Whole Health Coaching for Homeless Veterans' Healthcare Needs

(PWHC Trial)

Not currently recruiting at 2 trial locations

Overseen By Daniel M Blonigen, PhD MA

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Suicidal, Behavioral, Cognitive impairment

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 18

Duration: 24 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether Whole Health Coaching, provided by trained Peer Specialists, can help homeless Veterans reduce their frequent use of emergency and hospital services. The study compares two groups: one receiving usual care with added support tools, and another receiving structured coaching sessions focused on overall well-being. Veterans who have recently used VA homeless services and experienced multiple emergency care events might be suitable for this trial. The aim is to find ways to decrease healthcare costs and improve care for these Veterans. As an unphased trial, this study offers Veterans the opportunity to contribute to innovative care approaches that could enhance their well-being and reduce healthcare costs.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that Whole Health Coaching is safe for homeless Veterans?

Research has shown that Peer Support-Whole Health Coaching is generally safe for participants. An initial study tried this method with homeless veterans, and no serious side effects or negative events were reported, indicating the treatment is usually well-tolerated.

Peer specialists, individuals with personal experience, provide support through a structured coaching program to help veterans manage their health. This method emphasizes guidance and support over medication or medical procedures.

Although the study did not specifically focus on safety, the absence of negative reports is encouraging. This type of coaching aims to improve health without the risks often associated with medical treatments. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Peer Specialist - Whole Health Coaching (PS-WHC) because it offers a unique approach to addressing healthcare needs among homeless veterans through peer support. Unlike traditional care methods that primarily focus on medical interventions, this treatment uses a structured Whole Health Coaching curriculum delivered by peer specialists. This approach emphasizes personalized support and empowerment, potentially leading to improved health outcomes by fostering a supportive community and addressing the holistic needs of veterans.

What evidence suggests that Peer Support-Whole Health Coaching is effective for reducing acute care use among homeless Veterans?

Research has shown that Peer Support-Whole Health Coaching (Peer-WHC), which participants in this trial may receive, can help homeless Veterans by reducing their frequent visits to hospitals and emergency rooms. This method combines peer support with a structured coaching program to improve overall health. Studies have found this approach practical, well-received, and helpful in meeting the healthcare needs of homeless Veterans. Early results suggest that data analysis, combined with peer support and coaching, effectively decreases the need for urgent medical care in this group. By focusing on overall health, this program may offer a promising way to manage healthcare use. ^{1 2 3 5 6}

Who Is on the Research Team?

Daniel M. Blonigen, PhD MA

Principal Investigator

VA Palo Alto Health Care System, Palo Alto, CA

David A. Smelson, PsyD

Principal Investigator

VA Bedford HealthCare System, Bedford, MA

Are You a Good Fit for This Trial?

This trial is for Veterans enrolled in a VA care team, listed on the VA's Homeless Registry, and have used acute care services frequently. It's not open to those with suicidal tendencies or severe cognitive impairments that prevent understanding of the study.

Inclusion Criteria

Veterans who had a hot spotter qualifying event in two or more quarters in the past year will be eligible for participation

Veterans who are enrolled on a Patient Aligned Care Team (or "PACT") at a study site

Veterans who are on VA's Homeless Registry, which comprises those who utilized any VA homeless programs and services in the past 2 years

Exclusion Criteria

I understand the study details and can consent on my own.

Veterans who have a suicidal and/or behavioral flag in their medical record

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants will meet with a Peer Specialist for 18 sessions over 24 weeks, receiving Whole Health Coaching to reduce acute care utilization

24 weeks

18 sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of health outcomes and service engagement

9 months

What Are the Treatments Tested in This Trial?

Interventions

• Peer Support-Whole Health Coaching

Trial Overview

The study tests if Peer Specialists trained as Whole Health Coaches can help reduce frequent use of emergency and hospital services among homeless Veterans by providing support and guidance.

How Is the Trial Designed?

Group I: Peer Specialist - Whole Health Coaching (PS-WHC) Experimental Treatment 1 Intervention

Participants will meet with a Peer Specialist for 18 sessions over 24 weeks. The essential elements of this intervention include 1) general support provided via the core functions of a Peer Specialist, and 2) a structured Whole Health Coaching curriculum.

Group II: Enhanced Usual Care (EUC) Active Control 1 Intervention

Usual PACT care plus Hot Spotter Analytics (consists of access to field-based dashboard that allows PACTS to identify homeless Veterans on their panels who were super-utilizers, and the hot spotter manual).

Peer Support-Whole Health Coaching is already approved in United States for the following indications:

Approved in United States as Peer Whole Health Coaching for:

• Reducing acute care utilization among homeless veterans

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

A 12-week study tested a new hybrid model of peer support for veterans, combining mutual peer support with on-demand peer coaching, which was found to be acceptable and feasible for promoting heart-healthy behaviors.

