Permanent supportive housing (PSH), the gold standard intervention for ending chronic homelessness, has expanded rapidly across the U.S. in recent years. Due to a confluence of individual and environmental risk factors, PSH tenants face heightened risk for overdose. While evidence-based practices to prevent overdose exist, they have not been broadly implemented in PSH settings. This study will address this research to practice gap by studying the implementation of evidence-based practices to prevent overdose in 20 PSH buildings in New York. In a community-partnered stepped wedge randomized controlled trial, the investigators will study a package of implementation strategies that includes an implementation toolkit, tenant and staff implementation champions, limited practice facilitation, and learning collaboratives. Outcomes will be examined using surveys and qualitative interviews with PSH tenants and staff; observation; and analysis of Medicaid claims data.
This single-center study is a hybrid type 3 trial with a stepped wedge cluster randomized controlled trial design, with primary objectives of studying implementation of overdose prevention practices in PSH and secondary objectives of examining effectiveness on clinically relevant outcomes and multilevel factors influencing implementation. Twenty participating PSH building sites will be randomized into four intervention clusters of five buildings each. With the stepped wedge design, all clusters of study PSH buildings will begin in the control condition. Clusters are randomly assigned to receive the intervention at different times, with all eventually receiving the six-month implementation strategy package intervention from Corporation for Supportive Housing (CSH). Study investigators will survey PSH building tenants and staff; conduct observation of building policies and procedures; analyze tenant Medicaid data; and interview staff and tenants.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
1,350
Corporation for Supportive Housing (CSH) will deliver technical support for overdose (OD) prevention in the participating PSH buildings using a package of core implementation strategies: PSH Overdose Prevention (POP) Toolkit (an implementation manual/blueprint for overdose prevention practices); Implementation Champions (staff and tenants in each PSH building will be selected as implementation champions who support implementation and sustainment of OD prevention practices in their buildings); practice facilitation (the practice facilitator \[a trained CSH employee\] will work with the tenant and staff champions in small group workshops and coaching sessions, building their capacity and supporting their work toward implementation of building OD prevention practices); learning collaboratives (PSH buildings starting the intervention at the same time will attend learning collaborative meetings).
NYU Langone Health
New York, New York, United States
Fidelity Checklist Score
Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 1
Fidelity Checklist Score
Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 8
Fidelity Checklist Score
Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 15
Fidelity Checklist Score
Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 22
Fidelity Checklist Score
Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 29
Intervention Appropriateness Measure (IAM) Score
1-item assessment of intervention appropriateness (adapted from Weiner, et al.) for each of three overdose prevention categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 1
Intervention Appropriateness Measure (IAM) Score
1-item assessment of intervention appropriateness (adapted from Weiner, et al.) for each of three overdose prevention categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 8
Intervention Appropriateness Measure (IAM) Score
1-item assessment of intervention appropriateness (adapted from Weiner, et al.) for each of three overdose prevention categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 15
Intervention Appropriateness Measure (IAM) Score
1-item assessment of intervention appropriateness (adapted from Weiner, et al.) for each of three overdose prevention categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 22
Intervention Appropriateness Measure (IAM) Score
1-item assessment of intervention appropriateness (adapted from Weiner, et al.) for each of three overdose prevention categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 29
Feasibility of Intervention Measure (FIM) Score
1-item assessment of intervention feasibility (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 1
Feasibility of Intervention Measure (FIM) Score
1-item assessment of intervention feasibility (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 8
Feasibility of Intervention Measure (FIM) Score
1-item assessment of intervention feasibility (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 15
Feasibility of Intervention Measure (FIM) Score
1-item assessment of intervention feasibility (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 22
Feasibility of Intervention Measure (FIM) Score
1-item assessment of intervention feasibility (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 29
Brief Opioid Overdose Knowledge (BOOK) Survey Score
BOOK is a 12-item assessment of opioid overdose knowledge (Dunn, et al.) administered to staff. For each item, staff select either "True" or "False." The total score ranges from 0-12; higher scores indicate greater opioid overdose knowledge.
Time frame: Month 1
Brief Opioid Overdose Knowledge (BOOK) Survey Score
BOOK is a 12-item assessment of opioid overdose knowledge (Dunn, et al.) administered to staff. For each item, staff select either "True" or "False." The total score ranges from 0-12; higher scores indicate greater opioid overdose knowledge.
Time frame: Month 8
Brief Opioid Overdose Knowledge (BOOK) Survey Score
BOOK is a 12-item assessment of opioid overdose knowledge (Dunn, et al.) administered to staff. For each item, staff select either "True" or "False." The total score ranges from 0-12; higher scores indicate greater opioid overdose knowledge.
Time frame: Month 15
Brief Opioid Overdose Knowledge (BOOK) Survey Score
BOOK is a 12-item assessment of opioid overdose knowledge (Dunn, et al.) administered to staff. For each item, staff select either "True" or "False." The total score ranges from 0-12; higher scores indicate greater opioid overdose knowledge.
