Enhancing Community Integration for Homeless Veterans

退伍军人中的无家可归是一个普遍存在的问题，也是国家一级的优先事项。尽管有大量的 尽管在为退伍军人提供住房方面取得了进展，但一个根本问题仍然存在：永久住房是一个 成功融入社区的必要条件，但不是充分条件。社区整合(例如， 与朋友和家人的社会融合；工作和生产性活动的能力)对长期至关重要 精神和身体上的结果。提供住房只是促进无家可归者康复的第一步 退伍军人；一旦得到安置，他们需要不同类型的援助才能融入社区。 出于这些原因，我们建议在退伍军人管理局大洛杉矶(GLA)建立一个RR&D中心，其使命是 了解和改善无家可归者和最近安置的退伍军人的社区融合。该中心将 建立在GLA现有研究增强和奖励计划(REAP)的基础上，并将对其进行扩展 基本上是这样的。该中心将建立一个由研究人员、教育工作者和临床医生组成的跨学科社区 产生干预和转化性研究，以改善这些退伍军人的社区融合。这 中心将填补一个关键的空白--而不是关注导致退伍军人无家可归的风险因素，这 一组调查人员将把他们的技能用于解决被忽视的无家可归者和 最近收容的退伍军人。它还将吸引和培养专注于此的临床研究人员和实习生。 关键问题，如试点助学金计划和博士后奖学金计划。它是 合适的是，这个RR&D中心将设在GLA，它拥有世界上最大的无家可归者计划 目前正在为9,000名无家可归的退伍军人提供住房。 该中心的首要目标是了解和改善无家可归者和 最近收容的退伍军人。为了实现这些目标，该中心将围绕三个研究重点进行组织 依赖四个服务核心的区域(FA)。这些常见问题包括： ·FA1：开发和验证对预测社区融合的因素的创新评估， 包括认知(社会和非社会)和动机，以及社区融合。 ·FA2：确定预测社区融合改善的决定因素。 ·FA3：制定和调整干预措施，以加强无家可归者和最近-- 收容退伍军人！ 这些FA形成了一条连续的翻译途径。这一序列涉及三个关键步骤：第一，开发 评估与无家可归退伍军人社区融合有关的关键变量的创新方法。 这是一项迫切的需要--例如，无家可归退伍军人社区融合的关键方面不能 充分利用现有的措施。其次，使用这些方法确定以下决定因素 社区融合。识别应该在特定的认知水平上有足够的精确度 激励子过程。第三，使用这些信息来指导选择和制定干预措施 与康复相关的治疗靶点。干预方法的范围可以从心理社会程序到 从药物到神经刺激等新方法。试验的范围从早期阶段的证明- 在概念研究中，根据相对较小的样本对新疗法的可行性进行评估 对已在其他人群中验证但未验证的现有干预措施的后期适应 在无家可归的人群中。该中心的调查结果，包括经过验证的干预措施，随后将提交给 退伍军人事务部卫生服务调查人员的执行和传播。 该中心将支持四个服务核心。这些包括：招募核心，临床评估 核心、数据管理和统计核心以及技术核心。所有这四个核心都将提供 向三个FA中的每一个提供关键服务。

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.