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Homeless Veterans

 

Connecting Research to Practice

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Connecting Research to Practice

A program hosted by the National Center on Homelessness among Veterans to present current research on homeless populations that has implications for the field.  This occasional forum provides clinicians, VA homeless program managers, and front line staff the opportunity to discuss particular research studies and how findings might be considered in planning, developing, or implementing services for homeless or formerly homeless Veterans.



Dementia in Aging Homeless Veterans:  Research and Clinical Implications

March 26, 2019

John A. Schinka, PhD
Researcher, VA National Center on Homelessness among Veterans; Professor, School of Aging Studies, University of South Florida

In recent decades there has been rising concern with the prevalence and impact of dementia on the older U.S. population.  Most cases of dementia have onset at age 65 or older and risk increases with age.  In 2018 there were 53 million Americans age 65 or older, a population expected to grow to 88 million by 2050 and a concomitant increase in cases of dementia. The Veteran population is also aging (approximately 45% are now age 65 or older) and the proportion of older Veterans in the homeless population is significant (In FY15, 8.3% of Veterans receiving housing services from VA were age 65+). In addition to concerns about the risk of dementia for the growing number of Veterans age 65 or more, alarms are being raised in housing programs about symptoms of significant cognitive loss in Veterans in their 50s who are experiencing homelessness, substantially below the usual age of risk for dementia.  This webinar addresses aging and its impact on cognitive decline and risk for dementia; the evidence for cognitive impairment and functional decline in homeless populations and Veterans experiencing homelessness; and the implications and recommendations for clinical assessment and referral.

View the webinar


 

Housing Instability, Housing Services Utilization, and Suicide Morbidity among Transgender Veterans  

January 8, 2019

John Blosnich, PhD
Affiliated Researcher, VA National Center on Homelessness among Veterans; Research Health Scientist, Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System; and Assistant Professor, Division of General Internal Medicine, University of Pittsburgh

Ann Elizabeth Montgomery, PhD
Researcher, National Center on Homelessness among Veterans; Health Science Specialist, HSR&D, Birmingham VA Medical Center; and Assistant Professor, University of Alabama at Birmingham School of Public Health

Transgender individuals -- people whose sex assigned at birth is different from their gender identity -- experience numerous health risks and are overrepresented among the Veteran population engaged in care in the Veterans Health Administration (VHA). This webinar presents findings from recent research on transgender Veterans served by VHA who experience housing instability, specifically, their characteristics and the special risks they face; how frequently they use housing services; and how utilization of housing services might be related to their suicide risk. Drs. Blosnich and Montgomery were joined in their presentation by discussants Sonya Gabrielian, MD, MPH, a psychiatrist and investigator at the VA Greater Los Angeles HSR&D Center of Innovation and the VISN22 Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC); and Michael Kauth, PhD and Jillian Shipherd, PhD, Directors of the LGBT Health Program in the Office of Patient Care Services.

To view the webinar and download the presentation, go to: http://va-eerc-ees.adobeconnect.com/p807998l5y54/.


 

Challenges and Strategies for Serving Unstably Housed Veterans in Rural Areas: Evidence from the Supportive Services for Veteran Families (SSVF) Program 

December 11, 2018

Tom Byrne, PhD
Affiliated Researcher, VA National Center on Homelessness among Veterans; Investigator, Center for Healthcare Outcomes and Implementation Research (CHOIR) at the Edith Nourse Rogers VA Medical Center; and Assistant Professor, Boston University School of Social Work

Mike Boyd, LCSW
Regional Coordinator, Supportive Services for Veteran Families, VHA Homeless Programs Office

Although rural Veterans account for roughly one of seven Veterans experiencing homelessness on a given night, there is limited research about the nature of their housing instability and homelessness. Most research that seeks to understand “what works” for serving Veterans experiencing homelessness has been conducted in urban settings. Through interviews with Supportive Services for Veteran Families (SSVF) grantees, Tom Byrne and colleagues uncovered the various challenges to serving Veterans in rural areas. In this webinar he and SSVF Regional Coordinator Mike Boyd discuss these challenges and propose strategies and needed resources for overcoming them.

To view the webinar go to: http://va-eerc-ees.adobeconnect.com/pmqhmemktkyz/.


