The VA Grant and Per Diem (GPD) case management aftercare program provides six months of case management for homeless-experienced Veterans undergoing housing transitions. This Partnered Implementation Initiative (PII) proposes to implement and evaluate Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-in 32 GPD case management aftercare sites across the nation.
The VA Grant and Per Diem case management (GPD-CM) program provides six months of case management for homeless-experienced Veterans (HEVs) undergoing housing transitions. At present, no specific case management paradigm is required in the GPD-CM program, resulting in practice variation across sites. This Partnered Implementation Initiative (PII) implements Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-at 32 VA GPD-CM sites. The investigators will use the Replicating Effective Programs (REP) implementation bundle to support CTI implementation at all 32 sites. Half of these sites will also receive 9 months of external facilitation (enhanced REP) as additional support for CTI implementation. In a type 3 hybrid trial, the investigators will use mixed methods to examine the impacts of REP versus enhanced REP. Using trial data, the investigators will develop a business case analysis and implementation playbook for the investigators' program partners to support continued CTI spread and sustainment in the GPD-CM program.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
153
An evidence-based, structured, and time-limited case management practice
Site-specific support to help sites develop tailored plans to implement CTI.
A stakeholder-informed training and technical assistance implementation strategy
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, California, United States
Fidelity to CTI
% of Sites with adequate fidelity to CTI at 12 months, as measured by the CTI fidelity scale
Time frame: 12 months after implementation start
Sustainment of CTI
% of Sites with adequate fidelity to CTI at 18 months, as measured by the CTI fidelity scale
Time frame: 18 months after implementation start
Dollars spent delivering CTI at each site
Case manager salary and benefits
Time frame: Between 6 and 18 months after implementation start
Housing stability
Days between entry into the GPD case management program and indicator of housing instability
Time frame: Between 6 and 18 months after implementation start
Cost of CTI as Implemented
Mean monthly cost of CTI case management per GPD case management Veteran served, compared to the mean monthly cost in the non-CTI GPD case management programs.
Time frame: Between 6 and 18 months after implementation start
Hospitalization rates
Number of days between entry into the GPD case management program and hospitalization, number of hospitalizations, number of bed days
Time frame: Between 6 and 18 months after implementation start
Cost of Implementation Strategies
Dollars spent on REP versus enhanced REP
Time frame: Through study completion, 4 years
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Return on Investment (ROI) of CTI
Dollars saved via improved housing stability and decreased hospitalizations among patients engaged in CTI versus control participants
Time frame: 6-, 12-, and 18-months after GPD case management program enrollment
Outpatient service use
Number of outpatient appointments
Time frame: Between 6 and 18 months after implementation start