BACKGROUND/RATIONALE:
Homelessness among veterans has remained a national problem for over three decades. One of the most important VA programs for homeless veterans, the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is in need of evaluation, research, and improvement. HUD-VASH is the largest supported housing program for veterans in the nation and is continuing to expand. Research on understanding the needs of the heterogeneous population of homeless veterans is important in the VA's efforts to end homelessness.

OBJECTIVE(S):
There are three specific aims for this project. The first aim is to evaluate an innovative group-intensive peer-support (GIPS) model of case management for HUD-VASH at the VA Connecticut Healthcare System. Performance and client outcomes at this study site have been compared to other control HUD-VASH sites during the same time using VA administrative program data. This model has shown to not be associated with any adverse housing or clinical outcomes compared to treatment-as-usual and has been associated with greater social integration and increased case manager activities. The second aim was to survey HUD-VASH clinicians in the country about their receptiveness to using groups as part of their case management activities. Results of a survey in the New England area revealed many HUD-VASH clinicians are interested in using groups and group-based approaches may offer a viable alternative to current case management models. The third aim is to analyze national data on homeless veterans to characterize the needs of special subgroups of homeless veterans, including homeless female veterans, homeless veteran families, veterans with criminal justice involvement, and veterans living in rural areas. These analyses are currently ongoing.

METHODS:
Using VA administrative program data, a pre-post non-equivalent comparison cohort study was used to examine the clinical and cost-effectiveness of GIPS compared to other HUD-VASH programs in the country during the same time period. An online survey of HUD-VASH case managers was conducted to gather information about the current use and attitudes in regards to using groups as part of HUD-VASH case management. National VA administrative data and locally collected data on homeless veterans have been analyzed to identify special subgroups of homeless veterans, their service needs, and the services they receive. The results have found that GIPS is a viable, alternative model of case management that is associated with greater veteran social integration and increased case manager activities. Many HUD-VASH programs are interested in utilizing more groups in their work and are receptive to group-based models of care. Special populations of rural veterans, female veterans, and recent Iraq and Afghanistan veterans have highlighted the special needs of these groups and need to tailor services to address their needs.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This project has potential impact on VA homeless services, and in particular, supported housing. GIPS challenges traditional case management models and offers an effective, alternative service model in supported housing that may be implemented on a large scale to help VA end homelessness among veterans. Identification of special subgroups of homeless veterans and their service needs may help guide development of services to serve the heterogeneous population of homeless veterans and foster new innovative practices. We have also received funding to study two innovative interventions to help prevent and end veteran homelessness, namely money management services to help veterans gain financial literacy, learn about budgeting and saving, and achieve financial independent; and medical-legal partnerships which bring legal and healthcare providers to help veterans with civil legal problems like landlord disputes, evictions, and applying for disability.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX000745-01A1
Link: https://reporter.nih.gov/project-details/8392071

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PUBLICATIONS:

