Homelessness in Veterans is a widespread, vexing problem, and a priority at the national level. Despite 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 includes: 1) social integration (i.e., contact with family and friends) and 2) work outcome (maintaining productive activities in work or school). Providing housing is only the first step in facilitating recovery among homeless Veterans; once housed, they need different types of assistance to integrate into communities. For these reasons we established a REAP at GLA. Its mission is to understand and to improve community integration in homeless and recently-housed Veterans. The REAP mission has been enacted by establishing an interdisciplinary community of researchers, educators, and clinicians to generate intervention and translational research to improve community integration for these Veterans. The translational research involves the application of cognitive, social, and affective neuroscience approaches to better understand community integration and to guide treatment development. This REAP fills a critical gap -- rather than focusing on factors that confer risk for homelessness in Veterans, this team of investigators applies their skills to the neglected problem of community integration for homeless and recently-housed Veterans. The REAP also attracts and develops clinical researchers and trainees who focus on this critical problem. It is fitting that this REAP is based at GLA, which has the largest homeless program of any VA in the nation, serving 7,449 homeless Veterans in FY18. The REAP mission consists of several components: Research: This REAP supports translational studies to understand the nature of work and social community integration in homeless Veterans, and also intervention studies to rigorously evaluate innovative treatments to enhance community integration for these individuals. Training: This REAP encourages postdoctoral fellows and early career investigators to focus their professional talents on the topic of homelessness and community integration in Veterans. This goal is reflected in the Pilot Grant program and through multi-disciplinary mentorship. Facilitation: The proposed REAP provides support for independent grant submissions. Applications benefit from the infrastructure, such as recruitment pathways, and a rare collection of expertise in clinical trial methodology, outcomes research, and cognitive and social neuroscience. Activities in the next phase of the REAP are guided by key findings from the first phase. In phase 1 of the REAP, we conducted two independent prospective studies. Both studies found essentially no change in community integration (family, social, and work) over 12 months in GLA homeless programs. This lack of change occurred at the group level; it is clear that provision of housing is beneficial for community integration for some individuals, while disruptive for others. The translational and intervention questions of the next phase of the REAP stem from this disconnection between provision of housing and lack of improvement in community integration at the group level. Also, in these prospective studies from phase 1 of the REAP, we assessed potential determinants of community integration in participants after they received housing, and then followed them for a year. We found that motivational factors are strongly associated with community integration at 6 and 12 month follow up (more so than social and nonsocial cognition). Hence, the focus for phase 2 of the REAP is on motivational factors, both from neuroscientific and intervention perspectives.
Homelessness among Veterans is a 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 can be defined in terms of social integration (i.e., contact with family and friends) and work (maintaining activities in work or school), but these outcomes do not arise automatically once homeless Veterans receive housing. This Research Enhancement Award Program (REAP) based at the VA Greater Los Angeles serves 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 and recently-housed Veterans and the mission is accomplished through: 1) translational and intervention research, 2) training of early career investigators and clinicians, and 3) facilitation of new research projects on Veteran homelessness.