In 2012, an estimated more than 600,000 people were homeless on any given night in the United States — a population much more likely to suffer from physical and mental health disabilities. As a result, homelessness accounts for a substantial portion of health care and social service costs.
A technology-assisted health coaching program developed by a UNT Health Science Center team is designed to assist formerly homeless people by helping them learn how to live more independently.
The coaching program, called m.chat, is being funded by a Texas Medicaid 1115 waiver. The program is designed to complement permanent supportive housing (PSH) programs that pair rental vouchers with case management services.
Waivers are vehicles that states can use to test new or existing ways to deliver and pay for health care services under Medicaid and the Children’s Health Insurance Program (CHIP). Under Section 1115 of the Social Security Act — Research & Demonstration Projects — states can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP. Section 1115 gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects promoting Medicaid and CHIP programs’ objectives. The purpose of these demonstrations, which give States additional flexibility to design and improve their programs, is to demonstrate and evaluate policy approaches such as:
• Expanding eligibility to individuals who are not otherwise Medicaid or CHIP eligible
• Providing services not typically covered by Medicaid
• Using innovative service delivery systems that improve care, increase efficiency, and reduce costs.
Section 1115 demonstrations are approved for a five-year period and are renewable — typically for an additional three years. Demonstrations must be “budget neutral” to the Federal government, meaning that during the course of the project, Federal Medicaid expenditures will not be more than they would have been without the Waiver.
“PSH residents face significant challenges to living independently. Our goal is to help people make changes that will improve their health and well-being,” says Scott T. Walters, PhD, a Professor of Behavioral and Community Health at the UNTHSC School of Public Health, who heads up the m.chat project.
Dr. Walters’ research is focused on developing better ways of talking with people about change, and involves translating effective counseling strategies such as motivational interviewing to non-traditional settings (e.g., healthcare, criminal justice) and modalities (e.g., web, mobile, phone). He is currently principal investigator (PI) on both the m-chat coaching project to develop a brief motivational intervention to improve quality of life among people transitioning out of homelessness, as well as PI on another project comparing in-person vs. web-based interventions for increasing probation compliance.
A co-investigator on the m-chat project, Associate Professor Emily Spence-Almaguer, PhD, MSW, has found that 73 percent of Fort Worth PSH residents report at least one chronic health condition — most commonly asthma, Hepatitis C, heart disease or COPD. Fifty-five percent have also been treated for a mental health condition, 67 percent report a history of substance abuse, and 44 percent report co-occurring substance abuse and mental health concerns.
Dr. Spence-Almaguer’s research interests include methods associated with program evaluation and community assessment, as well as substantive focus on poverty, homelessness and interpersonal violence. In these methodological and substantive areas, her objective is to adapt strengths-based, solution-focused and participatory models of practice in community settings. She is also engaged in research projects that maximize student learning and community improvement through implementation of projects that offer applied learning opportunities while meeting community needs.
m.chat has been designed using data Drs. Walters and Spence-Almaguer have compiled, to address behaviors such as diet, exercise, substance use, medication adherence and social support.
The program has three main features: in-person health coaching, specialized coaching software, and a system of “Chat Bucks” that users can ear toward purchase of health and wellness supplies, such workout gear, weight scales, blood pressure monitors or even a discounted YMCA membership.
The m.chat program’s target objective is to help vulnerable individuals make positive behavior changes to help prevent more significant physical and mental health conditions from developing.
Participants also meet monthly with a coach who helps them set health and wellness goals. The m.chat software provides progress feedback, offers tips and information resources, and can be used to send text alerts reminding participants of their goals.
Positive results of the m.chat initiative are being reported. A UNTHSC release cites one of the program’s first participants, Hosea S., 57, saying he’s found the Chat Bucks feature a real motivator. “I’ve traded my bucks for athletic shoes, an MP3 player so I can listen to music while I walk, and even a movie gift card to help me stay busy, fight depression and get out more with others,” he observes.
Hosea suffers from heart problems, and has accordingly has set personal goals of eating healthier, walking every morning, and quitting smoking. “Already I’m feeling better,” he declares.
The primary goal for Teresa B., 55, was losing weight. “When I started the program,” she notes, “I weighed 306 pounds and within a month I was down to 293.” Teresa is reportedly working on adopting healthier eating habits, beginning an exercise plan, finding effective pain management and addressing issues related to bipolar depression and a history of substance abuse, and claims that she is learning to take care of herself “in a good way, without asking for a pill.”
“I’m working with my health coach on good days and bad days,” Teresa continues. “I had a lot of friends who never made it to their 50s like me, and I realize now that I should have been taking better care of myself years ago. I feel like I’ve been given a second chance.”
Located on a 33-acre, 1.2 million square-foot campus located in Fort Worth’s Cultural District, the UNT Health Science Center has a $220 million annual budget and adds approximately $600 million into Fort Worth’s economy annually. UNT Health has a combined faculty of more than 400, a staff of more than 1,400 and 750 part-time and adjunct faculty from other institutions and the community is the largest multi-specialty group practice providing direct patient care for the citizens of Tarrant County.
UNT Health handles more than a half million patient visits each year for everything from lab work and surgery visits to geriatric care. The group’s doctors practice in 40 medical and surgical specialties and subspecialties, including allergy/immunology, family practice, cardiology, gastroenterology, geriatrics, gynecology, internal medicine, neurology, obstetrics, oncology, orthopedics, pediatrics, physical therapy, psychiatry, sports medicine and surgery.
UNT Health Science Center comprises the Texas College of Osteopathic Medicine (TCOM), the Graduate School of Biomedical Sciences (GSBS), the School of Public Health (SPH), the School of Health Professions (SHP), which includes the Physician Assistant Studies and the Physical Therapy Programs, and the new UNT System College of Pharmacy.
The UNT Health Science Center also serves as home to several National Institutes of Health-funded research programs and currently leads all Texas health science centers in research growth. In the past five years, extramural research awards have increased by more than 100 percent.
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