Feasibility, Acceptability and Implementation Outcomes for Chargeup!: A Critical Time Intervention for Young Adults Transitioning from Homelessness to Supported Housing

Background and Purpose: Housing instability is common in young adulthood and is related to higher risk for mental health problems. The point of transition from homelessness to supported housing such as Transitional Housing (TH) or Rapid Rehousing (RRH) presents an ideal opportunity to support mental health and connect young adults to care. To address this, we developed and conducted feasibility testing of a team-based intervention adapted from Critical Time Intervetnion called ChargeUp! that was delivered to young adults within a TH to RRH program. We sought to (1) understand the feasibility and acceptability of the intervention and associated research procedures and to (2) identify key implementation barriers and facilitators.

Methods: Drawing on the ADAPT-ITT model, we developed a new adapted intervention, ChargeUp!, that we tested in a randomized feasibility pilot (N = 52). Participants were recruited and randomized at a TH/RRH program to either receive the enhanced intervention or the housing program as usual. Structured interviews with standardized measures were conducted at baseline, three months, six months, and one year. Qualitative interviews were conducted with intervention participants and staff at the end of the intervention. Quantitative data from structured interviews were analyzed using bivariate statistics and ANCOVA comparing baseline and six months outcomes by group. Qualitative data were analyzed using an inductive thematic approach focused on feasibility, acceptability, and implementation outcomes.

Results: The adapted model was described as a novel approach to providing mental health support in a holistic and innovative way. Strengths of the model included included: 1) flexible yet structured and time-limited approach; 2) innovative guiding values (developed using participatory methods) to promote fidelity; 3) individualized approach to care; and 4) healing partner (HP; mental health provider). The HP was especially well received and participants and staff noted that it overcame traditional stigmas related to seeking mental health services because “nothing has to be wrong with you to talk to the HP.” Challenges in delivering ChargeUp! included the difficulties in the peer specialist role (e.g., role, flexible supervision) and coordination across multiple systems/providers. The housing program and its rules led young people to exit the program and seek new housing or return to homelessness. Of the 26 participants randomized to the intervention, 15 completed it. Quantitative housing and employment outcomes were better in the intervention group than the control group; and mental health outcomes improved for both groups.

Discussion: ChargeUp! showed promise as a model that could transcend stigma and ensure mental health support is readily available within housing settings. It also was associated with better housing outcomes, though not always within the TH/RRH program. The challenges of the housing setting in which we tested the intervention highlight the need for policies that provide a greater range of housing supports that last longer to ensure that housing stability is fully addressed while simultaneously providing mental health support. Future research is needed to adapt the intervention for different housing contexts to ensure it can be tested in a future larger scale trial that includes housing programs in multiple locations.