CE24-013 - Community-based evaluation of a novel, system-wide harm reduction strategic plan for people experiencing homelessness in New York City

New York University School Of Medicine, New York NY

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Overdose (OD) and homelessness are two interlinked national crises in the United States (US). More than 1.25 million people experience homelessness each year, and drug OD is the leading cause of death among people experiencing homelessness (PEH). OD rates among PEH are 30–40 times higher than the general population. However, OD prevention interventions tailored for PEH remain underdeveloped, with limited evidence on effective strategies that reach this high-risk population. To fill this gap, this study will evaluate the implementation and impact of the New York City (NYC) Department of Homeless Services’ (DHS) Harm Reduction Strategic Plan (HRSP), a broad suite of shelter-based interventions tailored to PEH with the goal of reducing client OD risk. The HRSP—which combines universal harm reduction education provided to all clients at shelter entry (approximately 45,000 people annually) with an array of focused harm reduction and treatment services—is the first intervention of its kind implemented at scale in a large homeless services system in the US. We propose a rigorous, mixed-methods design that integrates epidemiological, data science, and qualitative methods to holistically evaluate the HRSP in collaboration with NYC DHS. Aim 1a is to estimate the impact of the HRSP shelter-based interventions on OD risk using epidemiological methods for impact evaluation applied to linked homeless services data, Medicaid claims data, and vital records. Aim 1b is to identify multidimensional subgroup heterogeneity (e.g., by race/ethnicity and other sociodemographic characteristics) in the impact of the HRSP interventions using a novel machine learning approach. Aim 2 is to identify optimal combinations of HRSP interventions to reduce OD risk using a two-stage machine learning strategy that will tease apart the impacts of simultaneously implemented HRSP component interventions. Aim 3 is to assess barriers and facilitators to implementation of the system-wide HRSP, and explore client and staff perspectives on substance use-related impacts using in-depth interviews and focus groups with DHS clients, staff, and key stakeholders. This innovative, community-partnered research is directly responsive to the CDC’s Overdose Prevention Research Priority of evaluating innovative OD prevention strategies tailored for populations facing a disproportionate burden of OD. This research is directly responsive to the current NOFO through its focus on a new and untested model of OD prevention delivered to a high-risk group in a community- based setting. In sum, we have a unique opportunity to rigorously evaluate the large-scale introduction of place-based OD prevention interventions tailored for PEH, a population that experiences a disproportionate burden of OD. The multidisciplinary investigator team will work with a Community Advisory Board to maximize the impact of the research, which has been designed to provide actionable evidence to inform local and national public health program and policy interventions.