August Spotlight: Veterans and Homelessness
On a single night in January 2009, there were 75,609 homeless Veterans. Between October 2008 and September, 2009, an estimated 136,334 Veterans spent at least one night in an emergency shelter or transitional housing program. With nearly 23 million Veterans in the U.S. population in 2009, the prevalence of Veterans experiencing homelessness on a single night was approximately 33 for every 10,0001 Veterans. In 2009, President Obama and Secretary Shinseki committed to addressing this major concern by ending homelessness among Veterans within five years.
VA HSR&D investigators are making important contributions toward achieving this goal by learning more about the causes, epidemiology of, and effective resolutions for Veteran homelessness. The following four studies were developed in partnership with the National Center on Homelessness Among Veterans to help facilitate faster implementation of findings into the VA system:
- Stefan Kertesz, M.D., M.Sc., part of the VA Medical Center in Birmingham, AL, is currently conducting the Homeless Solutions in a VA Environment (H-SOLVE) study, which seeks to determine whether 'VA implementation of Housing First' can be made to serve a vulnerable pool of Veterans by identifying organizational facilitators and barriers to the implementation of Housing First, which emphasizes moving people into housing as quickly as possible.
- Thomas O'Toole, M.D., of the Providence VA Medical Center, in Providence, RI, is currently working on the Aligning Resources to Care for Homeless Veterans (ARCH) that will examine ways to best organize and deliver primary care for homeless Veterans by assessing different adaptations of the PACT (Patient Aligned Care Team) primary care model to determine the most effective methods to deliver care to this population.
- Amy M. Kilbourne, Ph.D., HSR&D Center for Clinical Management, Ann Arbor, MI Population-based Outreach Services to Reduce Homelessness Among Veterans with Serious Mental Illness will develop a Navigator outreach program to identify Veterans with serious mental illness (SMI) and a lifetime history of homelessness to determine whether contact by the Navigator is associated with increased health services use, housing or other social services, as well as decreased mortality.
- Andrew J. Saxon, M.D. of the Seattle VA Medical Center, is conducting the Addiction Housing Case Management for Homeless Veterans Enrolled in Addiction Treatment study. The study will develop and test a model for homeless Veterans entering addiction treatment. Veterans will be randomized to addiction treatment with an addiction/housing case manager—or addiction treatment with a weekly housing group.
In addition, VA HSR&D has produced an Evidence Synthesis Report, and is also funding a study that will leverage VA's electronic medical record:
- Investigators at the VA Evidence-Based Synthesis Program in Portland, OR conducted a review of the literature from database inception (earliest 1947) through July 2010 to examine the epidemiology of homelessness among Veterans, as well as risk factors for Veterans compared to the general population. Clarifying what is known, and what is not known about Veteran homelessness will help guide the development of programs for at-risk Veterans. The complete ESP report is available online.
- The PRO-WATCH study, being conducted by Adi V. Gundlapalli, M.D., Ph.D. of the VA Salt Lake City Health Care System, is making use of VA's electronic health record and additional VA data to create a method of detecting or identifying Veterans at risk for homelessness. Investigators hope that the study will facilitate the development of a use-case for homelessness risk that could be used in planning and allocating resources and services for homeless Veterans.
1 Veteran Homelessness: A Supplemental Report to the 2009 Annual Homeless Assessment Report to Congress (2009 Veteran AHAR)