A cluster-randomized controlled trial testing the effectiveness of the Life Enhancing Alcohol-management Program (LEAP) for Housing First residents

一项整群随机对照试验，测试住房第一居民的生活改善酒精管理计划 (LEAP) 的有效性

• 批准号: 10529057
• 负责人: Seema Lisa Clifasefi
• 金额: $ 4.27万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-20 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10529057
• 关键词: Abstinence; Accident and Emergency department; Address; Affect; Alcohol consumption; Alcohols; Chronic; Client; Communities; Criminal Justice; Development; Dose; Emergency Care; Emergency medical service; Evaluation; Funding; Harm Reduction; Health; Healthcare; Homeless persons; Homelessness; Housing; Individual; Intervention; Jail; Leadership; Life; Mediator of activation protein; Medical; Morbidity - disease rate; Needs Assessment; Noise; Outcome; Participant; Pathway interactions; Persons; Pilot Projects; Policies; Population; Positioning Attribute; Process; Program Effectiveness; Program Evaluation; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Reporting; Research; Research Personnel; Role; Services; Site; Substance Use Disorder; Testing; Time; Ursidae Family; Use Effectiveness; Vulnerable Populations; Work; alcohol abstinence; alcohol abuse therapy; alcohol related problem; alcohol use disorder; arm; attributable mortality; base; community based participatory research; cost; effectiveness testing; epidemiologic data; evidence base; experience; flexibility; follow up assessment; follow-up; high risk drinking; improved; innovation; interest; intrinsic motivation; marginalized population; patient engagement; personalized approach; physical assault; programs; public health relevance; reduced alcohol use; response; service utilization; services as usual; sexual assault; social; stem; substance use; supported housing

PROJECT SUMMARY/ABSTRACT People experiencing chronic homelessness comprise a small yet high-morbidity, high-cost subset of the larger homeless population and are disproportionately impacted by alcohol-related harm. Unfortunately, traditional abstinence-based treatment does not adequately reach or engage this population, and both firsthand (problems stemming from one’s own alcohol use) and secondhand (problems stemming from others’ alcohol use) alcohol-related harm persists even after housing attainment. There have therefore been calls for more flexible and client-centered approaches tailored to this population’s needs. Housing First, which entails the provision of immediate, permanent, low-barrier, nonabstinence-based housing, is a response to this call. Research has shown that Housing First is associated with decreased alcohol use, alcohol-related harm, and publicly funded service utilization. Nonetheless, Housing First residents continue to experience both first- and secondhand alcohol-related harm. Thus, further community-based interventions are necessary. To this end, a pilot project was conducted in which researchers as well as Housing First residents, staff and management codeveloped, implemented, and initially evaluated the Life Enhancing Alcohol-management Program (LEAP). The LEAP entails low-barrier, community-level, house-wide resident programming—including leadership opportunities, activities, and pathways to recovery. At the 6-month follow up, LEAP participants reported significantly more engagement in meaningful activities than control participants (p < .001). Moreover, high levels of LEAP program engagement (>2 activities per month) predicted significant reductions in alcohol use and alcohol-related harm (ps < .01). To build on these promising findings, we propose a larger, cluster- randomized controlled trial of LEAP (N=500) as an innovative, community-based, and client-driven adjunct to Housing First. In the proposed project, 10 Housing First sites will be optimally matched and block randomized on a rolling basis to either LEAP or services-as-usual control conditions. At LEAP sites, research staff will work with housing staff and residents to conduct a needs assessment, form a community advisory board, and develop and implement this community-level intervention. Participants in the LEAP evaluation will meet criteria for at-risk drinking and will be assessed at baseline, 3-, 6-, and 12-month follow-ups. Analyses will test LEAP effectiveness in increasing engagement in meaningful activities, decreasing alcohol use, ameliorating both first- and secondhand alcohol-related harm, and improving quality of life. Engagement in meaningful activities will also be tested as a mediator of the LEAP effect on alcohol and quality-of-life outcomes. Finally, we will assess whether LEAP is associated with reduced costs stemming from participants’ use of emergency health-care and criminal justice services.

项目概要/摘要 经历长期无家可归的人只占人口中发病率高、成本高的一小部分。 无家可归者人数增多，并且受到酒精相关伤害的影响尤为严重。很遗憾， 传统的基于禁欲的治疗无法充分接触或吸引这一人群，而且 第一手（因自己饮酒而产生的问题）和二手（因他人饮酒而产生的问题） 即使在获得住房后，酒精相关的伤害仍然存在。因此有人呼吁 针对该人群的需求量身定制更灵活、以客户为中心的方法。住房第一，这意味着 提供直接、永久、低门槛、非禁欲住房就是对这一呼吁的回应。 研究表明，住房优先与减少饮酒、酒精相关伤害以及 公共资助服务的利用。尽管如此，“住房第一”的居民仍继续经历着“住房第一”和“住房第一”的生活。 二手酒精相关的伤害。因此，有必要采取进一步的社区干预措施。为此， 开展了一个试点项目，研究人员以及住房第一居民、工作人员和管理人员 共同开发、实施并初步评估了生活改善酒精管理计划 (LEAP)。 LEAP 需要低门槛、社区层面、全屋居民规划——包括领导力 机会、活动和康复途径。在 6 个月的随访中，LEAP 参与者报告说 与对照组参与者相比，他们明显更多地参与有意义的活动 (p < .001)。而且，高 LEAP 计划参与水平（每月 > 2 项活动）预测酒精使用量将显着减少 和酒精相关的伤害 (ps < .01)。为了以这些有希望的发现为基础，我们提出了一个更大的集群 LEAP 的随机对照试验 (N=500) 作为一种创新、基于社区和客户驱动的辅助手段 住房第一。在拟议的项目中，10个“住房优先”用地将得到优化匹配和街区 滚动随机分配到 LEAP 或照常服务控制条件。在 LEAP 站点，研究 工作人员将与住房工作人员和居民合作进行需求评估，形成社区咨询 董事会，并制定和实施这一社区级干预措施。 LEAP 评估的参与者将 符合危险饮酒标准，并将在基线、3、6 和 12 个月的随访中进行评估。分析 将测试 LEAP 在增加有意义的活动参与度、减少饮酒、 减轻与第一手和二手酒精相关的伤害，并提高生活质量。参与 有意义的活动也将作为 LEAP 对酒精和生活质量影响的中介进行测试 结果。最后，我们将评估 LEAP 是否与参与者的成本降低有关 使用紧急医疗保健和刑事司法服务。