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mHealth to Increase Service Utilization Among Recently Incarcerated Homeless Adults

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7. Project Summary/Abstract There is a significant revolving door of incarceration among homeless adults, a population with substantial health disparities. Homeless adults who receive the professional coordination of individualized care (i.e., case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be re-incarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (e.g., food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, legal aid). Many barriers (e.g., limited transportation, inability to schedule appointments, limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services. The proposed study will use mobile technology to address these barriers and fill gaps in the understanding of the causes of the revolving door of homeless incarceration. Specifically, 432 homeless adults who enroll in a shelter based Homeless Recovery Program after release from county jail will be randomly assigned to one of three treatment groups: 1) usual shelter based case management (UCM), 2) UCM plus a study provided smart phone (UCM+SP), and 3) UCM with a study provided smart phone that is preloaded with an innovative care management app (SPCM). The SPCM app is an extension of the research team's previous successful work using mobile devices to assess and modify health behaviors in low income and homeless adults. Those assigned to SPCM will receive smart phones that will prompt (twice weekly) connections to shelter based case managers. The app will also offer direct links to care managers (available during normal business hours) and crisis interventionists (available 24 hours a day, 7 days a week), with the touch of a button. It is hypothesized that SPCM will increase utilization of case and crisis management services thereby addressing unmet needs (e.g., alcohol/drug/mental health counseling), improve perceived social support and quality of life, and reduce homelessness and re-arrest. Another key focus of this study is to address gaps in the 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 (e.g., affect, thoughts, behaviors, events) of continued homelessness and arrest. This research represents a step toward integrated service connection and healthcare service provision for one of the most underserved, high need, and understudied populations in the United States. Smart phone apps that increase the use of available healthcare services and identify predictors of key outcomes could be used to reach hard to reach populations with histories of significant and persistent health disparities (e.g., homeless adults).
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