Priority Research Topics: Homelessness
In 2009, President Obama and VA Secretary Shinseki pledged to end Veteran homelessness in five years. VA HSR&D investigators are making important contributions toward achieving this goal by learning more about the causes, epidemiology of, and effective resolutions for Veteran homelessness. VA HSR&D has partnered with the VA National Center on Homelessness Among Veterans to identify priority research questions that would have the highest likelihood of being implemented into care for homeless Veterans. The four HSR&D-funded studies are:
- Stefan Kertesz, M.D., M.Sc., part of the VA Medical Center in Birmingham, AL, is currently conducting the Homeless Solutions in a VA Environment (H-SOLVE) study, which seeks to determine whether 'VA implementation of Housing First' can be made to serve a vulnerable pool of Veterans by identifying organizational facilitators and barriers to the implementation of Housing First, which emphasizes moving people into housing as quickly as possible.
- Thomas O'Toole, M.D., of the Providence VA Medical Center, in Providence, RI, is currently working on the Aligning Resources to Care for Homeless Veterans (ARCH) that will examine ways to best organize and deliver primary care for homeless Veterans by assessing different adaptations of the PACT (Patient Aligned Care Team) primary care model to determine the most effective methods to deliver care to this population.
- Amy M. Kilbourne, Ph.D., HSR&D Center for Clinical Management, Ann Arbor, MI Population-based Outreach Services to Reduce Homelessness Among Veterans with Serious Mental Illness will develop a Navigator outreach program to identify Veterans with serious mental illness (SMI) and a lifetime history of homelessness to determine whether contact by the Navigator is associated with increased health services use, housing or other social services, as well as decreased mortality. (View Dr. Kilbourne's presentation from the 2011 AcademyHealth Annual Research Meeting: Homelessness among Veterans with Serious Mental Illness: Public Health Impact and Outreach)
Andrew J. Saxon, M.D. of the Seattle VA Medical Center, is conducting the Addiction Housing Case Management for Homeless Veterans Enrolled in Addiction Treatment study. The study will develop and test a model for homeless Veterans entering addiction treatment. Veterans will be randomized to addiction treatment with an addiction/housing case manager-or addiction treatment with a weekly housing group. (View Dr. Saxon's presentation from the 2011 AcademyHealth Annual Research Meeting: Homelessness and Addiction Treatment Outcomes Among Veterans)
Drs. Kertesz, Kilbourne, O'Toole, and Saxon, described the above-referenced work at the AcademyHealth 2011 Annual Research Meeting. Their presentation can be downloaded as a PowerPoint here: Slide set 1 and Slide set 2.
In addition to these efforts, VA HSR&D has produced an Evidence Synthesis Report about Veteran homelessness, and is funding two other studies:
- Investigators at the VA Evidence-Based Synthesis Program in Portland, OR conducted a review of the literature from database inception (earliest 1947) through July 2010 to examine the epidemiology of homelessness among Veterans, as well as risk factors for Veterans compared to the general population. Clarifying what is known, and what is not known about Veteran homelessness will help guide the development of programs for at-risk Veterans. The complete ESP report is available online.
- The study, "PRO-WATCH: Homelessness as a Sentinel Event", being conducted by Adi V. Gundlapalli, M.D., Ph.D. of the VA Salt Lake City Health Care System, is making use of VA's electronic health record and additional VA data to create a method of detecting or identifying Veterans at risk for homelessness. Investigators hope that the study will facilitate the development of a use-case for homelessness risk that could be used in planning and allocating resources and services for homeless Veterans.
- The Marsha L. Ellison, PhD, MSW, of the Center for Health Quality Outcomes and Economic Research at the Boston VA Healthcare System, will soon begin the study "Improving Outcomes for Homeless Veterans with Peer Support," which aims to provide formerly homeless Veterans who have co-occurring substance abuse and mental illness with a psycho-education peer intervention that seeks to improve housing retention, community participation, and diminish substance use. Investigators will test the impact of the peer intervention of the MISSION Consumer Workbook by using peer support technicians who will augment the HUD-VASH case management services (usual care) in two sites: Bedford, MA and Pittsburgh, PA.