Peer to Community (P2C) Model for Supporting Community Integration Following Homelessness: A Pilot Randomized Controlled Trial

The investigators will conduct an open randomized controlled trial to pilot and evaluate the P2C model. The purpose of this pilot is to not only pilot the P2C intervention to determine the feasibility, acceptability, and initial effectiveness of the model, but also to pilot the study design to inform future, larger scale, implementation science research. While the study team will enter this pilot with the intention to complete a randomized controlled trial design, they will use a quasi-experimental design should the participants decline randomization. At the end of the trial, the study team will use the knowledge generated to inform refinements to the P2C model for future implementation science research.

Baseline data collection: Once all participants have been referred, research assistants will be provided with the names and contact information of potential participants. Research assistants will conduct interviews in person and read all interview components aloud to overcome threats to validity and reliability associated with illiteracy. These interviews will be composed of demographic elements (age, gender, sexual orientation, race, ethnicity, months housed/unhoused in the past year, health conditions, income), and a range of standardized measures that correspond with key constructs including community integration (primary outcome), meaningful activity engagement, mental well-being and substance use. Research assistants will use a visual stimulus when delivering these measures to reduce respondent fatigue. The team has used this strategy with a high degree of success in previous research when a large number of items is presented to individuals living with mental illness, substance use, or concurrent disorders and experiences of homelessness.

Qualitative interviews: In addition to demographic and quantitative items, the study team will deliver a baseline qualitative interview with participants in both UC and P2C groups to uncover participants' experiences of CI in the past and present. Interviews will be semi-structured, recorded on a digital recording device, and transcribed verbatim.

Recruitment, group assignment, and sample size estimation: The investigators will recruit participants through advertisements placed in the common areas of shelters, housing case management programs, and health care services in the recruitment city (Kingston, Ontario, Canada). The study team will also engage service providers in these organizations in our recruitment process by asking them to share information about this research with service users. Participants will be enrolled over a one-month period and will be included if they are: over the age of 16; have secured a tenancy within the last three months or are in the midst of moving into a tenancy; have experienced homelessness for at least one month in the past year; and acknowledge living with a mental illness and/or substance use disorder. The study team will assign participants to one of two groups: 1) usual care (UC); and 2) P2C. The UC group will receive typical services available in the community. The P2C group will be engaged in the P2C model in addition to any other supports available in their community. Participants will be assigned to groups that have been carefully matched based on gender, age, health condition, number of months of housed/unhoused in the past year, and income. The investigators will enroll 20 participants in each group (n=40 total). This sample size has been determined by modelling after sample sizes recommended for pilot research, with an attrition estimate of 15% [51].

Implementation: Once baseline interviews have been completed and participants have been assigned to P2C or UC groups, program staff will implement the P2C intervention with the P2C group. PSSs will be provided with the names and contact information for all participants in this group and will initiate the process of making contact with each within the first week to ensure that service for all participants begins at the same time. PSSs will initiate the development of relationships with each participant, while OT and SW at each site will ensure their availability for two days per week each for consultation. PSSs will meet with participants in the P2C group in community locations at least once per week. PSSs, OT and SW at each site will meet weekly for personal and professional support meetings as described in the overview of the P2C intervention in this proposal. The intervention and associated data collection will continue for a one-year period.