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CDP 12-256 – HSR&D Study

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CDP 12-256
Evaluation of VA's Supported Housing Program for Homeless Veterans (CDA 10-212)
Jack Tsai PhD
VA Connecticut Healthcare System West Haven Campus, West Haven, CT
West Haven, CT
Funding Period: October 2012 - September 2017

BACKGROUND/RATIONALE:
Homelessness among veterans has remained a national problem for over three decades. One of the most important VA programs for homeless veterans, the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is in need of evaluation, research, and improvement. HUD-VASH is the largest supported housing program for veterans in the nation and is continuing to expand. Research on understanding the needs of the heterogeneous population of homeless veterans is important in the VA's efforts to end homelessness

OBJECTIVE(S):
There are three specific aims for this project. The first aim is to evaluate an innovative group-intensive peer-support (GIPS) model of case management for HUD-VASH at the VA Connecticut Healthcare System. Performance and client outcomes at this study site have been compared to other control HUD-VASH sites during the same time using VA administrative program data. This model has shown to not be associated with any adverse housing or clinical outcomes compared to treatment-as-usual and has been associated with greater social integration and increased case manager activities. The second aim was to survey HUD-VASH clinicians in the country about their receptiveness to using groups as part of their case management activities. Results of a survey in the New England area revealed many HUD-VASH clinicians are interested in using groups and group-based approaches may offer a viable alternative to current case management models. The third aim is to analyze national data on homeless veterans to characterize the needs of special subgroups of homeless veterans, including homeless female veterans, homeless veteran families, veterans with criminal justice involvement, and veterans living in rural areas. These analyses are currently ongoing.

METHODS:
Using VA administrative program data, a pre-post non-equivalent comparison cohort study was used to examine the clinical and cost-effectiveness of GIPS compared to other HUD-VASH programs in the country during the same time period. An online survey of HUD-VASH case managers was conducted to gather information about the current use and attitudes in regards to using groups as part of HUD-VASH case management. National VA administrative data and locally collected data on homeless veterans have been analyzed to identify special subgroups of homeless veterans, their service needs, and the services they receive. The results have found that GIPS is a viable, alternative model of case management that is associated with greater veteran social integration and increased case manager activities. Many HUD-VASH programs are interested in utilizing more groups in their work and are receptive to group-based models of care. Special populations of rural veterans, female veterans, and recent Iraq and Afghanistan veterans have highlighted the special needs of these groups and need to tailor services to address their needs.

FINDINGS/RESULTS:
GIPS implementation has been found to be associated with greater increases in client social integration, case manager services, and faster acquisition of vouchers after program admission than control sites, with no evidence of adverse effects on housing or clinical outcomes. A regional online survey of HUD-VASH case managers showed generally positive attitudes about using groups in HUD-VASH, suggesting receptiveness to the GIPS model. Separate analyses of predictors of the housing attainment process in HUD-VASH found that history of incarceration was not an impediment to success in HUD-VASH. Analysis of gender differences in HUD-VASH have shown that female veterans show similar improvements in housing outcomes as male veterans, however homeless female veterans are more likely to have dependent children and may have unique needs. Analysis of homeless veterans in metropolitan and micropolitan areas yielded findings that homeless-related services for veterans in micropolitan and rural are often proximately located to one another. Lastly, we have found that VA medical-legal partnerships can improve veterans' housing and mental health outcomes.




IMPACT:
This project has potential impact on VA homeless services, and in particular, supported housing. GIPS challenges traditional case management models and offers an effective, alternative service model in supported housing that may be implemented on a large scale to help VA end homelessness among veterans. Identification of special subgroups of homeless veterans and their service needs may help guide development of services to serve the heterogeneous population of homeless veterans and foster new innovative practices. We have also received funding to study two innovative interventions to help prevent and end veteran homelessness, namely money management services to help veterans gain financial literacy, learn about budgeting and saving, and achieve financial independent; and medical-legal partnerships which bring legal and healthcare providers to help veterans with civil legal problems like landlord disputes, evictions, and applying for disability.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: Prevention
Keywords: Career Development
MeSH Terms: none