title: A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs.
abstract: BACKGROUND
  The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO).
  
  
  METHODS
  In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU-standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model.
  
  
  CONCLUSIONS
  This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval for this study was granted in October 2011. The three sites were trained on MISSION-Vet and GTO in the first half of 2013. The first GTO planning meetings began after training occurred, between January 2013 and November 2013, across the three sites. The data collection-via a fidelity measure embedded into the VA Computerized Patient Record System-began as each site initiated MISSION-Vet, between April 2013 and January 2014.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01430741.
authors.affiliation: VA National Center on Homelessness Among Veterans, Bedford, MA, USA. David.Smelson@umassmed.edu.|VA Center for Healthcare Organization and Implementation Research, Bedford, MA, USA. David.Smelson@umassmed.edu.|Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA. David.Smelson@umassmed.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Smelson
authors.affiliation: VA National Center on Homelessness Among Veterans, Bedford, MA, USA. Chinman@rand.org.|VISN 4 Mental Illness Research and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA. Chinman@rand.org.|RAND Corporation, Santa Monica, CA, USA. Chinman@rand.org.
authors.forename: Matthew
authors.initials: M
authors.lastname: Chinman
authors.affiliation: VA National Center on Homelessness Among Veterans, Bedford, MA, USA. Sharon.McCarthy@va.gov.|VISN 4 Mental Illness Research and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA. Sharon.McCarthy@va.gov.
authors.forename: Sharon
authors.initials: S
authors.lastname: McCarthy
authors.affiliation: VA National Center on Homelessness Among Veterans, Bedford, MA, USA. Gordon.Hannah@va.gov.|VISN 4 Mental Illness Research and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA. Gordon.Hannah@va.gov.
authors.forename: Gordon
authors.initials: G
authors.lastname: Hannah
authors.affiliation: VA National Center on Homelessness Among Veterans, Bedford, MA, USA. Leon.Sawh@va.gov.
authors.forename: Leon
authors.initials: L
authors.lastname: Sawh
authors.affiliation: VA Center for Healthcare Organization and Implementation Research, Bedford, MA, USA. mg@bu.edu.|Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA. mg@bu.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Glickman
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D055317:Evidence-Based Practice; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration*; D012107:Research Design; D019966:Substance-Related Disorders / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs