Rebuilding Bridges Program for Homeless Veterans

Overseen By Jack Tsai, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: VA Connecticut Healthcare System

Disqualifiers: Acute psychiatric decompensation, conservator

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

Compensation: Varies

Number of Visits: 3

Trial Summary

Do I have to stop taking my current medications for the trial?

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

What data supports the idea that Rebuilding Bridges Program for Homeless Veterans is an effective treatment?

The available research shows that the Rebuilding Bridges Program, also known as MISSION-Vet, is effective in helping homeless veterans with co-occurring mental health and substance use disorders. It was implemented within the VA's supportive housing programs and showed positive outcomes in treatment engagement and behavioral health. Compared to veterans without access to MISSION-Vet, those who participated in the program had better engagement in care, which is crucial for preventing future housing loss. This suggests that the program is effective in addressing the needs of homeless veterans. ^{1 2 3 4 5}

What safety data exists for the Rebuilding Bridges Program for Homeless Veterans?

The provided research does not contain specific safety data for the Rebuilding Bridges Program for Homeless Veterans. The articles focus on general methodologies for safety evaluation in clinical trials and drug development, such as active surveillance, integrative analysis of trial and observational data, and aggregate safety assessment planning. These methodologies could potentially be applied to assess the safety of the Rebuilding Bridges Program, but no direct safety data for this specific program is mentioned. ^{6 7 8 9 10}

Is the Rebuilding Bridges treatment a promising treatment for homeless veterans?

Yes, the Rebuilding Bridges treatment is promising because it focuses on helping homeless veterans by providing support and resources to improve their lives. It aims to prevent homelessness, help veterans find permanent housing, and offer the care and services they need to stay housed and become active community members. ^{11 12 13 14 15}

What is the purpose of this trial?

Pilot study on an intervention called Rebuilding Bridges to help veterans re-engaged with loved ones.

Research Team

Jack Tsai, PhD

Principal Investigator

VA Connecticut

Eligibility Criteria

This trial is for veterans over 18 who are in a VA homeless program and can give valid consent. It's not for those with recent severe psychiatric issues needing hospital or emergency services, or individuals under conservatorship.

Inclusion Criteria

I am over 18 years old.

Currently in a VA homeless program

Able to provide valid consent

Exclusion Criteria

I have a legal guardian or conservator.

I have not been hospitalized or needed emergency care for severe mental health issues in the last month.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Veterans participate in the Rebuilding Bridges intervention, including creating a genogram and attending weekly sessions to engage with their social network

3 weeks

3 visits (in-person)

Follow-up

Participants are monitored for social support, housing status, and other measures

2 years

Treatment Details

Interventions

• Rebuilding Bridges

Trial Overview The study tests 'Rebuilding Bridges,' an intervention designed to help homeless veterans reconnect with their loved ones, assessing its effectiveness as a pilot initiative.

Participant Groups

Group I: Rebuilding Bridges Experimental Treatment 1 Intervention

This is a one-group study and the group will receive the Rebuilding Bridges intervention

Who Is Running the Clinical Trial?

VA Connecticut Healthcare System

Lead Sponsor

Trials

86

Recruited

8,800+

Findings from Research

Participation in a multisite residential treatment program significantly improved mental health and community adjustment for 255 homeless veterans, indicating the program's efficacy in addressing psychiatric symptoms and housing status.

While improvements in mental health were observed, they were only weakly linked to other areas like substance abuse and employment, suggesting that treatment programs may need to address these domains separately for better overall outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mental health status and community adjustment after treatment in a residential treatment program for homeless veterans. Leda, C., Rosenheck, R.[2022]

The study aims to implement the MISSION-Vet intervention within the Homeless Patient Alignment Care Teams (HPACT) to better support homeless veterans with co-occurring mental health and substance use disorders, addressing a significant gap in care.

By comparing two implementation strategies—Facilitation and implementation as usual (IU)—across seven HPACT teams in the greater Los Angeles VA system, the study seeks to determine which method better achieves fidelity to the MISSION-Vet intervention and improves outcomes like permanent housing status.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs. Simmons, MM., Gabrielian, S., Byrne, T., et al.[2022]

The Bridges program, which utilized the CareLinkHub care management platform, enrolled 716 CABG patients and aimed to improve post-surgery care and reduce readmissions, but ultimately showed no significant impact on readmission rates or key health metrics like blood pressure and LDL control.

