Overdose prevention in supportive housing buildings: an intervention to enhance evidence-based practice and policy implementation

• In Event: The Intersection of Housing Insecurity and Substance Use Disorder—defining the crisis and identifying policy solutions

Abstract

Permanent supportive housing (PSH) following a Housing First model is a gold-standard intervention for chronic homelessness. Significant gaps remain in optimizing health for PSH tenants and state policies related to healthcare and related service provision in PSH are heterogenous or, often, absent. Overdose is a particularly large and under-addressed concern for PSH tenants, who face outsized and increasing risks for overdose mortality as the U.S. overdose crisis evolves and concentrates among highly marginalized populations. In this study, we sought to examine the feasibility and impact of a novel technical assistance intervention designed to empower PSH buildings to implement evidence-based overdose prevention practices and policies. The intervention was delivered by trained practice facilitators from the nonprofit Corporation for Supportive Housing to twenty congregate PSH buildings (serving >1200 PSH tenants) across New York. The six-month intervention included a written implementation Toolkit, training videos, tailored practice facilitation sessions, and learning collaboratives. Tenant implementation champions from each building participated alongside staff champions and other key building leaders. We studied the intervention using a stepped wedge randomized trial design, with both quantitative and qualitative outcome assessment. In this panel we will present results from REDCap logs completed by practice facilitators that detailed attendance and content of intervention sessions (n=225 sessions). We will also provide results from in-depth, qualitative interviews with PSH staff (n=22) and tenant champions (n=9) who participated in intervention activities. Interviews used a semi-structured interview guide to explore participants’ thoughts on the intervention, barriers and facilitators to new policy and practice implementation, and perceived impact. Rapid sequence qualitative analysis using templated summaries and a summary matrix was followed by line-by-line coding by 3 researchers and thematic analysis. We found that the intervention was positively received and feasible. Only one building discontinued the intervention, due to lack of staff time amidst competing demands. Apart from this building, 95% of planned practice facilitation sessions were held. Additionally, 17 buildings attended over half of the monthly learning collaboratives. In addition to staff participants, at least one tenant champion attended 63% of practice facilitation sessions (128 of 202 sessions) and 96% of learning collaboratives (22 of 23 sessions). Most practice facilitation sessions and learning collaboratives (94%; 211 of 225 sessions) included the full content as planned in the intervention guide. Qualitative interviews and REDCap logs suggested intervention impacts including improvements in building-level naloxone availability, overdose prevention planning and policy development, culture change surrounding substance use, and enhanced tenant-staff trust and communication. Barriers to evidence-based practice implementation were often related to larger policy issues including separation of property management from social services; low availability of substance use treatment in some geographic areas; and financing, staffing, and regulatory issues. We will discuss the public health and public policy significance of this study, which was novel in examining a housing-based (versus healthcare-based) intervention designed to create sustainable building-level change to improve tenant health. We will also discuss planned modifications for expansion of this intervention to a new state context (New Jersey) and to include scattered-site (in addition to congregate) PSH.

Author

• Kelly Doran, New York University
  Presenting Author