April 2016

VA HSR&D researchers conduct an extensive number of investigations designed to improve clinical decision-making and care, inform patients, evaluate changes in the healthcare system, and inform VA policymaking. In Progress is a new quarterly publication that will highlight ongoing HSR&D research on various topics.

In This Issue: Working to End Homelessness among Veterans

About 11% of the U.S. adult population are Veterans, and HUD's 2015 Annual Homeless Assessment Report (AHAR) estimates that 47,725 Veterans were homeless on any given night in January 2015. Moreover, according to theNational Coalition for Homeless Veterans, approximately 1.4 million additional Veterans are considered at risk for homelessness due to poverty, lack of support networks, and overcrowded or sub-standard housing. This issue features an article that discusses the VA Homelessness Health Services Research Initiative to help reduce homelessness and improve integrated care among Veterans, in addition to descriptions of several additional HSR&D studies that are in progress. Together they highlight healthcare system-level challenges and opportunities in how best to serve homeless Veterans and mitigate the risk of homelessness, especially in how VA can support adoption and spread of new models of care for vulnerable populations.

Feature Article

Identifying and Overcoming Organizational Barriers to Serving Homeless Veterans
Discussion of four studies that are part of the VA Homelessness Health Services Research Initiative. Among the findings:

• Frontline providers and local facility leaders played a key role in successfully implementing new models of care, including Housing First, the Homelessness Patient-aligned Care Team Model (H-PACT), and the Re-Engage outreach program for Veterans at risk of being lost to care.

Additional Ongoing Studies

Early Warning Indicators of Homelessness Risk among Veterans
This research is aimed at helping to identify Veterans who are currently homeless, or those Veterans at risk of being homeless. Among the findings:

• Veterans who separated from the military for misconduct were at nearly 7 times likelihood of becoming homeless compared to those with a normal separation.

Palliative Care for Homeless Veterans
This study seeks to describe the challenges associated with caring for homeless Veterans at the end of life. Among the findings:

• Lack of appropriate housing for Veterans with predictably declining functional status was cited as the most critical challenge in caring for Veterans at the end of life.

Improving Outcomes for Homeless Veterans with Peer Support
Investigators in this study are implementing and testing the peer-support component of an integrated mental health and substance abuse treatment for homeless Veterans with these co-occurring conditions. Among the findings:

• The mean number of sessions that Veterans engaged with Peer Specialists was 9 out of a potential 40 weekly sessions, ranging from 0 to 37, and there was substantial variation in the pattern of engagement.

Group Motivational Therapy for Homeless Veterans with Substance Use Disorder
Investigators in this randomized controlled trial are comparing group motivational therapy (GMI) to life style education among homeless Veterans with substance use disorder. There are no findings as yet, but GMI has the potential to be offered to a large number of homeless Veterans with substance use disorder.