MISSION-Vet HUD-VASH Implementation Study
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 7/1/2018 |
| Start Date: | October 29, 2012 |
| End Date: | June 30, 2016 |
A major goal for the Department of Veterans Affairs is to end Veteran homelessness by 2015.
The VA's largest homelessness initiative is the joint Departments of Housing and Urban
Development (HUD) and Veterans Affairs (VA) Supportive Housing program (HUD-VASH), which has
been expanded greatly over recent years via the allocation of 30,000 Housing First vouchers
between 2008 and 2010 and increased funding to hire 1,000 new program case managers. However,
recent expansion has resulted in a number of implementation challenges including delays in
the distribution of housing vouchers and dropout among program participants (25% of those
housed in HUD-VASH drop out within a year). Much of this dropout can be attributed to
untreated issues facing many Veterans enrolled in HUD-VASH. The most common among these
untreated issues are mental health and substance use disorders. The presence of these
disorders is due in large part to the fact that much of HUD-VASH case management focuses on
housing placement and maintenance, with limited attention to mental health, substance abuse,
and other related psychosocial issues, which when left untreated, negatively impacts voucher
distribution and housing stability. This project will test an implementation model-Getting To
Outcomes (GTO)-designed to assist in the delivery of an intervention for Veterans with
co-occurring mental health and substance use disorders (MISSION-Vet) in the HUD-VASH program.
The proposed study will compare implementation of MISSION-Vet currently being planned through
VA Office of Patient Care Services to an enhanced approach using the GTO model. Thus, this
project can contribute to ending all Veteran homelessness by 2015, a pledge made by President
Obama.
The VA's largest homelessness initiative is the joint Departments of Housing and Urban
Development (HUD) and Veterans Affairs (VA) Supportive Housing program (HUD-VASH), which has
been expanded greatly over recent years via the allocation of 30,000 Housing First vouchers
between 2008 and 2010 and increased funding to hire 1,000 new program case managers. However,
recent expansion has resulted in a number of implementation challenges including delays in
the distribution of housing vouchers and dropout among program participants (25% of those
housed in HUD-VASH drop out within a year). Much of this dropout can be attributed to
untreated issues facing many Veterans enrolled in HUD-VASH. The most common among these
untreated issues are mental health and substance use disorders. The presence of these
disorders is due in large part to the fact that much of HUD-VASH case management focuses on
housing placement and maintenance, with limited attention to mental health, substance abuse,
and other related psychosocial issues, which when left untreated, negatively impacts voucher
distribution and housing stability. This project will test an implementation model-Getting To
Outcomes (GTO)-designed to assist in the delivery of an intervention for Veterans with
co-occurring mental health and substance use disorders (MISSION-Vet) in the HUD-VASH program.
The proposed study will compare implementation of MISSION-Vet currently being planned through
VA Office of Patient Care Services to an enhanced approach using the GTO model. Thus, this
project can contribute to ending all Veteran homelessness by 2015, a pledge made by President
Obama.
This project tests an implementation platform-Getting To Outcomes (GTO)-designed to assist in
the delivery of an evidence-based intervention for Veterans with co-occurring mental health
and substance use disorders (MISSION-Vet) in the HUD-VASH program. This project will be a
cluster randomized controlled trial that compares implementation of MISSION-Vet augmented by
GTO to MISSION-Vet Implemented as Usual (IU) at three of the largest HUD-VASH programs in the
country: VA Central Western Massachusetts Healthcare System (Northampton, MA), VA Capitol
Health Care Network (Washington, D.C.), and VA Eastern Colorado Health Care System (Denver,
CO). This project will randomly assign 150 HUD-VASH case managers and 1106 Veterans on their
caseloads who have received HUD-VASH vouchers and case management services into these two
groups on a 1-year rolling admission basis determined by when the Veteran receives a housing
voucher. The control group will receive MISSION-Vet in addition to HUD-VASH case management
services and the intervention group will receive the same as the control, however the
HUD-VASH case manager will have access to GTO implementation support.
To compare case managers implementing MISSION-Vet augmented with GTO to HUD-VASH case
managers using IU strategies on the following variables: (1) fidelity to the MISSION-Vet
intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use,
and functional outcomes among Veterans; and (4) factors key to the successful deployment of a
new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, &
Maintenance (RE-AIM) model.
Data will be collected on fidelity to MISSION-Vet in both IU and GTO groups. Data will also
be collected on all subjects' substance use, overall mental health functioning, engagement in
substance abuse treatment services, the length of time housed, and community participation.
The investigators will collect data from individuals at baseline and three time points for up
to one year. The investigators' data analysis strategy will be to use a repeated-measures
model to test for the significance of the treatment-by-time interaction while accounting for
the clustered design of case manager within site.
This study intends to serve a dual function of comparing implementation of MISSION-Vet
currently being planned through VA Office of Patient Care Services to an enhanced
implementation approach using the GTO model. The proposed research will help to guide policy
and practice actions to implement MISSION-Vet with fidelity and effectiveness to achieve
maximum outcomes among homeless Veterans.
the delivery of an evidence-based intervention for Veterans with co-occurring mental health
and substance use disorders (MISSION-Vet) in the HUD-VASH program. This project will be a
cluster randomized controlled trial that compares implementation of MISSION-Vet augmented by
GTO to MISSION-Vet Implemented as Usual (IU) at three of the largest HUD-VASH programs in the
country: VA Central Western Massachusetts Healthcare System (Northampton, MA), VA Capitol
Health Care Network (Washington, D.C.), and VA Eastern Colorado Health Care System (Denver,
CO). This project will randomly assign 150 HUD-VASH case managers and 1106 Veterans on their
caseloads who have received HUD-VASH vouchers and case management services into these two
groups on a 1-year rolling admission basis determined by when the Veteran receives a housing
voucher. The control group will receive MISSION-Vet in addition to HUD-VASH case management
services and the intervention group will receive the same as the control, however the
HUD-VASH case manager will have access to GTO implementation support.
To compare case managers implementing MISSION-Vet augmented with GTO to HUD-VASH case
managers using IU strategies on the following variables: (1) fidelity to the MISSION-Vet
intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use,
and functional outcomes among Veterans; and (4) factors key to the successful deployment of a
new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, &
Maintenance (RE-AIM) model.
Data will be collected on fidelity to MISSION-Vet in both IU and GTO groups. Data will also
be collected on all subjects' substance use, overall mental health functioning, engagement in
substance abuse treatment services, the length of time housed, and community participation.
The investigators will collect data from individuals at baseline and three time points for up
to one year. The investigators' data analysis strategy will be to use a repeated-measures
model to test for the significance of the treatment-by-time interaction while accounting for
the clustered design of case manager within site.
This study intends to serve a dual function of comparing implementation of MISSION-Vet
currently being planned through VA Office of Patient Care Services to an enhanced
implementation approach using the GTO model. The proposed research will help to guide policy
and practice actions to implement MISSION-Vet with fidelity and effectiveness to achieve
maximum outcomes among homeless Veterans.
Inclusion Criteria:
VA HUD-VASH case manager at the Northampton, Denver, and Washington D.C. HUD-VASH programs
Exclusion Criteria:
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4
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