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

656 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial tests the Navigator program, which helps homeless individuals manage their healthcare and social needs after leaving the hospital. It aims to reduce hospital visits and improve overall health over several months.

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 data supports the effectiveness of the Navigator Program treatment for homeless adults?

The Navigator Program is a type of case management that helps homeless patients after they leave the hospital by connecting them with health and social services. Similar programs have shown success in improving housing stability and care coordination, which suggests that the Navigator Program could also help improve outcomes for homeless adults. ^{1 2 3 4 5}

Is the Navigator Program safe for homeless adults?

The Navigator Program is a case management approach designed to help homeless individuals with their healthcare and social service needs after leaving the hospital. While the research does not specifically address safety concerns, case management programs like this are generally considered safe as they focus on providing support and guidance rather than medical interventions. ^{1 2 6 7 8}

How is the Navigator Program treatment different from other treatments for homelessness?

The Navigator Program is unique because it focuses on helping homeless individuals transition from hospital care to community-based health and social services, addressing both health and social needs through a case management approach. Unlike other treatments, it specifically targets the post-discharge period to improve outcomes for homeless patients. ^{1 2 3 4 9}

Research Team

Stephen W Hwang, MD, MPH

Principal Investigator

Unity Health Toronto

Eligibility Criteria

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

I am 18 years old or older.

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

Navigator programme for hospitalised adults experiencing homelessness: protocol for a pragmatic randomised controlled trial. [2022]

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

Assessing Educational and Attitudinal Outcomes of a Student Learner Experience Focused on Homelessness. [2023]

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

Effectiveness of a Lay Navigation Program in an Academic Cancer Center. [2021]

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

Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation. [2023]

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

The case management relationship and outcomes of homeless persons with serious mental illness. [2022]

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

Opt-Out Patient Navigation to Improve Breast and Cervical Cancer Screening Among Homeless Women. [2022]

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

Lack of Consistent Investment in Federal Insurance Navigator Program Undermines Navigators' Equity Work in Vulnerable Communities. [2023]

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

Sick and unsheltered: Homelessness as a major risk factor for emergency care utilization. [2022]

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

Training Students as Navigators for Patients Experiencing Homelessness. [2023]