While the program did not improve overall patient outcomes, it successfully increased the rate of follow-up appointments with physicians within one week of discharge, indicating a potential area for future improvement in care transitions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of care management information technology model on quality of care after Coronary Artery Bypass Surgery: "Bridging the Divides". Weintraub, WS., Elliott, D., Fanari, Z., et al.[2019]

Veterans participating in the MISSION-Vet intervention showed significantly higher treatment engagement compared to those not receiving the intervention, indicating that MISSION-Vet can effectively connect homeless Veterans to care.

However, the study did not find significant differences in substance use, mental health hospitalizations, or housing stability between those receiving higher versus lower intensity MISSION-Vet services, suggesting that while engagement improved, it did not translate into better behavioral health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial. Smelson, DA., Chinman, M., Hannah, G., et al.[2022]

The Bridges program, which utilized the CareLinkHub care management platform, enrolled 2054 patients undergoing percutaneous coronary intervention (PCI) but showed little impact on reducing readmissions or improving key health metrics like LDL control during the short follow-up period.

While there was minimal improvement in blood pressure control and some patient-reported outcomes, the program did enhance follow-up with physicians within a week of discharge, indicating a potential area for future focus in improving transitional care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of care management information technology model on quality of care after percutaneous coronary intervention: "Bridging the Divides". Weintraub, WS., Fanari, Z., Elliott, D., et al.[2020]

A qualitative study involving experienced suicide researchers revealed significant challenges in defining and reporting adverse events (AEs) and serious adverse events (SAEs) in suicide prevention trials, which complicates safety evaluations.

Participants emphasized the urgent need for clear and consistent definitions and reporting standards for AEs and SAEs to improve the comparability of studies and enhance safety monitoring in at-risk populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Variability in the definition and reporting of adverse events in suicide prevention trials: an examination of the issues and a proposed solution. Oquendo, MA., Feldman, S., Silverman, E., et al.[2022]

Ongoing aggregate safety monitoring is crucial during clinical development to understand the safety profile of medicinal products and to implement effective risk-management strategies.

The article proposes two Bayesian meta-analytic approaches that allow sponsors to combine data from blinded and unblinded studies, enabling timely updates to safety profiles as new data becomes available.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Meta-analysis of blinded and unblinded studies for ongoing aggregate safety monitoring and evaluation. Lin, LA., Yuan, SS., Li, L., et al.[2021]

The FDA Amendments Act of 2007 led to the creation of a system for monitoring the safety of marketed drugs using automated health care data, highlighting the importance of active surveillance in drug safety.

The Observational Medical Outcomes Partnership, a collaboration between the FDA, academia, and the pharmaceutical industry, aims to improve drug safety surveillance by addressing governance, data access, and methodological challenges through a transparent and innovative approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advancing the science for active surveillance: rationale and design for the Observational Medical Outcomes Partnership. Stang, PE., Ryan, PB., Racoosin, JA., et al.[2022]

Randomized clinical trials (RCTs) provide valuable initial safety data for drugs, but they often involve a small number of subjects and short follow-up periods, which can leave some safety signals undiscovered until after approval.

The integration of post-marketing real-world data (RWD) with RCT data can enhance safety evaluations, particularly for cardiovascular risks associated with antidiabetic therapies, by identifying new safety signals and validating findings in broader patient populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Integrative Analysis of Randomized Clinical Trial and Observational Study Data to Inform Post-marketing Safety Decision-Making. Lin, LA., Zhang, Y., Straus, W., et al.[2022]

The Aggregate Safety Assessment Plan (ASAP) is designed to enhance safety planning and ongoing data review throughout a drug's life-cycle, promoting a systematic approach to understanding product safety.

