Veterans Experiencing Homelessness
Connecting Research to Practice
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 Veterans currently or formerly homeless. For 2021 and beyond, Connecting Research to Practice webinars are incorporated in the Center’s National Education Series.
- Motivational and Cognitive Predictors of Community Integration in Recently-Housed Veterans
- Helping Veterans Experiencing Homelessness Manage Their Money: A Guide for Case Managers
- Buprenorphine Treatment for Homeless Veterans with an Opioid Use Disorder: InnovativeMobile-Based, Low Threshold Option to Improve Patient Engagement
- Improving Recovery and Community Re-Engagement in the HUD-VASH Program
- Dementia in Aging Homeless Veterans: Research and Clinical Implications
- Housing Instability, Housing Services Utilization, and Suicide Morbidity among Transgender Veterans
- Challenges and Strategies for Serving Unstably Housed Veterans in Rural Areas: Evidence from the Supportive Services for Veteran Families (SSVF) Program
- Pathways into Homelessness among post-9/11-Era Veterans
- Addiction Housing Case Management for Homeless Veterans Enrolled in Addictions Treatment
- Homeless and Justice-Involved Veterans: What does the Research Tell us?
- Problem Solving Skills and Deficits Among Homeless Veterans with Serious Mental Illness
- Homelessness Among Recent U.S. Veterans
- Veteran Sex Offender Access to Housing and Health Services after Release from Incarceration: Obstacles and Best Practices
- The Role of Intimate Partner Violence in Housing Instability and Homelessness among Women Veterans
Motivational and Cognitive Predictors of Community Integration in Recently-Housed Veterans
March 10, 2020
Michael Foster Green, PhD, Director, VA Research Enhancement Award Program (REAP) on Enhancing Community Integration for Homeless Veterans; Director, Treatment Unit of the VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC); and Distinguished Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA
Jonathan K. Wynn, PhD, Health Science Specialist, VA Greater Los Angeles Healthcare System; and Research Psychologist, Semel Institute, UCLA
Sonya Gabrielian, MD, MPH, Health Services Researcher and Psychiatrist, VA Greater Los Angeles Healthcare System; and Assistant Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA
Cendrine Robinson, PhD, MPH, Scientific Program Manager, Behavioral Health & Social Reintegration, VA Rehabilitation Research & Development Service (RR&D)
Community integration -- connections to friends and family, work and productive activities, managing activities of daily living -- is a general problem for persons with many clinical psychiatric disorders and other vulnerable populations, including individuals experiencing homelessness. One important public health goal is to improve recovery for Veterans with a history of homelessness, though this goal remains elusive, partly because we do not know the determinants of community integration for these individuals.
The largest VA program to address homelessness involves a partnership between the Department of Housing and Urban Development and VA Supportive Housing -- the HUD-VASH program. This program has helped to reduce rates of homelessness among Veterans, but the broader goal of achieving community integration for Veterans once they receive housing has received much less attention.
In this Connecting Research to Practice webinar Dr. Michael Green and Dr. Jonathan Wynn, researchers at both VA and UCLA, share findings from two studies that looked at changes in community integration before and after Veterans were housed. Following the presentation Dr. Sonya Gabrielian, psychiatrist and researcher at VA Greater Los Angeles, and Dr. Cendrine Robinson, Scientific Program Manager in the VA’s Rehabilitation Research & Development Service, discuss the clinical implications of the research findings and what kinds of recovery-oriented interventions practitioners in the field might consider to improve community integration outcomes.
Helping Veterans Experiencing Homelessness Manage Their Money: A Guide for Case Managers
January 21, 2020
Eric Elbogen, PhD, ABPP (Forensic), Researcher, National Center on Homelessness among Veterans, Professor, Duke University School of Medicine
Allison Bond, LCSW, Community Resource and Referral Centers (CRRC) & Health care for Homeless Veterans (HCHV) Outreach National Program Manager, VHA Homeless Programs
Janine Griggs, MSW, LICSW, Clinical Program Specialist, National Grant and Per Diem (GPD) Program Office, VHA Homeless Programs
Veterans comprise 7% of the homeless population. According to the U.S. Department of Housing and Urban Development (HUD), 37,085 Veterans experienced homelessness on a single night in January 2019, a 51% decline since 2009. Research shows there are many reasons and risk factors underlying these numbers, including: posttraumatic stress disorder (PTSD), depression, serious mental illness, substance use disorder, and criminal justice contact. However, another potential – and sometimes overlooked -- contributor to homelessness lies in the challenge of achieving financial stability after military service.
