Special Journal Issue Features Several Articles by HSR&D Researchers on Homelessness among Veterans
For more than two decades, VA has dedicated substantial resources to addressing homelessness among Veterans. Moreover, in the past five years VA has spent billions of dollars on a federal initiative to prevent and end homelessness among Veterans. This special issue of Psychological Services focuses on homelessness and includes several articles by HSR&D researchers, including:
- Kertesz and colleagues examined the implementation of "Housing First" (HF) during a key period of its adoption, with a focus on HF fidelity. Housing First is an evidence-based permanent supportive approach to housing individuals vulnerable to homelessness that emphasizes immediate, rapid access without requiring preconditions such as treatment success. Investigators found a substantial degree of fidelity to principles of Housing First in the largest HF implementation effort to date. There were two HF domains for which high fidelity was readily attained: 1) removing sobriety and treatment preconditions, and 2) rapidly offering permanent housing.
- Cox and colleagues compared characteristics and healthcare utilization patterns of homeless Veterans entering substance use disorder (SUD) treatment. Findings showed VA acute services were utilized in high numbers, with more two-thirds of Veterans accessing emergency department (ED) services and nearly half accessing inpatient medical, psychiatric, or SUD services. Veterans with longer and/or more episodes of homelessness had more ED visits and inpatient days relative to those with shorter and fewer episodes. This suggests that successfully housing newly homeless Veterans may help deter over-utilization of acute services in this patient population.
- Tsai and colleagues assessed the one-year incidence of homelessness among Veterans seen in VA specialty mental health clinics. Findings showed that among more than 300,000 Veterans referred to VA outpatient specialty mental health clinics, 6% experienced a new episode of homelessness within one year. Also, women Veterans were at a slightly greater risk for homelessness than men (8% vs. 5%). These results suggest that monitoring early signs of housing vulnerability and preventing homelessness in this vulnerable, but treatment-engaged population, may be important in VA's efforts to end homelessness.
- Jones and colleagues compared the experiences of homeless and non-homeless Veterans with mental health and/or SUD who received primary care through VA's Patient-Aligned Care Teams (PACTs) between October 2012 and September 2013. Findings showed that compared with non-homeless Veterans, homeless Veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support. Results indicate that homeless persons with MH/SUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services.
- Dichter and colleagues examined the association between housing instability and past-year intimate partner violence (IPV) victimization and unhealthy alcohol use among 554 women Veterans receiving VA primary care. Study results showed that one in five women who reported an experience of past-year IPV also reported current housing instability (vs. 1 in 10 women who screened negative for past-year IPV). Investigators did not find a statistically significant association between screening positive for unhealthy alcohol use and housing instability.
Special Issue: Homelessness among Veterans, Other Adults, and Youth. Psychological Services. May 2017;14(2).
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