Ongoing Research Projects

The eHaRT-A Project (PI: Frohe): The current eHaRT-A study entails the codevelopment, implementation and evaluation of the digital version of the HaRRT Center’s harm reduction treatment for alcohol (HaRT-A). HaRT-A was codeveloped by the HaRRT Center codirectors, Drs. Collins and Clifasefi, and partnering community advisory board (CAB) members more than 10 years ago (see below in our completed projects to learn more!). This two-phased project will codevelop and iteratively test the electronic version of HaRT-A (i.e., eHaRT-A), which will be adapted into a video-conferencing platform and implemented via “telehealth stations” that will be set up at our partnering permanent supportive housing facilities (i.e. DESC) around Seattle. With the ongoing support of the HaRRT CAB, eHaRT-A will adapt all in-person HaRT-A material into a digital platform that is iteratively tested (N=20) to ensure acceptability and feasibility of the prototype. The effectiveness of this approach will then be tested in a 2-arm randomized controlled trial (N=160) comparing supportive housing services-as-usual to our digital eHaRT-A telehealth intervention. The ultimate goal of eHaRT-A is to improve treatment delivery for alcohol use disorders (AUD) among individuals living in DESC who typically have little- to no- access to technology.

Supporting Technology Use and Harm Reduction (STaHR) (PI: Frohe): This study is conducting a needs assessment to better understand technology use and harm reduction within permanent, supportive housing facilities throughout Seattle. STaHR is recruiting 30 individuals who use drugs (any substance besides nicotine or one prescribed by a doctor) and have lived experience of chronic homelessness to complete one assessment. Participants will be asked open-ended questions about their substance use, what they currently do (if anything) to reduce any substance-related harms and whether they would be interested in receiving any harm reduction services virtually in the future. After interviews are completed, we will work with a community advisory board (CAB) to conduct a conventional content analysis and identify all barriers or facilitators to using technology broadly, and specifically for harm-reduction service provision. This study will lay the foundation for future programming aimed at supporting technology use and harm reduction within permanent, supportive housing facilities throughout Seattle.

Counseling for Harm Reduction and Retention in Medication assisted treatment at Cherokee Nation (CHaRRM-CN) (PIs: Nelson, Collins & Lincoln): The CHaRRM-CN project is a NIDA-funded collaboration involving the HaRRT Center, WSU’s Partnerships for Native Health Center, and the Cherokee Nation of Oklahoma. The study entails the codevelopment, implementation and evaluation of a counseling program that centers Native values and traditions in supporting patients receiving medication assisted treatment for opioid use disorders. The effectiveness of this approach will be tested in a 2-arm randomized controlled trial (N=160) conducted with Cherokee Nation Health Services. Goals are to increase people’s connection to their culture and traditions and thereby enhance retention in medication assisted treatment, reduce substance-related harm and improve quality of life. This study starts this summer!

The Doorway Project (PI: Clifasefi): The Doorway Project is a University of Washington and YouthCare-led state-funded initiative supported by the Washington State Legislature, focused on addressing youth and young adult homelessness in the University District through continuous community-engaged collaboration with U District service providers and community members. Together with U-District service providers and community stakeholders, our mission is to empower and uplift the voices of youth and young adults experiencing homelessness to co-develop effective and innovative solutions that foster lasting change and create a more inclusive and supportive environment for all young people affected by homelessness. The Doorway project aims to expand and improve service capacity and outcomes through coordinated, comprehensive, and collaborative service delivery. Through our unwavering commitment to self-determination and community partnership, we aim to create a brighter future for young people where homelessness is replaced by stability, healing, and opportunity.

The Life Enhancing Alcohol-management Program 2.0 (LEAP 2.0) (PI: Clifasefi) builds on a longstanding partnership between the UW HaRRT Center and housing first residents, staff, and management of DESC. The pilot program was developed through a community based participatory research framework, and entails low-barrier, community-level, house-wide resident programming—including leadership opportunities, activities, and pathways to recovery. Results from the pilot indicated that LEAP participants reported more engagement in meaningful activities than their control counterparts. Further, higher levels of engagement with the LEAP predicted significant reductions in alcohol use and alcohol-related harm.  To build on these promising findings, in LEAP 2.0, we are be conducting a 10-site, cluster-randomized controlled trial to assess LEAPs impact on substance use, health, cost and service utilization, as well as quality of life outcomes.

