Providers' reflections on infrastructure and improvements to promote access to care for Veterans experiencing housing instability in rural areas of the United States: A qualitative study.

Veterans in rural areas of the United States face barriers to accessing healthcare and other services, which are intensified for those experiencing housing instability. Recent legislative acts have the potential to address obstacles faced by rural patients in the U.S.

Examining the Intersection of Housing Instability and Violence Among LGBTQ Adults.

To assess the relationship between LGBTQ status and (1) current, recent, and lifetime experiences of housing instability, (2) risk of housing instability due to fears of interpersonal violence, and (3) perceived housing challenges, this study examined online survey data from individuals with a household income <$35,000 ( = 1,270). Analyses compared LGBTQ and cisgender heterosexual respondents using chi-square tests and logistic regression. Over their lifetime, LGBTQ respondents had increased odds of sleeping outdoors (adjusted odds ratios [AOR] = 1.

Individual, social, and environmental factors associated with active transportation commuting during the COVID-19 pandemic.

Objective: Physical inactivity is a major public health concern. Though active transportation through bicycling and walking can increase physical activity and thereby positively affect health, factors that influence people's decisions to commute using active transportation modes remain underexplored and often fail to capture equity-related barriers. Increases in active transportation during the COVID-19 pandemic call for a better understanding of these influences.

At the Intersection of Homeless Encampments and Heroin Addiction: Service Use Barriers, Facilitators, and Recommendations from the City of Philadelphia's Encampment Resolution Pilot.

We provide an overview of the pilot and evaluation measures used for an independent evaluation of the Encampment Resolution Pilot (ERP) wherein the City of Philadelphia closed two homeless encampments in May 2018 and sought to assist those displaced by the closures with housing and treatment services. The evaluation used the Rapid Assessment, Response, and Evaluation method to collect qualitative findings on service use barriers and facilitators from open-ended interviews with people staying in the encampments (N = 27) and service providers (N = 10). We assessed how the ERP allowed providers to "push the system" by removing access barriers, and providing amenable, effective, and accessible housing and drug treatment services that led to more widely adopted best practices.

Association Between Registered Sex Offender Status and Risk of Housing Instability and Homelessness among Veterans.

Research is limited about whether and to what extent registered sex offenders (RSOs) face an increased risk of housing instability. The intersection of RSO and housing instability is particularly salient for veterans as there are disproportionately higher rates of veterans among both RSOs and homeless populations. This study assessed the relationship between RSO status and risk of housing instability and homelessness among military veterans.

Correlates of Transitions Into Housing Instability Among Veterans Accessing Veterans Health Administration Health Care.

Background: Prior research has explored the patterns and dynamics of homelessness; such an understanding is necessary to improve policy and programmatic responses and prevent new episodes of housing instability.

Objectives: The objectives of this study are to identify correlates of veterans' transitions into housing instability and inform initiatives aimed to address their needs, with a focus on how to prevent new episodes of housing instability.

Methods: The cohort for this study includes 4,633,069 veterans who responded to the Veterans Health Administration's universal screen for housing instability at least twice between October 1, 2012, and September 30, 2016; 1.

Mitigating loss of health insurance and means tested benefits in an unconditional cash transfer experiment: Implementation lessons from Stockton's guaranteed income pilot.

•Cash transfers, universal basic income, and guaranteed income have re-emerged as potential solutions to income volatility.•Methods used in Stockton's guaranteed income experiment, are testing how GI can exist alongside existing safety net benefits.•A multi-tiered approach to mitigating potential means tested benefits loss is both effective and ethically sound.

Mental health care in the context of intimate partner violence: Survivor perspectives.

Experience of violence or abuse from an intimate partner (intimate partner violence, IPV) can result in a variety of psychological and mental health impacts for which survivors may seek psychotherapy or other mental health services. Individuals experiencing IPV may have specific needs and preferences related to mental health care, yet the question of how to best provide client-centered mental health care in the context of IPV has received little attention in the literature. In this article, we report on findings from qualitative interviews with 50 women reporting past-year IPV who received care through the Veterans Health Administration regarding experiences with and recommendations for mental health services.

The Importance of Context: Linking Veteran Outpatients Screening Positive for Housing Instability with Responsive Interventions.

This study aims to explore the relationship between the context of screening for housing instability and Veterans' access to services, with the goal of ensuring effective processes to address housing instability among Veterans. This study used administrative data from 100,022 Veterans' electronic medical records and qualitative data collected during in-depth interviews with 22 health care providers and six Homeless Program staff. A mixed effects logistic regression assessed the relationship between Veterans' screening experiences and connection with services; qualitative data were analyzed using a grounded theory approach to present providers' reflections on administering screening for housing instability and responding to Veterans' positive screens with needed resources.

Making Connections: Understanding How Screening, Triage, and Referral Processes Can Promote Veteran Housing Stability.

To improve understanding of the screening, triage, and referral processes within social determinant of health-Electronic Medical Record (EMR) integration, we explored how Veterans connect with needed resources following screening for housing instability using three data sources: administrative Homelessness Screening Clinical Reminder (HSCR) data, administrative Supportive Services for Veterans Families (SSVF) data, and chart review data. The cohort included Veterans who had responded to the HSCR in the 90 days prior to presenting for SSVF services between October 2012 and 2015 (N = 134); chart reviews were abstracted for a sample (n = 53). Most Veterans who presented for SSVF services had screened negative for housing instability (68.

