Assessing the impact of peer-led harm reduction on people experiencing homelessness and problem substance use: The SHARPS study

INTERVENTION: The intervention that will be assessed is a relational, peer‐delivered intervention for those experiencing homelessness and problem substance use. It was developed during the SHARPS feasibility study. At the core of this intervention is the provision of Peer Navigators (PNs) within The Salvation Army (TSA) homelessness services. The control group will receive standard care as provided by TSA’s homelessness services. Ten full‐time PNs will be recruited and employed by TSA on 18‐month contracts for 40 hours per week (i.e. one‐month training, intervention for 12 months plus 1‐month wind‐down, additional 1‐month recruitment period, and 3 months post‐intervention work). All PNs will have lived experience of problem substance use and/or homelessness and are likely to have different experiences of recovery/harm reduction. PNs will be provided with the intervention guide which will provide them with the necessary information to carry out their role, including practical tools, anticipated challenges, and information about the needs of specific sub‐populations. Each PN will provide practical and emotional support to their ‘caseload’. The caseloads have been determined using feasibility work and PPI feedback. Each PN will start with 25 clients, which it is anticipated might reduce to 17‐20 clients throughout the intervention due to drop‐out. Practical support provided will likely encompass: healthcare; housing; benefits; help to access benefits; and setting up and advocacy within multi‐agency appointments. Psychosocial and emotional support may include: listening; being consistent and reliable; helping to secure volunteering and employment opportunities; and helping to (re)connect with family and friends. A fund will also be available to the PNs to pay for travel, food, hot CONDITION: Improvement of mental health and quality of life in people experiencing homelessness and problem substance use. ; Mental and Behavioural Disorders PRIMARY OUTCOME: The co‐primary outcomes are changes to mental health measured using the compositive Patient Health Questionnaire Anxiety and Depression Scale (PHQ‐ADS) and quality of life measured using the ICEpop CAPability Measure for Adults (ICECAP‐A) both from baseline to 12 months INCLUSION CRITERIA: 1. >18 years and experiencing/at risk of homelessness (ETHOS definition) 2. Self‐report problem substance use (using pre‐determined scoring ‘cut off’) 3. Able to provide informed consent. SECONDARY OUTCOME: 1. Changes to mental health measured using the Patient Health Questionnaire Anxiety and Depression (PHQ‐ADS) and the ICEpop CAPability Measure for Adults (ICECAP‐A) at 6 and 15 months; 2. Harmful substance use measured using the Maudsley Addiction Profile (MAP) and the Leeds Dependence Questionnaire (LDQ) at 6, 12 and 15 months; 3. Risk‐taking behaviours measured using the MAP at 6, 12 and 15 months; 4. Social functioning including occupation/education roles measured using the MAP at 6, 12 and 15 months; 5. Physical health measured using the MAP and European Quality of Life measured using the EuroQol health‐related quality of life measure (EQ‐5D‐5L) at 6, 12 and 15 months; 6. Course of homelessness measured using RAND at 6, 12 and 15 months; 7. Social outcomes, therapeutic alliance with PN and support workers, and service accessibility measured using items from the Social Satisfaction Questionnaire (SSQ) and the Interpersonal Support Evaluation List (ISEL) 12‐item version at 6, 12 and 15 months; 8. Service utilisation measured using MAP, self‐report hospitalisations and items from the Client Evaluation of Self and Treatment (CEST) at 6, 12 and 15 months; 9. Relational empathy measured using the Consultation and Relational Empathy measure (CARE at 6, 12 and 15 months