Homelessness Diversion for Emergency Department Patients Facing Homelessness

Overseen By Vanessa Schick

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: The University of Texas Health Science Center, Houston

Disqualifiers: Conservator, Moving from Texas, others

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

Compensation: Varies

Number of Visits: Unknown

Duration: 6 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether a program designed to help people avoid homelessness can reduce emergency room visits. It seeks to identify who benefits most from this program and how it can be improved for different communities. Participants will either receive the usual treatment (treatment-as-usual, TAU) or join the new homelessness diversion program. Suitable candidates for this trial are those at imminent risk of becoming homeless, who speak English or Spanish, have recently been discharged from specific hospitals, and have Medicaid, Medicare, or no insurance. As an unphased trial, this study provides a unique opportunity to contribute to innovative solutions for preventing homelessness.

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 this homelessness diversion program is safe?

Research has shown that programs like the one under study, which help people avoid entering homeless shelters, are generally safe. These programs aim to find alternative housing solutions by offering resources and support, not medical treatment.

No evidence suggests negative effects from this type of program. The goal is to reduce emergency room visits and help people find stable housing. Participants in similar programs have not reported any harm to their health. Instead, these programs aim to improve overall well-being by addressing housing issues.

Since this is not a drug or medical treatment, the focus remains on providing support and resources, which participants manage well. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores new ways to support emergency department patients facing homelessness. Unlike the standard treatment-as-usual, which may focus on immediate medical needs, the homelessness diversion (HD) approach aims to address housing stability directly, potentially preventing future homelessness. This strategy could lead to more long-term solutions, reducing the cycle of repeated hospital visits. By focusing on immediate intervention and connecting patients with housing resources, this method might offer a more holistic solution to a complex problem.

What evidence suggests that this trial's treatments could be effective for reducing emergency department use among patients facing homelessness?

This trial will compare the effectiveness of two approaches for patients facing homelessness: the Homeless Diversion (HD) program and Treatment-as-Usual (TAU). Research has shown that programs designed to prevent homelessness, like the HD program in this trial, can effectively reduce the number of people without homes and help them find stable housing. Studies indicate that these programs are especially effective when implemented in hospital emergency rooms, as they address the social issues affecting both health and housing. These programs rank among the most effective ways to assist people experiencing homelessness in the community. By directly tackling housing instability, these programs can also improve overall health. This method may succeed more than traditional ways of dealing with homelessness. ^{6 7 8 9 10}

Who Is on the Research Team?

Jack Tsai, PhD

Principal Investigator

The University of Texas Health Science Center, Houston

Are You a Good Fit for This Trial?

This trial is for English or Spanish speakers discharged from a Harris Health Hospital ED who are at imminent risk of homelessness and have Medicaid, Medicare, or no insurance. It's not for those with a legal guardian or plans to leave Texas within 6 months.

Inclusion Criteria

Discharged from a Harris Health Hospital ED (Ben Taub or LBJ)

At imminent risk of homelessness

Patients with Medicaid, Medicare or who are uninsured

Exclusion Criteria

Plans to move away from Texas in 6 months

Having a conservator (legal guardian)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive homelessness diversion services integrated into the emergency department

6 months

Monthly visits

Follow-up

Participants are monitored for changes in health-related quality of life

6 months

Monthly assessments

What Are the Treatments Tested in This Trial?

Interventions

• Homeless diversion (HD)
• Treatment-as-usual (TAU)

Trial Overview The study is testing if integrating Homelessness Diversion (HD) services into the emergency department discharge process can reduce future ED visits. It compares HD support against the usual treatment patients receive when leaving the hospital.

How Is the Trial Designed?

Group I: Homeless diversion (HD) group Experimental Treatment 1 Intervention

Group II: Treatment-as-usual (TAU) group Active Control 1 Intervention

Who Is Running the Clinical Trial?

The University of Texas Health Science Center, Houston

Lead Sponsor

Trials

974

Recruited

361,000+

National Institute on Minority Health and Health Disparities (NIMHD)

Collaborator

Trials

473

Recruited

1,374,000+

Citations

1. reporter.nih.gov reporter.nih.gov/search/14E9CE024F8FC5D27598B8961CAA4A01A2FFCEB861BF/project-details/10851834

Project Details - NIH RePORTER Emergency departments (ED) provide an opportune space to target homeless diversion efforts to maximize the reach to individuals with elevated health and housing ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8427990/

Effectiveness of interventions to reduce homelessness A range of housing programs and case management interventions appear to reduce homelessness and improve housing stability, compared to usual services.

3. endhomelessness.org endhomelessness.org/blog/improving-homeless-response-systems-through-diversion-and-problem-solving/

Improving Homeless Response Systems Through ... Diversion is the intervention that has the greatest impact on the community level for those experiencing homelessness.

4. researchgate.net researchgate.net/publication/348307330_Emergency_department_interventions_for_homelessness_A_systematic_review

Emergency department interventions for homelessness Conclusion This review demonstrated that ED interventions can be effective in improving the social determinants of health of homeless ...

5. usich.gov usich.gov/sites/default/files/document/Federal%20Homelessness%20Prevention%20Framework_2.pdf

A Federal Homelessness Prevention Framework Highest Risk of Housing Instability and Homelessness looked at a variety of ACS data to identify neighborhoods to prioritize for Emergency ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9222893/

Prioritizing homelessness in emergency medicine education Patients experiencing homelessness visit the emergency department (ED) often and have worse clinical outcomes. Caring for this patient population is complex ...

7. comptroller.nyc.gov comptroller.nyc.gov/reports/safer-for-all/

Safer for All - Office of the New York City Comptroller Brad ... Individuals experiencing street homelessness are more likely to be chronically homeless, have higher rates of serious mental illness, substance ...

8. buildingchanges.org buildingchanges.org/wp-content/uploads/2018/04/2018_DiversionOverview_FINAL.pdf

Homeless to Housed in a Hurry: Diversion Overview In some areas of the country, Diversion has been used successfully to help people identify alternatives to entering shelter and prevent them from becoming ...

9. annemergmed.com annemergmed.com/article/S0196-0644(19)31126-6/fulltext

Commentary: How Can Emergency Departments Help End ... This assumption is incorrect and potentially dangerous. A survey of 191 homeless ED patients in San Francisco found that only 29% reported food, shelter, and ...

10. otda.ny.gov otda.ny.gov/policy/directives/2020/ADM/20-ADM-10.pdf

20-ADM-10 - Homeless Services Plan and Outcome Reporting The plan should include the following components: homelessness prevention services, outreach, emergency shelter, housing assessment and.