Program in UT’s College of Pharmacy Provides Cellphones to People Experiencing Homelessness

By Jade Fabello in 40 Acres, Research, Sept | Oct 2024 on September 1, 2024 at 1:20 am | No Comments

On June 28, the United States Supreme Court ruled on a major case related to homelessness, City of Grants Pass v. Johnson. The decision allows cities to enforce laws banning camping and vagrancy, effectively allowing punishment for sleeping outside. Experts at the University of California, Berkeley have characterized the decision not only as inhumane, but also ineffective, as punitive responses to homelessness tend to push people further away from recovery. Many groups, however, understand the issue of homelessness as being about access to resources and are working to provide the basic tools needed to function in society.  

One such group is Interactive Care Coordination and Navigation (iCAN), a collaborative research project between the UT College of Pharmacy and multiple homeless advocacy organizations in Texas.

University of Texas Professor of Health Outcomes Leticia Moczygemba, PharmD ’04, PhD ’08, is the principal investigator for the project. Throughout various phases over the past few years, the iCAN team has provided smartphones to unhoused populations to investigate how technology allows people experiencing homelessness to manage their health and social needs.  

“I think one thing that drives us is that we have this vision that all people experiencing homelessness should have access to a smartphone,” Moczygemba says. “In today’s world, there’s this digital disparity that’s talked about sometimes, which is people who have technology versus those who don’t. But the way we’re moving, we argue that having access to a phone with data and internet is a basic need.”  

Scheduling medical appointments, accessing online health portals, and contacting services such as Social Security become incredibly difficult tasks without ready access to the tools to do so. This is in addition to the added social difficulties of not being able to contact family and others. “In order to be successful in navigating the health care and social services systems, it is critical to have a phone,” Moczygemba says.  

The iCAN study has taken various forms since 2018, including shorter pilot studies and a recent six-month randomized control trial. Funding permitting, the team has intentions to scale the project to larger sizes and more populations. During the various iterations of the study, dozens of individuals experiencing homelessness received a smartphone with unlimited data, calls, messaging, and transportation (through an automatically renewing CapMetro virtual bus pass). The phones came preloaded with a variety of useful apps and a contact list of various local resources, health care providers, homeless advocacy organizations, and food pantries.  

UT postdoctoral fellows take on much of the day-to-day leadership of the team and project management in the field. PharmD students often help on the back end, with tasks such as setting up the phones with the various resources. Graduate students at the College of Pharmacy help with data collection, analysis, and developing protocol, while undergraduate researchers assist in a variety of other tasks. “Really all different levels of trainees have been involved at various points in time,”  Moczygemba says.  

After the second iteration of the study, the iCAN team conducted a series of exit interviews, which highlighted many of the barriers faced by people experiencing homelessness. Many participants attributed their homeless status to their chronic health conditions. “I am homeless because I had four brain surgeries. I mean, I was fine. I had a home and everything … Now I[’ve] lost everything,” one participant said.   

The stigma faced by people experiencing homelessness often disallows folks from completing tasks, from the most mundane to the most severe. Once, when asking a clerk at a downtown hotel to call an ambulance for a medical emergency, one participant of the study recalled, “They wouldn’t call 911. They would not call me an ambulance. Instead, they called security on me because I was homeless.”  

Another participant said that lacking a phone number has been a huge barrier to their obtaining employment and housing.  

“You know, my only other option would have been to give them the phone number for the [shelter] … Not fun convincing an employer to hire a homeless guy,” they said.  

With these situations in mind, the iCAN program has continually iterated on the project. Importantly, a key aspect of the study has been prioritizing the community and fostering trust between researchers and the populations they serve. Taking the time to build trust is not always a given in similar research projects.  

“I think that even though sometimes people mean well, if you’re doing this work, you might try to rush that process, but it can’t really be rushed,” Moczygemba says. “It doesn’t always follow traditional research timelines.”   

Balancing those considerations, Moczygemba and the team developed the program in close collaboration with established homelessness service providers, namely Sunrise Homeless Navigation Center, The Charlie Center, and Trinity Center, as well as the Central Texas health information exchange Connxus. They also regularly consulted the community advisory board, a focus group made up of the service providers and people who have experienced homelessness.  

“We’re really proud of that community-engaged approach because our community advisory has given us recommendations on verbiage and [concerns we could address],” she says.  

With direct feedback from the community, the iCAN project started providing lanyards with each phone, to make them more secure and less likely to be stolen. The board helped the team create clearer messaging for when participants could expect text responses from the team (during work hours), and what separate channels of communication were for.  

According to Moczygemba, one of the most meaningful pieces of feedback the team received from a participant was that the team had “thought of everything.” From automated text messages with practical reminders to others with encouraging messages, all of the little things have reportedly worked to build the iCAN project into a valuable resource.  

In the relatively short time the project has operated, many participants reported being aided by this tool in finding jobs and housing. Moczygemba also recalled one participant telling her how they got to hear their grandchild’s first cry over the phone because of the program.  

The study operates with the knowledge that resolving homelessness will require policy and systemic change, but their work so far is a testament to what is possible when resources are provided.

CREDIT: Mathias Ball

Tags: research