Changes in Homelessness Among US Veterans After Implementation of the Ending Veteran Homelessness Initiative.

Importance: Homelessness is a persistent and growing problem. What role health systems should play and how that role is incorporated into larger strategic efforts are not well-defined.

Objective: To compare homelessness among veterans with that in the general population during a 16-year study period before and after implementation of the Ending Veteran Homelessness Initiative, a program to rehouse veterans experiencing homelessness.

Veteran Patient Experience Academy: Putting Veterans First.

With a national priority to make the Veteran Health Administration (VA) a leading customer service organization and provide patient-centric services to veterans and their families, the Wilmington VA Medical Center (W VAMC) partnered with the University of Delaware's Department of Hospitality and Sport Business Management at the Learner College of Business & Economics to develop The program focused on employee training and provided tools to enhance the veterans' experience, operationalized the VA Way (VA Core Values, Service Behaviors, Service Recovery), and Own the Moment. Phase 1 of the VA Patient Experience Academy launched with 25 managers in February 2019 and were followed by 5 cohorts including physicians, nurse practitioners, registered nurses, licensed practical nurses, medical staff assistants, and staff. The participants were selected from the W VAMC and 5 Community-Based Outpatient Clinics.

Impact of an unannounced standardized veteran program on access to community-based services for veterans experiencing homelessness.

Background: The United States Department of Veterans Affairs established a program in which actors incognito portray veterans experiencing homelessness with pre-determined needs to identify barriers to access and services at community-based organizations.

Methods: From 2017 to 2019, actors who varied in gender, skin color and age portrayed one of three scripts at all VA Community-Based Resource and Referral Centers (CRRCs) serving veterans experiencing homelessness in 30 cities and completed an evaluative survey. They carried authentic VA identification and were registered in a VA patient database for each identity.

A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs.

Background: Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop program" to address housing and health care needs of homeless veterans. However, while 70% of HPACT's veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation.

Integrating Permanent Supportive Housing and Co-Occurring Disorders Treatment for Individuals Who Are Homeless.

Objectives: While permanent housing, addictions, and mental health treatment are often critical needs to achieve housing stability and community reintegration, few studies have systematically integrated them into a single comprehensive approach for people experiencing chronic homelessness. This pilot study examined the feasibility and preliminary outcomes of systematically integrating permanent supportive housing and an evidence-based co-occurring disorders intervention called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION).

Methods: This single-group open pilot enrolled 107 people with co-occurring disorders experiencing chronic homelessness from two Massachusetts inner-city and rural areas.

Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration's "Homeless Patient Aligned Care Team" Program.

Introduction: Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a "homeless medical home" initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites.

Methods: We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients.

Screening for Homelessness in the Veterans Health Administration: Monitoring Housing Stability through Repeat Screening.

Objective: This study examined veterans' responses to the Veterans Health Administration's (VHA's) universal screen for homelessness and risk of homelessness during the first 12 months of implementation.

Methods: We calculated the baseline annual frequency of homelessness and risk of homelessness among all veterans who completed an initial screen during the study period. We measured changes in housing status among veterans who initially screened positive and then completed a follow-up screen, assessed factors associated with such changes, and identified distinct risk profiles of veterans who completed a follow-up screen.

Factors Associated With Premature Exits From Supported Housing.

Objective: Many homeless consumers who enroll in supported housing programs--which offer subsidized housing and supportive services--disengage prematurely, before placement in permanent community-based housing. This study explored factors associated with exiting a supported housing program before achieving housing placement.

Methods: With the use of administrative data, a roster was obtained for consumers enrolled in the Veterans Affairs (VA) Greater Los Angeles supported housing program from 2011 to 2012.

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.

Development and validation of an instrument to assess imminent risk of homelessness among veterans.

Objectives: Veterans are overrepresented within the homeless population compared with their non-veteran counterparts, particularly when controlling for poverty. The U.S.

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.

Homeless female U.S. veterans in a national supported housing program: comparison of individual characteristics and outcomes with male veterans.

As more women serve in the U.S. military, the proportion of females among homeless veterans is increasing.

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.

Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts.

Objectives: In this population-based cohort study, we assessed baseline risk factors for homelessness, including the role of service in the Iraq or Afghanistan conflicts, among a large cohort of recent veterans.

Methods: Data for this study came from administrative records for 310,685 veterans who separated from active military duty from July 1, 2005, to September 30, 2006. We used survival analysis methods to determine incidence rates and risk factors for homelessness, based on baseline data for military factors, demographic characteristics, and diagnoses of behavioral health disorders and traumatic brain injury.

Challenges associated with screening for traumatic brain injury among US veterans seeking homeless services.

We identified the prevalence of traumatic brain injury (TBI) among homeless veterans and assessed the TBI-4, a screening tool created to identify TBI history. Between May 2010 and October 2011, 800 US veterans from two hospitals, one eastern (n = 122) and one western (n = 678) completed some or all measures. Findings suggested that 47% of veterans seeking homeless services had a probable history of TBI (data for prevalence obtained only at the western hospital).

New to care: demands on a health system when homeless veterans are enrolled in a medical home model.

Objectives: We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use.

Methods: We used case-control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011.

Results: We followed 127 homeless and 106 nonhomeless veterans.

Universal screening for homelessness and risk for homelessness in the Veterans Health Administration.

We examined data for all veterans who completed the Veterans Health Administration's national homelessness screening instrument between October 1, 2012, and January 10, 2013. Among veterans who were not engaged with the US Department of Veterans Affairs homeless system and presented for primary care services, the prevalence of recent housing instability or homelessness was 0.9% and homelessness risk was 1.

Military sexual trauma among homeless veterans.

Background: Military sexual trauma (MST) is the Veteran Health Administration's (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans.

A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders.

This article reports the results of a low-intensity wraparound intervention, Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION), to augment Treatment as Usual (TAU) and engage and retain homeless veterans with a co-occurring disorder (COD) in care. Using a quasi-experimental design, 333 homeless veterans were enrolled, 218 who received MISSION along with TAU and 115 who received TAU alone. Group assignment was based on MISSION treatment slot availability at time of enrollment.

Prevalence and risk of homelessness among US veterans.

Introduction: Understanding the prevalence of and risk for homelessness among veterans is prerequisite to preventing and ending homelessness among this population. Homeless veterans are at higher risk for chronic disease; understanding the dynamics of homelessness among veterans can contribute to our understanding of their health needs.

Methods: We obtained data on demographic characteristics and veteran status for 130,554 homeless people from 7 jurisdictions that provide homelessness services, and for the population living in poverty and the general population from the American Community Survey for those same jurisdictions.