Background: Veterans are overrepresented within the homeless population-comprising approximately 12% of homeless adults-and are at a particularly high risk of homelessness compared to the general population of individuals living in poverty. To prevent and end homelessness among veterans, the U.S. Department of Veterans Affairs (VA) has refined its programming and policies to focus on ending chronic homelessness and preventing new episodes of homelessness. To support the latter, VA has allocated close to $1 billion toward homelessness prevention services since Federal Fiscal Year (FFY) 2011 through the Supportive Services for Veteran Families (SSVF) program. To assist in the identification of veterans in need of homelessness prevention, the National Center on Homelessness Among Veterans developed the Homelessness Screening Clinical Reminder (HSCR), a two-question universal screener that assesses housing instability and risk among veterans who present for outpatient care and are not already engaged with VA Homeless Programs. During FFY 2013, more than 4 million veterans accessing outpatient health services through the Veterans Health Administration (VHA) responded to the HSCR. Among those screened, 0.8% reported current homelessness and 1.0% reported imminent risk. Veterans who screen positive are offered a referral for further assessment and intervention; of note is the community-based SSVF program, which provides supportive services and temporary financial assistance to quickly end or prevent episodes of homelessness. Objectives: The proposed study will evaluate VA's efforts at identifying veterans at risk of homelessness and linking them with services of their choosing that are both efficient and effective. The objectives are: 1. To validate the HSCR and assess prevalence and risk factors for homelessness and imminent risk among veteran users of VHA healthcare services. 2. To assess the effectiveness of the HSCR at linking veterans who screen positive for homelessness or risk with subsequent services. 3. To evaluate the psychometric properties and efficacy of an existing instrument (SSVF Instrument) used by the SSVF program to quantify risk of homelessness among veterans. Methods: The proposed study will employ a mixed methods approach, using a combination of data from existing VA data sources and primary data collection. The evaluation and validation of the two instruments identified here-the HSCR and SSVF Instrument-will use secondary data collected during regular VA operations. To assess the effectiveness of the HSCR at linking veterans to needed services, the study team will use a mixed methods explanatory sequential design whereby initial analysis of secondary quantitative data will be followed by primary qualitative data collection. Anticipated Impact on Veteran's Healthcare: The existing body of research related to homelessness prevention is limited in terms of its practical application to policies and programs; the primary contribution of this study will be the examination and refinement of the current set of policies and practices to identify, refer, and intervene with veterans who are experiencing homelessness or are at risk. This study will have an immediate impact on the system of care by informing and guiding more efficient and effective use of homelessness prevention resources.
This study will use a mixed methods approach to examine and refine VA's policies and practices to identify, refer, and intervene with veterans experiencing homelessness or risk. This study will impact the system of care by informing and guiding more efficient and effective use of homelessness prevention resources. Specifically, using responses to VA's Homelessness Screening Clinical Reminder (HSCR)?a universal screener of homelessness and imminent risk among veterans?this study will assess prevalence and risk for homelessness among veterans. In addition, the study will evaluate the effectiveness of the HSCR at linking veterans who screen positive for homelessness or risk with services and explore factors related to veterans' positive screens and reasons they accept or refuse referrals. The study will also evaluate an existing instrument used by the Supportive Services for Veteran Families (SSVF) program?a VA-funded, community- based, nation-wide homelessness prevention program?to quantify risk of homelessness among veterans.
