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: 10578691
• 负责人: Seema Lisa Clifasefi
• 金额: $ 59.86万
• 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 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10578691
• 关键词: Abstinence; Accident and Emergency department; Address; Affect; Alcohol consumption; Alcohols; Chronic; Client; Communities; Creativeness; 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; 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; Use Effectiveness; Vulnerable Populations; Work; alcohol abstinence; alcohol abuse therapy; alcohol related problem; alcohol use disorder; arm; attributable mortality; community based participatory research; comparison control; 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 engagement; stem; substance use; supported housing; verbal

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.

项目总结/文摘

项目成果

The life-enhancing alcohol-management program: Results from a 6-month nonrandomized controlled pilot study assessing a community based participatory research program in housing first.

• DOI: 10.1002/jcop.22291
• 发表时间: 2020-04
• 期刊: JOURNAL OF COMMUNITY PSYCHOLOGY
• 影响因子: 2.3
• 作者: Clifasefi, Seema L.;Collins, Susan E.
• 通讯作者: Collins, Susan E.

Characterizing components of and attendance at resident-driven Housing First programming in the context of community-based participatory research.

• DOI: 10.1002/jcop.22491
• 发表时间: 2021-07
• 期刊: Journal of community psychology
• 影响因子: 2.3
• 作者: Collins SE;Goldstein SC;King VL;Orfaly VE;Gu J;Clark A;Vess A;Lee G;Taylor EM;Fentress T;Braid AK;Clifasefi SL
• 通讯作者: Clifasefi SL

Content Analysis of Health Concerns among Housing First Residents with a History of Alcohol Use Disorder.

• DOI: 10.1353/hpu.2021.0035
• 发表时间: 2021
• 期刊: JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED
• 影响因子: 1.4
• 作者: Mackelprang, Jessica L.;Clifasefi, Seema L.;Grazioli, Veronique S.;Collins, Susan E.
• 通讯作者: Collins, Susan E.

Combining behavioral harm-reduction treatment and extended-release naltrexone for people experiencing homelessness and alcohol use disorder in the USA: a randomised clinical trial.

• DOI: 10.1016/s2215-0366(20)30489-2
• 发表时间: 2021-04
• 期刊: LANCET PSYCHIATRY
• 影响因子: 64.3
• 作者: Collins, Susan E.;Duncan, Mark H.;Saxon, Andrew J.;Taylor, Emily M.;Mayberry, Nigel;Merrill, Joseph O.;Hoffmann, Gail E.;Clifasefi, Seema L.;Ries, Richard K.
• 通讯作者: Ries, Richard K.