Using patient-reported outcome measures for program evaluation: Design and findings on intention-to-treat outcomes from the Veterans Outcome Assessment survey.

The Veterans Outcomes Assessment (VOA) program surveys Veteran Health Administration (VHA) patients when they begin mental health treatment and at follow-up at three months to obtain patient-reported outcomes measures (PROM). It complements VA's evolving program in measurement-based care by providing additional data that can be useful for program evaluation including assessments of patients who have not been seen for ongoing mental health care. In principle, it provides data on intention-to-treat outcomes for program evaluation to complement the outcomes for patients who are receiving ongoing treatment that can be derived from measurement-based care.

A National Study of Veterans Treatment Court Participants: Who Benefits and Who Recidivates.

Although there are now over 400 veterans treatment courts (VTCs) in the country, there have been few studies on participant outcomes in functional domains. Using national data on 7931 veterans in the Veterans Affairs (VA) Veterans Justice Outreach program across 115 VA sites who entered a VTC from 2011 to 2015, we examined the housing, employment, income, and criminal justice outcomes of VTC participants; and identified veteran characteristics predictive of outcomes. VTC participants spent an average of nearly a year in the program and 14% experienced a new incarceration.

Diversion of Veterans With Criminal Justice Involvement to Treatment Courts: Participant Characteristics and Outcomes.

Objective: This study compared characteristics and outcomes between veterans who participated in veterans treatment courts (VTCs) and veterans involved in criminal justice who participated in other treatment courts (TCs) or who participated in neither VTCs or TCs.

Methods: Data from 22,708 veterans (N=8,083 VTC participants, 680 participants in other TCs [other-TC participants], and 13,945 participants in neither VTCs nor TCs [non-TC participants]) in the Veterans Justice Outreach (VJO) program were analyzed by using multilevel regression models.

Results: VTC participants were more likely than other VJO participants to have served in Iraq or Afghanistan, but there were no sociodemographic disparities in access to VTCs.

Impact of Supported Housing on Social Relationships Among Homeless Veterans.

Objective: This study examined social network structure and function among a sample of 460 homeless veterans who participated in an experimental trial of the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program.

Methods: Participants were randomly assigned to HUD-VASH (housing subsidies and case management), case management only, or standard care. Mixed-model longitudinal analysis was used to compare treatment groups on social network outcomes over 18 months.

A 20-Site Comparison of Transition-in-Place Versus Traditional Transitional Housing Programs.

Transition-in-Place (TIP) is a housing model being piloted in the veterans affairs transitional housing program, Grant & Per Diem (GPD). This observational 20-site study compares characteristics and outcomes of 488 clients in TIP and 10,388 clients in traditional GPD programs. TIP participants were younger, better educated, healthier, and reported higher employment income than traditional GPD participants.

Homeless Veterans Eligible for Medicaid Under the Affordable Care Act.

Objective: Among homeless veterans and those at risk of homelessness currently enrolled in Veterans Affairs (VA) health care, this study examined the proportion likely to become eligible for Medicaid in 2014 and their health needs.

Methods: A total of 114,497 homeless and at-risk veterans were categorized into three groups: currently covered by Medicaid, likely to become eligible for Medicaid, and not likely.

Results: Seventy-eight percent of the sample was determined to be likely to become eligible for Medicaid in states that expand Medicaid.

Characteristics and Use of Services Among Literally Homeless and Unstably Housed U.S. Veterans With Custody of Minor Children.

Objective: The study examined the number of homeless veterans with minor children in their custody ("children in custody"), compared sociodemographic and clinical characteristics among homeless veterans with and without children in custody, and observed differences in referral and admission patterns among veterans with and without children in custody for a variety of U.S. Department of Veterans Affairs (VA) programs for homeless veterans.

Street outreach and other forms of engagement with literally homeless veterans.

Street outreach is one of the most direct methods of engaging homeless individuals, but the characteristics of those most likely to be engaged this way is not well-understood. Data from the Department of Veterans Affairs (VA) Homeless Operations Management and Evaluation System showed that of the 70,778 literally homeless veterans engaged in VA homeless services in 2011-2012, 12% were through street outreach while the majority was through provider referrals (41%) and self-referrals (28%). Veterans engaged through street outreach had more extensive histories of recent homelessness, were more likely to be chronically homeless, and were more likely to be referred and admitted to the VA's supported housing program than other veterans.

National comparison of literally homeless male and female VA service users: entry characteristics, clinical needs, and service patterns.

Background: Although there are growing numbers of homeless female U.S. veterans, the U.

Latent homeless risk profiles of a national sample of homeless veterans and their relation to program referral and admission patterns.

Objectives: We identified risk and need profiles of homeless veterans and examined the relation between profiles and referrals and admissions to Department of Veterans Affairs (VA) homeless service programs.

Methods: We examined data from the VA's new Homeless Operations Management and Evaluation System on 120,852 veterans from 142 sites nationally in 2011 and 2012 using latent class analyses based on 9 homeless risk factors. The final 4-class solution compared both referral and admission to VA homeless services.

The impact of current alcohol and drug use on outcomes among homeless veterans entering supported housing.

Permanent supported housing has increasingly been identified as a central approach to helping homeless individuals with disabilities exit from homelessness. Given that one third or more of homeless individuals actively use substances, it is important to determine the extent to which individuals who report using alcohol and/or drugs at the time of housing benefit from such programs. The current study examines data from the evaluation of the United States Department of Housing and Urban Development-Veterans Affairs (HUD-VA) Supported Housing (HUD-VASH) program to determine differences in housing and clinical outcomes among participants with two different levels of active alcohol or drug use at time of housing entry.

