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

背景和意义：通过支持性服务的浅层补贴部分， 退伍军人家庭（SSVF）计划，退伍军人和他们的家庭生活在美国的高生活成本地区 无家可归或有可能无家可归的人可以获得长达2年的租金 通过社区非营利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财政自给自足。的影响 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产生了毁灭性的影响。此外，无家可归者可以 这对医疗系统和整个社会来说都是昂贵的。解决长期退伍军人的财务问题 住房不稳定是退伍军人事务部目前正在采取的最重要的举措之一。 创新：我们的研究-评估在美国15个不同社区实施的计划-将是 最大的一次调查是研究长期金融支持对美国面临住房不稳定的个人的影响。 此外，我们将使用结构化和非结构化数据以及详细的退伍军人级别的服务数据， 参加该计划的退伍军人获得的财政援助。最后，我们将VA临床数据与税收结合起来 通过美国财政部提供的申报数据，以估计浅层补贴的影响 收入和就业结果。 具体目标：目标1：确定实施和使用浅层补贴的障碍和促进因素 该计划使用半结构化访谈与VA运营合作伙伴，SSVF受资助者员工，VA 无家可归的服务提供者，以及使用浅层补贴计划的退伍军人。目标2：描述和识别 预测2020财年参加浅层补贴计划的退伍军人的财政支持金额- 2023财年使用HMIS、VA行政和公开可用的社区层面数据。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 通过回顾性队列分析，对住房、收入、就业、健康和医疗保健成本结果进行分析 2020 - 2023财年。3b：与标准相比，对浅层补贴计划进行经济评估 SSVF和常规护理使用来自已发表文献以及目标2和3a的输入参数。 方法：在目标1中，我们将与国家VA利益相关者，SSVF受资助者员工， VA无家可归的服务提供者，和退伍军人谁参加了SSVF计划。在目标2中， 构建多层次回归模型，以确定个人和社区层面的预测浅层 补贴的使用和支出。在目标3a中，我们将拟合与浅层补贴计划相关的结果模型 启动到随后的死亡率，从无家可归，收入，就业和成本结果退出， 由倾向分数定义的加权人群。在目标3b中，我们将使用输入构建仿真模型 各种来源的参数。 下一步/实施：这项研究将是未来研究的重要组成部分。我们将 与我们的业务合作伙伴设计研究，以实施和评估政策建议， 研究加强浅层补贴计划。这些信息将特别重要，因为SSVF 计划办公室正在考虑将浅层补贴计划扩大到整个社区 国家此外，在未来的分析中，我们将研究健康状况（如脑外伤）对 伤害，战斗伤害和阿片类药物滥用）和干预措施，以解决这些条件对收入和 就业通过这一系列研究项目，我们将帮助VA有效地提供服务， 弱势退伍军人的生活。

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.