Improving Housing Outcomes for Homeless Veterans

背景/理由：在退伍军人事务部--尽管有许多以证据为基础的住房 干预措施--许多无家可归的退伍军人仍然难以获得和维持住房。社交技能(人际交往 沟通或工具技能，如资金管理)是重要的-但被忽视- 无家可归的成年人住房结果的决定因素。然而，社交技能干预通常是缺席的。 从一系列退伍军人无家可归者服务机构中。 目标：这份CDA将使我做好准备，成为一名专注于弱势群体的退伍军人管理局实施科学家 人口，特别是有无家可归经历的退伍军人；它将制定和研究执行和 “技能干预”的有效性--建立在现有的、有效的社会技能干预基础上，并侧重于 与住房相关的社交技能-为退伍军人事务部支持性住房(VASH)计划量身定做。这一干预将是 由消费者提供者(“同龄人”)和有执照的临床社会工作者共同提供，旨在改善VASH 受试者的住房保有与心理健康。利用行为模型的理论框架 弱势群体，以及《执行综合框架》的补充指导 研究(CFIR)，具体目标是：1)开发一种技能干预措施，提高住房保留率和 有流浪经历的退伍军人的心理健康；2)在受控试点试验中，研究可行性， 对与改善住房密切相关的因素的技能干预的可接受性和有效性 流浪经历过的退伍军人的留住和心理健康，包括促成因素(社会技能， 认知)和行为(卫生服务使用、社会互动、资金管理)；以及3)检查障碍 以及未来在常规VASH护理中实施技能干预的促进者。 方法：为了达到特定的目标1，我们将补充我们正在进行的社会技能培训的文献综述 通过进行关键线人访谈进行干预；我们还将利用兰德/加州大学洛杉矶分校的适当性 召集地方和全国无家可归者方案利益攸关方(资深消费者)组成的专家小组的方法 提供商、退伍军人管理局工作人员和领导层)。具体目标2和3需要进行干预的受控试点试验， 采用效率-实施混合型1设计。对于具体目标2，我们将实施以下技能 在两支退伍军人管理局大洛杉矶(GLA)VASH团队内进行干预。我们会评估其可行性，并 可接受性，还比较社交技能、服务使用、社交方面的变化(从基线到6个月随访) 接受干预的退伍军人(n=30)与对照组之间的互动和资金管理 (n=20)在不同的GLA VASH团队中接受常规护理的退伍军人。对于具体目标3，我们将使用调查 和定性方法，以探讨未来执行《公约》的潜在障碍和促进者 对常规护理的干预。CDA培训部分将侧重于实施科学、质量 以及量化方法、实用试验和促进学术追求的技能。 意义：尽管退伍军人管理局大幅扩大了对无家可归者的循证做法的使用 退伍军人，在安置无家可归的有经验的退伍军人和确保 他们的健康和幸福。为了加快退伍军人管理局改善对无家可归退伍军人的照顾的努力，我们必须 实施在其他退伍军人管理局环境中有效但尚未在 无家可归者服务机构。此外，作为一名初级医生兼调查员，致力于改善对无家可归者的护理 老兵们，我必须填补我的培训中的空白，主要是在实施科学和定性领域 方法：研究方法。

Background/Rationale: Across VA—despite the availability of numerous evidence-based housing interventions—many homeless Veterans still struggle to obtain and sustain housing. Social skills (interpersonal communication or instrumental skills, like money management) are an important—but underappreciated— determinant of housing outcomes for homeless adults. However, social skills interventions are usually absent from the array of VA homeless services. Objectives: This CDA will prepare me to become a VA implementation scientist focused on vulnerable populations, particularly homeless-experienced Veterans; it will develop and study the implementation and effectiveness of a “skills intervention”—built from existing, effective social skills interventions and focused on housing-related social skills—tailored to the VA Supportive Housing (VASH) program. This intervention will be co-delivered by a consumer provider (“peer”) and a licensed clinical social worker, aiming to improve VASH participants' housing retention and mental health. Using the theoretical framework of the Behavioral Model for Vulnerable Populations, with additional guidance from the Consolidated Framework for Implementation Research (CFIR), the Specific Aims are to: 1) develop a skills intervention that improves housing retention and mental health among homeless-experienced Veterans; 2) in a controlled pilot trial, study the feasibility, acceptability, and effectiveness of the skills intervention on factors strongly associated with improved housing retention and mental health among homeless-experienced Veterans, including enabling factors (social skills, cognition) and behaviors (health service use, social interactions, money management); and 3) examine barriers to and facilitators of future implementation of the skills intervention in routine VASH care. Methods: To achieve Specific Aim 1, we will complement our ongoing literature review of social skills training interventions by conducting key informant interviews; we will also use the RAND/UCLA appropriateness method to convene an expert panel of local and national homeless program stakeholders (Veteran consumer providers, VA staff, and leadership). Specific Aims 2 and 3 entail a controlled pilot trial of the intervention that employs an effectiveness-implementation hybrid type 1 design. For Specific Aim 2, we will implement the skills intervention within two VA Greater Los Angeles (GLA) VASH teams. We will assess its feasibility and acceptability, also comparing changes (from baseline to 6-month follow-up) in social skills, service use, social interactions, and money management among Veterans who receive the intervention (n=30) vs. a control group (n=20) of Veterans on distinct GLA VASH teams receiving usual care. For Specific Aim 3, we will use surveys and qualitative methods to explore potential barriers to and facilitators of future implementation of the intervention in routine care. The CDA training component will focus on implementation science, qualitative and quantitative methods, pragmatic trials, and skills to facilitate academic pursuits. Significance: Though the VA has dramatically expanded its use of evidence-based practices for homeless Veterans, there remain substantial challenges to keeping homeless-experienced Veterans housed and ensuring their health and well-being. To accelerate VA's efforts to improve care for homeless Veterans, we must implement novel services that are effective in other VA settings but have not been implemented within homeless services. Moreover, as a junior physician-investigator committed to improving care for homeless Veterans, I must fill gaps in my training, primarily in the areas of implementation science and qualitative methods.