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Principal Investigator: ELIZABETH J SANTA ANA
Organization: RALPH H JOHNSON VA MEDICAL CENTER
Fiscal Year: 2024
Funding agency: Veterans Affairs
Justification: High inpatient readmissions among Veterans with SUDs constitutes a costly and persistent
healthcare problem. VHA Handbook 1160.06 guides the development and implementation of recovery-oriented
mental health (MH) services, although significant service gaps remain on VA inpatient settings. ‘Combined
Recovery Program (CRP)’ is designed to address these gaps by enhancing stabilization of Veterans with SUDs
beyond hospital discharge and consists of ‘Group Motivational Interviewing’, an adaptation of motivational
interviewing; and ‘Life Skills for Housing Maintenance’, involving skills training for enhancing housing stability.
To be added to CRP, Stable & Able (S&A) is a VA Home Telehealth (HT) nurse-monitored program providing
assessment and self-management skills in the post-hospitalization phase.
Gaps Addressed: This proposal addresses VA research priorities: access to care and MH, benefitting Veterans
with SUDs. A significant proportion of these Veterans exhibit homelessness and suicidality. Study objectives
address SAIL MH Composite measures ‘PDE1’ to increase Post-Discharge Treatment Engagement in MH care;
and ‘HRF7’ to increase care processes for Veterans at high risk for suicide. During the COVID-19 pandemic,
telehealth solutions offer safe treatment options as well as reduce isolation.
Innovativeness: This proposal is consistent with 2018 MISSION Act in priority areas: mental illness, SUD, and
housing instability via a technology-enabled format and through addressing gaps in the current inpatient recovery
model involving limited availability of staff training in and availability of recovery-oriented services. CRP and S&A
present innovative/novel interventions ready for deployment. Both CRP and S&A were designed specifically to
assist high risk Veterans with SUDs to remain stably housed. S&A is conveniently provided via App using an
iPad, cell phone, or the Medtronic Commander Flex and allows 3 mos. of daily monitoring by trained HT staff.
Specific Aim I: Assess the relative effects of Treatment Engagement and Substance Use [and SUD-related
problems] between CRP+S&A vs. CRP and CRP+S&A vs. TAU by 3-mos follow-up.
Primary Hypothesis 1a: Treatment Engagement: Participants in CRP + S&A will attend more outpatient SUD
treatment sessions and general MH treatment sessions compared to participants in CRP and to TAU.
Primary Hypothesis 1b: Substance Use: Participants in CRP + S&A will lower quantity and frequency of
substance use and SUD-related problems compared to participants in CRP and to TAU.
Secondary Hypothesis 1c: Preventable Services: Participants in CRP + S&A will reduce Preventable
Healthcare Services (hospital readmissions and ED visits) compared to participants in CRP and to TAU.
Secondary Hypothesis 1d: Participants in CRP + S&A will report Greater QoL; # of Days Living in Stable
Housing; and # of Days Engaging in Community Events and/or Activities compared to CRP and to TAU.
Specific Aim II: Conduct Veteran participant thematic interviews and Staff ‘focus’ interviews to assess qualitative
facilitators and barriers to implementation.
Project Methods: 195 Veterans with SUDs in the Charleston VAMC inpatient setting will be recruited.
Participants will be randomly assigned to: (1) CRP + S&A; (2) CRP; and (3) TAU. Participants will be followed-
up at 1 and 3-months and data analyzed using mixed methods. Investigators of this project plan to evaluate
implementation of the interventions proposed in other VA inpatient programs within the VISN through future
implementation projects and will utilize study findings in partnership for improving SAIL performance measures.
Description of Primary Outcomes: A. Treatment Engagement (measured in SUD and general MH treatment
sessions attended); B. Substance Use (measured in quantity and frequency) and SUD-related problems.
Secondary outcomes: C. Preventable Services (measured in hospital readmissions and ED visits) and D. Quality
of Life, #Days Living in Stable Housing, and # Days Engaging in Community Events and/or Activities.
Terms: <Access to Care><Active Follow-up><Address><Admission><Admission activity><After Care><After-Treatment><Aftercare><Age><Alcohol Chemical Class><Alcohols><Ambulatory Care><Area><Assess implementation><Behavior><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Care given by nurses><Caring><Cell Phone><Cellular Phone><Cellular Telephone><Chronic><Communities><Community Integration><Data><Development><Devices><Diagnosis><Drug Use Disorder><ED visit><ER visit><Effectiveness><Eligibility><Eligibility Determination><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Evaluation><Event><Exhibits><Frequencies><Goals><Health><Health Care Systems><Health Care Technology><Health Services Accessibility><Health Technology><Healthcare><Healthcare Systems><Healthcare Technology><Home><Homelessness><Hospital Admission><Hospitalization><Hospitals><Housing><Impairment><Implementation assessment><Inpatients><Intervention><Intervention Strategies><Interview><Investigators><Life><Maintenance><Measures><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Mental disorders><Mental health disorders><Methods><Mobile Phones><Modeling><Monitor><Nicotine Dependence><Nurses><Nursing Care><Occupational><Out-patients><Outcome><Outcome Assessment><Outpatient Care><Outpatients><Participant><Patients><Performance><Phase><Population><Procedures><Process><Protocol Screening><Psychiatric Disease><Psychiatric Disorder><Psychiatric therapeutic procedure><Psychological Health><QOL><Quality of life><Randomized><Recommendation><Recovery><Relapse><Reporting><Research Personnel><Research Priority><Researchers><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Self Management><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Social Functioning><Substance Use Disorder><Technology><Training><Veterans><access to health services><access to services><access to treatment><accessibility to health services><active followup><ages><arm><availability of services><barriers to implementation><care access><care as usual><co-morbid><co-morbidity><community engagement><comorbidity><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cost><design><designing><developmental><engagement with communities><evaluate implementation><evaluation of implementation><follow up><follow-up><followed up><followup><function socially><functioning social><future implementation><handbook><health care><health care service><health service access><health services availability><health training><healthcare service><high risk><homeless><homes><hospital re-admission><hospital re-admission rates><hospital readmission><hospital readmission rate><housing instability><iPhone><illicit drug use><implementation barriers><implementation challenges><implementation evaluation><implementation intervention><improved><innovate><innovation><innovative><inpatient care><inpatient psychiatric settings><inpatient service><instably housed><intervention arm><interventional strategy><meeting><meetings><mental health care><mental healthcare><mental illness><motivational enhancement therapy><motivational interview><multi-modality><multimodality><nicotine addiction><nicotine dependent><novel><nurse><online app><outpatient treatment><patient response><patient specific response><post treatment><preservation><primary outcome><programs><psychiatric care><psychiatric illness><psychiatric therapy><psychiatric treatment><psychological disorder><randomisation><randomization><randomly assigned><re-admission><re-admission rates><re-hospitalization><re-hospitalization rate><readmission><readmission rates><recruit><reduced substance use><reduction in substance use><rehospitalization><rehospitalization rate><relative effectiveness><responsive patient><secondary outcome><service availability><service gap><service utilization><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><skills><skills training><smart phone><smartphone><social><substance use><substance use and disorder><substance use reduction><substance use treatment><substance using><suicidal><suicidal risk><suicidality><suicide risk><telehealth><treatment access><treatment arm><treatment as usual><treatment effect><unhoused><unstable housing><unstably housed><usual care><web app><web application><web based app><web based application>