Project Summary
Substance use disorders (SUD) are both a cause and a consequence of housing instability for more
than 30% of people and 60% of people experiencing housing instability report a history of SUD. Improving
housing stability for people with SUD requires evidence-based support to improve retention in permanent
supportive housing (PSH). Despite the need for additional support, housing staff are often under-resourced to
provide the intensive care needed for housing residents. As a result, residents often do not have the skills to
integrate into a new housing context and property owners create and uphold untenable requirements for lease
which together lead to lease violations and a return to housing instability. Technology offers a relative
advantage to staff delivery in the context of workforce shortages and capacity challenges to facilitate person-
centric, standardized, evidence-based support to residents with SUD. The proposed research seeks to address
the need for support for people with SUD in housing communities, with a focus on harm reduction principles
and enhancing access to evidence-based strategies including cognitive behavioral therapy (CBT) informed
skills and contingency management (CM) to improve individual stability. Voice-based assistants delivered by
smart speakers (e.g., Amazon Alexa and Echo) offer an accessible format for teaching skills and incentivizing
engagement. The primary goal of the proposed solution is to augment the support accessible to people with
SUD in housing communities to improve resident stability. We plan to accomplish this goal by using smart
speakers to teach residents how to apply harm reduction principles through CBT informed skills to real world
challenges. Additionally, we will incentivize participation through CM and provide staff resources to support
intervention uptake. We will demonstrate feasibility through a proof-of concept prototype. Our specific aims are
(1) Collaborate with community partners in housing communities to understand determinants of
intervention implementation through a community-based participatory research approach, leveraging the
Consolidated Framework for Implementation Research. This formative work will include developing a
collaborative board of housing staff and people with lived/living experience to iteratively co-design the product
and identify approaches to implementation. (2) Create content for residents as an application prototype.
The content will include two weeks of smart speaker-delivered educational content for residents on CBT skills
and its application to tasks of daily living. It will also include a subset of educational modules for housing
program staff to feel confident in sharing the program with residents and help them to understand program
data to better support residents. (3) Evaluate the usability, acceptability, feasibility, and effectiveness of
the application prototype by assessing 25 residents on acceptability, usability, and knowledge gain. We will
also assess usability of an existing harm reduction education intervention for staff to prepare for Phase II
adaptation.