Time frame: Month 22
Brief Opioid Overdose Knowledge (BOOK) Survey Score
BOOK is a 12-item assessment of opioid overdose knowledge (Dunn, et al.) administered to staff. For each item, staff select either "True" or "False." The total score ranges from 0-12; higher scores indicate greater opioid overdose knowledge.
Time frame: Month 29
Perceived Stigma Toward Substance Users Scale Score
8-item assessment of perceived stigma toward substance users (Luoma, et al.). Survey is administered to staff. Each item is ranked on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). The score is the sum of responses (with some items reverse-scored). The total score ranges from 8-32, with higher scores indicating greater perceived stigma.
Time frame: Month 1
Perceived Stigma Toward Substance Users Scale Score
8-item assessment of perceived stigma toward substance users (Luoma, et al.). Survey is administered to staff. Each item is ranked on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). The score is the sum of responses (with some items reverse-scored). The total score ranges from 8-32, with higher scores indicating greater perceived stigma.
Time frame: Month 8
Perceived Stigma Toward Substance Users Scale Score
8-item assessment of perceived stigma toward substance users (Luoma, et al.). Survey is administered to staff. Each item is ranked on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). The score is the sum of responses (with some items reverse-scored). The total score ranges from 8-32, with higher scores indicating greater perceived stigma.
Time frame: Month 15
Perceived Stigma Toward Substance Users Scale Score
8-item assessment of perceived stigma toward substance users (Luoma, et al.). Survey is administered to staff. Each item is ranked on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). The score is the sum of responses (with some items reverse-scored). The total score ranges from 8-32, with higher scores indicating greater perceived stigma.
Time frame: Month 22
Perceived Stigma Toward Substance Users Scale Score
8-item assessment of perceived stigma toward substance users (Luoma, et al.). Survey is administered to staff. Each item is ranked on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). The score is the sum of responses (with some items reverse-scored). The total score ranges from 8-32, with higher scores indicating greater perceived stigma.
Time frame: Month 29
Tenant Substance-Use-Related Emergency Department Visits
Data derived from NY Medicaid data.
Time frame: Month 1
Tenant Substance-Use-Related Emergency Department Visits
Data derived from NY Medicaid data.
Time frame: Month 8
Tenant Substance-Use-Related Emergency Department Visits
Data derived from NY Medicaid data.
Time frame: Month 15
Tenant Substance-Use-Related Emergency Department Visits
Data derived from NY Medicaid data.
Time frame: Month 22
Tenant Substance-Use-Related Emergency Department Visits
Data derived from NY Medicaid data.
Time frame: Month 29
Tenant Substance-Use-Related Emergency Department Visits
Data derived from NY Medicaid data.
Time frame: Month 35
Tenant Receipt of Medication for Opioid Use Disorder (MOUD)
Data derived from NY Medicaid data.
Time frame: Month 1
Tenant Receipt of Medication for Opioid Use Disorder (MOUD)
Data derived from NY Medicaid data.
Time frame: Month 8
Tenant Receipt of Medication for Opioid Use Disorder (MOUD)
Data derived from NY Medicaid data.
Time frame: Month 15
Tenant Receipt of Medication for Opioid Use Disorder (MOUD)
Data derived from NY Medicaid data.
Time frame: Month 22
Tenant Receipt of Medication for Opioid Use Disorder (MOUD)
Data derived from NY Medicaid data.
Time frame: Month 29
Tenant Receipt of Medication for Opioid Use Disorder (MOUD)
Data derived from NY Medicaid data.
Time frame: Month 35
Tenant Receipt of Specialty Substance Use Disorder (SUD) Treatment
Data derived from NY Medicaid data. Specialty SUD treatment includes outpatient, inpatient, and detoxification.
Time frame: Month 1
Tenant Receipt of Specialty Substance Use Disorder (SUD) Treatment
Data derived from NY Medicaid data. Specialty SUD treatment includes outpatient, inpatient, and detoxification.
Time frame: Month 8
Tenant Receipt of Specialty Substance Use Disorder (SUD) Treatment
Data derived from NY Medicaid data. Specialty SUD treatment includes outpatient, inpatient, and detoxification.
Time frame: Month 15
Tenant Receipt of Specialty Substance Use Disorder (SUD) Treatment
Data derived from NY Medicaid data. Specialty SUD treatment includes outpatient, inpatient, and detoxification.
Time frame: Month 22
Tenant Receipt of Specialty Substance Use Disorder (SUD) Treatment
Data derived from NY Medicaid data. Specialty SUD treatment includes outpatient, inpatient, and detoxification.
Time frame: Month 29
Tenant Receipt of Specialty Substance Use Disorder (SUD) Treatment
Data derived from NY Medicaid data. Specialty SUD treatment includes outpatient, inpatient, and detoxification.
