Preventing Overdose in Supportive Housing: Stepped Wedge Randomized Controlled Trial of a Multi-Sector, Upstream Intervention

Homelessness and housing instability are strongly linked with overdose risk. Permanent supportive housing (PSH)—subsidized housing paired with support services—is a key part of the national strategy to end homelessness. PSH tenants face high overdose risk due to a confluence of factors. Despite this risk, little past research has examined overdose prevention in PSH or even as related to housing more generally. We propose a multi-sector, community-partnered, stepped wedge randomized controlled trial (RCT) to evaluate the impact of a technical assistance (TA) intervention designed to support PSH agencies in sustainably implementing evidence-based practices to reduce tenant overdose and improve tenant health more broadly. The intervention will be delivered to PSH agencies in New Jersey and New York by a collaborative multi-sector team led by community organizations with national footprints. The intervention addresses not only individual tenant behavioral risks but also acts at the larger agency and building levels. The study includes a UG3 planning phase and a UH3 trial phase, with milestones defined for each phase.