Incarceration histories of homeless veterans and progression through a national supported housing program.

There is increasing concern that adults with a past history of incarceration are at particular disadvantage in exiting homelessness. Supported housing with case management has emerged as the leading service model for assisting homeless adults; however there has been limited examination of the success of adults with past history of incarceration in obtaining housing within this paradigm. Data were examined on 14,557 veterans who entered a national supported housing program for homeless veterans, the Housing and Urban Development-Veterans Affairs Supportive Housing program (HUD-VASH) during 2008 and 2009, to identify characteristics associated with a history of incarceration and to evaluate whether those with a history of incarceration are less likely to obtain housing and/or more likely to experience delays in the housing attainment process.

Homelessness in a national sample of incarcerated veterans in state and federal prisons.

The Veterans Health Administration (VHA) has been increasing efforts to reach out to assist incarcerated veterans. While previous studies have shown strong associations between incarceration and homelessness, few studies have examined distinctive characteristics of incarcerated homeless and non-homeless veterans. National administrative data on 30,348 incarcerated veterans served by the Health Care for Re-entry Veterans (HCRV) program were analyzed.

Risk of incarceration and clinical characteristics of incarcerated veterans by race/ethnicity.

Purpose: Unprecedented growth in the US prison population has highlighted the overrepresentation of racial/ethnic minorities in prisons. This study examined the hypothesis that veteran status is protective against incarceration for veterans of different racial/ethnic minorities and compared the clinical characteristics of incarcerated veterans by race/ethnicity.

Methods: Using national data from a prisoner re-entry program and data from the 2010 National Survey of Veterans, this study examined the risk of incarceration among veterans who were racial/ethnic minorities and compared sociodemographic and clinical characteristics to White incarcerated veterans.

Alcohol and drug use disorders among homeless veterans: prevalence and association with supported housing outcomes.

This study examines the prevalence of alcohol and drug disorders among homeless veterans entering the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program and its association with both housing and clinical outcomes. A total of 29,143 homeless veterans were categorized as either having: no substance use disorder, only an alcohol use disorder, only a drug use disorder, or both alcohol and drug use disorders. Veterans were compared on housing and clinical status prior to admission to HUD-VASH and a smaller sample of 14,086 HUD-VASH clients were compared on their outcomes 6 months after program entry.

Differential impact of supported housing on selected subgroups of homeless veterans with substance abuse histories.

Objective: Studies have demonstrated that supported housing is an effective intervention for individuals who are homeless and have a mental illness or substance use disorder. This study examined data from an experimental trial of the U.S.

Sobriety as an admission criterion for transitional housing: a multi-site comparison of programs with a sobriety requirement to programs with no sobriety requirement.

Background: This study examined whether homeless clients enrolled in transitional housing programs that required sobriety (SR) as an admission criterion have outcomes comparable to clients enrolled in programs that did not require sobriety (NSR) as an admission criterion.

Methods: A total of 1062 military veterans in 40 transitional housing programs funded by the United States Department of Veterans Affairs were grouped based on whether they were in SR or NSR programs and followed over a one-year period after program discharge. Participants in SR and NSR programs were compared on their ratings of the social climate of the program, and housing and psychosocial outcomes.

Requiring sobriety at program entry: impact on outcomes in supported transitional housing for homeless veterans.

Objective: An important distinction in models of housing for the homeless is whether programs that require abstinence prior to program admission produce better outcomes than unrestricted programs. Data from a large transitional housing program were used to compare client characteristics of and outcomes from programs requiring abstinence at admission and programs not requiring abstinence.

Methods: The U.

Do faith-based residential care services affect the religious faith and clinical outcomes of homeless veterans?

Data on 1,271 clients in three residential care services funded by the Department of Veterans Affairs was used to examine: (1) how religious-oriented programs differ in their social environment from secular programs, (2) how religious-oriented programs affect the religiosity of clients, and (3) how client religiosity is associated with outcomes. Programs were categorized as: secular, secular now but religious in the past, and currently religiously oriented. Results showed (1) participants in programs that were currently religious reported the greatest program clarity, but secular services reported the most supportive environments; (2) participants in programs that were currently religious did not report increases in religious faith or religious participation over time; nevertheless (3) greater religious participation was associated with greater improvement in housing, mental health, substance abuse, and quality of life.

Factors related to rapidity of housing placement in Housing and Urban Development-Department of Veterans Affairs Supportive Housing program of 1990s.

The Housing and Urban Development-Department of Veterans Affairs Supportive Housing (HUD-VASH) program is the largest supported housing program in the country for homeless veterans who are seeking rapid entry into permanent independent housing. This study examined factors related to how rapidly clients were housed in the early years of the program and how long they stayed in the program. Mental health, substance abuse, work/income, criminal history, and site were examined as predictors of process times.

Association of substance use and VA service-connected disability benefits with risk of homelessness among veterans.

Recent public attention on homelessness has shifted beyond emergency services and supportive housing to primary prevention. This study compares a national sample of homeless and nonhomeless Veterans Affairs (VA) mental health services users to determine risk and protective factors for homelessness. Using VA administrative data, veterans were identified as homeless (ie, used VA homeless services or received a diagnostic code for "lack of housing") or nonhomeless and compared using logistic regression.

Patient and program predictors of 12-month outcomes for homeless veterans following discharge from time-limited residential treatment.

The U.S. Department of Veterans Affairs provides transitional residential treatment to homeless veterans through three types of programs: VA-staffed Domiciliary care, and two types of community-based treatment (one funded through locally managed contracts and the other through national grants).