JF McGuire, VA Northeast Program Evaluation Center; RA Rosenheck, VA Northeast Program Evaluation Center

Objectives: Since 1987, VA has made a major commitment to providing services to homeless veterans. Up to 12% of prisoners in the nation’s jails have been estimated to be veterans, one-fourth of whom were homeless prior to arrest. Outreach to incarcerated veterans is a facet of a growing number of homeless programs. This study examines homeless jail veteran characteristics at outreach compared to non-jail homeless veterans, and compares use of VA treatment services by the two groups.

Methods: Using standardized intake assessment data from the VA Greater Los Angeles Healthcare System’s Homeless Center, we compared the clinical status of veterans contacted in jail to the general homeless veterans outreach population. We used assessments of 9,765 veterans (8,089 non-jail and 1,676 jail veterans) contacted through outreach from May, 1997 through August, 1999. Clinical status was measured by a medical problem summary index and Addiction Severity Index scores for substance abuse and psychiatric status. Using hospital administrative databases, one-year pre- and post-outreach VA service utilization data were compared. Differences were tested using t test and Chi square analyses.

Results: Jail outreach veterans were younger, more likely to be Hispanic, and more likely married than the non-jail outreach veterans. Jail veterans were homeless for shorter periods of time: 74% vs. 42% were homeless for less than 6 months. Over the 3 years prior to outreach contact, jail veterans were less likely to have been disabled or retired (11% vs. 16%), or to have been employed (15% vs. 31%), but they were more likely to unemployed (74% vs. 52%).

There were no differences in number of medical problems. However, jail veterans reported higher ASI problem ratings for alcohol and drug dependence and lower problem ratings on the ASI psychiatric index.

Prior to outreach, 30% of jail veterans had received VA health care services, which increased to 38% in the year after contact. In contrast, among non-jail veterans, 45% had received VA health care services prior to outreach, which increased to 85% in the year after contact. Thus, while the likelihood of receiving VA services increased by 8% among jail veterans, it increased by 40% among non-jail veterans.

Conclusions: In comparison to the general homeless population, incarcerated veterans have been homeless for shorter periods of time, have more problems with substance abuse, and are less likely to be disabled. While outreach increases their access to VA healthcare services, the magnitude of the effect is smaller than among other homeless veterans.

Impact: There are substantial numbers of homeless veterans in jail who have high levels of substance abuse and employment potential. Outreach increases access to VA services but not as effectively as with other homeless veterans. Approaches which emphasize linkage to substance abuse and vocational rehabilitation opportunities may more effectively meet the needs of this population.