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 UNT Health Science Center 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 Scott T. Walters, PhD, Professor of Behavioral and Community Health at the UNTHSC School of Public Health, who leads the project.
Associate Professor Emily Spence-Almaguer, MSW, PhD, a co-investigator on the project, has found that 73 percent of Fort Worth PSH residents 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 even 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.
57-year-old Hosea S., one of the program’s first participants, has found the Chat Bucks to be a real motivator.
“I’ve traded my bucks for athletic shoes, an MP3 player so I can listen to music while I walk, and even a movie gift card to help me stay busy, fight depression and get out more with others,” he said.
Hosea, who suffers from heart problems, has set goals to eat healthier, walk every morning and stop smoking.
“Already I’m feeling better,” he said.
For 55-year-old Teresa B., the goal has been to lose weight.
“When I started the program, I weighed 306 lbs. and within a month I was down to 293,” she said.
Teresa, who is working on healthier eating habits, a beginning exercise plan, pain management and issues related to manic depression and a history of drug abuse, said she is learning to take care of herself “in a good way, without asking for a pill.”
“I’m on a limited income, and the Chat Bucks have helped me get a discounted YMCA membership. I’m working with my health coach on good days and bad days. I had a lot of friends who never made it to their 50s like me, and I realize now that I should have been taking better care of myself years ago. I feel like I’ve been given a second chance,” she said.
The program was first introduced in December 2014, with approximately 100 individuals already participating.
Dr. Walters’ work in developing Web-based health solutions for vulnerable populations has been recognized in other areas as well, including the MAPIT program for probationers in the U.S. criminal justice system.