Navigator Program for Homeless Adults

Overseen By Michael Liu, MPhil

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Unity Health Toronto

Disqualifiers: Inability to consent, Recent outreach services

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

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to evaluate how the Navigator program, a specialized case management initiative, can assist individuals experiencing homelessness after hospital discharge. It will assess whether additional support from a Homeless Outreach Counsellor can enhance health outcomes and decrease emergency visits. The program targets those unexpectedly admitted to the hospital and identified as homeless during their stay. Participants will receive assistance both during their hospital stay and for approximately 90 days post-discharge. As an unphased trial, this study provides a unique opportunity for personalized support and potential improvements in health and well-being.

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 the Navigator Program is safe for individuals experiencing homelessness?

Research has shown that the Navigator Program has succeeded in other studies. It assists homeless individuals with their healthcare and social needs. In past studies, participants reported better access to housing resources and nonprofit organizations, indicating that the program helps people find the support they need after leaving the hospital.

No serious safety issues have emerged with the Navigator Program. It focuses on case management, helping people plan their care and connect with services. Since the program does not involve medication or medical procedures, it is generally well-tolerated. No reports of negative effects have been associated with its use. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Navigator Program for homeless adults because it offers a new level of support during and after hospital stays. Unlike standard care, which typically ends after discharge with basic follow-up arrangements, this program assigns participants a dedicated Homeless Outreach Counsellor. This counsellor provides continuous support for about 90 days post-discharge, ensuring a smoother transition and potentially improving health outcomes. This approach could bridge crucial gaps in care that homeless individuals often face, offering a more personalized and sustained support system.

What evidence suggests that the Navigator Program is effective for individuals experiencing homelessness?

Research has shown that the Navigator Program, which participants in this trial may receive, improves the health of homeless adults after hospital discharge. Studies have found that this program connects individuals with regular doctors and reduces their need for emergency care. Participants often find the transition from hospital to home easier, enhancing their overall health. In this trial, the Navigator Program provides a Homeless Outreach Counsellor to support individuals during their hospital stay and for about 90 days after discharge. This approach aims to overcome obstacles to care and offer ongoing support, leading to better health management and fewer hospital readmissions. ^{1 5 6 7 8}

Who Is on the Research Team?

Stephen W Hwang, MD, MPH

Principal Investigator

Unity Health Toronto

Are You a Good Fit for This Trial?

This trial is for adults over 18 who are homeless at the time of an unplanned hospital admission. It includes those without shelter, in emergency shelters, or in temporary housing. Participants must not have used Homeless Outreach services within 90 days and must be able to consent to the study.

Inclusion Criteria

Identified as being homeless at the time of admission or anytime during the index hospital admission. This includes patients who are: unsheltered (absolutely homeless and living on the streets or in places not intended for human habitation), emergency sheltered (staying in overnight shelters for people who are homeless, as well as shelters for those impacted by family violence), or provisionally accommodated (whose accommodation is temporary or lacks security of tenure).

I was unexpectedly admitted to the hospital for a medical reason.

Exclusion Criteria

I have been helped by a Homeless Outreach Counsellor in the last 3 months.

I am unable to understand and agree to the study's details on my own.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Navigator Program Intervention

Participants receive support from a Homeless Outreach Counsellor during hospital admission and for approximately 90 days after discharge

90 days

Regular contact with Homeless Outreach Counsellor

Standard Care

Participants receive support from Care Transition Facilitators during hospital stay to arrange discharge plans and follow-up

During hospital stay

Follow-up

Participants are monitored for outcomes such as hospital readmissions, mortality, and follow-up with primary care providers over a 180-day period

180 days

Follow-up visits with primary care providers and other healthcare appointments

What Are the Treatments Tested in This Trial?

Interventions

• Navigator Program

Trial Overview The Navigator Program is being tested as a case management intervention for homeless individuals after hospital discharge. The trial will track follow-up with primary care, re-hospitalization rates, quality of care transitions, and overall health over six months.

How Is the Trial Designed?

