ABSTRACT
People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, Harm Reduction Treatment for Alcohol (HaRT-A) was developed together with people with the lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. The parent RCT showed that HaRT-A precipitated statistically significant reductions in alcohol use, alcohol-related harm, AUD symptoms, and positive urine toxicology tests. This secondary study tested HaRT-A effects on more distal, 6-month pre-to-posttreatment changes on jail and emergency department (ED) utilization. People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: (a) collaborative tracking of participant-preferred alcohol metrics, (b) elicitation of harm-reduction and QoL goals, and (c) discussion of safer-drinking strategies. Administrative data on jail and ED utilization were extracted for 6 months pre- and posttreatment. Findings indicated no statistically significant treatment group differences on 6-month changes in jail or ED utilization (ps > .23). Exploratory analyses showed that 2-week frequency of alcohol use was positively correlated with number of jail bookings in the 12 months surrounding their study participation. Additionally, self-reported alcohol-related harm, importance of reducing alcohol-related harm, and perceived physical functioning predicted more ED visits. Future studies are needed to further assess how harm-reduction treatment may be enhanced to move the needle in criminal justice and healthcare utilization in the context of larger samples, longer follow-up timeframes, and more intensive interventions.
Subject(s)
Alcoholism , Ill-Housed Persons , Alcoholism/therapy , Emergency Service, Hospital , Female , Harm Reduction , Humans , Jails , Male , Quality of LifeABSTRACT
Parents and their school-age children can impact one another's sleep. Most sleep-tracking tools, however, are designed for adults and make it difficult for parents and children to track together. To examine how to design a family-centered sleep tracking tool, we designed DreamCatcher. DreamCatcher is an in-home, interactive, shared display that aggregates data from wrist-worn sleep sensors and self-reported mood. We deployed DreamCatcher as a probe to examine the design space of tracking sleep as a family. Ten families participated in the study probe between 15 and 50 days. This study uses a family systems perspective to explore research questions regarding the feasibility of children actively tracking health data alongside their parents and the effects of tracking and sharing on family dynamics. Our results indicate that children can be active tracking contributors and that having parents and children track together encourages turn-taking and working together. However, there were also moments when family members, in particular parents, felt discomfort from sharing their sleep and mood with other family members. Our research contributes to a growing understanding of designing family-centered health-informatics tools to support the combined needs of parents and children.
