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2015 HSR&D/QUERI National Conference Abstract

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1062 — The Social Context of Housing Transitions among Homeless Veterans with Serious Mental Illness and Substance Use Disorders

Gabrielian SE, VA Greater Los Angeles; Bromley E, VA Greater Los Angeles; Greenberg J, VA Greater Los Angeles; Young AS, VA Greater Los Angeles;

Objectives:
Though a breadth of VA homeless services offer housing and healthcare, many homeless Veterans with serious mental illness (SMI) and co-occurring substance use disorders (SUD) struggle to sustain stable housing without additional supports. Among Veterans with SMI and SUD who have experienced homelessness, we sought to understand the roles of Veterans' interpersonal supports on housing transitions, e.g., from residential rehabilitation to supported housing.

Methods:
Using administrative data, we identified homeless Veterans with SMI and SUD admitted to VA Greater Los Angeles' Domiciliary"”a residential rehabilitation program"”from 12/2008-11/2011. On a random sample (N = 36), we used the Residential Time-Line Follow-Back Inventory to gather housing histories since exiting rehabilitation. We conducted and analyzed semi-structured qualitative interviews on a purposive sample (n = 19) of Veterans, across three tiers of longitudinal housing outcomes: 1) stable, independent housing; 2) sheltered housing, continually engaged in structured housing programs; and 3) unstable housing. Interviews identified and discussed the roles of formal (paid staff) and informal (family/ friends) supports who helped identify, secure, and retain housing units. Interviews also reviewed the sources of problems that arose in housing.

Results:
All Veterans described their social support context as important to finding and maintaining housing. Veterans in each of the three longitudinal housing outcomes described different social support contexts. Veterans in stable and independent housing described strong roles of informal supports in identifying and retaining housing. Veterans in sheltered housing relied predominantly on formal supports, like case managers. Veterans with unstable housing described cursory interactions with formal and informal supports; many did not rely on any supports during housing transitions. Across housing outcomes, most problems described were interpersonal conflicts.

Implications:
Social context, including patterns of formal and informal support, was associated with longitudinal housing outcomes for participants. Interpersonal supports"”or lack thereof"”affected participants' housing choices, retention of these settings, and problems that arose in housing settings.

Impacts:
To improve housing outcomes for homeless Veterans with SMI and SUD, these findings suggest a role for social skills training and other clinical interventions that help this population connect with friends/family, effectively use formal supports, and decrease interpersonal conflicts in housing settings.