Group I: Navigator Program Experimental Treatment 1 Intervention

In addition to receiving Standard Care, participants in the intervention arm will be assigned to a Homeless Outreach Counsellor. The Homeless Outreach Counsellor will connect with the participant as soon as possible during the admission and will provide support during the hospital admission and for approximately 90 days after hospital discharge.

Group II: Standard Care Active Control 1 Intervention

Standard Care consists of support from Care Transition Facilitators who work with patients during their hospital stay to arrange discharge plans and make follow-up arrangements. Care Transition Facilitators do not routinely work with patients after hospital discharge. As part of the routine discharge process, the health care team provides patients with medical recommendations, appointments for follow-up care as needed, a written discharge summary, and prescriptions as needed. If the patient has an identified primary care provider, a copy of the discharge summary is sent electronically to the primary care provider.

Who Is Running the Clinical Trial?

Unity Health Toronto

Lead Sponsor

Trials

572

Recruited

470,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Published Research Related to This Trial

The navigation program for cancer patients showed marginally lower rates of emergency room visits and unplanned hospitalizations among those who used the service, indicating some potential benefits in care coordination.

However, the program had low visibility and utilization among patients, and overall patient experiences were mixed, suggesting that a more focused approach may be needed to effectively support high-risk or anxious patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of a Lay Navigation Program in an Academic Cancer Center. Winget, M., Holdsworth, L., Wang, S., et al.[2021]

Navigators in the federal Insurance Navigator Program play a crucial role in promoting health equity by providing essential services and support to underserved communities, going beyond their basic responsibilities.

The study highlights that navigators develop their equity skills through on-the-job experience, but face significant challenges due to financial instabilities, which hinder their ability to effectively assist those in need.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lack of Consistent Investment in Federal Insurance Navigator Program Undermines Navigators' Equity Work in Vulnerable Communities. van Eijk, MS., Kett, PM., Prueher, L., et al.[2023]

The Navigator Programme, a case management intervention for homeless patients, is being rigorously evaluated in a randomized controlled trial involving 640 adults to assess its effectiveness in improving posthospital outcomes, particularly follow-up care within 14 days of discharge.

The study aims to measure various outcomes, including postdischarge mortality, readmission rates, and quality of care transitions, over a 180-day period, highlighting the potential for structured support to enhance healthcare access for vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Navigator programme for hospitalised adults experiencing homelessness: protocol for a pragmatic randomised controlled trial. Liu, M., Pridham, KF., Jenkinson, J., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12312349/

Implementing a hospital-based case management ... This qualitative study explores supports and challenges to the implementation of the Navigator Program, a hospital-based critical time ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT04961762

NCT04961762 | Navigator Program for Homeless Adults Effect of a Navigator Program on Post-Hospital Outcomes for Homeless Adults: A Pragmatic Randomized Controlled Trial. Conditions. Homeless PersonsCase ...

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/36517099/

protocol for a pragmatic randomised controlled trial This randomised controlled trial examines the impact of the Navigator Programme on posthospital outcomes among adults experiencing homelessness.

4. bmjopen.bmj.com bmjopen.bmj.com/content/12/12/e065688

Navigator programme for hospitalised adults experiencing ... This randomised controlled trial examines the impact of the Navigator Programme on posthospital outcomes among adults experiencing homelessness. Methods and ...

5. withpower.com withpower.com/trial/phase-9-2021-2054d

Navigator Program for Homeless Adults · Info for Participants This trial tests the Navigator program, which helps homeless individuals manage their healthcare and social needs after leaving the hospital. It aims to reduce ...

6. sirenetwork.ucsf.edu sirenetwork.ucsf.edu/tools-resources/resources/piloting-housing-support-navigator-program-safety-net-hospital

Piloting a housing support navigator program at a safety ... RESULTS: Nearly half of the patients referred to the HSN were connected with a housing resource such as a nonprofit organization, shelter, or ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9756200/

Navigator programme for hospitalised adults experiencing ... The Navigator Programme is a Critical Time Intervention case management programme that was developed to help homeless patients with their postdischarge needs.

8. sma.org sma.org/southern-medical-journal/article/piloting-a-housing-support-navigator-program-at-a-safety-net-hospital/

Piloting a Housing Support Navigator Program at a Safety ... Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial.