Pathways into homelessness among post 9/11 era veterans

This article may not exactly replicate the final version published in the APA journal. It is not the copy of record.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. Here we track veterans’ trajectories from military service to homelessness through qualitative, semistructured interviews with 17 post-9/11-era veterans. Our objective was to examine how veterans become homeless—including the role of military and postmilitary experiences—and how they negotiate and attempt to resolve episodes of homelessness. We identify and report results in 5 key thematic areas: transitioning from military service to civilian life, relationships and employment, mental and behavioral health, lifetime poverty and adverse events, and use of veteran-specific services. We found that veterans predominantly see their homelessness as rooted in nonmilitary, situational factors such as unemployment and the breakup of relationships, despite very tangible ties between homelessness and combat sequelae that manifest themselves in clinical diagnoses such as posttraumatic stress disorder. Furthermore, although assistance provided by the U.S. Department of Veterans Affairs (VA) and community-based organizations offer a powerful means for getting veterans rehoused, veterans also recount numerous difficulties in accessing and obtaining VA services and assistance. Based on this, we offer specific recommendations for more systematic and efficient measures to help engage veterans with VA services that can prevent or attenuate their homelessness

Predictors of homelessness among families and single adults after exit from homelessness prevention and rapid re-housing programs: evidence from the Department of Veterans Affairs Supportive Services for Veteran Families Program

This article assesses the extent and predictors of homelessness among Veterans (both Veterans in families with children and single adults Veterans) exiting the Supportive Services for Veteran Families (SSVF) program, which is a nationwide homelessness prevention and rapid re-housing program geared primarily towards those experiencing crisis homelessness. Among rapid re-housing participants, 16% and 26% of single adult Veterans experienced an episode of homelessness at one and two years post-SSVF exit; the comparable figures at those follow-up times for Veterans in families were 9.4% and 15.5%, respectively. Relatively fewer single adult Veterans and Veterans in families receiving homelessness prevention services experienced an episode of homelessness at one and two years post-SSVF exit. Veteran-level characteristics, including age, gender, prior history of homelessness and recent engagement with VA healthcare were generally more salient predictors of homelessness following SSVF exit than variables measuring SSVF program factors, or community-level housing market conditions.U.S. Department of Veterans Affairs, National Center on Homelessness Among Veteran

Homelessness and Public Health in Los Angeles

Los Angeles faces a housing crisis of unprecedented scale. After years of underinvestment, in 2016/2017 LA County voters approved Measures H and HHH, which provided an infusion of resources for homeless services, permanent housing, and integrated outreach through the LA County Homeless Initiative (HI). An estimated 58,936 individuals in LA County remain homeless as of January 2019, 75% of them unsheltered and living on streets, in tents, or encampments. Our best estimates suggest that the homeless population has grown since 2017.HI takes a Housing First approach to homelessness, with the largest amount of total funds allocated to housing solutions. However, rehousing is often subject to delays in construction and case management. These delays, combined with persistent market forces driving new homelessness, have left the county well short of its targets. While no forecasts were issued, the initial gap analysis for HI had assumed a 34% reduction in the total homeless count from 2016 to 2019. The count has in fact increased by 26% over that period, meaning 28,000 more homeless clients than anticipated on any night. Whereas cities with comparable homeless crises such as New York have focused on increasing the availability of emergency shelters and safe havens in addition to permanent housing, LA County’s relatively low investment in transitional options has resulted in persistent levels of unsheltered homelessness.Research has shown that homelessness has severe health consequences. Homeless individuals have a high risk of mortality, with a recent LA County Medical Examiner report finding an average age of death of 48 for women and 51 for men. Homeless individuals have much higher risks of mental illness, substance abuse, infectious disease, chronic illness, violence, and reproductive health risks than the general population. Much less is known about the health burdens associated with being unsheltered, but most evidence points to substantially greater health risks given the more intense exposures to violence, weather, pollution, poor sanitation, and behavioral risk. Research is just beginning to quantify the burdens of living on the streets.Our analysis of the LA County homelessness response drew on expert interviews, data analysis, and document review. Beyond the growing numerical gap between HI’s targets and actual trends, we identified five critical service gaps that require immediate attention: Taking a person-centered approach that recognizes both the diversity of client needs and the limitations of existing resources, yet honors the principle that everyone deserves housing; Improving access to emergency shelters by reducing legal and political barriers to construction and adopting “low barrier shelters” that facilitate entry; Delivering comprehensive street medicine and other services to unsheltered homeless populations using evidence-based models that support the path to housing and recovery Adopting more extensive outreach models that engage citizens, empower homeless clients and leverage mobile technology so that case workers can focus on clients most in need; Strengthening data collection and research methods to understand the consequences of unsheltered homelessness, pilot new service models, and evaluate rehousing efforts

