Housing Transitions QUERI

Phase 1

• Conditions: Homelessness
• Interventions: Behavioral: Critical Time Intervention; Other: External Facilitation; Other: Replicating Effective Programs

• Registration Number: NCT05312229
• Lead Sponsor: VA Office of Research and Development

Brief Summary

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.

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 Timeline

• Study Start: 2021-10-01
• Study First Submitted: 2022-03-10
• Study First Submitted QC: 2022-04-04
• Study First Posted: 2022-04-05
• Status Verified: 2025-01
• Last Update Submitted: 2025-01-22
• Last Update Posted: 2025-01-23
• Primary Completion: 2025-09-30
• Study Completion: 2025-09-30

Recruitment & Eligibility

• Status: ENROLLING_BY_INVITATION
• Sex: All
• Target Recruitment: 153

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 & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
REP + External Facilitation (Enhanced REP)	Replicating Effective Programs	REP plus site specific weekly facilitation to support CTI implementation.
REP + External Facilitation (Enhanced REP)	External Facilitation	REP plus site specific weekly facilitation to support CTI implementation.
Replicating Effective Programs (REP)	Critical Time Intervention	A stakeholder-informed training and technical assistance implementation strategy
Replicating Effective Programs (REP)	Replicating Effective Programs	A stakeholder-informed training and technical assistance implementation strategy
REP + External Facilitation (Enhanced REP)	Critical Time Intervention	REP plus site specific weekly facilitation to support CTI implementation.

Primary Outcome Measures

Name	Time	Method
Sustainment of CTI	18 months after implementation start	% of Sites with adequate fidelity to CTI at 18 months, as measured by the CTI fidelity scale
Dollars spent delivering CTI at each site	Between 6 and 18 months after implementation start	Case manager salary and benefits
Fidelity to CTI	12 months after implementation start	% of Sites with adequate fidelity to CTI at 12 months, as measured by the CTI fidelity scale

Secondary Outcome Measures

Name	Time	Method
Return on Investment (ROI) of CTI	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
Cost of CTI as Implemented	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.
Outpatient service use	Between 6 and 18 months after implementation start	Number of outpatient appointments
Cost of Implementation Strategies	Through study completion, 4 years	Dollars spent on REP versus enhanced REP
Housing stability	Between 6 and 18 months after implementation start	Days between entry into the GPD case management program and indicator of housing instability
Hospitalization rates	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

Trial Locations

Locations (1)

VA Greater Los Angeles Healthcare System, West Los Angeles, CA; 🇺🇸 West Los Angeles, California, United States