mHealth to Increase Service Utilization Among Recently Incarcerated Homeless Adults

Homeless adults are more likely than adults in the general population to become incarcerated,1 and 15%-32% of jailed adults report being homeless at some point in the year prior to their arrest.1,2 High rates of mental health and/or substance use disorders are major causes for this incarceration disparity1,3,4 and are significant drivers of homeless adults’ high rates of disease, shorter life expectancies, and disproportionately high health care costs.5-7 Upon release from jail, homeless adults have few social and monetary resources and therefore have a limited ability to obtain permanent housing and are at risk for re-arrest.8 Studies have shown that homeless adults involved in the criminal justice system who receive counseling and case management services experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated .8-10 However, many barriers (e.g., limited transportation, inability to schedule appointments, limited knowledge of available services) prevent recently incarcerated homeless adults from obtaining these valuable and needed case management, crisis management, substance abuse, and mental health services.10,11 In order to overcome barriers to use of effective and available care management and mental health services, a paradigm shift is needed in the way care management is delivered to this at-risk population. The use of technology to reduce barriers to service utilization among at-risk and hard to reach populations has great potential for intervention science.12 This research team has demonstrated successes with technology driven interventions….Three of the PI’s previous studies have successfully used smart phone apps to collect data and conduct interventions in samples of homeless13,14 and other socioeconomically disadvantaged adults.15 We propose to extend our previous successful work using mobile devices and ecological momentary assessments (EMAs) to achieve this paradigm shift. This application proposes a three-arm randomized controlled trial. Specifically, male and female homeless adults who enroll in a shelter based homeless recovery program following release from the Dallas County Jail (N=300) will be randomized to one of three treatment groups: Usual Care Management (UCM); Usual Care plus Smart Phone (UCM+SP); or Usual Care plus Smart Phone based Care Management (SPCM). SPCM will be delivered through a modified version of the PI’s previously developed smart phone application (i.e., “app”) on a study provided smart phone. The app will not provide care management and crisis intervention services directly; however, it will prompt contact (twice weekly) and provide links to service providers simply through the touch of a button. Another key focus of this study is to address gaps in our understanding of mechanisms that drive re-arrest and homelessness by using traditional in-person (i.e., baseline, 1, 3, and 6 months post-baseline) and smart phone based (i.e., daily for 6 months) assessment methods to identify distal and proximal predictors of continued homelessness and arrest among a highly disadvantaged and understudied population