Identifying and Measuring Risk for Homelessness among Veterans

 描述（由申请人提供）： 背景资料：退伍军人在无家可归的人口中所占比例过高，约占无家可归成年人的12%，与生活在贫困中的一般人口相比，退伍军人无家可归的风险特别高。为了防止和结束退伍军人中的无家可归现象，美国退伍军人事务部（VA）已经完善了其计划和政策，重点是结束长期无家可归和防止新的无家可归事件。为了支持后者，退伍军人事务部自2011年联邦财政年度以来，通过退伍军人家庭支持服务（SSVF）计划，为无家可归预防服务拨款近10亿美元。为了帮助识别需要预防无家可归的退伍军人，国家退伍军人无家可归中心开发了无家可归筛查临床提醒（HSCR），这是一个两个问题的通用筛选器，用于评估门诊护理退伍军人的住房不稳定性和风险，并且尚未参与VA无家可归者计划。在2013年联邦财政年度，超过400万退伍军人通过退伍军人健康管理局（VHA）获得门诊医疗服务，对HSCR做出了回应。在接受筛查的人中，0.8%的人报告目前无家可归，1.0%的人报告即将面临无家可归的风险。筛查呈阳性的退伍军人可转诊接受进一步评估和干预;值得注意的是基于社区的SSVF方案，该方案提供支持性服务和临时财政援助，以迅速结束或防止无家可归事件。目的：拟议的研究将评估退伍军人事务部在确定面临无家可归风险的退伍军人方面所做的努力，并将他们与他们选择的高效和有效的服务联系起来。目标是：1.验证HSCR，并评估VHA医疗保健服务的退伍军人用户中无家可归和迫在眉睫的风险的患病率和风险因素。2.评估HSCR在将无家可归或风险筛查阳性的退伍军人与后续服务联系起来方面的有效性。3.评估SSVF计划使用的现有工具（SSVF工具）的心理测量特性和有效性，以量化退伍军人无家可归的风险。研究方法：拟议的研究将采用混合方法，结合使用现有VA数据源和原始数据收集的数据。此处确定的两种仪器（HSCR和SSVF仪器）的评价和确认将使用常规VA操作期间收集的二级数据。为了评估HSCR在将退伍军人与所需服务联系起来方面的有效性，研究小组将使用混合方法解释性顺序设计，对次要定量数据进行初步分析，然后进行主要定性数据收集。对退伍军人医疗保健的预期影响：与无家可归预防相关的现有研究机构在政策和计划的实际应用方面是有限的;本研究的主要贡献将是检查和完善当前的一套政策和做法，以识别，参考和干预正在经历无家可归或处于危险之中的退伍军人。这项研究将通过提供信息和指导更有效地利用无家可归预防资源，对护理系统产生直接影响。

 DESCRIPTION (provided by applicant): 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.