Assessing longitudinal housing status using Electronic Health Record data: a comparison of natural language processing, structured data, and patient-reported history

IntroductionMeasuring long-term housing outcomes is important for evaluating the impacts of services for individuals with homeless experience. However, assessing long-term housing status using traditional methods is challenging. The Veterans Affairs (VA) Electronic Health Record (EHR) provides detailed data for a large population of patients with homeless experiences and contains several indicators of housing instability, including structured data elements (e.g., diagnosis codes) and free-text clinical narratives. However, the validity of each of these data elements for measuring housing stability over time is not well-studied.MethodsWe compared VA EHR indicators of housing instability, including information extracted from clinical notes using natural language processing (NLP), with patient-reported housing outcomes in a cohort of homeless-experienced Veterans.ResultsNLP achieved higher sensitivity and specificity than standard diagnosis codes for detecting episodes of unstable housing. Other structured data elements in the VA EHR showed promising performance, particularly when combined with NLP.DiscussionEvaluation efforts and research studies assessing longitudinal housing outcomes should incorporate multiple data sources of documentation to achieve optimal performance

The Impact of COVID-19 on Access to Resources among Individuals Experiencing Homelessness and Traumatic Brain Injury

The rates of traumatic brain injury (TBI) are higher among individuals experiencing homelessness compared with the general population. Individuals experiencing homelessness and a TBI may experience barriers to care. COVID-19 may have further impacted access to basic resources, such as food, shelter, and transportation for individuals experiencing homelessness. This study aimed to answer the following research question: What is the impact of COVID-19 on access to resources among individuals experiencing homelessness and TBI? A cross-sectional study design and purposive sampling were utilized to interview 38 English-speaking adults experiencing homelessness and who had sustained a TBI (ages 21–73) in one Colorado city. Qualitative questions related to the impact of COVID-19 were asked and qualitative analysis was used to analyze the responses. Three primary themes emerged regarding the types of resources that were restricted by COVID-19: basic/biological needs, financial needs, and a lack of connection. COVID-19 has shown the social work field the need for continued innovation and better practice standards for individuals who are not housed. For those living with a reported TBI history and experiencing homelessness, COVID-19 made it difficult to access basic services for survival

The Intersection of Traumatic Brain Injury and Homelessness

The rates of TBI are significantly higher among individuals experiencing homelessness compared to the general population. Up to half of individuals experiencing homelessness may have a TBI. Accurate prevalence rates of TBI among individuals experiencing homelessness are difficult to obtain due to different methods of sampling participants and differing definitions of TBI; therefore, estimates may be underrepresented. Despite past research that has examined the relationship between TBI and homelessness, there are specific gaps in knowledge such as correlates and risk factors of TBI among individuals experiencing homelessness. This three-manuscript dissertation attempts to address these gaps in knowledge. The first manuscript examined the temporal relationship between TBI and homelessness. This relationship is hypothesized as bi-directional, as factors associated with homelessness may increase the risk of TBI, while at the same time, factors associated with TBI may impact one’s housing stability. The directionality and mental health correlates were examined. Findings showed higher rates of reported TBI among a sample of adults experiencing homelessness compared to what current literature suggests, further suggesting that TBI may be a significant risk factor of homelessness. Manuscript two arose during the COVID-19 pandemic. Access to resources were restricted for housed and unhoused individuals. Manuscript two studied the impact that COVID-19 had on access to resources among individuals experiencing homelessness and a TBI. Qualitative findings revealed that basic/biological needs, financial needs, and lack of social support were more restricted by COVID-19 among individuals experiencing homelessness and a TBI. Continued innovations such as tiny home villages, safe parking lots, and safe camping spaces are recommended to provide safety and a sense of community among unhoused individuals. Manuscript three studied the role of social support among individuals experiencing homelessness and a TBI. Positive social support among individuals experiencing homelessness and a TBI is important because it can serve as a protective factor against stress, substance use, and housing instability. The consequences of a TBI along with risk factors for homelessness, specifically substance use, can impact social support. Findings showed that substance use was a barrier to staying housed and rates of social support were low across the sample

Correlates of Acquiring a Traumatic Brain Injury before Experiencing Homelessness: An Exploratory Study

The rates of traumatic brain injury (TBI) are significantly higher among individuals experiencing homelessness compared to the general population. The relationship between TBI and homelessness is likely bi-directional as factors associated with homelessness may increase the risk of acquiring a TBI, and factors associated with TBI could lead to homelessness. This study builds upon previous research by investigating the following research questions: (1) What are the rates of TBI among a sample of individuals experiencing homelessness? (2) Does a TBI experience precede or follow an initial period of homelessness? And, (3) What are the correlates of TBI prior to homelessness including self-reported mental health variables? A cross-sectional study design and purposive sampling were utilized to interview 115 English-speaking adults (ages 18–73) in two Colorado cities. Results show, 71% of total participants reported a significant history of TBI, and of those, 74% reported a TBI prior to experiencing homelessness. Our logistic regression models reveal a significant relationship between mental health and acquiring a TBI prior to experiencing homelessness. Implications include prioritizing permanent supportive housing followed by other supportive services

Correlates of Acquiring a Traumatic Brain Injury before Experiencing Homelessness: An Exploratory Study

The rates of traumatic brain injury (TBI) are significantly higher among individuals experiencing homelessness compared to the general population. The relationship between TBI and homelessness is likely bi-directional as factors associated with homelessness may increase the risk of acquiring a TBI, and factors associated with TBI could lead to homelessness. This study builds upon previous research by investigating the following research questions: (1) What are the rates of TBI among a sample of individuals experiencing homelessness? (2) Does a TBI experience precede or follow an initial period of homelessness? And, (3) What are the correlates of TBI prior to homelessness including self-reported mental health variables? A cross-sectional study design and purposive sampling were utilized to interview 115 English-speaking adults (ages 18–73) in two Colorado cities. Results show, 71% of total participants reported a significant history of TBI, and of those, 74% reported a TBI prior to experiencing homelessness. Our logistic regression models reveal a significant relationship between mental health and acquiring a TBI prior to experiencing homelessness. Implications include prioritizing permanent supportive housing followed by other supportive services