Predictive modeling of housing instability and homelessness in the Veterans Health Administration

OBJECTIVE: To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (VHA). DATA SOURCES/STUDY SETTING: Electronic medical record data from 5.8 million Veterans who responded to the VHA's Homelessness Screening Clinical Reminder (HSCR) between October 2012 and September 2015. STUDY DESIGN: We randomly selected 80% of Veterans in our sample to develop predictive models. We evaluated the performance of both logistic regression and random forests—a machine learning algorithm—using the remaining 20% of cases. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from two sources: VHA's Corporate Data Warehouse and National Homeless Registry. PRINCIPAL FINDINGS: Performance for all models was acceptable or better. Random forests models were more sensitive in predicting housing instability and homelessness than logistic regression, but less specific in predicting housing instability. Rates of positive screens for both outcomes were highest among Veterans in the top strata of model‐predicted risk. CONCLUSIONS: Predictive models based on medical record data can identify Veterans likely to report housing instability and homelessness, making the HSCR screening process more efficient and informing new engagement strategies. Our findings have implications for similar instruments in other health care systems.U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Grant/Award Number: IIR 13-334 (IIR 13-334 - U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSRD))Accepted manuscrip

The Potential for Public-Private Partnerships: Philanthropic Leaders Considering Housing as a Platform

Explores foundation leaders' approaches to housing as a platform for layering programs and services to improve quality of life, views on funding partnerships with the federal government, and suggestions for targeted collaborations. Includes case studies

New Ways of Addressing the Psychological Traumas of War: Supplementing Traditional Social Supports to Prevent Homelessness Among Mentally Ill Veterans

Both nationally and in Rhode Island, there is a high prevalence of veterans in the homeless population. Many homeless veterans suffer from serious mental health issues and military specific traumas, adding to the social stigma they face. To avoid homelessness, veterans need to treat their mental illness with the assistance of their social support networks. Despite incredible advances in technology and mental health care, provision of mental health services to veterans still remains very traditional. With an influx of veterans returning from the current conflicts in Iraq and Afghanistan, a greater number of younger clients will be entering the system. Because of their comfort with computers, the Internet and social networking tools, there is a natural progression for these veterans to use the Internet to support one another in their return from combat and readjustment to civilian life. To prevent isolation and encourage continued receipt of mental health services, online social support services can help veterans avoid homelessness when used as a supplement to traditional mental health treatment. A survey of nine (N=9) social workers at the VAMC showed that social workers who serve veterans would find online social supports helpful for their clients and would recommend these services as a supplement to their traditional therapeutic treatment

Sun Devils Together: Breaking Stigmas on Student Homelessness

abstract: In universities, such as Arizona State, students are becoming homeless at an alarming rate. These homeless ASU students are often invisible, as seen through the lack of information on who they are and what resources the university has developed to help them. Typically, students arrive at university campuses with most of the resources required for them to pursue a degree. However, several economic factors such as unemployment or financial instability can impact these resources which influence students ability to stay enrolled in classes. This feature is reflected in the well understood concept of the starving student. Despite this paradigm, the fact remains that students under this stress are attending classes and are under financial stress to do so while being unable to meet their basic needs. These intertwined elements result in ASU students becoming exposed to cyclical needs-insecurities including homelessness. Therefore, the team decided to develop a project called Sun Devils Together which addresses the needs of ASUs students facing homelessness and overall aims to help increase the accessibility of available resources through reducing the silo effect that occurs due to lack of communication between different departments and increases faculty, staff, and student awareness regarding the issue. In order to achieve this, the team has collaborated with the Assistant Dean of Students to produce a training module for ASU faculty, professional staff, and students. The team is contributing information to the creation of a new website that will have all the resources available to students in one place. In addition, the team will create a coded pamphlet with a map of resources that will be given out to different departments around campus that students may potentially reach out to for help while informing those departments regarding the existence of other departments that work towards the same cause

Use of harm reduction strategies in an occupational therapy life skills intervention

