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Priority Topics: Understanding and Ending Veteran Homelessness

In 2009, President Obama and Secretary of Veterans Affairs Shinseki committed to ending homelessness among Veterans within five years. Working toward this goal, HSRD recently funded four studies on homelessness. The studies were developed in partnership with the VA's National Center on Homelessness, and include priority research questions whose findings would have the highest likelihood of being implemented into care for homeless Veterans. The studies address such questions as: How can healthcare services among homeless Veterans with serious mental illness be improved? What are the best ways to deliver primary care to homeless Veterans? Can those Veterans at-risk for homelessness be identified and, if so, can their housing stability be improved to prevent homelessness from occurring? Studies include:

• Investigators at the VA Evidence-Based Synthesis Program in Portland, OR conducted a review of the literature to clarify what is known -- and what is not known about Veteran homelessness to will help guide the development of VA programs for at-risk Veterans. The complete ESP report is available online.
• 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.
  
  Dr. Stefan Kertesz' work is described further on page 19 of the Spring 2011 issue of VA Research Today.
• 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 to the four studies mentioned, 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.

Two additional studies examining other aspects of Veteran homelessness are also being conducted:

• PRO-WATCH: Homelessness as a Sentinel Event, is a 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.
• Marsha L. Ellison, PhD, MSW, of the Center for Health Quality Outcomes and Economic Research at the Boston VA Healthcare System, will soon begin, a study (Improving Outcomes for Homeless Veterans with Peer Support) that aims to test the impact of a peer intervention designed to improve treatment engagement, housing retention, and community functioning among formerly homeless Veterans who have co-occurring substance abuse and mental illness.