Improving Housing Outcomes for Homeless Veterans

背景/依据：在VA中-尽管有许多基于证据的住房 许多无家可归的退伍军人仍然在努力获得和维持住房。社会技能（人际关系） 沟通或工具技能，如资金管理）是一个重要的，但低估了- 无家可归的成年人的住房结果的决定因素。然而，社会技能干预通常是缺席 从退伍军人事务部的流浪者服务中心 目标：本CDA将帮助我成为一名专注于脆弱群体的VA实施科学家 人口，特别是无家可归的经验丰富的退伍军人;它将制定和研究的实施， “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， 住房相关的社会技能-量身定制的VA支持性住房（VASH）计划。这次干预将是 由消费者提供者（“同行”）和持牌临床社会工作者共同提供，旨在改善VASH 参与者的住房保留和心理健康。使用行为模型的理论框架， 弱势群体，《综合执行框架》提供了更多指导 根据《住房研究框架》，具体目标是：1）制定一项技能干预措施，改善住房保留情况， 无家可归的退伍军人的心理健康; 2）在一项对照试验中，研究可行性， 可接受性和技能干预的有效性与改善住房密切相关的因素 无家可归的退伍军人的保留和心理健康，包括有利因素（社会技能， 认知）和行为（卫生服务使用，社会交往，资金管理）;和3）检查障碍 和促进未来在常规VASH护理中实施技能干预。 方法：为了实现具体目标1，我们将补充我们正在进行的社会技能训练的文献综述 通过进行关键线人访谈进行干预;我们还将使用兰德/加州大学洛杉矶分校的适当性 召集地方和国家无家可归者计划利益相关者专家小组（退伍军人消费者）的方法 供应商，VA工作人员和领导）。具体目标2和3需要对干预措施进行对照试点试验， 采用有效性-实现混合类型1设计。对于具体目标2，我们将实施以下技能 两个VA大洛杉矶（GLA）VASH团队内的干预。我们会评估其可行性， 可接受性，还比较了社会技能、服务使用、社会 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）接受常规护理的不同GLA VASH团队的退伍军人。对于具体目标3，我们将使用调查 探讨今后执行《行动纲领》的潜在障碍和促进因素， 常规护理干预。CDA培训部分将侧重于实施科学、质量 定量方法、实用试验和促进学术追求的技能。 意义：虽然退伍军人事务部已经大大扩大了对无家可归者的循证实践的使用， 退伍军人，仍然存在巨大的挑战，以保持无家可归的经验退伍军人住房，并确保 他们的健康和幸福。为了加快VA的努力，以改善照顾无家可归的退伍军人，我们必须 实现在其他VA环境中有效但在 无家可归者服务。此外，作为一名致力于改善无家可归者护理的初级医生调查员， 退伍军人，我必须填补我的培训空白，主要是在实施科学和定性领域， 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.