Homeless Veterans with Mental Illness: Predicting and Enhancing Recovery

描述(由申请人提供)： 退伍军人中的无家可归是一个普遍存在的问题，是国家一级的高度优先事项。2010年联邦预防和结束无家可归战略计划的目标之一是“在五年内防止和结束退伍军人中的无家可归现象”。提交给国会的2009年年度无家可归者评估报告的补充报告对无家可归退伍军人的状况进行了惨淡的描述：2009年1月的一个晚上，75,609名退伍军人无家可归。在美国，退伍军人无家可归的比例大约是非退伍军人成年人的两倍。住房和城市发展部(HUD)和退伍军人管理局(VA)的一个联合计划通过HUD-VA支持性住房计划(HUD-VASH)为无家可归的退伍军人提供住房援助和支持性服务。这一计划是一项巨大的成就；然而，住房状况是成功融入社区的必要条件，但不是充分条件。社区融合的其他重要方面包括与家人和朋友的社会联系，参与工作和学校，以及日常生活活动(购物、交通)。在实现住房之后，社区融合的这些方面往往保持不变。对于那些患有严重精神疾病(SMI)的人，如精神病患者，无家可归的比率比普通人群高出10-20倍。对于患有SMI的非常大的无家可归退伍军人群体中功能结果的预测因素，人们知之甚少。这项研究的目的是确定哪些特定因素(即神经认知、社会认知或动机变量)预测患有精神障碍的无家可归退伍军人的功能结果。在拟议的为期3年的研究中，我们将招募120名有精神障碍病史的退伍军人参加HUD-VASH计划，并前瞻性地评估他们在12个月期间的社区融合情况。目标是确定结果的主要决定因素(S)，以包括在随后的治疗研究中。拟议项目的目的是基于退伍军人事务部大洛杉矶医疗系统(GLA)的VISN 22精神疾病研究、教育和临床中心(MIRECC)先前关于SMI功能结果的预测和决定因素的研究。当我们完成这项研究时，我们将知道哪些因素是患有精神障碍的无家可归退伍军人社区融合的关键决定因素(S)，并将拥有必要的信息来提出更大规模的干预研究。我们认为，目前的申请是一个集中和系统的研究计划的开始，致力于改善患有SMI的无家可归退伍军人的生活。

DESCRIPTION (provided by applicant): Homelessness in Veterans is a widespread problem and is a high priority at the national level. The 2010 Federal Strategic Plan to Prevent and End Homelessness has as one of its goals to "Prevent and end homelessness among Veterans in five years." The Supplemental Report to the 2009 Annual Homeless Assessment Report to Congress offered a bleak account of the status of homeless Veterans: On a single night in January 2009, 75,609 Veterans were homeless. Veterans are homeless at about twice the rate of non- Veteran adults in the U.S. A joint program between Housing and Urban Development (HUD) and the VA offers housing assistance and supportive services to homeless Veterans through the HUD - VA Supportive Housing (HUD-VASH) Program. This program is a tremendous accomplishment; however, housing status is a necessary, but not sufficient, condition for successful community integration. Other important facets of community integration include social connections with family and friends, participation in work and school, and activities of daily living (shopping, transportation. These aspects of community integration frequently remain unchanged after housing is achieved. For those with severe mental illness (SMI), such as psychotic disorders, rates of homelessness are 10-20 times higher than in the general population. Little is known about predictors of functional outcome within the very large group of homeless Veterans with SMI. The research aims for this project are to determine which specific factors (i.e., neurocognition, social cognition, or motivational variables) predict functional outcome in homeless Veterans with psychotic disorders. In the proposed 3-year study we will recruit 120 Veterans with a history of a psychotic disorder who are in the HUD- VASH program and assess their community integration over a 12 month period prospectively. The goal is to identify the primary determinant(s) of outcome to be included in a subsequent treatment study. The aims of the proposed project are based on previous research at the VISN 22 Mental Illness Research, Education and Clinical Center (MIRECC) at VA Greater Los Angeles Healthcare System (GLA) on predictors and determinants of functional outcome in SMI. When we complete this study we will know which factors are key determinant(s) of community integration in homeless Veterans with psychotic disorders and will have the necessary information to propose a larger intervention study. We view the current application as the start of a concentrated and systematic research program dedicated to improving the lives of homeless Veterans with SMI.