Homelessness Support

This research aims to reduce food insecurity by improving access to plant-based healthy foods, enhancing nutrition literacy, and improving health among food-insecure families. It focuses on families living under the federal poverty line and involves both children and adults up to 99 years old. The study evaluates different approaches to increasing consumption of unprocessed and minimally processed fruits, vegetables, whole grains, legumes, and nuts or seeds over one year. Participants join one of four study arms based on their eligibility and interest. In the dual intervention arm, participants attend five weekly nutrition classes with age-appropriate interactive activities and receive a food prescription voucher to pick up plant-based meals from a food pantry. Some arms involve nutrition education only, with classes tailored by age, while others provide food without a prescription. Food pickup is expected twice a week for up to a year, providing enough meals for household members. During the study, participants complete surveys and nutrition knowledge tests before and after each class, with additional follow-up surveys every three months and a final knowledge test one year after starting. Researchers monitor servings of healthy plant-based foods consumed and assess food insecurity status and nutrition knowledge changes. The study includes families receiving care from specific primary care clinics, and participation spans up to one year with regular assessments and support.

Researchers are evaluating the effects of combining poverty alleviation with depression treatment compared to depression treatment alone in low-income rural Bangladeshi women aged 18 to 45 who have depression. The study aims to find out if adding poverty alleviation improves depression symptoms at 6 months, reduces relapse at 18 months, and enhances treatment uptake and retention. Other outcomes include economic vulnerability, anxiety, culturally specific symptoms, quality of life, and function. The study includes a mixed methods evaluation examining how well the interventions are adopted and delivered. Participants are randomly assigned to one of two groups. The control group receives six sessions of a group-based psychotherapy adapted from the WHO Problem Management Plus program, focusing on problem solving, social support, behavioral activation, and relaxation. The experimental group receives the same psychotherapy plus a poverty alleviation package that includes financial literacy education, savings accounts, consumption support (equivalent to 1 kg of rice per day for six months), three goats with 12 months of feed and veterinary care, gardening supplies, and agricultural skill building. Participants in both groups take part in research interviews at 6, 12, and 18 months to assess depression and other outcomes. The study measures changes in depressive symptoms primarily at 6 months, with additional assessments of relapse, economic status, anxiety, function, quality of life, and tension over 18 months. A thorough implementation evaluation includes interviews with participants and staff to understand treatment adoption, retention, and fidelity. The total participation period spans 18 months.

Youth experiencing homelessness face many challenges including high rates of substance use and mental health disorders, which can have long-lasting effects on their well-being. This research aims to study a comprehensive prevention program that targets social factors affecting these youth to improve their health outcomes. The study uses a dismantling design to identify which parts of the intervention are most effective in reducing opioid misuse and improving mental health among homeless youth aged 14 to 24 years. Participants will be randomly assigned to one of four groups: Motivational Interviewing combined with the Community Reinforcement Approach plus usual services; Strengths-Based Outreach and Advocacy plus usual services; a combination of all three interventions; or usual services alone offered by a community drop-in center. The interventions include counseling sessions, advocacy to help meet basic needs and connect with resources, and usual drop-in center support. The study evaluates how these approaches impact opioid use disorder prevention and mental health outcomes. Youth will be assessed at the start and then again at 3, 6, 12, 18, and 24 months to monitor substance use, mental health, and overall well-being. Assessments include interviews about substance use, questionnaires for depression and anxiety, and health surveys. The study also explores how factors like age, sex, and past experiences affect responses to the interventions. Researchers will track costs to help guide future programs for homeless youth.

Researchers are evaluating how digital and face-to-face delivery of first-line osteoarthritis (OA) treatment compare in reaching patients across Sweden. The study aims to improve access to care for people with hip or knee OA by understanding if a digital program can increase equal access in both urban and rural areas. This observational study compares a traditional face-to-face program called Better management of patients with OsteoArthritis (BOA) to a newer digital version called Joint Academy (JA). The digital program JA offers daily video instructions, individualized exercises, and educational information via a mobile app. Participants communicate with a physical therapist through chat and phone for supervision throughout the program. The face-to-face BOA program provides treatment at primary care clinics and has been in use since 2008. Data on patient participation from both programs during 2021-2023 will be collected and compared, including geographic factors like population density and county size. Participants' postal codes and primary care center locations will be recorded to analyze treatment utilization per 100,000 residents in different regions. The study collects data from the BOA registry and JA database to assess how well each program reaches patients. The goal is to determine if digital delivery improves access and adherence compared to face-to-face care. The study runs until July 2025 and involves adults diagnosed with hip or knee OA who have consented to participate.

This research aims to evaluate the local implementation of the Early Adolescent Skills for Emotions (EASE) program, originally developed by the World Health Organization (WHO), focused on addressing psychological distress in urban youth aged 10 to 15 years. The study examines the program's acceptability, feasibility of training community helpers, recruitment and retention challenges, and delivery through community partnerships using both qualitative and quantitative methods. The research also applies the RE-AIM framework to assess reach, effectiveness, adoption, implementation, and maintenance. The EASE intervention consists of seven group sessions for adolescents and three group sessions for their caregivers, each lasting 90 minutes. Adolescents learn skills such as recognizing emotions, managing distress through slow breathing, engaging in meaningful activities, and problem-solving. The program was adapted based on community feedback to improve relevance and accessibility for urban youth in New York City. This pilot study collaborates with community-based organizations and caregiver participants who are the adolescent's legal guardians. Participants will engage in the group sessions and complete various assessments including the Pediatric Symptom Checklist Youth Report and other mental health and well-being questionnaires at 8 months. The study monitors psychological distress, school membership, parental stress, and other outcomes to evaluate the intervention's impact. The total participation duration and follow-up are designed to support understanding of the program's feasibility and effectiveness in this urban setting.

