Enhancing Community Integration for Homeless Veterans

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Homelessness in Veterans is a widespread 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 (e.g., social integration with friends and family; capacity for work and productive activities) is essential for long-term mental and physical outcomes. 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 are proposing an RR&D Center at the VA Greater Los Angeles (GLA) with a mission to understand and to improve community integration in homeless and recently-housed Veterans. The Center will build on an existing Research Enhancement and Award Program (REAP) at GLA and will expand it substantially. The Center will establish an interdisciplinary community of researchers, educators, and clinicians to generate intervention and translational research to improve community integration for these Veterans. This Center will fill a critical gap -- rather than focusing on factors that confer risk for homelessness in Veterans, this team of investigators will apply their skills to the neglected problem of community integration for homeless and recently-housed Veterans. It will also attract and develop clinical researchers and trainees who focus on this critical problem, with components such as a Pilot Grant program and a Postdoctoral Fellowship program. It is fitting that this RR&D Center will be based at GLA, which has the largest homeless program of any VA in the nation, and is current providing housing for > 9,000 Veterans who have experienced homelessness. The overarching goal of this Center is to understand and improve community integration for homeless and recently-housed Veterans. To achieve these goals, the Center will be organized around three research focus areas (FAs) that rely on four service Cores. The FAs include: · FA1: To develop and validate innovative assessments of factors that predict community integration, including cognition (social and nonsocial) and motivation, as well as community integration. · FA2: To identify determinants that predict improvements in community integration. · FA3: To develop and adapt interventions to enhance community integration for homeless and recently- housed Veterans.! These FAs form a sequential translational pathway. The sequence involves three key steps: First, develop innovative methods to assess key variables that are linked to community integration in homeless Veterans. This is a critical need – for example, key aspects of community integration in homeless Veterans cannot be adequately captured with existing measures. Second, use those methods to identify the determinants of community integration. The identification should be with sufficient precision at the level of specific cognitive or motivational sub-processes. Third, use that information to guide choice of and develop interventions for recovery-related therapeutic targets. The intervention approaches can range from psychosocial procedures to medications to novel methods such as neurostimulation. The trials can range from early-stage proof-of- concept studies in which novel treatments are evaluated in terms of feasibility in relatively small samples to later-stage adaptations of existing interventions that have been validated in other populations, but not validated in homeless populations. Findings from this Center, including validated interventions, would be then passed to VA health services investigators for implementation and dissemination. The Center will support four service Cores. These include: the Recruitment Core, the Clinical Assessment Core, the Data Management and Statistics Core, and the Technology Core. All four of these Cores will provide critical services to each of the three FAs.