NCT05176977

Brief Summary

Use of acute care services (e.g., hospitalizations, Emergency Department visits) contributes substantially to the cost of healthcare for Veterans. Homelessness is a robust social determinant of super utilization of acute care. The goal of this project is to test if Peer Specialists trained in Whole Health Coaching can reduce homeless Veterans' frequent use of acute care.

Trial Health

75
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
177

participants targeted

Target at P75+ for not_applicable

Timeline
2mo left

Started Feb 2022

Longer than P75 for not_applicable

Geographic Reach
1 country

3 active sites

Status
active not recruiting

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Progress97%
Feb 2022Jun 2026

First Submitted

Initial submission to the registry

December 16, 2021

Completed
19 days until next milestone

First Posted

Study publicly available on registry

January 4, 2022

Completed
28 days until next milestone

Study Start

First participant enrolled

February 1, 2022

Completed
3.7 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

October 22, 2025

Completed
8 months until next milestone

Study Completion

Last participant's last visit for all outcomes

June 30, 2026

Expected
Last Updated

February 10, 2026

Status Verified

February 1, 2026

Enrollment Period

3.7 years

First QC Date

December 16, 2021

Last Update Submit

February 9, 2026

Conditions

Acute Care Service UtilizationMental Health StatusPhysical Health StatusHousing

Keywords

Homeless PersonsCosts and Cost AnalysisMental HealthPeer Support

Outcome Measures

Primary Outcomes (1)

  • Days of all-cause hospitalization

    Data on all-cause hospitalization (medical/surgical, substance use, and mental health) (bed days of care) will be obtained from the CDW Inpatient and Outpatient files. VA-paid acute care at non-VA facilities will also be searched in the Fee Basis and Program Integrity Tool (PIT) files, including "Choice" care.

    9 months (post-baseline)

Secondary Outcomes (13)

  • ED visits

    9 months (post-baseline)

  • Substance Use

    9 months (post-baseline)

  • Alcohol Use Problems (AUDIT)

    9 months (post-baseline)

  • Depression (PHQ-9)

    9 months (post-baseline)

  • PTSD (PCL-5)

    9 months (post-baseline)

  • +8 more secondary outcomes

Study Arms (2)

Peer Specialist - Whole Health Coaching (PS-WHC)

EXPERIMENTAL

Participants will meet with a Peer Specialist for 18 sessions over 24 weeks. The essential elements of this intervention include 1) general support provided via the core functions of a Peer Specialist, and 2) a structured Whole Health Coaching curriculum.

Behavioral: Peer Support-Whole Health Coaching

Enhanced Usual Care (EUC)

NO INTERVENTION

Usual PACT care plus Hot Spotter Analytics (consists of access to field-based dashboard that allows PACTS to identify homeless Veterans on their panels who were super-utilizers, and the hot spotter manual).

Interventions

Peer Support-Whole Health CoachingBEHAVIORAL

Participants will meet with a Peer Specialist for 18 sessions over a period of 24 weeks. The essential elements of this intervention include 1) general support provided via the core functions of a Peer Specialist and 2) a structured Whole Health Coaching curriculum.

Also known as: PS-WHC
Peer Specialist - Whole Health Coaching (PS-WHC)

Eligibility Criteria

Sexall
Healthy VolunteersNo
Age GroupsChild (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

  • Veterans who:
  • are on VA's Homeless Registry, which comprises those who utilized any VA homeless programs and services in the past 2 years
  • are enrolled on a Patient Aligned Care Team (or "PACT") at a study site
  • had a hot spotter qualifying event in two or more quarters in the past year will be eligible for participation

You may not qualify if:

  • Veterans who have a suicidal and/or behavioral flag in their medical record and those who are too cognitively impaired to understand the informed consent process and other study procedures will be excluded

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (3)

Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR

North Little Rock, Arkansas, 72114-1706, United States

Location

VA Palo Alto Health Care System, Palo Alto, CA

Palo Alto, California, 94304-1207, United States

Location

VA Bedford HealthCare System, Bedford, MA

Bedford, Massachusetts, 01730-1114, United States

Location

Related Publications (1)

  • Blonigen D, Hyde J, McInnes DK, Yoon J, Byrne T, Ngo T, Smelson D. Integrating data analytics, peer support, and whole health coaching to improve the health outcomes of homeless veterans: Study protocol for an effectiveness-implementation trial. Contemp Clin Trials. 2023 Feb;125:107065. doi: 10.1016/j.cct.2022.107065. Epub 2022 Dec 23.

    PMID: 36572239RESULT

MeSH Terms

Conditions

Psychological Well-Being

Condition Hierarchy (Ancestors)

Personal SatisfactionBehavior

Study Officials

  • Daniel M. Blonigen, PhD MA

    VA Palo Alto Health Care System, Palo Alto, CA

    PRINCIPAL INVESTIGATOR

  • David A. Smelson, PsyD

    VA Bedford HealthCare System, Bedford, MA

    PRINCIPAL INVESTIGATOR

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
SINGLE
Who Masked
OUTCOMES ASSESSOR
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
FED
Responsible Party
SPONSOR

Study Record Dates

First Submitted

December 16, 2021

First Posted

January 4, 2022

Study Start

February 1, 2022

Primary Completion

October 22, 2025

Study Completion (Estimated)

June 30, 2026

Last Updated

February 10, 2026

Record last verified: 2026-02

Data Sharing

IPD Sharing
Will not share

Locations

US(3)