Housing, opportunities, motivation and engagement (HOME) for homeless youth at-risk for opioid use disorder: study protocol for a randomized controlled trial

Abstract

Background Homeless youth experience high rates of substance use disorders, exposures to violence, mental and physical health conditions, and mortality. They have been particularly affected by the opioid crisis. However, no study to date has used a randomized controlled design to test preventive interventions of opioid and other drug use among this vulnerable population. Resolution of youth homelessness through housing and supportive services including prevention services, often referred to as “Housing First,” has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. Housing First has been tested through randomized trials among homeless adults with mental health and substance use disorders, but has not been empirically tested for opioid prevention among homeless youth. Methods Homeless youth will be recruited from a drop-in shelter site frequented by disconnected youth; they will be screened for eligibility, including current homelessness, age 18–24 years, and not currently meeting criteria for opioid use disorder (OUD). In a controlled trial, 240 youth will then be randomized to one of two conditions, (1) housing + opioid and related risk prevention services, or (2) opioid and related risk prevention services alone. This project utilizes existing efficacious models of prevention to address opioid-related risks, including motivational interviewing, strengths-based outreach and advocacy, and an HIV risk preventive intervention. Follow-up will be conducted at 3, 6, 9 and 12-months post-baseline. The economic cost of each intervention will be determined to support implementation decisions with other providers and their funders. Discussion This study will provide essential information for researchers and providers on the efficacy of housing + opioid and related risk prevention services in an RCT for effects on opioid use and mechanisms underlying change. Because youth experiencing homelessness are at increased risk for a variety of adverse outcomes, the proposed intervention may produce substantial health care benefits to the youths and society at large. Trial registration ClinicalTrials.gov, NCT04135703, Registered October 13, 2019, https://clinicaltrials.gov/ct2/show/NCT04135703?term=NCT04135703&draw=2&rank=1#contacts

Multidisciplinary Strategies for Preventing Opioid Misuse and Escalation by Targeting Mental Health Symptoms and Conditions

“…The study at Ohio State University (Drs. Kelleher and Slesnick, MPIs), the Housing, Opportunities, Motivation, and Engagement project, is evaluating a comprehensive intervention to prevent OUD that integrates independent housing and opioid and related risk prevention services for young adults aged 18 to 24 who are experiencing homelessness (Slesnick et al, 2021 ). Housing assistance is being provided to youth via a housing-first approach, and the intervention pays 6 months of housing costs directly to landlords and utility companies.…”

Application of the ecobiodevelopmental model for research among youth experiencing homelessness

“…Currently, Slesnick et al. is conducting a randomized controlled trial encompassing housing, opioid risk and prevention services, and cognitive therapy for suicide prevention for YEH in a mid‐western city (Chavez et al., 2021; Slesnick et al., 2021). Multi‐faceted interventions for YEH like this one address the complex adversity and needs across interrelated outcomes in a population at high‐risk for negative outcomes as the EBD framework encourages.…”

Lessons learned from housing first, rapid rehousing trials with youth experiencing homelessness

“…Bundling behavioral health and health services within housing models has the potential to improve outcomes for youth, but there are gaps in our understanding about the most effective ways to design and implement these approaches, especially given developmental needs of adolescents and emerging young adults. This paper addresses that gap by documenting lessons learned and providing recommendations on the practical experiences of our study team in a randomized clinical trial testing supportive housing as an opioid/other substance use prevention for YEH, 18–25 years old [ 24 , 25 ].…”

“…For example, some suggest that more structured housing and treatment intervention models may be necessary for youth as compared to adults and they may not align with a housing first philosophy [ 30 ]. A review of HF for adults and youth is offered in order to contextualize the discussion of lessons learned and recommendations derived from completed and ongoing HF trials with youth [ 24 , 25 , 33 ].…”