 
Pathways into Homelessness among post-9/11-Era Veterans

November 14, 2018

Stephen Metraux, PhD
VA National Center on Homelessness among Veterans, Philadelphia, PA

Gala True, PhD
South Central Mental Illness Research Education and Clinical Center, U.S. Department of Veterans Affairs
Section of General Internal Medicine & Geriatrics, Tulane University School of Medicine, New Orleans, LA

Despite the scale of Veteran homelessness and government–community initiatives to end homelessness among Veterans, few studies have featured individual Veteran accounts of experiencing homelessness. Center researcher Stephen Metraux and colleagues tracked Veterans’ trajectories from military service to homelessness to examine how Veterans become homeless—including the role of military and post-military experiences—and how they negotiate and attempt to resolve episodes of homelessness. Drs. Metraux and True shared findings from the Pathways into Homelessness study they conducted with VA colleagues Tom Byrne, Meagan Cusack, and Nora Hunt-Johnson.

To view the webinar go to: http://va-eerc-ees.adobeconnect.com/pwhbw7aobn01/.




Addiction Housing Case Management for Homeless Veterans Enrolled in Addictions Treatment

October 10, 2018

Andrew J. Saxon MD
Director, Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System Professor, Department of Psychiatry and Behavioral Sciences, University of Washington
Director, Addiction Psychiatry Residency Program, University of Washington

Carol Malte, MSW
Research Health Science Specialist, Center of Excellence in Substance Abuse Treatment and Education (CESATE)
VA Puget Sound Health Care System, Seattle, WA

Homeless Veterans entering substance use disorder (SUD) treatment have worse treatment outcomes and incur more costs than their housed counterparts. Many homeless Veterans never obtain housing after treatment entry, and a substantial proportion of those who do subsequently return to homelessness. Center Research Affiliate Andrew Saxon, MD and his colleagues conducted an HSR&D funded study from 2011 to 2016 to determine whether intensive addiction/housing case management (ACHM) for homeless Veterans newly entering VA SUD treatment produced better outcomes than a housing support group (HSG) intervention. Dr. Saxon and researcher Carol Malte of the VA Puget Sound Health Care System inaugurated the Center’s Connecting Research to Practice series to discuss the study’s findings and implications for improving care for homeless Veterans.

To view the webinar go to: http://va-eerc-ees.adobeconnect.com/p47ededfwcvg/.



Homeless and Justice-Involved Veterans: What does the Research Tell us?

June 12, 2018

Andrea Finlay, PhD
Research Health Scientist, Center for Innovation to Implementation, VA Palo Alto; Researcher in Residence, Veterans Justice Programs, VHA Homeless Programs Office; and Affiliated Researcher, National Center on Homelessness among Veterans, VA HSR&D Los Angeles Center of Innovation (COIN) and VISN22 Mental Illness Research, Education, and Clinical Center

Jessica Blue-Howells, LCSW
National Coordinator, Health Care for Reentry Veterans and National Program Manager, Project CHALENG, VHA Homeless Programs Office Health Lead, Homeless-Patient Aligned Care Team (PACT), VA Greater Los Angeles Healthcare System

While there is not research that demonstrates that homelessness causes incarceration or that incarceration causes homelessness, there has long been an understanding that the two influence and create risk for one another. In this webinar Andrea Finlay examines the prevalence of and risk factors for criminal justice involvement among homeless Veterans, and the prevalence of and risk factors for homelessness among justice-involved Veterans. Jessica Blue-Howells discusses the Health Care for Reentry Veterans and Veterans Justice Outreach programs designed to address treatment needs, including homelessness, and risk factors among justice-involved Veterans. Dr. Finlay and Ms. Blue-Howells conclude with future directions for researchers and providers of housing, legal, health, and social services to homeless and criminally justice-involved Veterans.

To view the webinar go to: http://va-eerc-ees.adobeconnect.com/pn5t8f2rh23t/.



Problem Solving Skills and Deficits Among Homeless Veterans with Serious Mental Illness

April 10, 2018

Sonya Gabrielian, MD, MPH
Investigator, VA HSR&D Los Angeles Center of Innovation (COIN) and VISN22 Mental Illness Research, Education, and Clinical Center

Chris Jetton, PhD
Mental Health Lead, Homeless-Patient Aligned Care Team (PACT), VA Greater Los Angeles Healthcare System

Few interventions teach housing-related independent living skills to homeless Veterans. To inform the development of such interventions for Veterans in HUD-VASH with serious mental illness, Dr. Gabrielian and her colleagues examined these Veterans’ problem-solving skills and deficits. They performed semi-structured interviews and cognitive tests with 20 Veterans in HUD-VASH who retained housing for ≥1 year (“stayers”) and 20 Veterans in HUD-VASH who lost housing in <1 year (“exiters”). Salient types of problems were identified in the qualitative data; problem-solving approaches were categorized by complexity level and correlations were sought between such and Veterans’ HUD-VASH outcomes. Instrumental (e.g., money management), interpersonal, and health-related problems were prominent in Veterans’ narratives. Cognition was poor among stayers and exiters. Problem-solving approaches were highly relevant to day-to-day functioning in HUD-VASH. There was a trend towards greater problem-solving complexity in stayers vs. exiters. These data explore potential challenges faced in HUD-VASH and help inform the development of a housing-focused skills training intervention in this program.