By implementing the ASAP process, drug developers can improve early detection of safety signals, better characterize risks, and ensure consistent safety messaging across studies, ultimately aiding in informed decision-making.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aggregate Safety Assessment Planning for the Drug Development Life-Cycle. Hendrickson, BA., Wang, W., Ball, G., et al.[2021]

A study involving 29 homeless women veterans identified five main factors leading to their homelessness, including childhood adversity, trauma during military service, and post-military mental health issues.

The research highlights the need for comprehensive solutions that address the interconnected challenges faced by women veterans, emphasizing trauma-informed care and holistic approaches to support their recovery and prevent homelessness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Homelessness and trauma go hand-in-hand": pathways to homelessness among women veterans. Hamilton, AB., Poza, I., Washington, DL.[2022]

Veteran Coffee Socials, held weekly in local coffee shops, successfully engaged an average of 8.5 veterans per meeting over 9 months, totaling 2236 interactions, which helped combat social isolation among veterans transitioning to civilian life.

These gatherings not only fostered relationships among veterans but also connected them with community organizations and healthcare resources, demonstrating a positive impact on building social support networks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Veteran Coffee Socials: A Community-Building Strategy for Enhancing Community Reintegration of Veterans. Gorman, JA., Scoglio, AAJ., Smolinsky, J., et al.[2019]

The Department of Veterans Affairs has made significant progress in reducing homelessness among veterans by implementing evidence-based strategies and focusing on four key goals: prevention, permanent housing, tailored care, and community support.

These efforts are transforming the lives of veterans by not only providing them with stable housing but also ensuring they receive the necessary services to thrive and reintegrate into their communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Innovative Efforts to Address Homelessness Among Veterans. O'Toole, TP., Pape, L.[2022]

A study involving 17 post-9/11 veterans revealed that their experiences of homelessness are primarily linked to nonmilitary factors like unemployment and relationship breakdowns, rather than solely military-related issues.

Veterans face significant challenges in accessing services from the U.S. Department of Veterans Affairs (VA) and community organizations, highlighting the need for improved engagement strategies to help prevent homelessness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pathways into homelessness among post-9/11-era veterans. Metraux, S., Cusack, M., Byrne, TH., et al.[2022]

The U.S. Department of Veterans Affairs (VA) has reached out to nearly 6,500 incarcerated veterans since 2002, highlighting its commitment to preventing homelessness among veterans with serious mental illnesses and substance abuse disorders.

The VA's comprehensive approach, which includes health, mental health, and social resources, positions it well to support veterans transitioning from correctional facilities, emphasizing the importance of evaluating program effectiveness to enhance homelessness prevention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Closing a front door to homelessness among veterans. McGuire, J.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Mental health status and community adjustment after treatment in a residential treatment program for homeless veterans. [2022]

2. England pubmed.ncbi.nlm.nih.gov

A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

The impact of care management information technology model on quality of care after Coronary Artery Bypass Surgery: "Bridging the Divides". [2019]

4. England pubmed.ncbi.nlm.nih.gov

An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

The impact of care management information technology model on quality of care after percutaneous coronary intervention: "Bridging the Divides". [2020]

6. England pubmed.ncbi.nlm.nih.gov

Variability in the definition and reporting of adverse events in suicide prevention trials: an examination of the issues and a proposed solution. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Meta-analysis of blinded and unblinded studies for ongoing aggregate safety monitoring and evaluation. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Advancing the science for active surveillance: rationale and design for the Observational Medical Outcomes Partnership. [2022]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Integrative Analysis of Randomized Clinical Trial and Observational Study Data to Inform Post-marketing Safety Decision-Making. [2022]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Aggregate Safety Assessment Planning for the Drug Development Life-Cycle. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

"Homelessness and trauma go hand-in-hand": pathways to homelessness among women veterans. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Veteran Coffee Socials: A Community-Building Strategy for Enhancing Community Reintegration of Veterans. [2019]

13. United States pubmed.ncbi.nlm.nih.gov

Innovative Efforts to Address Homelessness Among Veterans. [2022]

14. United States pubmed.ncbi.nlm.nih.gov

Pathways into homelessness among post-9/11-era veterans. [2022]

15. Netherlands pubmed.ncbi.nlm.nih.gov

Closing a front door to homelessness among veterans. [2022]