The HaRTS-TRENDS study (PI: Collins) is the follow-up to the prior single-arm HaRT-S pilot (see below) and continues the prior study’s partnership between the UW, Washington State University and the Downtown Emergency Service Center (DESC). This 2-arm, 12-month pilot RCT (N=94) will test the efficacy of HaRTS-TRENDS versus brief advice to quit among smokers receiving services at a community-based agency that provides supportive housing to single adults experiencing chronic homelessness. Specifically, we will test group differences on complete switchover to safer nicotine use as well as tobacco-specific nitrosamines, the primary group of cancer-causing chemicals in tobacco. We would like to thank DESC for their long-term and persistent partnership in inspiring and realizing this project.

The HaRTC study (PIs: Collins and Nelson) is a 3-phase study that comprises the adaptation and randomized controlled trial of harm-reduction talking circles (HaRTC) for urban Native primary care patients experiencing AUD. We expect HaRTC will increase patients’ enculturation, which will, in turn, precipitate a reduction in alcohol-related harm, improvement in quality of life, and a decrease in publicly funded service utilization and associated costs. Our partners on HaRTC include WSU’s Partnerships for Native Health and SIHB. HaRTC is a 5-year NIAAA-funded project that is 1 of 3 other projects that will be conducted within WSU’s Native Center for Alcohol Research and Education (NCARE). The larger Center will focus on training Native researchers and providers, supporting the 3 featured projects with methods and statistical advising, and working with Native communities to develop approaches to address alcohol-related harm.

The HaRP study (PI: Collins) is the follow-up to a prior single-arm pilot, Project Vivitrol (see below). In this four-arm, NIH-funded randomized controlled trial, we are testing extended-release naltrexone and harm reduction counseling as ways to reduce alcohol-related harm and improve quality of life among people experiencing homelessness and severe alcohol use disorder. Our partners on HaRP include Evergreen Treatment Service’s REACH program, DESC, King County, and the Dutch Shisler Sobering Center. (Click Here to view the study protocol.) This study began in August 2013 and is currently in its completion phase.

Completed Projects

The Staying in Touch and Engaged Project  (Co-PI’s: Clifasefi & Collins): The STEP project is a UW (Population Health Initiative grant) + WSU (Arts & Humanities grant) co-funded pilot study which aims to support DESC residents in staying in touch with researchers and in engaging in meaningful activities during the COVID-19 outbreak and social distancing directives. A 16-week, 2-group randomized controlled pilot trial will compare remote assessment of substance-use and health-related quality of life assessment paired with immediate versus delayed provision of remotely delivered meaningful activities.

The LEAP 1.0 project (PI: Clifasefi) was an NIH-funded project that entailed the community-based development and evaluation of harm-reduction programming for people with lived experience of chronic homelessness and severe alcohol use disorder who are living in a Housing First program that is owned operated by the Downtown Emergency Service Center (DESC). Currently under scientific review, findings indicated a statistically significant difference between the LEAP and services-as-usual control conditions on participants’ level of involvement in meaningful activities. Although there were no significant group differences on alcohol outcomes, we did find that people who participated in more LEAP programming showed significantly less heavy drinking and alcohol-related problems over the 6-month follow-up.

Following the end of the research project, this programming was successfully implemented on an ongoing basis with the support of an ITHS grant (PI: Clifasefi). This project involved working together with our LEAP community partners (i.e., DESC residents, staff and management) to: a) evaluate and strengthen our existing partnership, b) assess the impact of the LEAP process on the partnership, and c) build community capacity by developing and piloting a technical assistance package for others wishing to implement the LEAP.