Homelessness Among Recent U.S. Veterans

March 13, 2018

Stephen Metraux, PhD
VA National Center on Homelessness among Veterans, Philadelphia, PA

Patricia Bradford
Network Homeless Coordinator, VISN 7, Veterans Health Administration

Media and advocacy outlets have expressed alarm about homelessness among post-9/11 era Veterans, with little systematic research available to evaluate these claims and to offer an empirically-based profile of the nature and extent of homelessness. In this webinar, Dr. Metraux draws upon research, media and advocacy accounts to identify the factors that are particular to homelessness among this most recent cohort of Veterans, with a particular focus on defining military-based factors of this era and broader systemic forces that were formative to their experiences after returning to civilian life. These factors interact to create a set of circumstances that do not appear to currently create substantially elevated rates of homelessness among post-9/11 Veterans, but potentially do warrant policy attention and interventions in specific areas, as well as further monitoring of homelessness risk over the cohort’s collective life course.

To view the webinar go to: http://va-eerc-ees.adobeconnect.com/p51g7jgl1yj5/.



Veteran Sex Offender Access to Housing and Health Services after Release from Incarceration: Obstacles and Best Practices
 

February 13, 2018

Molly Simmons, PhD
Associate Policy Researcher, RAND Corporation

Keith McInnes, ScD, MSc
VA Health Services Researcher, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, Massachusetts VA Medical Center, and Research Assistant Professor, Boston University School of Public Health

Veterans leaving incarceration — “reentry Veterans” — need to be engaged in services upon release in order to reduce their risk of homelessness and reoffending. The VA’s national Health Care for Reentry Veterans (HCRV) program uniquely works to address this gap and identifies 10,000-15,000 incarcerated Veterans annually transitioning back to the community. Within this reentry population, sex offenders are both a particularly vulnerable group and a large sub-population (29% of those incarcerated nationally) who are likely to experience homelessness and emotional and financial hardship due to policies that restrict their housing options. Some research shows that the emotional and financial toll of residency restrictions hamper the efforts of sex offenders to reintegrate into the community, thus making them more likely to re-offend. This study, funded in part by the National Center on Homelessness among Veterans, sought to identify common pathways that sex offenders in Massachusetts take upon release from incarceration; housing restrictions; and barriers to housing, employment and healthcare. In addition, researchers Molly Simmons, Keith McInnes and their colleagues documented best practices used by the VA, and state and community organizations to overcome the barriers faced by sex offenders.

To view the Research Brief, click HERE.  (Due to technical difficulties, the webinar was not recorded.)



The Role of Intimate Partner Violence in Housing Instability and Homelessness among Women Veterans

January 9, 2018

Melissa Dichter, PhD
VA Center for Health Equity Research and Promotion (CHERP)
University of Pennsylvania Perelman School of Medicine

Ann Elizabeth Montgomery, PhD
National Center on Homelessness among Veterans
Health Services Research and Development Program, Birmingham VA Medical Center
University of Alabama at Birmingham School of Public Health

Intimate partner violence (IPV) – physical, sexual, and/or stalking and psychological aggression by a current or former intimate partner -- is a serious public health problem that affects millions of Americans. Women Veterans face an elevated risk of lifetime IPV compared with women who have not served in the military. In addition, IPV is associated with and contributes to housing instability among women in the general population and women Veterans. Melissa Dichter, Ann Elizabeth Montgomery and colleagues recently conducted a study to examine the relationship between IPV and housing instability among women Veterans receiving care in the Veterans Health Administration (VHA). They found nearly one in four women who screened positive for past-year IPV had an indicator of housing instability. Interviews with those who screened positive for homelessness or imminent risk revealed three broad themes: IPV interacts with housing stability both directly and indirectly; experiences of IPV impact women’s definitions of housing safety and security; IPV can present barriers to accessing housing services and other support systems. Findings from this study indicate a need to coordinate systems and services to address the ways that IPV can increase housing insecurity among women Veterans receiving VHA care. Drs. Dichter and Montgomery discussed study results and the implications for improving care for women Veterans who have experienced IPV and associated housing instability.

To view the webinar go to: http://va-eerc-ees.adobeconnect.com/pgjprhfdfj0u/.


 

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