On January 21, 2020 Dr. Eric Elbogen presented a brief psychoeducational, recovery-oriented money management intervention called $teps for Achieving Financial Empowerment ($AFE). Designed primarily for case managers working with Veterans with psychiatric disabilities, $AFE has been tested and shows that when Veterans use the skills learned in the program, they demonstrate less impulsive buying; greater knowledge about finances; more responsible spending/saving; increased number of hours working; and Increased engagement in vocational activities. Following the $AFE overview, representatives from VHA Homeless Programs discussed how the issue of financial empowerment is being addressed in the Health Care for Homeless Veterans and Grant & Per Diem programs and the feasibility of incorporating $AFE into current practices.
Buprenorphine Treatment for Homeless Veterans with an Opioid Use Disorder: Innovative Mobile-Based, Low Threshold Option to Improve Patient Engagement
October 1, 2019
Theddeus Iheanacho, MD, Medical Director, Errera Community Care Center, VA Connecticut Healthcare System and Associate Professor of Psychiatry, Yale University School of Medicine
Elizabeth Oliva, PhD, Opioid Overdose Education and Naloxone Distribution (OEND) Program Coordinator, VA Program Evaluation and Resource Center, VA Office of Mental Health Operations; and Investigator, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System
The opioid epidemic has greatly impacted homeless and at-risk populations, including Veterans. A recent study showed that 6% of Veterans entering a VHA homeless program in 2016 had an opioid use disorder (OUD). In the VA health care system, opioid use disorder medication, such as buprenorphine and methadone, is available only in specialty substance use disorder (SUD) clinics at many sites. Accessing these clinics can be challenging for Veterans experiencing homelessness due to unstable living environment, lack of social support, transportation difficulties, emotional trauma, and limited finances. There are national efforts to increase the availability of medications for opioid use disorder outside of specialty SUD clinics (e.g., Stepped Care for Opioid Use Disorder Train-the-Trainer). This presentation focused on an innovative effort to increase the availability and accessibility of buprenorphine. Dr. Theddeus Iheanacho piloted a mobile, community-based access team (M-CAT) for buprenorphine treatment within established homeless programs in the VA Connecticut Healthcare System. In this Connecting Research to Practice he shared what he learned in comparing M-CAT with usual care and discuss next steps for scaling the model at other VA medical centers. Dr. Elizabeth Oliva commented on the pilot findings and shared information about VA’s education and technical assistance in treating opioid use disorder.
July 9, 2019
Sonya Gabrielian, MD, MPH, Psychiatrist and Health Services Researcher, VA Greater Los Angeles and UCLA David Geffen School of Medicine
Evangelina (Vangie) Ligons, LCSW, HUD-VASH Coordinator, VA Greater Los Angeles
Latasha Saffo, LCSW, HUD-VASH Social Worker Supervisor (Intake Team), VA Greater Los Angeles
Jesse Vazzano, LICSW, National Director, HUD-VA Supportive Housing (HUD-VASH), Homeless Programs Office, Veterans Health Administration
Veterans with a history of homelessness who participate in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program receive subsidized permanent housing and community-based supportive services. While HUD-VASH is often credited for the 48% decrease in Veteran homelessness from 2009-2018, permanent housing is only the first step towards recovery from homelessness, a process that ideally entails building a fulfilling life with autonomy and social relationships. Though clinical services are prioritized in HUD-VASH—with clear parameters to facilitate the acquisition and maintenance of rental units—there are few guidelines to promote recovery among Veterans who successfully achieve housing. This webinar shared findings from a recent study that seeks to address a lack of knowledge about the HUD-VASH program’s impact on Veterans’ social integration and self-sufficiency. The study’s principal investigator, Sonya Gabrielian, discussed the implications for practice with HUD-VASH National Director Jesse Vazzano and HUD-VASH social workers Vangie Ligons and Latasha Saffo.
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.
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/.
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; and 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/.
October 10, 2017
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; and 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); and 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/.
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/.
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.
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.)
January 9, 2018
Melissa Dichter, PhD, VA Center for Health Equity Research and Promotion (CHERP); and University of Pennsylvania Perelman School of Medicine
Ann Elizabeth Montgomery, PhD, Researcher, National Center on Homelessness among Veterans; Health Services Research and Development Program, Birmingham VA Medical Center; and 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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