Homeless Veterans with Mental Illness: Predicting and Enhancing Recovery

描述（由申请人提供）： 退伍军人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“在五年内预防和结束退伍军人无家可归。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的退伍军人的状况作了一个黯淡的描述：2009年1月的一个晚上，75,609名退伍军人无家可归。退伍军人无家可归的比率约为美国非退伍军人成年人的两倍。住房和城市发展部（HUD）与退伍军人事务部（VA）之间的一项联合方案通过住房和城市发展部-退伍军人事务部支持性住房（HUD-VASH）方案向无家可归的退伍军人提供住房援助和支持服务。该方案是一项巨大的成就;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、参加工作和学校以及日常生活活动（购物、交通）。社区融合的这些方面在住房问题解决后往往保持不变。对于那些患有严重精神疾病（SMI），如精神障碍的人来说，无家可归的比率比普通人群高出10-20倍。很少有人知道预测功能的结果在非常大的一组无家可归的退伍军人与SMI。本项目的研究目的是确定哪些具体因素（即，神经认知、社会认知或动机变量）预测无家可归的退伍军人精神障碍患者的功能结果。在拟议的3年研究中，我们将招募120名有精神病史的退伍军人，他们参加了HUD- VASH计划，并前瞻性地评估他们在12个月内的社区融合情况。目的是确定将纳入后续治疗研究的结局的主要决定因素。拟议项目的目的是基于VA大洛杉矶医疗保健系统（GLA）VISN 22精神疾病研究、教育和临床中心（MIRECC）先前对SMI功能结局的预测因素和决定因素的研究。当我们完成这项研究时，我们将知道哪些因素是无家可归的精神病退伍军人社区融合的关键决定因素，并将获得必要的信息来提出更大的干预研究。我们认为目前的应用程序作为一个集中和系统的研究计划，致力于改善与SMI无家可归的退伍军人的生活的开始。

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.