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| ID | Type | Description | Link |
|---|---|---|---|
| QUE 25-013 | Other Grant/Funding Number | QUERI |
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| Name | Class |
|---|---|
| University of California, Los Angeles | OTHER |
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The Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) Program provides subsidized permanent housing with case management to homeless-experienced Veterans (HEVs). Up to 40% of Veterans exit HUD-VASH within two years of attaining housing; substance use disorders (SUDs) are one of the largest causes of returns to homelessness for HEVs. CARE-VASH QUERI proposes to implement and evaluate two evidence-based SUD services - Medications for addiction treatment (MAT) and cognitive behavioral therapy for SUDs (CBT-SUD) - among Veterans in HUD-VASH.
The Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program provides subsidized, permanent housing and supports to Veterans experiencing homelessness. Substance use disorders (SUDs) are a common primary or contributing factor to negative exits from HUD-VASH. The Coordinated Access for Addiction Recovery and Equity in VA Supportive Housing (CARE-VASH) QUERI will implement two evidence-based practices (EBPs) for SUDs-Medications for Addiction Treatment (MAT) and cognitive behavioral therapy for SUDs (CBT-SUD)-in 12 HUD-VASH sites. We will use the Replicating Effective Programs (REP) implementation bundle to support EBP implementation at all 12 sites. Half the sites (n=6) will also receive 9 months of consumer engagement (REP+CE). In a type 3 hybrid trial, we will use mixed methods to examine the impacts of REP vs. REP+CE. Using our trial data, we will develop a budget impact analysis and implementation playbook for our program partners to spread and sustain MAT and CBT-SUD in HUD-VASH.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Replicating Effective Programs (REP) | Experimental | A stakeholder-informed training and technical assistance implementation strategy |
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| REP + Consumer Engagement (CE) | Active Comparator | REP plus CE package (educational materials, peer coaching, toolkit) to support MAT and CBT-SUD implementation. |
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| Control Group | No Intervention | No MAT or CBT-SUD implementation |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Medication for Addiction Treatment (MAT) | Drug | MAT includes medications for alcohol use disorder (MAUD) and medications for opioid use disorder (MAUD). It reduces substance use, increases SUD treatment engagement, enhances quality of life, and reduces overdoses. |
| Measure | Description | Time Frame |
|---|---|---|
| Reach of MAT (Medications for Addiction Treatment) |
| 18 months post-implementation |
| Reach of CBT-SUD (Cognitive Behavioral Therapy-Substance Use Disorders) |
| 18 months post-implementation |
| Adoption of MAT (Medications for Addiction Treatment) | % (percent of) Department of Housing and Urban Development - VA Supportive Housing (HUD-VASH) and mental health prescribers engaged with Veterans who ordered Medications for Opioid Use Disorder (MOUD) / Medications for Alcohol Use Disorder (MAUD) at least once | 18 months post-implementation |
| Adoption of CBT-SUD (Cognitive Behavioral Therapy-Substance Use Disorders) | % (percent of) Department of Housing and Urban Development - VA Supportive Housing (HUD-VASH) case managers who delivered ≥1 CBT-SUD (Cognitive Behavioral Therapy-Substance Use Disorders) session | 18 months post-implementation |
| Sustainment of MAT (Medications for Addiction Treatment) |
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| Measure | Description | Time Frame |
|---|---|---|
| Housing retention | Difference in the mean days homeless over 1 year of follow-up for Veterans enrolled in trial sites that received the base versus enhanced implementation strategy, versus the expected number of days homeless had they enrolled in a comparison group of all sites not engaged in the trial | 1 year after implementation by cohort |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sonya E Gabrielian, MD MPH | Contact | (310) 478-3711 | 49853 | Sonya.Gabrielian@va.gov |
| Jenny M Barnard, BA | Contact | (626) 367-1077 | Jenny.Barnard@va.gov |
| Name | Affiliation | Role |
|---|---|---|
| Sonya Emi Gabrielian, MD MPH | VA Greater Los Angeles Healthcare System, West Los Angeles, CA | Principal Investigator |
| Evelyn T Chang, MD MSHS | VA Greater Los Angeles Healthcare System, Sepulveda, CA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Greater Los Angeles Healthcare System, West Los Angeles, CA | West Los Angeles | California | 90073-1003 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41877142 | Derived | Gabrielian S, Chang ET, Treichler EBH, Barnard J, Nelson RE, Wong MS, Jackson NJ, Finley EP. Comparing two strategies to support the implementation of evidence-based practices for substance use disorders in VA's permanent supportive housing program: a protocol for a type 3 hybrid cluster-randomized controlled trial. Implement Sci. 2026 Mar 24;21(1):30. doi: 10.1186/s13012-026-01498-z. |
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Investigators are implementing two evidence-based Substance Use Disorder (SUD) services - Medications for addiction treatment (MAT) and cognitive behavioral therapy for SUDs (CBT-SUD) - among Veterans in the Department of Housing and Urban Development-VA Supportive Housing Program (HUD-VASH).
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| Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) | Behavioral | An evidence-based psychotherapy that uses cognitive behavioral therapy to further recovery goals across SUD diagnoses. |
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| 18-27 months post-implementation |
| Sustainment of CBT-SUD (Cognitive Behavioral Therapy-Substance Use Disorders) |
| 18-27 months post-implementation |
| Provider experience |
Experiences of and satisfaction with providing HUD-VASH services to HEVs with SUDs pre- and post- implementation, which will be assessed using semi-structured qualitative interviews (data will be coded from key findings in the narratives provided during the interviews). |
| Baseline and 18 months post-implementation |
| Cost impact of Medications for Addiction Treatment (MAT) and Cognitive Behavioral Therapy-Substance Use Disorders (CBT-SUD) | The predominant cost of delivering MAT in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) programs is prescriber time; for CBT-SUD, the predominant cost is case manager time. We will use VA administrative data to identify visits in which MAT was prescribed or CBT-SUD was delivered. Interviews with HUD-VASH prescribers will be used to estimate minutes/visit spent on MAT, including visits in which MAT was discussed but not prescribed; at implementation sites, we will add a mandated field to templated CBT-SUD notes that indicates time spent outside the encounter (e.g., preparing for the visit). | 18 months (during the course of implementation) |
| Acute care utilization | Emergency department visits and hospitalizations associated with primary SUD diagnoses | 1 year after implementation by cohort |
| Erin P Finley, PhD MPH | VA Greater Los Angeles Healthcare System, West Los Angeles, CA | Principal Investigator |
| Emily Treichler, PhD | VA San Diego Healthcare System, San Diego, CA | Principal Investigator |
| ID | Term |
|---|---|
| D019966 | Substance-Related Disorders |
| ID | Term |
|---|---|
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D004304 | Dosage Forms |
| D015928 | Cognitive Behavioral Therapy |
| ID | Term |
|---|---|
| D004364 | Pharmaceutical Preparations |
| D013678 | Technology, Pharmaceutical |
| D008919 | Investigative Techniques |
| D001521 | Behavior Therapy |
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
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