Women's Participation in Research on Intimate Partner Violence: Findings on Recruitment, Retention, and Participants' Experiences.

Background: Research on intimate partner violence (IPV) faces unique challenges to recruitment and retention. Little is known about successful strategies for recruiting and retaining in research women who have experienced IPV, and their experiences of research participation.

Purpose: This article presents findings on recruitment, retention, and research participation experiences from a longitudinal observational study of IPV among women receiving care through the Veterans Health Administration.

Screening for Housing Instability: Providers' Reflections on Addressing a Social Determinant of Health.

Background: The Veterans Health Administration (VHA) has a long history of addressing social determinants of health, including housing. In 2012, the VA integrated a two-question Homelessness Screening Clinical Reminder (HSCR) into the electronic medical record in outpatient clinics to identify Veterans experiencing housing instability and ensure referral to appropriate services.

Objective: This study explores perspectives of VA clinical providers regarding administration of the HSCR, their role in addressing housing status, and how a patient's housing status impacts clinical decision-making.

Veterans' assignment to single-site versus scattered-site permanent supportive housing.

To address homelessness among Veterans, a growing proportion of permanent supportive housing units supported by the U.S. Departments of Housing and Urban Development and Veterans Affairs Supportive Housing (HUD-VASH) program are allocated to programs where multiple Veterans with a history of homelessness live in a particular building, referred to as single-site housing.

The intersection of interpersonal violence and housing instability: Perspectives from women veterans.

Women veterans in the United States face a disproportionate risk of housing instability (HI) and interpersonal violence (IV), largely perpetrated by intimate partners or involving nonpartner sexual violence, compared to both male veterans and nonveteran women. To explore the ways in which IV and HI intersect in the experiences of women veterans, we analyzed transcripts of in-depth qualitative interviews with 20 women veterans who had screened positive for HI at a Veterans Affairs Medical Center. Three broad themes emerged related to the intersection of IV (specifically intimate partner violence or nonpartner sexual violence) and HI among women veterans: (1) HI can be precipitated by and increase vulnerability to IV, (2) experiences of IV impact women's definitions of housing safety and security, and (3) IV can pose a barrier to accessing housing services and other support systems.

Barriers and facilitators to housing access and maintenance in HUD-VASH: Participant and staff perspectives.

Though the U.S. Departments of Housing and Urban Development (HUD) and Veterans Affairs (VA) supportive housing (HUD-VASH) program endeavors to address barriers to Veterans accessing and maintaining housing, participants report challenges that lead to program exits.

Supporting veterans' transitions from permanent supportive housing.

Objectives: Little research has assessed the nature of veterans' departures from permanent supportive housing (PSH), which may be of positive valence (e.g., moving into more independent housing).

Examining the bidirectional association between veteran homelessness and incarceration within the context of permanent supportive housing.

Homelessness and incarceration share a bidirectional association: individuals experiencing homelessness are more likely to be incarcerated and former inmates are more likely to become homeless. Permanent supportive housing (PSH) programs have demonstrated positive outcomes for participants with criminal histories, yet participants continue to exit to jail or prison and experience subsequent homelessness. Using data on Veterans participating in a PSH program at 4 locations between 2011 and 2014 (N = 1,060), logistic regression was used to examine the risk factors for exiting PSH because of incarceration and returning to homelessness.

Pathways into homelessness among post-9/11-era veterans.

Despite the scale of veteran homelessness and government-community initiatives to end homelessness among veterans, few studies have featured individual veteran accounts of experiencing homelessness. Here we track veterans' trajectories from military service to homelessness through qualitative, semistructured interviews with 17 post-9/11-era veterans. Our objective was to examine how veterans become homeless-including the role of military and postmilitary experiences-and how they negotiate and attempt to resolve episodes of homelessness.

Needles in a Haystack: Screening and Healthcare System Evidence for Homelessness.

Effectiveness of screening for homelessness in a large healthcare system was evaluated in terms of successfully referring and connecting patients with appropriate prevention or intervention services. Screening and healthcare services data from nearly 6 million U.S.

Factors contributing to eviction from permanent supportive housing: Lessons from HUD-VASH.

Introduction: Eviction from housing is associated with several negative outcomes, further exacerbated among high-need populations requiring financial and supportive services to maintain housing stability. This study investigated risk and protective factors-both characteristics and precipitating events of tenant eviction-informing permanent supportive housing (PSH) programs' efforts to identify tenants at risk and intervene.

Methods: Using administrative data for a cohort of 20,146 Veterans participating in PSH, this study assessed differences in Veterans who exited the program due to eviction and Veterans who exited because they accomplished their goals.

Factors Associated With Veterans' Access to Permanent Supportive Housing.

Objective: The objective of this study was to identify individual- and program-level characteristics associated with veterans' ability to move into permanent housing following receipt of a housing voucher and to identify factors associated with more rapid placement into housing.

Methods: This study used secondary quantitative and primary quantitative and qualitative data collected from veterans participating in the U.S.