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Commentary

Using Research and Data to End Veteran Homelessness

No Veteran should be homeless in this country they fought to defend. VA is committed to ending homelessness among Veterans because it is our nation’s duty to ensure all Veterans have a place to call home. Although significant progress has been made to prevent and end Veteran homelessness, recent data from the U.S. Department of Housing and Urban Development show that on a single night in January 2023, 35,574 Veterans experienced homelessness in the United States. This figure reflects a 7.4 percent increase in the number of Veterans experiencing homelessness from 2022.

Despite these increases, there is still an overall downward trend in Veteran homelessness. The estimated number of Veterans experiencing homelessness in the United States has declined by 52 percent since 2010. The last three years alone saw an approximately 4 percent overall reduction in Veteran homelessness.

We know what works. Veteran homelessness is solvable, and we have the right tools for the job, ranging from outreach services, which serve as the front doors to VA healthcare and benefits, to emergency and transitional housing for Veterans who need a place to stay tonight, to permanent housing and more. All these services are built around the evidence-based Housing First approach. This approach prioritizes getting Veterans into housing and then assists them with access to healthcare and other supports that promote stable housing and improved quality of life. These programs are overseen by the Veterans Health Administration’s Homeless Programs Office (HPO), which serves as the backbone of VA’s response to Veteran homelessness.

The Role of Research in Addressing Veteran Homelessness

Within HPO, the National Center on Homelessness among Veterans (NCHAV) promotes and conducts research that explores the causes and contributing factors of Veteran homelessness, develops new models for service delivery, and evaluates the effectiveness of programs and services. In partnership with other VA program offices and various federal and non-federal partners, we now have more than two decades of research on homeless Veterans.

Through annual assessments of homeless Veterans, we understand their housing, healthcare, and social needs (Tsai et al., 2019). We have identified key risk factors of Veteran homelessness, and worked to understand how experiences of homelessness and VA service use intersect with sex and race (Montgomery et al., 2020). Various studies have found that the continuum of VA homeless programs is effective in serving diverse groups of Veterans, from temporary financial assistance to permanent supported housing services.

The positive impact research has on better understanding and addressing the complexities of Veteran homelessness cannot be overstated. Through rigorous analysis and evaluation, researchers have been able to answer pivotal questions that have directly informed policy, program design, and service delivery for homeless Veterans. Here are some key areas where research has made significant contributions.

• Effectiveness of the Housing First Approach. Research has robustly supported the Housing First model as an effective strategy for ending homelessness among Veterans. Many studies have demonstrated that Housing First programs significantly increase housing stability and reduce the use of emergency services for homeless Veterans. This evidence has led to the widespread adoption of Housing First principles across VA homeless programs.
• Identifying Key Risk Factors. Research has been crucial in identifying risk factors associated with Veteran homelessness, enabling targeted interventions. Factors that are strongly associated with homelessness among Veterans include substance abuse, mental health disorders, and low income (Tsai & Rosenheck, 2015). Understanding these risk factors has guided the development of specialized support services within VA programs.
• Impact of Supportive Services on Health Outcomes. Investigations into the role of supportive services offered to homeless

Veterans have shown positive impacts on health outcomes. Research has found that access to comprehensive healthcare and supportive services through VA programs led to improved mental and physical health among homeless Veterans (O’Toole et al., 2016). These findings underscore the importance of integrated healthcare services in addressing the whole health needs of homeless Veterans.

• Veteran Homelessness and Community Integration. Studies have explored how community integration practices affect homeless Veterans’ reintegration into society. For instance, research has examined the benefits of community-based programs in supporting homeless Veterans’ social and community reintegration, and in improving social connections and reducing isolation.
• Prevention of Homelessness Among Veterans. Research has also focused on preventive measures to keep Veterans from becoming homeless. Studies have analyzed the effectiveness of early intervention programs in preventing homelessness among at-risk Veterans, revealing that timely support and intervention can significantly reduce the likelihood of homelessness.

