mHealth to Increase Service Utilization Among Recently Incarcerated Homeless Adults

7.项目摘要/摘要 在无家可归的成年人中有一扇重要的旋转门被监禁，这是一个相当大的人口 健康差距。接受个体化护理的专业协调的无家可归成年人(即个案 管理人员)在出狱后的一段时间内，他们的心理健康和精神实质较少 使用问题，更有可能获得稳定的住房，而不太可能再次入狱。这是 因为案件经理通过帮助客户克服障碍来满足他们的各种需求 到所需服务(例如，食物、衣物、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、法律援助)。许多障碍(例如，有限的 交通、无法安排预约、对可用服务的了解有限)防止无家可归 最近从监狱获释的成年人，无法获得可用的案件管理，危机 管理、药物滥用和精神健康服务。拟议的研究将使用移动技术来 消除这些障碍，填补在理解无家可归者旋转门原因方面的空白 监禁。具体地说，432名参加基于收容所的无家可归者恢复计划的无家可归成年人 从县监狱释放后，将被随机分配到三个治疗组中的一个：1)通常的庇护所 基于案例管理(UCM)，2)UCM加上一项研究提供的智能手机(UCM+SP)，以及3)UCM具有 Study提供了预装创新护理管理应用程序(SPCM)的智能手机。SPCM APP是研究团队之前成功工作的延伸，使用移动设备评估和 改变低收入和无家可归成年人的健康行为。分配到SPCM的人员将收到SMART 手机将提示(每周两次)连接到基于庇护所的案件经理。该应用程序还将提供 直接链接到护理经理(在正常工作时间可用)和危机干预者(24小时可用) 一天工作几个小时，一周7天)，只需按一下按钮。据推测，SPCM将增加对 案件和危机管理服务，从而解决未得到满足的需求(例如，酒精/毒品/精神健康 咨询)，改善感受到的社会支持和生活质量，减少无家可归和再次被捕。 这项研究的另一个关键重点是解决在理解驱动重新逮捕和 通过使用传统的面对面(即基线、基线后1、3和6个月)和智能手机实现无家可归 基于(即，连续6个月每天)评估方法以识别远端和近端预测因素(例如，影响， 思想、行为、事件)持续无家可归和被捕。这项研究代表着迈向 集成服务连接和医疗保健服务，满足服务最少、需求最高的人群之一， 以及美国未被充分研究的人口。增加可用的智能手机应用程序的使用 医疗保健服务和确定关键结果的预测因素可用于接触到难以接触到的人群 有明显和持续的健康差距的历史(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).