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CDA 15-074 – HSR&D Study

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CDA 15-074
Improving Housing Outcomes for Homeless Veterans
Sonya Emi Gabrielian MD MPH
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: March 2017 - February 2022

BACKGROUND/RATIONALE:
Social skills are an important and underappreciated determinant of housing outcomes for homeless Veterans. Yet, social skills interventions are uncommon within VA homeless services.

OBJECTIVE(S):
This study aims to develop and study the implementation and effectiveness of a "skills intervention"--built from existing, effective social skills interventions and focused on housing-related social skills--tailored to the VA Supportive Housing (VASH) program. This intervention will be co-delivered by a peer and a social worker, aiming to improve VASH participants' housing retention and mental health. Using the theoretical framework of the Behavioral Model for Vulnerable Populations, with guidance from the Consolidated Framework for Implementation Research, the Aims are to: 1) develop a intervention that improves housing retention and mental health among homeless Veterans; 2) in a controlled pilot trial, study the feasibility, acceptability, and effectiveness of the intervention on factors strongly associated with improved housing retention and mental health among homeless Veterans; and 3) examine barriers to and facilitators of future implementation of the intervention in routine VASH care.

METHODS:
For Aim 1, we conducted key informant interviews with experts in social skills training (n=12); used the RAND/UCLA appropriateness method to convene a panel (n=11) of experts in homelessness and psychosocial rehabilitation; conducted a focus group (n=7) with local homeless program leadership and frontline clinicians; and have planned a focus group (n=12) with homeless Veterans. Aims 2 and 3 entail a controlled effectiveness-implementation hybrid type 1 pilot trial. For Aim 2, we will implement the intervention at the VA Greater Los Angeles (GLA) Domiciliary with homeless Veterans engaged in VASH. We will assess the intervention's feasibility and acceptability, comparing changes over 6 months in social skills, service use, social interactions, and money management among Veterans who receive the intervention (n=30) vs. a control group (n=20). For Aim 3, we will use surveys and qualitative methods to explore barriers to and facilitators of implementation of the intervention in routine care.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
To accelerate efforts to improve care for homeless Veterans, we must implement novel services that are effective in other VA settings but have not been implemented within homeless services. .

PUBLICATIONS:

Journal Articles

  1. Chinchilla M, Gabrielian S, Hellemann G, Glasmeier A, Green M. Determinants of Community Integration Among Formerly Homeless Veterans Who Received Supportive Housing. Frontiers in psychiatry. 2019 Jun 26; 10:472.
  2. Gabrielian S, Hamilton AB, Gelberg L, Hellemann G, Koosis ER, Johnson A, Young AS. A protocol to develop and study the effectiveness and implementation of social skills training that improves supported housing retention for persons with serious mental illness. Contemporary clinical trials communications. 2019 Jun 1; 14:100344.
  3. Gabrielian S, Hamilton AB, Gelberg L, Koosis ER, Johnson A, Young AS. Identifying Social Skills That Support Housing Attainment and Retention Among Homeless Persons With Serious Mental Illness. Psychiatric services (Washington, D.C.). 2019 May 1; 70(5):374-380.
  4. Montgomery AE, Szymkowiak D, Cusack MC, Austin EL, Vazzano JK, Kertesz SG, Gabrielian S. Veterans' assignment to single-site versus scattered-site permanent supportive housing. The American Journal of Orthopsychiatry. 2019 Jan 17.
  5. Montgomery AE, Gabrielian SE, Cusack MC, Austin EL, Kertesz SG, Vazzano JK. Applying the Housing First approach to single-site permanent supportive housing. Journal of Social Distress and the Homeless. 2018 Nov 20; 28(1):24-33.
  6. Llerena K, Gabrielian S, Green MF. Clinical and cognitive correlates of unsheltered status in homeless persons with psychotic disorders. Schizophrenia Research. 2018 Feb 24.
  7. Simmons MM, Gabrielian S, Byrne T, McCullough MB, Smith JL, Taylor TJ, O'Toole TP, Kane V, Yakovchenko V, McInnes DK, Smelson DA. A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs. Implementation science : IS. 2017 Apr 4; 12(1):46.


DRA: Other Conditions
DRE: Prevention
Keywords: none
MeSH Terms: none