The HaRT-S study (PI: Collins) was developed together with clients, staff and management at the Downtown Emergency Service Center (DESC). The goal was to create an innovative, empirically informed and client-driven alternative to traditional smoking cessation interventions. The HaRT-S intervention comprised elicitation of participants’ goals for their smoking, discussion of safer nicotine use strategies, and provision of e-cigarettes and nicotine replacement therapy to support people’s reduction in smoking related harm. Findings of our initial, single-arm pilot trial (N=44) with individuals with the lived experience of homelessness and smoking indicated 18% increase in odds of reporting 7-day, biochemically validated, point-prevalence abstinence. All participants who achieved abstinence reported using e-cigarettes. Participants also evinced reductions in cigarette dependence (-45%), frequency (-29%), and intensity (-78%; all ps<.05). Participants who used e-cigarettes during the study experienced an additional 44% reduction in smoking intensity and a 1.2-point reduction in dependence compared to participants who did not use e-cigarettes.

Collins, S. E., Nelson, L.A., Stanton, J., Mayberry, N., Ubay, T., Taylor, E.M.,…& the HaRT-S Community Advisory Board. (in press). Harm reduction treatment for smoking (HaRT-S): Findings from a single-arm pilot study with smokers experiencing chronic homelessness. Substance Abuse.

Collins, S. E., Orfaly, V. E., Wu, T., Chang, S., Hardy, R. V., Nash, A., … & Clifasefi, S. L. (2018). Content analysis of homeless smokers’ perspectives on established and alternative smoking interventions. International Journal of Drug Policy, 51, 10-17.

The aim of the Harm Reduction Treatment for Alcohol (HaRT-A) study (PI: Collins) was to codevelop and evaluate a harm-reduction alternative to abstinence-based alcohol treatment together with people experiencing homelessness and AUD. The HaRT-A comprised a 4-session behavioral AUD intervention. Components included participant-led tracking of their preferred metrics, elicitation of participants’ harm-reduction goals, and discussion of safer drinking strategies using a nonjudgmental, empathetic stance, and acceptance of participants wherever they were along the spectrum of behavior change (see manual). This study was conducted in partnership with DESC, REACH and Harborview Medical Center’s Pioneer Square Clinic.

Collins, S. E., Goldstein, S. C., Suprasert, B., Doerr, S. A., Gliane, J., Song, C., … & Hoffmann, G. (2020). Jail and Emergency Department Utilization in the Context of Harm Reduction Treatment for People Experiencing Homelessness and Alcohol Use Disorder. Journal of Urban Health, 1-8.

Collins, S. E., Clifasefi, S. L., Lonnie, N.A., Stanton, J, Goldstein, S.C., Taylor, E.M.,… & Jackson, T.R. (2019). Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder. International Journal of Drug Policy, 67, 24-33. 

Collins, S. E., Clifasefi, S. L., Stanton, J., The LEAP Advisory Board, Straits, K. J. E., Gil-Kashiwabara, E.,… & Wallerstein, N. (2018). Community-based participatory research (CBPR): Towards equitable involvement of community in psychology research. American Psychologist, 73(7), 884-898.

Collins, S. E., Taylor, E., Jones, C., Haelsig, L., Grazioli, V. S., Mackelprang, J. L., … & Clifasefi, S. L. (2017). Content analysis of advantages and disadvantages of drinking among individuals with the lived experience of homelessness and alcohol use disorders. Substance Use & Misuse, 1-10.

Collins, S. E., Jones, C. B., Hoffmann, G., Nelson, L. A., Hawes, S. M., Grazioli, V. S., … & Herndon, P. (2016). In their own words: Content analysis of pathways to recovery among individuals with the lived experience of homelessness and alcohol use disorders. International Journal of Drug Policy27, 89-96.

The Navigation Center Evaluation (Co-PIs: Clifasefi and Collins) was contracted by the City of Seattle’s Human Services Department. It entailed a 2-part program evaluation of the collaboration between the City of Seattle, DESC, REACH and SPD to create and serve a “Navigation Center,” a low-barrier, 24-hour, 60-day, referral-only shelter for adults experiencing unsheltered homelessness and substance use disorder. The HaRRT Center worked together with community members (i.e., people with the lived experience of homelessness who are guests of the Center), as well as local stakeholders that have partnered together to operate the Center, to yield recommendations for future planning, development and program enhancement.

Part 1 (July 2017-February 2018) entailed qualitative interviews and focus groups to document and analyze stakeholders’ (i.e., Center guests; DESC, REACH and SPD onsite and outreach staff and management; and City partners) experiences with and perceptions of the Center as well as potential points for improvement of the Center’s policies, procedures, amenities, services, and community-building efforts.