However, specialized research is needed to inform efforts and progress in addressing Veteran homelessness. As reported in the recent 2023 National Veteran Suicide Report, the elevated rates of suicide among homeless Veterans in recent years deserve careful examination. Preventing Veterans’ returns to homelessness after achieving housing stability is a current focus of HPO. In addition, issues around staff safety and turnover in VA homeless programs need further study. Ways to optimize case management models across VA homeless programs merit attention, and finally, HPO is studying the needs of an increasingly aging homeless Veteran population. These are just some examples of issues for which HPO is seeking further research and data-based solutions.

Additionally, for fiscal year 2025, NCHAV is inviting researchers to consider and explore the following questions.

Homeless Prevention

1. What factors contributed to the increased numbers of homeless Veterans counted in the 2023 Point-in-Time (PIT) count?
2. How can VA better engage in primary and secondary prevention of homelessness?
3. In what ways can VA better prevent criminal justice involvement and incarceration?
4. How can non-VA data sources be used to study homelessness among Veterans?
5. What new models of care are effective in preventing homelessness among certain subpopulations of Veterans (particularly women, rural, transgender, Asian American, and/or Native American/Alaskan Native Veterans)?

Expanding Eligibility for Homeless Veterans

1. What is the prevalence of Other than Honorable (OTH) or punitive military discharges among homeless Veterans (especially those not in the VA system)?
2. What would be the estimated impact of expanding eligibility for VA healthcare among homeless Veterans?
3. How can homeless Veterans with OTH or punitive military discharges be better served by VA and community partners?

Employment Services

1. What are effective approaches to help homeless Veterans who receive public assistance or VA-service connected disability seek employment?
2. What new or existing models of care can improve employment outcomes for homeless Veterans?
3. What new technologies can help homeless Veterans find and obtain employment?

One Team Collaboration between SSVF, GPD, HCHV, and HUD-VASH

1. What are the facilitators and barriers to One Team Collaboration between VA homeless programs?
2. What are staff and Veteran attitudes about One Team Collaboration among VA homeless programs (including in communities where SSVF grantees are only providing housing navigation)?
3. What are ways to optimize One Team Collaboration among VA homeless programs?

Specialty Healthcare Services

1. What specialty healthcare services are important for addressing needs of homeless Veterans?
2. How is the Homeless Veterans Dental Program serving needs of Veterans?
3. In what ways might VA specialty healthcare services be better integrated with VA homeless services?
4. How can food insecurity among homeless Veterans be addressed?
5. What interventions are effective in preventing suicide among homeless Veterans?

Research empowers us with knowledge, and knowledge is the precursor to change. By understanding the specific needs of homeless Veterans, we can tailor interventions that speak directly to their experiences. This enlightenment fosters profound empathy and a sense of urgency, driving communities and policymakers alike toward action. It is this informed action that can transform the lives of countless Veterans, offering them the support, dignity, and opportunities they rightfully deserve. It also reminds us that Veteran homelessness is solvable.

Let us, therefore, champion the cause of research in understanding Veteran homelessness. Let us support it, fund it, and most importantly, implement its findings.

We look forward to refining and enhancing our existing evidence-based solutions while also responding to the changing needs and barriers that Veterans face. We are excited for the day when no Veteran experiences the tragedy and indignity of homelessness – and every Veteran has a safe, stable, accessible, and affordable home.

References

1. Montgomery, AE, Tsai, J, & Szymkowiak, D. "Housing In stability and Homeless Program Use Among Veterans: The Intersection of Race, Sex, and Homelessness," Housing Policy Debate 2020;30:396-408
2. O'Toole, T, Johnson, E, Aiello, R, & Kane, V. "Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: The Veterans Health Administra tion's 'Homeless Patient Aligned Care Team' Program," Preventing Chronic Disease 2016;Centers for Disease Control and Prevention. https://www.cdc.gov/pcd/is sues/2016/15_0567.htm
3. Tsai, J, Blue-Howells, J, & Nakashima, J. "Needs of Homeless Veterans: 5 Years of the CHALENG Survey 2012 16," Journal of Public Health 2019;e16-24.
4. Tsai, J, & Rosenheck, R. "Risk Factors for Homeless ness Among US Veterans," Epidemiologic Reviews 2015;37(1):177-95