Journal Articles

1. Tsai J, Yakovchenko V, Jones N, Skolnik A, Noska A, Gifford AL, McInnes DK. "Where's My Choice?" An Examination of Veteran and Provider Experiences With Hepatitis C Treatment Through the Veteran Affairs Choice Program. Medical care. 2017 Jul 1; 55 Suppl 7 Suppl 1:S13-S19. [view]
2. Tsai J, Kasprow WJ, Quarles JL, Hoff RA. A 20-Site Comparison of Transition-in-Place Versus Traditional Transitional Housing Programs. Administration and policy in mental health. 2017 Sep 1; 44(5):747-755. [view]
3. Tsai J, Ramaswamy S, Bhatia SC, Rosenheck RA. A Comparison of Homeless Male Veterans in Metropolitan and Micropolitan Areas in Nebraska: A Methodological Caveat. American journal of community psychology. 2015 Dec 1; 56(3-4):357-67. [view]
4. Radhakrishnan R, Kiluk BD, Tsai J. A Meta-analytic Review of Non-specific Effects in Randomized Controlled Trials of Cognitive Remediation for Schizophrenia. The Psychiatric quarterly. 2016 Mar 1; 87(1):57-62. [view]
5. Tsai J, Pietrzak RH, Hoff RA, Harpaz-Rotem I. Accuracy of screening for posttraumatic stress disorder in specialty mental health clinics in the U.S. Veterans Affairs Healthcare System. Psychiatry Research. 2016 Jun 30; 240:157-62. [view]
6. Tsai J, Kasprow WJ, Rosenheck RA. Alcohol and drug use disorders among homeless veterans: prevalence and association with supported housing outcomes. Addictive Behaviors. 2014 Feb 1; 39(2):455-60. [view]
7. Tsai J, Whealin JM, Pietrzak RH. Asian American and Pacific Islander military veterans in the United States: health service use and perceived barriers to mental health services. American journal of public health. 2014 Sep 1; 104 Suppl 4:S538-47. [view]
8. Tsai J, Rosenheck RA, Kasprow WJ, Kane V. Characteristics and Use of Services Among Literally Homeless and Unstably Housed U.S. Veterans With Custody of Minor Children. Psychiatric services (Washington, D.C.). 2015 Oct 1; 66(10):1083-90. [view]
9. Tsai J, Jenkins D, Lawton E. Civil Legal Services and Medical-Legal Partnerships Needed by the Homeless Population: A National Survey. American journal of public health. 2017 Mar 1; 107(3):398-401. [view]
10. Tsai J, Elhai JD, Pietrzak RH, Hoff RA, Harpaz-Rotem I. Comparing four competing models of depressive symptomatology: a confirmatory factor analytic study of 986,647 U.S. veterans. Journal of affective disorders. 2014 Aug 1; 165:166-9. [view]
11. Tsai J, Rosenheck RA, McGuire JF. Comparison of outcomes of homeless female and male veterans in transitional housing. Community mental health journal. 2012 Dec 1; 48(6):705-10. [view]
12. Tsai J, Rosenheck RA. Conduct disorder behaviors, childhood family instability, and childhood abuse as predictors of severity of adult homelessness among American veterans. Social psychiatry and psychiatric epidemiology. 2013 Mar 1; 48(3):477-86. [view]
13. Tsai J, Harpaz-Rotem I, Armour C, Southwick SM, Krystal JH, Pietrzak RH. Dimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the National Health and Resilience in Veterans Study. The Journal of clinical psychiatry. 2015 May 1; 76(5):546-53. [view]
14. Tsai J, Flatley B, Kasprow WJ, Clark S, Finlay A. Diversion of Veterans With Criminal Justice Involvement to Treatment Courts: Participant Characteristics and Outcomes. Psychiatric services (Washington, D.C.). 2017 Apr 1; 68(4):375-383. [view]
15. Tsai J, Rosenheck RA, Kasprow WJ, McGuire JF. Do faith-based residential care services affect the religious faith and clinical outcomes of homeless veterans? Community mental health journal. 2012 Dec 1; 48(6):682-91. [view]
16. Edens EL, Tsai J, Rosenheck RA. Does stimulant use impair housing outcomes in low-demand supportive housing for chronically homeless adults? The American journal on addictions. 2014 May 1; 23(3):243-8. [view]
17. Pietrzak RH, Rosenheck RA, Cramer JA, Vessichio JC, Tsai J, Southwick SM, Krystal JH, VA CSP 504 Collaborative Group. Elucidating the transdiagnostic dimensional structure of trauma-related psychopathology: Findings from VA cooperative study 504 - risperidone treatment for military service related chronic post traumatic stress disorder. Journal of affective disorders. 2015 Feb 1; 172:331-6. [view]
18. Whealin JM, Seibert-Hatalsky LA, Howell JW, Tsai J. E-mental health preferences of Veterans with and without probable posttraumatic stress disorder. Journal of rehabilitation research and development. 2015 Nov 1; 52(6):725-38. [view]
19. Tsai J, Rosenheck RA. Examination of Veterans Affairs disability compensation as a disincentive for employment in a population-based sample of Veterans under age 65. Journal of Occupational Rehabilitation. 2013 Dec 1; 23(4):504-12. [view]
20. Mota NP, Tsai J, Sareen J, Marx BP, Wisco BE, Harpaz-Rotem I, Southwick SM, Krystal JH, Pietrzak RH. High burden of subthreshold DSM-5 post-traumatic stress disorder in U.S. military veterans. World psychiatry : official journal of the World Psychiatric Association (WPA). 2016 Jun 1; 15(2):185-6. [view]
21. Tsai J, Rosenheck RA. Homeless and nonhomeless VA service users likely eligible for Medicaid expansion. Journal of rehabilitation research and development. 2014 Aug 1; 51(5):675-84. [view]
22. Tsai J, Rosenheck RA, Kane V. Homeless female U.S. veterans in a national supported housing program: comparison of individual characteristics and outcomes with male veterans. Psychological Services. 2014 Aug 1; 11(3):309-16. [view]
23. Tsai J, Kasprow WJ, Culhane D, Rosenheck RA. Homeless Veterans Eligible for Medicaid Under the Affordable Care Act. Psychiatric services (Washington, D.C.). 2015 Dec 1; 66(12):1353-6. [view]
24. Tsai J, Rosenheck RA. Homeless veterans in supported housing: exploring the impact of criminal history. Psychological Services. 2013 Nov 1; 10(4):452-8. [view]
25. Tsai J, Pietrzak RH, Rosenheck RA. Homeless veterans who served in Iraq and Afghanistan: gender differences, combat exposure, and comparisons with previous cohorts of homeless veterans. Administration and policy in mental health. 2013 Sep 1; 40(5):400-5. [view]
26. Tsai J, Link B, Rosenheck RA, Pietrzak RH. Homelessness among a nationally representative sample of US veterans: prevalence, service utilization, and correlates. Social psychiatry and psychiatric epidemiology. 2016 Jun 1; 51(6):907-16. [view]
27. Tsai J, O'Toole T, Kearney LK. Homelessness as a public mental health and social problem: New knowledge and solutions. Psychological Services. 2017 May 1; 14(2):113-117. [view]
28. Tsai J, Rosenheck RA, Kasprow WJ, McGuire JF. Homelessness in a national sample of incarcerated veterans in state and federal prisons. Administration and policy in mental health. 2014 May 1; 41(3):360-7. [view]
29. Chwastiak L, Tsai J, Rosenheck R. Impact of health insurance status and a diagnosis of serious mental illness on whether chronically homeless individuals engage in primary care. American journal of public health. 2012 Dec 1; 102(12):e83-9. [view]
30. Tejani N, Rosenheck R, Tsai J, Kasprow W, McGuire JF. Incarceration histories of homeless veterans and progression through a national supported housing program. Community mental health journal. 2014 Jul 1; 50(5):514-9. [view]
31. Mota N, Tsai J, Kirwin PD, Harpaz-Rotem I, Krystal JH, Southwick SM, Pietrzak RH. Late-life exacerbation of PTSD symptoms in US veterans: results from the National Health and Resilience in Veterans Study. The Journal of clinical psychiatry. 2016 Mar 1; 77(3):348-54. [view]
32. Tsai J, Harpaz-Rotem I, Pilver CE, Wolf EJ, Hoff RA, Levy KN, Sareen J, Pietrzak RH. Latent class analysis of personality disorders in adults with posttraumatic stress disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry. 2014 Mar 1; 75(3):276-84. [view]
33. Tsai J, Kasprow WJ, Rosenheck RA. Latent homeless risk profiles of a national sample of homeless veterans and their relation to program referral and admission patterns. American journal of public health. 2013 Dec 1; 103 Suppl 2:S239-47. [view]
34. Tsai J, Sippel LM, Mota N, Southwick SM, Pietrzak RH. LONGITUDINAL COURSE OF POSTTRAUMATIC GROWTH AMONG U.S. MILITARY VETERANS: RESULTS FROM THE NATIONAL HEALTH AND RESILIENCE IN VETERANS STUDY. Depression and anxiety. 2016 Jan 1; 33(1):9-18. [view]
35. Decker SE, Rosenheck RA, Tsai J, Hoff R, Harpaz-Rotem I. Military sexual assault and homeless women veterans: clinical correlates and treatment preferences. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2013 Nov 1; 23(6):e373-80. [view]
36. Tsai J, Kasprow WJ, Kane V, Rosenheck RA. National comparison of literally homeless male and female VA service users: entry characteristics, clinical needs, and service patterns. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2014 Jan 1; 24(1):e29-35. [view]
37. Tsai J, Hoff RA, Harpaz-Rotem I. One-year incidence and predictors of homelessness among 300,000 U.S. Veterans seen in specialty mental health care. Psychological Services. 2017 May 1; 14(2):203-207. [view]
38. Tsai J, Rosenheck RA. Outcomes of a group intensive peer-support model of case management for supported housing. Psychiatric services (Washington, D.C.). 2012 Dec 1; 63(12):1186-94. [view]
39. Tsai J, El-Gabalawy R, Sledge WH, Southwick SM, Pietrzak RH. Post-traumatic growth among veterans in the USA: results from the National Health and Resilience in Veterans Study. Psychological medicine. 2015 Jan 1; 45(1):165-79. [view]
40. El-Gabalawy R, Tsai J, Harpaz-Rotem I, Hoff R, Sareen J, Pietrzak RH. Predominant typologies of psychopathology in the United States: a latent class analysis. Journal of psychiatric research. 2013 Nov 1; 47(11):1649-57. [view]
41. Tsai J, Rosenheck RA. Psychiatric comorbidity among adults with schizophrenia: a latent class analysis. Psychiatry Research. 2013 Nov 30; 210(1):16-20. [view]
42. Tsai J, Rosenheck RA. Psychosis, Lack of Job Skills, and Criminal History: Associations With Employment in Two Samples of Homeless Men. Psychiatric services (Washington, D.C.). 2016 Jun 1; 67(6):671-5. [view]
43. Tsai J, Rosenheck RA. Risk factors for ED use among homeless veterans. The American journal of emergency medicine. 2013 May 1; 31(5):855-8. [view]
44. Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiologic Reviews. 2015 Jan 16; 37:177-95. [view]
45. Tsai J, Rosenheck RA, Kasprow WJ, McGuire JF. Risk of incarceration and clinical characteristics of incarcerated veterans by race/ethnicity. Social psychiatry and psychiatric epidemiology. 2013 Nov 1; 48(11):1777-86. [view]
46. Tsai J, Rosenheck RA, J Kasprow W, McGuire JF. Risk of incarceration and other characteristics of Iraq and Afghanistan era veterans in state and federal prisons. Psychiatric services (Washington, D.C.). 2013 Jan 1; 64(1):36-43. [view]
47. Tsai J, Rosenheck RA, Kasprow WJ, McGuire JF. Sobriety as an admission criterion for transitional housing: a multi-site comparison of programs with a sobriety requirement to programs with no sobriety requirement. Drug and Alcohol Dependence. 2012 Oct 1; 125(3):223-9. [view]
48. Pietrzak RH, Tsai J, Kirwin PD, Southwick SM. Successful aging among older veterans in the United States. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. 2014 Jun 1; 22(6):551-63. [view]
49. Harpaz-Rotem I, Tsai J, Pietrzak RH, Hoff R. The dimensional structure of posttraumatic stress symptomatology in 323,903 U.S. veterans. Journal of psychiatric research. 2014 Feb 1; 49:31-6. [view]
50. Tsai J, Desai MU, Cheng AW, Chang J. The effects of race and other socioeconomic factors on health service use among American military veterans. The Psychiatric quarterly. 2014 Mar 1; 85(1):35-47. [view]
51. Tsai J, Rosenheck RA, Decker SE, Desai RA, Harpaz-Rotem I. Trauma experience among homeless female veterans: correlates and impact on housing, clinical, and psychosocial outcomes. Journal of traumatic stress. 2012 Dec 1; 25(6):624-32. [view]
52. Tsai J, Mota NP, Pietrzak RH. U.S. Female Veterans Who Do and Do Not Rely on VA Health Care: Needs and Barriers to Mental Health Treatment. Psychiatric services (Washington, D.C.). 2015 Nov 1; 66(11):1200-6. [view]
53. Tsai J, Rosenheck R. Uninsured veterans who will need to obtain insurance coverage under the patient protection and affordable care act. American journal of public health. 2014 Mar 1; 104(3):e57-62. [view]
54. Tsai J, Rosenheck RA. Use of group treatment among case managers in Department of Veterans Affairs supported housing program. Journal of rehabilitation research and development. 2013 Jul 1; 50(4):471-6. [view]
55. Tsai J, Rosenheck RA. Use of the internet and an online personal health record system by US veterans: comparison of Veterans Affairs mental health service users and other veterans nationally. Journal of the American Medical Informatics Association : JAMIA. 2012 Nov 1; 19(6):1089-94. [view]
56. Tsai J, Rosenheck RA. VA Disability Compensation and Money Spent on Substance Use Among Homeless Veterans: A Controversial Association. Psychiatric services (Washington, D.C.). 2015 Jun 1; 66(6):641-4. [view]
57. Tsai J, Mota NP, Southwick SM, Pietrzak RH. What doesn't kill you makes you stronger: A national study of U.S. military veterans. Journal of affective disorders. 2016 Jan 1; 189:269-71. [view]
58. Tsai J, Doran KM, Rosenheck RA. When health insurance is not a factor: national comparison of homeless and nonhomeless US veterans who use Veterans Affairs Emergency Departments. American journal of public health. 2013 Dec 1; 103 Suppl 2:S225-31. [view]

VA Cyberseminars

1. Tsai J. Homeless veterans and their interactions with the legal system. HSR&D Career Development Award Enhancement Initiative [Cyberseminar]. 2017 Feb 14. [view]
2. Tsai J. Unmet legal needs among populations experiencing homelessness: A survey of health care for the homeless sites. [Cyberseminar]. National webinar for the National Center for Medical-Legal Partnership. 2016 Jun 23. [view]

Government Briefings

1. Tsai J. Delayed and confused: Experiences of veterans accessing Hepatitis C treatment through the Choice First program: Briefing before the Oral presentation for Examining the New Landscape of Care in the Community; 2016 Aug 8; Arlington, VA. [view]

Conference Presentations

1. Tsai J. "Where's my choice?" Experiences of veterans accessing Hepatitis C treatment in the VA and the Choice program. Poster session presented at: VA Rural Health State of the Science Conference; 2016 Sep 12; Washington, DC. [view]
2. Tsai J. Dissociative subtype of DSM-5 posttraumatic stress disorder in U.S. veterans. Poster session presented at: Epidemiology Research Exchange Annual Conference; 2016 Sep 5; Barcelona, Spain. [view]
3. Tsai J. Longitudinal course of posttraumatic growth among U.S. military veterans. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2015 Nov 1; Orleans, LA. [view]
4. Tsai J. Medical student beliefs and attitudes towards mental illness across three countries. Paper presented at: Psychological Society of South Africa Annual Congress; 2016 Sep 22; Johannesburg, South Africa. [view]

DRA: Health Systems
DRE: Prevention
Keywords: none
MeSH Terms: none