In 2012, more than 600,000 people were homeless on any given night in the United States.
This population is much more likely to suffer from physical and mental health disabilities. As a result, homelessness accounts for substantial health care and social service costs.
One solution to dealing with the problem of homelessness is permanent supportive housing (PSH), where people receive a rental voucher along with case management services.
To complement those services, a team from the University of North Texas Health Science Center (UNTHSC) has developed a technology-assisted health coaching program called m.chat, funded by a Texas Medicaid 1115 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,” said Dr. Scott T. Walters, professor of behavioral and community health at the UNTHSC School of Public Health, who leads the project.
Associate professor Dr. Emily Spence-Almaguer, a co-investigator on the project, has found that 73 percent of PSH residents in sample study community Fort Worth, Texas, report at least one chronic health condition, most commonly asthma, Hepatitis C, heart disease or COPD. Fifty-five percent have received treatment for a mental health condition, 67 percent report having a history of substance abuse, and 44 percent report both co-occurring substance abuse and mental health concerns.
From this data, m.chat was designed to address behaviors such as diet, exercise, substance use, medication adherence, social support and recreation/leisure.The m.chat program has three features: in-person health coaching, specialized coaching software, and a system of “Chat Bucks” that can be earned for the purchase of health and wellness supplies, such workout gear, a scale, blood pressure monitor or a discounted YMCA membership. The program is unique in the way that persuasive technology and triggers are used to help motivate and encourage individuals toward more positive health behaviors. The goal is to help people make positive behavior changes and prevent more significant physical and mental health conditions from occurring.
Participants meet monthly with a coach who helps them set health and wellness goals. Goals can be both long- and short-term, defining specific actions a person wants to take, such as losing 10 pounds over six months through a healthy diet and physical activity plan. The m.chat software provides feedback on progress, offers tips and resources, and can send text alerts to remind people about their goals.
The program was first introduced in North Texas in December 2014, with approximately 150 individuals already participating.
The program was designed to be available for PSH residents nationally, in an approach similar to another Web-based health solutions program, MAPIT, developed by Dr. Walters for probationers in the U.S. criminal justice system.