Unsheltered homelessness among veterans: correlates and profiles

We identified correlates of unsheltered status among Veterans experiencing homelessness and describe d distinct subgroups within the unsheltered homeless Veteran population using data from a screening instrument for homelessness that is administered to all Veterans accessing outpatient care at a Veterans Health Administration (VHA) facility . Correlates o f unsheltered homelessness included male gender, white race, older age, lower levels of VHA eligibility, substance use disorders, frequent use of VHA inpatient and infrequent use of VHA outpatient services, and residing in the West. We identified six disti nct subgroups of unsheltered Veterans; the tri - morbid frequent users represented the highest need group, but the largest group was comprised of Veterans who made highly infrequent use of VHA healthcare services. Differences between sheltered and unshelter ed Veterans and heterogeneity within the unsheltered Veteran population should be considered in targeting housing and other interventions.National Center on Homelessness Among Veteran

“You don’t see them on the streets of your town”: challenges and strategies for serving unstably housed veterans in rural areas

Research on policy and programmatic responses to homelessness has focused largely on urban areas, with comparatively little attention paid to the rural context. We conducted qualitative interviews with a nationwide sample of rural-serving agencies receiving grants through the U.S. Department of Veterans Affairs’ Supportive Services for Veteran Families program to better understand the housing needs, available services, needed resources, and challenges in serving homeless and unstably housed veterans in rural areas. Respondents discussed key challenges—identifying unstably housed veterans, providing services within the rural resource context, and leveraging effective collaboration—and strategies to address these challenges. Unmet needs identified included emergency and subsidized long-term housing options, transportation resources, flexible financial resources, and additional funding to support the intensive work required in rural areas. Our findings identify promising programmatic innovations and highlight the need for policy remedies that are responsive to the unique challenges of addressing homelessness and housing instability in rural areas.Accepted manuscrip

Pathways into multiple exclusion homelessness in seven UK cities

This paper interrogates pathways into multiple exclusion homelessness (MEH) in the UK and, informed by a critical realist theoretical framework, explores the potential causal processes underlying these pathways. Drawing on an innovative multistage quantitative survey, it identifies five experiential clusters within the MEH population, based on the extent and complexity of experiences of homelessness, substance misuse, institutional care, street culture activities and adverse life events. It demonstrates that the most complex forms of MEH are associated with childhood trauma. It also reveals that the temporal sequencing of MEH-relevant experiences is remarkably consistent, with substance misuse and mental health problems tending to occur early in individual pathways, and homelessness and a range of adverse life events typically occurring later. The strong inference is that these later-occurring events are largely consequences rather than originating causes of MEH, which has important implications for the conceptualisation of, and policy responses to, deep exclusion. </jats:p

Cost of health care utilization among homeless frequent emergency department users

Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity

Rearranging the Deck Chairs or Reallocating the Lifeboats?: Homelessness Assistance and Its Alternatives

Problem: At present, homelessness in the United States is primarily addressed by providing emergency and transitional shelter facilities. These programs do not directly address the causes of homelessness, and residents are exposed to victimization and trauma during stays. We need an alternative that is more humane, as well as more efficient and effective at achieving outcomes. Purpose: This article uses research on homelessness to devise alternative forms of emergency assistance that could reduce the prevalence and/or duration of episodes of homelessness and much of the need for emergency shelter. Methods: We review analyses of shelter utilization patterns to identify subgroups of homeless single adults and families with minor children, and propose alternative program models aimed at the particular situations of each of these subgroups. Results and conclusions: We argue that it would be both more efficient and more humane to reallocate resources currently devoted to shelters. We propose the development of community-based programs that instead would focus on helping those with housing emergencies to remain housed or to quickly return to housing, and be served by mainstream social welfare programs. We advocate providing shelter on a limited basis and reserving transitional housing for individuals recently discharged from institutions. Chronic homelessness should be addressed by permanent supportive housing

Predictors Of Readmission In Shelters And Other Services Among Homeless Adults In Detroit

Admission to an emergency shelter reflects an important outcome in a person\u27s life, and many admissions to an emergency shelter reflects a human and financial cost. This article discusses the evolution of the measurement and understanding of homelessness. It looks at characteristics of people who make use of shelter in a chronic fashion to better understand what might predict risk for future continued use. This includes an analysis of a large dataset of emergency shelter utilization in Detroit Michigan collected between 2008 and 2012. Analysis reveals that fundamental demographic information, individual\u27s interactions with the shelter system (good or bad), and affluence and education attainment meaningfully predict readmissions to emergency shelters