Study Time Period | Â | Study Day 1 | Study Day 7 (first week after returning home) | Study Day 8 to Day 90 (second week to week 12) | ||||
---|---|---|---|---|---|---|---|---|
 | Acute Hospital Stay | Discharge home (Day 1) | First SWSCM Home visit (Day 7) | Baseline phone call (Day 7)* | Second SWSCM Home visit (Day 30) | SWSCM Follow-up calls and visits (ends Day 60–90) | Final Outcome phone call (Day 90)* | Goggle Analytics (7–90 days) |
ENROLLMENT | Â | Â | Â | Â | Â | Â | Â | Â |
 Screening (Steps 1–3) | X |  |  |  |  |  |  |  |
 Patient Consent (Step 4) | X |  |  |  |  |  |  |  |
 Caregiver Consent | X |  | X |  |  |  |  |  |
 Randomization |  | X |  |  |  |  |  |  |
INTERVENTIONS | Â | Â | Â | Â | Â | Â | Â | Â |
 SWSCM Intervention |  |  |  |  |  |  |  |  |
  Biopsychosocial assessment |  |  | X |  |  |  |  |  |
  Establish service plan |  |  | X |  |  |  |  |  |
  Update service plan |  |  |  |  | X | X |  |  |
  Maintain interaction log |  |  |  |  | X | X |  |  |
  Close out assessment |  |  |  |  |  | X |  |  |
MISTT website | Â | Â | Â | Â | Â | Â | Â | Â |
 Orientation |  |  | X |  |  |  |  |  |
 Reminders |  |  |  |  | X | X |  |  |
ASSESSMENTS | Â | Â | Â | Â | Â | Â | Â | Â |
 Baseline clinical data collection | X | X |  |  |  |  |  |  |
 Outcomes Data Assessment |  |  |  | X |  |  | X |  |
 MISTT Website Utilization |  |  |  |  |  |  |  | X |