Participants engaged well with the program, maintaining regular communication and reporting positive experiences, indicating that this model could effectively support behavior change in veterans with cardiovascular disease risk factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Innovation to Expand the Reach of Peer Support: A Feasibility and Acceptability Study. Goldstein, KM., Voils, CI., Bastian, LA., et al.[2022]

In a study involving 15 primary care Veterans with PTSD, peer-delivered Whole Health Coaching showed high participant satisfaction and retention, with 11 out of 15 participants continuing in the program, indicating its potential effectiveness in supporting wellness goals.

The coaching was delivered with high fidelity by peers, and factors such as the flexibility of sessions and the peer-provider relationship were key to participant engagement, suggesting that peer support can be a valuable addition to primary care interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Engagement, experience, and satisfaction with peer-delivered whole health coaching for veterans with PTSD: A mixed methods process evaluation. Johnson, EM., Possemato, K., Khan, S., et al.[2022]

A pilot study involving 48 Veterans showed that a 9-week peer-led program, 'Taking Charge of My Life and Health' (TCMLH), significantly reduced perceived stress and improved mental health and quality of life, indicating its potential effectiveness in enhancing well-being.

The program also increased patient engagement, suggesting that empowering Veterans to explore their personal values and life goals can lead to better health outcomes, warranting further research and expansion of the program.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining the Impact of a Peer-Led Group Program for Veteran Engagement and Well-Being. Abadi, MH., Barker, AM., Rao, SR., et al.[2021]

Patients with chronic kidney disease reported overwhelmingly positive experiences with one-to-one peer support, highlighting its role in providing practical information and emotional support based on lived experiences.

Peer support not only helped patients feel less isolated but also empowered them to manage their treatment better, suggesting that well-matched and trained peer supporters can significantly enhance patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring kidney patients' experiences of receiving individual peer support. Hughes, J., Wood, E., Smith, G.[2022]

Peer health coaching significantly lowers hemoglobin A1c (A1c) levels in patients with diabetes who have low self-management and medication adherence, indicating its effectiveness in high-risk groups.

In contrast, patients with high self-management and adherence showed similar improvements in A1c regardless of whether they received coaching or usual care, suggesting that coaching is particularly beneficial for those struggling with diabetes management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer coaching to improve diabetes self-management: which patients benefit most? Moskowitz, D., Thom, DH., Hessler, D., et al.[2022]

The Veterans Administration has successfully integrated a wide range of Whole Health services, such as acupuncture, yoga, and nutrition classes, into their healthcare system, allowing for comprehensive care that is fully covered by medical benefits.

Ongoing evaluations of these Whole Health services have provided valuable insights into their effectiveness, employee well-being, and cost impacts, highlighting the potential for system-wide transformation in healthcare delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What We Have Learned About the Implementation of Whole Health in the Veterans Administration. Kligler, B., Khung, M., Schult, T., et al.[2022]

The Department of Veterans Affairs (VA) is implementing a Whole Health System of Care that emphasizes Health and Wellness Coaching as a key component for improving veteran care.

As the VA's Whole Health transformation progresses, there is potential for integrating its Health and Wellness Coaching model into the Department of Defense's Total Force Fitness initiatives, enhancing support for military personnel at the unit level.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Untapped Power of Health and Wellness Coaching. Howard, K., Gantt, CJ., Grimsgaard Noyes, S., et al.[2023]

A qualitative study involving 14 Whole Health coaches from the Veterans Health Administration revealed that they adapted their coaching strategies to meet the unique needs of rural Veterans during the COVID-19 pandemic, focusing on social support and self-care alternatives.

Coaches emphasized the importance of leveraging technology to maintain connections with Veterans and expressed increased concerns about mental health challenges faced by this population during the pandemic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Meeting the Needs of Rural Veterans: A Qualitative Evaluation of Whole Health Coaches' Expanded Services and Support during COVID-19. Hale-Gallardo, J., Kreider, CM., Castañeda, G., et al.[2023]

In a study of 13,559 Veterans who screened positive for depression, those who used Whole Health services showed a decrease in their depression scores (PHQ-2) from 4.49 to 1.77, but this improvement was not significantly better than the conventional care group's decrease from 4.46 to 1.46.

Veterans with more complex health issues, such as PTSD and obesity, were more likely to use Whole Health services, indicating that while Whole Health may help in managing symptoms, it did not lead to a significantly better outcome compared to traditional care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Utilization of Whole Health and Longitudinal Outcomes After Screening Positive for Possible Depression Documented in Veterans Health Administration's Electronic Health Record. Reed, DE., Chen, C., Harvey, K., et al.[2023]

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