Click here to view our report.

Click here for the slide presentation.

Click here for the panel discussion.

Part 2 (November 2017-August 2018) entailed a single-arm assessment of self-reported changes in guests’ housing, substance use, mental health, physical health, and quality of life prior and subsequent to their entry into the Center. Findings indicated participants were 23% less likely to report any alcohol or drug use for each month after their move-in date through the 120-day follow-up. Participants’ experience of substance-related harm, including overdose, did not change in a statistically significant way; however, for each month after move-in, participants were 22% more likely to report having access to naloxone, 12% more likely to use clean injection equipment, and 20% more likely to report giving clean equipment to someone they know. Participants also reported significantly better “general health” over the follow-up.

Click here to view our report.

We were contracted by the Department of Social and Health Services (DSHS) to conduct a process evaluation of King County’s Regional Mental Health and Veterans Courts  (Co-PIs: Clifasefi and Collins). In this work, we documented the Courts’ current operations and services and compared these with their stated missions and national standards using qualitative data analysis methods. Our findings yielded recommendations for future planning, development and program enhancement.

Click here to view our report.

Contrasting with the criminal justice system as usual, Seattle’s Law Enforcement Assisted Diversion (LEAD) program is a pre-booking diversion program that entails a) a one-time diversion from booking and prosecution for a low-level drug or prostitution offense, b) referral to harm-reduction case management, and c) legal assistance. This program was developed by the King County Prosecuting Attorney’s Office, the Seattle City Attorney’s Office, the Seattle Police Department, the King County Sheriff’s Office, the King County Executive, the Mayor’s Office, the Washington State Department of Corrections, The Defender Association, the ACLU of Washington, REACH, and community members. Compared to the system-as-usual control participants, LEAD participants were less likely to recidivate and placed less strain and cost on the legal and criminal justice systems. More contact with LEAD case managers was associated with incrementally higher likelihood of obtaining shelter, housing, vocational services, jobs, and income and benefits. In turn, housing and jobs were associated with reduced recidivism.

Click here for a video that features LEAD.

For more information and to read about our findings please visit

Project Vivitrol® (PI: Collins) was a single-arm pilot study of extended-release naltrexone as medication support for harm reduction counseling among currently and formerly chronically homeless individuals with alcohol dependence. Participants in this study were able to define their own goals—abstinence and use reduction were not required. Findings indicated significant and biochemically verified decreases on alcohol use and alcohol-related harm among participants. Our partners on Project Vivitrol include DESC, ETS’s REACH, King County, and the Dutch Shisler Sobering Center.

Collins, S. E., Duncan, M. H., Smart, B. F., Saxon, A. J., Malone, D. K., Jackson, T. R., & Ries, R. K. (2015). Extended-release naltrexone and harm reduction counseling for chronically homeless people with alcohol dependence. Substance Abuse36(1), 21-33.

Collins, S. E., Grazioli, V. S., Torres, N. I., Taylor, E. M., Jones, C. B., Hoffman, G. E., … & Herndon, P. (2015). Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence. Addictive behaviors, 45, 184-190.

Project M2M (PI: Collins) was a three-year, NIH-funded randomized controlled trial testing the efficacy of two web-based motivational enhancement interventions for college drinkers. One intervention encouraged participants to weigh the pros and cons of their drinking, and the other provided personalized normative feedback about drinking. Findings indicated that web-based personalized normative feedback was associated with reductions in drinking quantity and frequency up to 6 months after exposure to the intervention. Weighing the pros and cons of their drinking helped participants decrease their drinking and alcohol-related harm.

Collins, S. E., Kirouac, M., Lewis, M. A., Witkiewitz, K., & Carey, K. B. (2014). Randomized controlled trial of web-based decisional balance feedback and personalized normative feedback for college drinkers. Journal of studies on alcohol and drugs75(6), 982-992.

Collins, S. E., Kirouac, M., Taylor, E., Spelman, P., Grazioli, V., Hoffman, G., Haelsig, L., Holttum, J., Kanagawa, A., Nehru, M., and Hicks, J. (2014). Advantages and disadvantages of college drinking in students’ own words: Content analysis of the decisional balance worksheet. Psychology of Addictive Behaviors, 28(3), 727.