Reducing overdose and other harms in NYC single-adult shelters

Community-based Evaluation of a Novel, System-wide Harm Reduction Strategic Plan for People Experiencing Homelessness in New York City

This project will use linked city records and interviews to see if harm-reduction efforts in NYC single-adult shelters reduce overdoses and other health harms among adults who use drugs.

Quick facts

• Study type: Observational
• Enrollment: 80 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: NYU Langone Health (Academic / other)
• Locations: 1 site (New York, New York)
• Trial ID: NCT07170072 on ClinicalTrials.gov

What this trial studies

This mixed-methods study examines the implementation and impact of a Harm Reduction Strategic Plan (HRSP) portfolio across the NYC single-adult shelter system. For Aims 1a, 1b, and 2, researchers will analyze linked administrative homeless services, Medicaid, and vital records for people who entered shelters during 2021–2026 and matched Medicaid comparison groups. Aim 3 will conduct in-depth qualitative interviews and focus groups with clients and staff at shelters that implemented HRSP to explore experiences, facilitators, and barriers. Administrative aims use de-identified datasets with no direct contact, while qualitative aims enroll consenting English-speaking adults who report past-year drug use.

Who should consider this trial

Good fit: Ideal participants for the qualitative component are English-speaking adults (18+) who are staying or have stayed in an NYC single-adult shelter that implemented HRSP and who report past-year drug use and are willing to be interviewed.

Not a fit: People who are not shelter residents, who do not use drugs, who are under 18, or who do not speak English are unlikely to benefit directly from the interview components and may be underrepresented in the administrative analyses.

Why it matters

Potential benefit: If successful, the project could reduce overdose rates and improve access to harm-reduction services for people staying in NYC shelters.

How similar studies have performed: Other harm-reduction programs have shown reductions in overdose and improved care engagement in community settings, but coordinated HRSP implementation across an entire shelter system is relatively novel and not yet widely studied.

Eligibility criteria

Inclusion Criteria:

For Aims 1a, 1b, and 2: There will be no participant enrollment or direct contact with individuals as these aims will involve the use of an analytic dataset comprised of linked administrative NYC homeless services, Medicaid, and vital records. The dataset will include records for individuals who entered the NYC DHS single-adult shelter system during calendar years 2021-2026, as well as a matched comparison group(s) (as identified through Medicaid data) during the same years. The matched comparison group will be comprised of individuals age 18 and older with active Medicaid coverage at the time of observation.

For Aim 3 Homeless Services Client participant group: To be eligible for participation in this study, an individual must meet all of the following criteria:

* Adult 18 year of age or older
* Speak English
* Is staying or has stayed in an NYC single-adult shelter that has implemented HRSP interventions
* Report past-year drug use
* Able and willing to provide consent

For Aim 3 Homeless Services Staff participant group: To be eligible for participation in this study, an individual must meet all of the following criteria:

* 18 years of age or older
* Speak English
* Works at an adult shelter service provider agency that implemented HRSP or received HRSP interventions (role may include case manager, security staff, shelter director, medical staff, organizational leadership)
* Able and willing to provide consent

For Aim 3 Homeless Services Stakeholder participant group: To be eligible for participation in this study, an individual must meet all of the following criteria:

* 18 years of age or older
* Speak English
* Works in a role in which they have key insight to the HRSP interventions, including planning and implementation (role may include homeless services administrator or other key stakeholder)
* Able and willing to provide consent

Exclusion Criteria:

Aims 1a, 1b, and 2: Children under age 18 years of age will be excluded.

Aim 3: Under age 18 years old, currently a prisoner (we are not sampling from locations where we expect to encounter prisoners), unable to communicate in English (because the interview and focus group guides will not be validated for use in other languages), and unable to provide informed consent.

For Aim 3 Homeless Services Client participant group: those who are not staying or have not stayed at a shelter with HRSP interventions and those who do not report past-year drug use will not be excluded.

For Aim 3 Homeless Services Staff participant group: those who have not been employed in a shelter with the HRSP interventions will be excluded. In alignment with standard techniques of purposeful sampling and the study goal of ensuring a range of experiences is captured in the qualitative interviews, additional targeting or exclusion criteria might be set by investigators as needed to ensure that a diverse range of experiences is included among qualitative interview participants.

Where this trial is running

New York, New York

• NYU Langone Health — New York, New York, United States (Recruiting)

Study contacts

• Principal investigator: Bennett Allen, PhD — NYU Langone Health
• Study coordinator: Bennett Allen, PhD

Conditions Overdose; Harm Reduction