Abstract

Background and Significance: Through the Shallow Subsidy component of the Supportive Services for Veteran Families (SSVF) program, Veterans and their families living in high cost-of-living locations in the US who are experiencing homelessness or at risk of becoming homeless can receive up to 2 years of rental subsidies and job training through non-profit organizations in the community. The goal of the program is for Veterans to achieve long-term financial self-sufficiency through employment and housing stability. The impact on Veteran housing, healthcare cost, and health outcomes as well as Veteran satisfaction with this program is not known. Poverty has a devastating effect on Veterans’ health and well-being. In addition, homelessness can be costly both to the healthcare system and society as a whole. Solving the problem of long-term Veteran financial and housing instability is one of the most important initiatives the VA is currently pursuing. Innovation: Our study – evaluating a program implemented in 15 different communities in the US – will be the largest to examine the impact of long-term financial support for individuals facing housing instability in the US. In addition, we will use both structured and unstructured data and detailed, Veteran-level data on services and financial assistance received by Veterans enrolled in this program. Finally, we will join VA clinical data with tax filings data available through the US Department of the Treasury to estimate the impact of Shallow Subsidies on income and employment outcomes. Specific aims: Aim 1: Identify barriers and facilitators to implementation and use of the Shallow Subsidy program using semi-structured interviews with VA operations partners, SSVF grantee employees, VA homeless services providers, and Veterans using the Shallow Subsidy program. Aim 2: Describe and identify predictors of the amount of financial support for Veterans enrolled in the Shallow Subsidy program for FY2020- FY2023 using HMIS, VA administrative, and publically-available community-level data. Aim 3: Perform an outcome and economic assessment of the Shallow Subsidy program. 3a: Measure the impact of this program on housing, income, employment, health, and healthcare cost outcomes through retrospective cohort analyses for FY2020-FY2023. 3b: Conduct economic evaluations of the Shallow Subsidy program compared to standard SSVF and usual care using input parameters from the published literature and from Aims 2 and 3a. Methodology: In Aim 1, we will conduct interviews with national VA stakeholders, SSVF grantee employees, VA homeless service providers, and Veterans who have enrolled in the SSVF program. In Aim 2 we will construct multi-level regression models to identify both individual- and community-level predictors of Shallow Subsidy use and expenditures. In Aim 3a, we will fit outcome models relating Shallow Subsidy program initiation to the subsequent mortality, exit from homelessness, income, employment, and cost outcomes in weighted populations defined by propensity scores. In Aim 3b, we will construct simulation models using input parameters from a variety of sources. Next steps/Implementation: This research will be an important building block for future studies. We will work with our operations partners to design studies to implement and assess the policy recommendations from this study to enhance the Shallow Subsidy program. This information will be especially important as the SSVF program office is considering expanding the Shallow Subsidy program to other communities throughout the country. In addition, in future analyses we will examine the impact of health conditions (such as traumatic brain injury, combat injury, and opioid misuse) and interventions to address these conditions on income and employment. Through this portfolio of research projects, we will help VA efficiently deliver services to improve the lives of vulnerable Veterans.

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DRA: Health Systems

DRE: TRL - Applied/Translational

Keywords: Homeless

MeSH Terms: None at this time.