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Helping Formerly Homeless Veterans Re-Integrate is the Mission of VA’s THRIVe Center

Two men and a woman sitting and talking.
Pictured from left, Associate Director Dr. Stephen Marder, Director Michael Green, PhD, and Associate Director Dr. Sonya Gabrielian of a VA Rehabilitation Research and Development Center known as THRIVe on the West LA VA campus. THRIVe’s mission is to help formerly homeless Veterans successfully re-integrate into their communities. Photo by Cara Deptula.

As VA stands firm in its commitment to house every homeless Veteran, there’s a critical question that remains: once a Veteran is housed, how do we make sure they successfully integrate into their community?

Finding the answer is the mission of a VA Rehabilitation Research and Development Center known as THRIVe, headquartered at West Los Angeles VA Medical Center. 

THRIVe stands for Toward Homelessness Recovery and Integration for Veterans, and since 2020 its team of investigators, led by Director Michael Green, PhD; and Associate Directors Dr. Sonya Gabrielian and Dr. Stephen Marder, has been doing innovative work to help formerly homeless Veterans retain housing and re-integrate into their communities. 

The key takeaway from THRIVe leadership is that just providing housing isn’t enough for Veterans to be successful in their daily lives. 

“There has been such an overriding focus on providing housing that it’s sometimes easy to forget that we’re working with the whole person, the whole Veteran, and that their social, family and work needs for establishing purpose and connection are not always met with the provision of a roof,” said Green.

Coming Together to Serve Veterans

The approximately 20 researchers at THRIVe have a wide range of expertise in everything from psychiatric rehabilitation to clinical psychopharmacology to urban planning and social work. Green, Gabrielian and Marder are all also professors in the department of psychiatry at UCLA.

Green has spent most of his career focused on studying psychotic disorders such as schizophrenia. Many of his previous findings in psychosis and homelessness have been applicable to the center’s work, he said.

Gabrielian has long been involved with research involving homeless populations. “I have always been interested in safety net systems of health care and systems of care that serve the underserved,” she said. That interest led her to VA back in 2011. 

Marder came to VA in 1977. In addition to his work with THRIVe, he’s director of VA Desert Pacific’s Mental Illness Research, Education, and Clinical Center. “We’re showing that these Veterans need other services as well if they’re going to reestablish their lives in the community,” said Marder of THRIVe’s efforts.

Helping Veterans Get to Their Goals

According to Green, one of the most important findings the center has discovered thus far relates to internal motivation. In two independent studies, the team discovered that self-reported motivation and motivational beliefs were the best personal predictors of future community integration for Veterans.

Their findings are actively being used to develop training for VA Greater Los Angeles Healthcare System (VAGLAHS) staff who serve homeless Veterans.

The team took their findings about motivation and developed a new type of therapy to help improve motivation among formerly homeless Veterans.

The intervention is actually a combination of two evidence-based interventions: motivational interviewing (MI) and Cognitive Behavioral Therapy (CBT). MI involves asking questions that help the person overcome insecurities and find internal motivation to change. CBT is a well-known form of therapy that aids the person in changing their thought patterns and behaviors. 

“With MI, we ask the Veteran to define their own goals, and the therapist works with the Veteran to increase their motivation,” said Gabrielian.

The team emphasizes that MI can be done by any provider who’s trained in the technique – they don’t have to be a licensed therapist. CBT, however, must be performed by a therapist.

So far, VAGLAHS service providers at the Domiciliary; Psychosocial Rehab and Recovery Center; and Homeless Patient Aligned Care Team have undergone training in motivational interviewing, with more trainings planned for the future.

The team is developing a website toolkit with training videos, articles, case examples, and recent publications. 

“This problem that Veterans have in finding the motivation and drive to return to their communities and integrate – it is treatable,” said Marder. “It is manageable.”

Planning for the Future

Green recently presented to VA leadership who are overseeing the Master Plan 2022, the agreement that outlines the transformation of the West LA VA Medical Center into a community and home for Veterans.

With 233 units for formerly homeless Veterans already open on campus and at least 967 more in the works, the center’s work will become increasingly important to ensure the needs of all residents are met. 

“There are challenges after someone gets an apartment and that is increasingly going to be a focus moving ahead,” said Green. “As we start having some success with housing Veterans, we still have these other obstacles ahead of us.”

The center is funded through 2030, so there’s a lot planned for the years ahead. Some of the research topics that are emerging include race, ethnicity, and community integration; mobile phone social support from peers; and exploring and strengthening family relationships. 

The team also hopes to help change public perception around homelessness.

“There’s a tendency to want to not see homeless people, to miss their promise and capabilities,” said Marder. “Research programs to understand their barriers and how to address them can come a long way in changing the way communities look at people who’ve been homeless.”