevention services in an RCT for effects on opioid use and mechanisms underlying change. Because youth experiencing homelessness are at increased risk for a variety of adverse outcomes, the proposed intervention may produce substantial health care benefits to the youths and society at large. Trial registration ClinicalTrials.gov, NCT04135703, Registered October 13, 2019, https://clinicaltrials.gov/ct2/show/NCT04135703?term=NCT04135703&draw=2&rank=1#contacts

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