Thesis (M.S.)--Boston UniversityObjectives of Study: Harm reduction intervention strategies have the potential to support positive health outcomes. However, no studies have explored how these strategies can be implemented in an occupational therapy intervention. This study addresses this knowledge gap by examining harm reduction strategies that were discussed during group and individual sessions of an occupational therapist-led life skills intervention for people who have a mental illness and are or were homeless. Methods: This study is a secondary analysis of a larger study that used a longitudinal repeated measures design to implement a life skills intervention. This secondary analysis uses a mixed methods design. Qualitative methods were used for data collection and initial analysis. Quantitative methods were then used to analyze differences between settings. Results: Three major themes emerged from the data: Financial, Physical, and Psychosocial Hann Reduction. The most prevalent theme was Financial Harm Reduction. All three themes were present throughout all of the different life skills intervention modules. There was no significant difference in the themes used between settings. Limitations and Recommendations for Further Research: This study was limited to what was documented in the therapy notes. Although the notes may not include every discussion that occurred, these results suggest that harm-reduction strategies can be utilized in an occupational therapy intervention. Additional research is needed to investigate how harm reduction can be implemented in other areas of occupational therapy practice

Taking Care of the New Home Front: Leveraging Greater Federal Resources to Expand Community Capacity for NYS Veterans and Families

This report from the Syracuse University Institute for Veterans and Military Families (IVMF) looks at the progress of the Supportive Services for Veteran Families (SSVF) program, a first-of-its-kind initiative that assists veteran families at imminent risk of homelessness in maintaining safe, permanent housing.SSVF is also designed to meet the needs of veteran families that have become homeless by rapidly re-engaging with permanent housing and other support structures to achieve quick housing outcomes and community integration. SSVF ensures that every veteran household in New York State would have access to high-quality, outcome-oriented homelessness prevention services.The New York State Health Foundation (NYSHealth) and IVMF recognized this program as an opportunity to make a demonstrable impact in preventing veteran homelessness in New York State. With support from NYSHealth, the IVMF is working to grow the capacity for SSVF grantee applicants and will work with existing grantees to help increase their capacity to serve veterans. As result of NYSHealth's investment, New York State secured $26 million in federal resources through the SSVF program in 2013

Six-year mortality in a street-recruited cohort of homeless youth in San Francisco, California.

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004. Methods. Using data collected from a longitudinal, venue-based sample of street youth 15-24 years of age, we calculated age, race, and gender-adjusted mortality rates. Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3-18.9]). Gender specific SMRs were 16.1 (95% CI [3.3-47.1]) for females and 9.4 (95% CI [4.0-18.4]) for males. Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the states general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population

An Investigation of the Perceptions of Community Residents and Volunteer Researchers for the Community Health of the Clarke Square Neighborhood

The study explored the similarities and differences in community residents’ perceptions and volunteer researchers’ perceptions of community health indicators in the Clarke Square Neighborhood. The study sought to identify noteworthy differences between community residents’ perceptions and volunteer researchers’ perceptions, indicating the importance of including community members in community health research. In the study, community residents in the Clarke Square Neighborhood conducted a survey that had previously been done by volunteer researchers from the Urban Ecology Center and the Medical College of Wisconsin regarding community health indicators in the Clarke Square Neighborhood. The study also included a focus group, which discussed the perceptions of community residents and volunteer researchers regarding community health in the Clarke Square Neighborhood and the role that communities play in research. The study found several noteworthy differences in the perceptions of community residents and volunteer researchers regarding community health in the Clarke Square Neighborhood

Hidden in Plain Sight: Homeless Students In America's Public Schools

Student homelessness is on the rise, with more than 1.3 million homeless students identified during the 2013-14 school year. This is a 7 percent increase from the previous year and more than double the number of homeless students in 2006-07. As high as these numbers seem, they are almost certainly undercounts.Despite increasing numbers, these students - as well as the school liaisons and state coordinators who support them - report that student homelessness remains an invisible and extremely disruptive problem.Students experiencing homelessness struggle to stay in school, to perform well, and to form meaningful connections with peers and adults. Ultimately, they are much more likely to fall off track and eventually drop out of school more often than their non-homeless peers.This study:provides an overview of existing research on homeless students,sheds light on the challenges homeless students face and the supports they say they need to succeed,reports on the challenges adults - local liaisons and state coordinators - face in trying to help homeless students, andrecommends changes in policy and practice at the school, community, state and national level to help homeless students get on a path to adult success.This is a critical and timely topic. The recent reauthorization of the Every Student Succeeds Act (ESSA) provides many new and stronger provisions for homeless students (effective Oct. 1, 2016); requires states, district and schools for the first time to report graduation rates for homeless students (effective beginning with the 2016-17 school year); and affirms the urgency and importance of dealing with homelessness so that all children can succeed