Health TrialsbyHealthPanel

Coordinated Access for Addiction Recovery and Equity in VA Supportive Housing

ConditionsHomelessnessSubstance Use Disorder (SUD)
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
AgeNot listed
SponsorVA Office of Research and Development

About this trial

The Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) Program provides subsidized permanent housing with case management to homeless-experienced Veterans (HEVs). Up to 40% of Veterans exit HUD-VASH within two years of attaining housing; substance use disorders (SUDs) are one of the largest causes of returns to homelessness for HEVs. CARE-VASH QUERI proposes to implement and evaluate two evidence-based SUD services - Medications for addiction treatment (MAT) and cognitive behavioral therapy for SUDs (CBT-SUD) - among Veterans in HUD-VASH.

Eligibility criteria

This trial accepts healthy volunteers

Qualifiers

Homeless-experienced Veterans (HEVs) enrolled in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) Program.

Disqualifiers

None

Trial design

Design model

Parallel

Treatments tested in this trial

  • Medication for Addiction Treatment (MAT)

    Drug

    MAT includes medications for alcohol use disorder (MAUD) and medications for opioid use disorder (MAUD). It reduces substance use, increases SUD treatment engagement, enhances quality of life, and reduces overdoses.

  • Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD)

    Behavioral

    An evidence-based psychotherapy that uses cognitive behavioral therapy to further recovery goals across SUD diagnoses.

Treatment groups

7,908 Participants
are divided into 3 treatment groups
Group A: Replicating Effective Programs (REP)Experimental treatment 2 interventions
Group B: REP + Consumer Engagement (CE)Active comparator 2 interventions
Group C: Control GroupNo intervention 0 interventions

Trial outcomes

Primary outcomes

1

Reach of MAT (Medications for Addiction Treatment)

* (percent of) Veterans who used Medications for Opioid Use Disorder (MOUD) for OUD, ≥1 prescription * (percent of) Veterans who used MOUD for OUD for 180 days since initial prescription (without a break ≥14 days in supply) * (percent of) Veterans who used Medications for Alcohol Use Disorder (MAUD) for AUD, ≥1 prescription * (percent of) Veterans who used MAUD for AUD for 180 days since initial prescription (without a break ≥14 days in supply)

Time frame
18 months post-implementation
2

Reach of CBT-SUD (Cognitive Behavioral Therapy-Substance Use Disorders)

* (percent of) Veterans with stimulant use disorder who had ≥1 visit for Cognitive Behavioral Therapy-Substance Use Disorders (CBT-SUD) or contingency management * (percent of) Veterans with substance use disorder with ≥1 CBT-SUD visit * (percent of) Veterans with substance use disorder with ≥9 CBT-SUD visits

Time frame
18 months post-implementation
3

Adoption of MAT (Medications for Addiction Treatment)

% (percent of) Department of Housing and Urban Development - VA Supportive Housing (HUD-VASH) and mental health prescribers engaged with Veterans who ordered Medications for Opioid Use Disorder (MOUD) / Medications for Alcohol Use Disorder (MAUD) at least once

Time frame
18 months post-implementation
4

Adoption of CBT-SUD (Cognitive Behavioral Therapy-Substance Use Disorders)

% (percent of) Department of Housing and Urban Development - VA Supportive Housing (HUD-VASH) case managers who delivered ≥1 CBT-SUD (Cognitive Behavioral Therapy-Substance Use Disorders) session

Time frame
18 months post-implementation

Secondary outcomes

1

Housing retention

Difference in the mean days homeless over 1 year of follow-up for Veterans enrolled in trial sites that received the base versus enhanced implementation strategy, versus the expected number of days homeless had they enrolled in a comparison group of all sites not engaged in the trial

Time frame
1 year after implementation by cohort
2

Provider experience

Experiences of and satisfaction with providing HUD-VASH services to HEVs with SUDs pre- and post- implementation, which will be assessed using semi-structured qualitative interviews (data will be coded from key findings in the narratives provided during the interviews).

Time frame
Baseline and 18 months post-implementation
3

Cost impact of Medications for Addiction Treatment (MAT) and Cognitive Behavioral Therapy-Substance Use Disorders (CBT-SUD)

The predominant cost of delivering MAT in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) programs is prescriber time; for CBT-SUD, the predominant cost is case manager time. We will use VA administrative data to identify visits in which MAT was prescribed or CBT-SUD was delivered. Interviews with HUD-VASH prescribers will be used to estimate minutes/visit spent on MAT, including visits in which MAT was discussed but not prescribed; at implementation sites, we will add a mandated field to templated CBT-SUD notes that indicates time spent outside the encounter (e.g., preparing for the visit).

Time frame
18 months (during the course of implementation)
4

Acute care utilization

Emergency department visits and hospitalizations associated with primary SUD diagnoses

Time frame
1 year after implementation by cohort

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

VA Office of Research and Development

Lead sponsor

University of California, Los Angeles

Collaborator

Source ClinicalTrials.gov

This trial is not recruiting at the moment. You can still explore other options: