Homelessness in Veterans is a widespread, vexing problem, and an urgent priority at the national level. The VA set a goal to prevent and eliminate homelessness in Veterans within 5 years (that is, by 2015). This is an important goal because Veterans are greatly overrepresented among the homeless (16% versus 8% non- Veterans). Using models such as supportive housing, the VA has made substantial progress in housing Veterans. For example, between 2010 and 2013, the number of homeless Veterans decreased by 24%. Despite this substantial progress in providing housing for Veterans, a fundamental problem remains. Permanent housing is a necessary, but not sufficient, condition for successful community integration. Community integration is defined in terms of: 1) social integration (i.e., contact with family and friends) and 2) work integration (maintaining productive activities in work or school). Providing housing is only the first step in facilitating recovery among homeless Veterans; once housed, they will need different types of assistance to integrate into communities. Community integration does not arise automatically once housing is provided. Hence, we propose a Research Enhancement Award Program (REAP) application linked to the homeless programs at VA Greater Los Angeles Healthcare System (GLA) to serve as an interdisciplinary center to generate intervention and translational research to improve community integration for homeless Veterans. The REAP will fill a critical gap: Rather than focusing on factors that confer risk for homelessness in Veterans (a complex question already being widely studied), we will instead apply our group's skills to the neglected problem of community integration for Veterans once housing has been provided. It will attract and develop clinical researchers and trainees who will focus their energies on this critical problem. The REAP will be based at GLA, which has served 34,000 homeless Veterans since FY 2006, including 4,000 new homeless Veterans each year, and has the largest homeless program of any VA in the nation. The mission of this REAP is to understand and to improve community integration in homeless Veterans. This mission consists of several components: Research: This REAP will support: 1) translational studies using cognitive neuroscience methods and concepts to understand the determinants of work and social integration in homeless Veterans after housing is provided, and 2) intervention studies to rigorously evaluate with randomized controlled trials innovative treatments to enhance community integration for these individuals. Training: This REAP will encourage postdoctoral fellows and junior investigators to focus their professional talents on the topic of homelessness and community integration in Veterans. This goal will be accomplished by the Pilot Grant Program and through multi-disciplinary mentorship. Facilitation for new projects: The proposed REAP will provide support for independent grant submissions. Future applications will benefit from the REAP infrastructure, such as recruitment pathways, and a rare collection of expertise in clinical trial methodology, outcomes research, and cognitive and social neuroscience. To facilitate the development of new projects, the REAP will provide services to projects, including: 1) recruitment and assessment of participants for all REAP research projects; and 2) data management and statistical support for future applications.
Homelessness among Veterans is an urgent priority at the national level, and the VA has made substantial progress recently in housing Veterans through supportive housing programs. However, a fundamental problem remains: Permanent housing is a necessary, but not sufficient, condition for successful community integration. Community integration includes: 1) social integration (i.e., contact with family and friends) and 2) work integration (maintaining activities in work or school). It is now clear that community integration does not arise automatically once homeless Veterans receive housing. We propose a Research Enhancement Award Program (REAP) based in the homeless programs at VA Greater Los Angeles to serve as an interdisciplinary center to study community integration in homeless Veterans. The mission of this REAP is to understand and to improve community integration in homeless Veterans and it will consist of: 1) translational and intervention research, 2) training of young investigators nd clinicians, and 3) facilitation of new research projects.