Time frame: Month 35
Adoption Checklist Score
20-item checklist assessing building adoption of each overdose prevention practice. Checklist is included in a subset of staff surveys. Buildings will receive an adoption checklist score of 0 (not adopted) or 1 (adopted) for each of 20 overdose prevention practices. The total score is the sum of responses and ranges from 0-20, with higher scores indicating greater adoption.
Time frame: Month 1
Adoption Checklist Score
20-item checklist assessing building adoption of each overdose prevention practice. Checklist is included in a subset of staff surveys. Buildings will receive an adoption checklist score of 0 (not adopted) or 1 (adopted) for each of 20 overdose prevention practices. The total score is the sum of responses and ranges from 0-20, with higher scores indicating greater adoption.
Time frame: Month 8
Adoption Checklist Score
20-item checklist assessing building adoption of each overdose prevention practice. Checklist is included in a subset of staff surveys. Buildings will receive an adoption checklist score of 0 (not adopted) or 1 (adopted) for each of 20 overdose prevention practices. The total score is the sum of responses and ranges from 0-20, with higher scores indicating greater adoption.
Time frame: Month 15
Adoption Checklist Score
20-item checklist assessing building adoption of each overdose prevention practice. Checklist is included in a subset of staff surveys. Buildings will receive an adoption checklist score of 0 (not adopted) or 1 (adopted) for each of 20 overdose prevention practices. The total score is the sum of responses and ranges from 0-20, with higher scores indicating greater adoption.
Time frame: Month 22
Adoption Checklist Score
20-item checklist assessing building adoption of each overdose prevention practice. Checklist is included in a subset of staff surveys. Buildings will receive an adoption checklist score of 0 (not adopted) or 1 (adopted) for each of 20 overdose prevention practices. The total score is the sum of responses and ranges from 0-20, with higher scores indicating greater adoption.
Time frame: Month 29
Acceptability of Intervention Measure (AIM) Score
1-item assessment of intervention acceptability (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 1
Acceptability of Intervention Measure (AIM) Score
1-item assessment of intervention acceptability (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 8
Acceptability of Intervention Measure (AIM) Score
1-item assessment of intervention acceptability (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 15
Acceptability of Intervention Measure (AIM) Score
1-item assessment of intervention acceptability (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 22
Acceptability of Intervention Measure (AIM) Score
1-item assessment of intervention acceptability (adapted from Weiner, et al.) for each of the three overdose prevention practice categories, administered to staff and rated on a Likert scale from 1 (completely disagree) to 5 (completely agree).
Time frame: Month 29
Organizational Priority Measure Score
7-item assessment of organizational priority (adapted from Klein, et al.) administered to staff and rated on a Likert scale from 1 (not true) to 5 (definitely true). The total score is the sum of responses and ranges from 7 to 35; higher scores indicate higher organizational priority.
Time frame: Month 1
Organizational Priority Measure Score
7-item assessment of organizational priority (adapted from Klein, et al.) administered to staff and rated on a Likert scale from 1 (not true) to 5 (definitely true). The total score is the sum of responses and ranges from 7 to 35; higher scores indicate higher organizational priority.
Time frame: Month 8
Organizational Priority Measure Score
7-item assessment of organizational priority (adapted from Klein, et al.) administered to staff and rated on a Likert scale from 1 (not true) to 5 (definitely true). The total score is the sum of responses and ranges from 7 to 35; higher scores indicate higher organizational priority.
Time frame: Month 15
Organizational Priority Measure Score
7-item assessment of organizational priority (adapted from Klein, et al.) administered to staff and rated on a Likert scale from 1 (not true) to 5 (definitely true). The total score is the sum of responses and ranges from 7 to 35; higher scores indicate higher organizational priority.
Time frame: Month 22
Organizational Priority Measure Score
7-item assessment of organizational priority (adapted from Klein, et al.) administered to staff and rated on a Likert scale from 1 (not true) to 5 (definitely true). The total score is the sum of responses and ranges from 7 to 35; higher scores indicate higher organizational priority.
Time frame: Month 29
Sustainment based on Fidelity Checklist Score
Sustainment of the overdose prevention practices will be measured using fidelity checklist score results. Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 15
Sustainment based on Fidelity Checklist Score
Sustainment of the overdose prevention practices will be measured using fidelity checklist score results. Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 22
Sustainment based on Fidelity Checklist Score
Sustainment of the overdose prevention practices will be measured using fidelity checklist score results. Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 29
Sustainment based on Fidelity Checklist Score
Sustainment of the overdose prevention practices will be measured using fidelity checklist score results. Buildings will receive a fidelity checklist score of 0 (not implemented), 1 (partial implementation), or 2 (full implementation) for each overdose prevention practice. The primary outcome is total summed score, with higher scores indicating greater fidelity.
Time frame: Month 36
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