Increasing the Numbers of Homeless Veterans Served by the Veterans Health Administration from 2008 to 2015: maintaining focus on the intended target population and on sustaining service intensity

ABSTRACT

In 2009, the Department of Veterans Affairs (VA) set a goal of ending veteran homelessness by expanding health care and housing services. The process of expanding programs on a large scale can lead to erosion of focus on program goals, especially if it involves serving a target population that is challenging to assist and that may require delivery of services at a high level of intensity. This study examined changes from 2008 to 2015 in the numbers of homeless veterans served; changes in in the target population served (socio-demographic and diagnoses treated); and changes in the intensity of services provided (number of mental health contacts per veteran annually). The number of homeless veterans served increased 125% (by over 134,000/year) as compared to only 15% for non-homeless veterans. Housing subsidies provided through HUD vouchers increased 75-fold from less than 1000 to almost 60,000. These large expansions were accomplished with little evidence of changes in sociodemographic characteristics or diagnoses among those treated, or reductions in the numbers of mental health services provided per veteran. These data demonstrate a large expansion of services for homeless veterans, especially supported housing, and successful maintenance of focus on the intended target population.

KEYWORDS:

• Homelessness
• veterans
• Mental Health services
• VA
• ‌Quality of Care
• ‌Implementation

Acknowledgements

This study represents the opinions of the authors and not the U.S. Department of Veterans Affairs.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the IRB of the VA Connecticut healthcare System which granted a waiver of informed consent.

Additional information

Notes on contributors

Robert Rosenheck

Robert Rosenheck is a Senior Investigator in Health Services Research at the VA New England MIRECC and Professor of Psychiatry at Yale Medical School and has worked on homelessness for three decades.

Hannah Sorkin

Hannah Sorkin is a senior at Princeton University.

Elina Stefanovics

Elina Stefanovics is Research Scientist at Yale in the Department of Psychiatry and a sociologist at the VA New England MIRECC.