Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Go to the ORD website
Go to the QUERI website
HSRD Conference Logo



2023 HSR&D/QUERI National Conference Abstract

Printable View

1118 — Effectiveness of temporary financial assistance for reducing homelessness among Veterans: an interrupted time series analysis

Lead/Presenter: Alec Chapman,  COIN - Salt Lake City
All Authors: Chapman AB (IDEAS Center, Veterans Affairs Salt Lake City Health Care System; Department of Internal Medicine, University of Utah School of Medicine), Montgomery AE (National Center on Homelessness among Veterans, University of Alabama School of Public Health; Birmingham VA Medical Center, Birmingham, AL) Byrne T (National Center on Homelessness among Veterans, University of Alabama School of Public Health; School of Social Work, Boston University; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center) Effiong A (IDEAS Center, Veterans Affairs Salt Lake City Health Care System; Department of Internal Medicine, University of Utah School of Medicine) Velasques T (IDEAS Center, Veterans Affairs Salt Lake City Health Care System; Department of Internal Medicine, University of Utah School of Medicine) Suo Y (IDEAS Center, Veterans Affairs Salt Lake City Health Care System; Department of Internal Medicine, University of Utah School of Medicine) Pettey W (IDEAS Center, Veterans Affairs Salt Lake City Health Care System; Department of Internal Medicine, University of Utah School of Medicine) Nelson RE (IDEAS Center, Veterans Affairs Salt Lake City Health Care System; Department of Internal Medicine, University of Utah School of Medicine)

Objectives:
Housing status is an important social determinant of health and ending Veteran homelessness is a priority area for Veterans Health Administration (VHA). Supportive Services for Veteran Families (SSVF) aims to prevent homelessness and support housing stability among Veterans experiencing homelessness or risk by providing various forms of aid including temporary financial assistance (TFA). The objective of this analysis was to evaluate the immediate and long-term effect of SSVF and TFA at reducing homelessness among a national cohort of Veterans.

Methods:
We performed an interrupted time series (ITS) analysis with a control group to assess the impact of TFA on prevalence of unstable housing before and after 30,312 Veterans’ enrollment in SSVF between October 2015 and September 2018. We used a previously validated Natural Language Processing (NLP) system to classify Veterans as stably or unstably housed based on clinical texts in the VA electronic health record (EHR). We then estimated prevalence of unstable housing as the proportion of the cohort classified as unstably housed on each day from 180 days prior to the index date of program entry and up to 365 days after. A linear segmented regression model taking into account a lag 24 autocorrelation was fit to estimate the association between receipt of TFA and the probability of being unstably housed.

Results:
The probability of unstable housing fell by 8.6 (p < 0.001) percentage points overall immediately following SSVF enrollment and decreased over the 365-day follow up period by 0.10 (p < 0.001) percentage points per day. For Veterans enrolled in SSVF who received TFA, relative to those who did not, the probability of being unstably housed fell by 18.3 (p < 0.001) percentage points immediately following SSVF enrollment and increased over the 365-day follow-up period by 0.07 (p < 0.001) percentage points per day. While the difference between the two groups attenuated over time, prevalence remained lower among TFA recipients throughout the entire study period due to the large initial decrease.

Implications:
Enrollment in SSVF is associated with a decrease in the probability of unstable housing immediately as well as over the subsequent 365 days. SSVF enrollees who received TFA had even larger immediate decreases in this probability. Short-term relief provided by TFA may need to be supplemented with additional support beginning 6-12 months after program exit.

Impacts:
SSVF episodes last, on average 90 days. Our results indicate that a short-term financial investment such as TFA can have a long-lasting positive impact on Veteran housing outcomes.