mHealth to Increase Service Utilization Among Recently Incarcerated Homeless Adults

7.项目总结/摘要 在无家可归的成年人中，有一个重要的旋转门， 健康差距。无家可归的成年人接受个性化护理的专业协调（即，情况 在他们从监狱释放后的这段时间里， 他们更有可能获得稳定的住房，并且不太可能再次被监禁。这是 因为个案经理通过帮助客户克服障碍来满足客户的各种需求 所需的服务（例如，食物、衣服、住房、职业培训、药物滥用和心理健康治疗， 医疗、药物、社会支持、身份证明、法律的援助）。许多障碍（例如，有限 交通、无法安排预约、对现有服务的了解有限）， 最近从监禁中获释的成年人无法获得可用的案件管理， 管理、药物滥用和心理健康服务。拟议的研究将使用移动的技术， 解决这些障碍，填补空白，了解无家可归者旋转门的原因， 监禁。具体来说，432名无家可归的成年人参加了一个以收容所为基础的无家可归者恢复计划， 从县监狱释放后，将被随机分配到三个治疗组之一：1）通常的庇护所 基于病例管理（UCM），2）UCM+智能手机研究（UCM + SP），以及3）UCM与 研究提供了预装了创新护理管理应用程序（SPCM）的智能手机。SPCM 应用程序是研究小组以前成功工作的延伸，使用移动的设备来评估和 改变低收入和无家可归的成年人的健康行为。那些分配到SPCM的人将获得智能 电话，将提示（每周两次）连接到庇护所的案件经理。该应用程序还将提供 与护理经理（在正常工作时间提供）和危机干预人员（24小时提供）的直接联系 每周7天，每天7小时），只需按一下按钮。据推测，SPCM将增加 个案和危机管理服务，从而解决未得到满足的需求（例如，酒精/毒品/心理健康 咨询），改善感知的社会支持和生活质量，减少无家可归和再次被捕。 本研究的另一个重点是解决在理解驱动再逮捕的机制方面的差距， 无家可归者通过使用传统的面对面（即，基线、基线后1、3和6个月）和智能手机 基于（即，每天持续6个月）的评估方法来识别远端和近端预测因子（例如，影响， 思想，行为，事件）继续无家可归和逮捕。这项研究代表了一个步骤， 综合服务连接和医疗保健服务提供，为最缺乏服务，高需求， 和未被充分研究的人群。智能手机应用程序，增加了可用的 医疗保健服务和确定关键结果预测因子可用于覆盖难以覆盖的人群 具有显著和持续的健康差异的历史（例如，无家可归的成年人）。

7. Project Summary/Abstract There is a significant revolving door of incarceration among homeless adults, a population with substantial health disparities. Homeless adults who receive the professional coordination of individualized care (i.e., case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be re-incarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (e.g., food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, legal aid). Many barriers (e.g., limited transportation, inability to schedule appointments, limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services. The proposed study will use mobile technology to address these barriers and fill gaps in the understanding of the causes of the revolving door of homeless incarceration. Specifically, 432 homeless adults who enroll in a shelter based Homeless Recovery Program after release from county jail will be randomly assigned to one of three treatment groups: 1) usual shelter based case management (UCM), 2) UCM plus a study provided smart phone (UCM+SP), and 3) UCM with a study provided smart phone that is preloaded with an innovative care management app (SPCM). The SPCM app is an extension of the research team's previous successful work using mobile devices to assess and modify health behaviors in low income and homeless adults. Those assigned to SPCM will receive smart phones that will prompt (twice weekly) connections to shelter based case managers. The app will also offer direct links to care managers (available during normal business hours) and crisis interventionists (available 24 hours a day, 7 days a week), with the touch of a button. It is hypothesized that SPCM will increase utilization of case and crisis management services thereby addressing unmet needs (e.g., alcohol/drug/mental health counseling), improve perceived social support and quality of life, and reduce homelessness and re-arrest. Another key focus of this study is to address gaps in the understanding of mechanisms that drive re-arrest and homelessness by using traditional in-person (i.e., baseline, 1, 3, and 6 months post-baseline) and smart phone based (i.e., daily for 6 months) assessment methods to identify distal and proximal predictors (e.g., affect, thoughts, behaviors, events) of continued homelessness and arrest. This research represents a step toward integrated service connection and healthcare service provision for one of the most underserved, high need, and understudied populations in the United States. Smart phone apps that increase the use of available healthcare services and identify predictors of key outcomes could be used to reach hard to reach populations with histories of significant and persistent health disparities (e.g., homeless adults).