Researchers are evaluating a smartphone-based intervention called Smart-T Alcohol designed to reduce alcohol use among adults experiencing homelessness who report hazardous drinking. This randomized controlled trial will compare the effects of the Smart-T Alcohol intervention plus usual shelter-based care versus usual care alone. The study aims to assess alcohol consumption, drinking risk factors, and the intervention's effectiveness in specific subgroups such as women and younger adults. Participants will be recruited from five shelters in Dallas, TX and Oklahoma City, OK, and will complete screening and training visits. They will use a smartphone app to complete daily surveys for one week before randomization. The intervention period lasts eight weeks, during which participants receive either usual care or usual care plus the Smart-T Alcohol app that delivers on-demand tips and tailored messages based on daily survey responses to support drinking reduction goals. Follow-up assessments occur at 9, 13, and 26 weeks post-enrollment. Throughout the 13-week study period, all participants complete brief daily smartphone surveys to track alcohol use and related factors like mood and motivation. Researchers will monitor drinking patterns, alcohol-related problems, and changes in risk indicators. Data collection includes app-based assessments and follow-up visits at shelters or via phone. The study also documents engagement with existing treatment services, and participants reporting heavy or high-intensity drinking receive additional referrals for support.

Researchers are studying patients who are sent to the emergency department by their general practitioners to find out how many could instead be treated in walk-in clinics. These clinics offer quick, basic medical care without appointments and can perform simple tests like blood work and X-rays. The goal is to improve patient flow and reduce emergency room overcrowding in the le-de-France region. The study observes adult patients referred to the emergency department with a letter from their general practitioner during weekdays from 9 a.m. to 8 p.m. These patients have medical or traumatic reasons for their visit and are stable when arriving and during care. Patients needing intensive hospital care or who have life-threatening conditions are not included. Participants will be monitored during their emergency department visit to assess whether their care could have been managed in a walk-in clinic. The main measure is the proportion of patients referred by general practitioners who could have been treated in such clinics. The study helps understand how emergency services can be better used and runs until August 2025.

This research aims to improve access to primary care for patients experiencing homelessness who frequently use the emergency department (ED) but often lack follow-up care. The study compares two approaches to post-ED primary care: referral to a clinic or referral to a street medicine team that seeks patients directly on the street to reduce barriers to care. The goal is to assess which method better supports follow-up and health outcomes for this vulnerable population. Participants will be assigned to either receive a referral to the Comprehensive Care Clinic at Denver Health or to the Colorado Coalition for the Homeless Stout Street medicine clinic at discharge. The street medicine team will attempt to contact patients within two weeks using electronic health record tools. Both groups will receive the hospital appointment line number. The study uses a non-randomized design with single masking. During the study, researchers will review health records at one and three months after the initial ED visit to measure follow-up rates, emergency department visits, hospitalizations, and mortality. Data will be collected from Denver Health, the street medicine clinic, and a health information exchange. Participants' health outcomes and care engagement will be monitored through chart reviews over the three-month period following their ED discharge.

This research investigates the effects of Narrative Exposure Therapy (NET), a short-term trauma-focused therapy, on PTSD and depression symptoms in Ukrainian refugees living in Norway. The study also aims to train Ukrainian health workers in Norway to deliver NET. NET has shown promise in reducing PTSD symptoms in people affected by war and organized violence, making it a relevant approach for this vulnerable group displaced by conflict. Participants will be randomly assigned to receive immediate NET treatment or to a waitlist control group that receives treatment after the initial participant's treatment and re-assessment. NET involves structured sessions where individuals reconstruct their life story to process traumatic memories, supported by trained health professionals who complete a standardized digital training and supervised practice. The study includes baseline assessment, post-treatment evaluation shortly after therapy ends, and a 6-month follow-up. During the study, participants will complete validated questionnaires in Ukrainian or Russian to assess PTSD symptoms, depression, dissociation, and trauma exposure. These assessments occur at baseline, immediately after treatment, and six months later. Data collection is conducted through interviews with therapists to ensure quality and understanding. Safety procedures are in place for participants with high depression or suicidal scores. The total study duration includes training, treatment, and follow-up phases, with careful data protection and ethical oversight.

Researchers are evaluating a supportive housing program designed for adults who are unhoused and have complex health needs. This study uses a cohort design with a matched control group to assess the program's impact on emergency department visits and hospital stays. The study also explores participant well-being, program implementation, fidelity, and cost-effectiveness, using a hybrid type 1 effectiveness-implementation framework that combines quantitative and qualitative methods. The intervention, called the Social Medicine Housing Initiative, provides permanent supportive housing without prerequisites such as substance use cessation or treatment adherence. Housing is offered through a rent-geared-to-income model, with participants paying up to 30% of their income. Alongside housing, customized social and medical support tailored to individual needs is provided in collaboration with housing providers, the Social Medicine team, and community agencies. A matched control group is created by selecting individuals similar in health service use from administrative hospital records. Participants who join the housing program and consent to the study will engage in surveys and interviews assessing their well-being and experiences. Data on health service use, including emergency visits and hospital days, will be collected from administrative databases over 30 months. This comprehensive approach combines participant feedback and health data to evaluate the program’s effects, with no exclusion criteria for study participation once enrolled in the housing initiative.