Assessing an Initiative to Facilitate Long-Term Financial and Housing Stability in Vulnerable Veterans

背景和意义：通过支持服务的浅层补贴部分 退伍军人家庭(SSVF)计划，退伍军人及其家人生活在美国高生活成本地区 无家可归或面临无家可归风险的人可以获得长达2年的租赁期 通过社区非营利性组织提供补贴和职业培训。该计划的目标是 退伍军人通过就业和住房稳定实现长期的经济自给自足。其影响 关于退伍军人住房、医疗保健成本和健康结果以及退伍军人对该计划的满意度 不知道。 贫困对退伍军人的健康和福祉具有毁灭性的影响。此外，无家可归者可能 对医疗系统和整个社会来说都是昂贵的。解决长期退伍老兵财务问题 住房不稳定是退伍军人事务部目前正在推行的最重要的举措之一。 创新：我们的研究--评估在美国15个不同社区实施的项目--将是 最大的调查是对美国面临住房不稳定的个人提供长期财政支持的影响。 此外，我们将同时使用结构化和非结构化数据，以及有关服务和 参加该计划的退伍军人获得的经济援助。最后，我们将把退伍军人事务部的临床数据与税务联系起来 可通过美国财政部获得的备案数据，以估计浅薄补贴的影响 关于收入和就业结果。 具体目标：目标1：确定执行和使用浅表补贴的障碍和促进者 计划使用与退伍军人管理局运营合作伙伴、SSVF受赠人员工、退伍军人管理局的半结构化访谈 无家可归者服务提供者，以及使用浅表补贴计划的退伍军人。目标2：描述和识别 2020财年参加浅表补贴计划的退伍军人财政支持金额的预测因素- 使用卫生管理信息系统、退伍军人管理局和公共可用的社区级数据。目标3：执行 浅层补贴计划的结果和经济评估。3A：衡量该计划的影响 通过回溯性队列分析对住房、收入、就业、健康和医疗保健成本结果进行分析 2020财年至2023财年。3B：对照标准对浅表补贴计划进行经济评估 使用已发表文献和AIMS 2和3a中的输入参数进行SSVF和常规护理。 方法：在目标1中，我们将对国家退伍军人管理局利益相关者、SSVF受赠人、 弗吉尼亚州无家可归者服务提供者，以及参加SSVF计划的退伍军人。在《目标2》中我们将 构建多水平回归模型以识别个人和社区水平的浅表疾病预测因素 补贴使用和支出情况。在目标3a中，我们将拟合与浅表补贴计划相关的结果模型 引发随后的死亡、脱离无家可归、收入、就业和成本结果 由倾向分数定义的加权人口。在目标3b中，我们将使用输入构建仿真模型 来自各种来源的参数。 下一步/实施：这项研究将成为未来研究的重要组成部分。我们会工作的 与我们的运营合作伙伴一起设计研究，以实施和评估由此提出的政策建议 研究加强浅层补贴计划。这一信息将特别重要，因为SSVF 项目办公室正在考虑将浅层补贴计划扩大到全国其他社区 国家。此外，在未来的分析中，我们将检查健康状况(如创伤性脑)的影响 伤害、战斗伤害和阿片类药物滥用)和干预措施，以解决这些情况对收入和 就业。通过这一系列研究项目，我们将帮助退伍军人管理局有效地提供服务，以提高 脆弱的退伍军人的生活。

Background and Significance: Through the Shallow Subsidy component of the Supportive Services for Veteran Families (SSVF) program, Veterans and their families living in high cost-of-living locations in the US who are experiencing homelessness or at risk of becoming homeless can receive up to 2 years of rental subsidies and job training through non-profit organizations in the community. The goal of the program is for Veterans to achieve long-term financial self-sufficiency through employment and housing stability. The impact on Veteran housing, healthcare cost, and health outcomes as well as Veteran satisfaction with this program is not known. Poverty has a devastating effect on Veterans’ health and well-being. In addition, homelessness can be costly both to the healthcare system and society as a whole. Solving the problem of long-term Veteran financial and housing instability is one of the most important initiatives the VA is currently pursuing. Innovation: Our study – evaluating a program implemented in 15 different communities in the US – will be the largest to examine the impact of long-term financial support for individuals facing housing instability in the US. In addition, we will use both structured and unstructured data and detailed, Veteran-level data on services and financial assistance received by Veterans enrolled in this program. Finally, we will join VA clinical data with tax filings data available through the US Department of the Treasury to estimate the impact of Shallow Subsidies on income and employment outcomes. Specific aims: Aim 1: Identify barriers and facilitators to implementation and use of the Shallow Subsidy program using semi-structured interviews with VA operations partners, SSVF grantee employees, VA homeless services providers, and Veterans using the Shallow Subsidy program. Aim 2: Describe and identify predictors of the amount of financial support for Veterans enrolled in the Shallow Subsidy program for FY2020- FY2023 using HMIS, VA administrative, and publically-available community-level data. Aim 3: Perform an outcome and economic assessment of the Shallow Subsidy program. 3a: Measure the impact of this program on housing, income, employment, health, and healthcare cost outcomes through retrospective cohort analyses for FY2020-FY2023. 3b: Conduct economic evaluations of the Shallow Subsidy program compared to standard SSVF and usual care using input parameters from the published literature and from Aims 2 and 3a. Methodology: In Aim 1, we will conduct interviews with national VA stakeholders, SSVF grantee employees, VA homeless service providers, and Veterans who have enrolled in the SSVF program. In Aim 2 we will construct multi-level regression models to identify both individual- and community-level predictors of Shallow Subsidy use and expenditures. In Aim 3a, we will fit outcome models relating Shallow Subsidy program initiation to the subsequent mortality, exit from homelessness, income, employment, and cost outcomes in weighted populations defined by propensity scores. In Aim 3b, we will construct simulation models using input parameters from a variety of sources. Next steps/Implementation: This research will be an important building block for future studies. We will work with our operations partners to design studies to implement and assess the policy recommendations from this study to enhance the Shallow Subsidy program. This information will be especially important as the SSVF program office is considering expanding the Shallow Subsidy program to other communities throughout the country. In addition, in future analyses we will examine the impact of health conditions (such as traumatic brain injury, combat injury, and opioid misuse) and interventions to address these conditions on income and employment. Through this portfolio of research projects, we will help VA efficiently deliver services to improve the lives of vulnerable Veterans.