Journey to Home: development of a conceptual model to describe Veterans' experiences with resolving housing instability

Abstract

Recent research has focused on risk factors for Veteran housing instability and programmatic responses. However, little is known about Veterans’ experiences of becoming unstably housed and navigating available resources to resolve housing crises. This qualitative paper, based on open-ended interviews with Veterans (n = 60), presents the Journey to Home conceptual model, which offers a framework for understanding Veterans’ journeys through housing instability, including the factors that contribute to vulnerability, the range of housing conditions that Veterans describe as inadequate, how Veterans connect to assistance through VA and community providers, and barriers and facilitators to connecting with and using available assistance, resulting in either continued housing instability or successful housing outcomes. Ongoing efforts to end Veteran homelessness should prioritize strategies that respond to complex vulnerabilities.

Keywords:

• homelessness
• housing need
• housing affordability
• Veterans
• social determinants of health
• social work

Acknowledgements

The views expressed here do not necessarily reflect those of the U.S. Department of Veterans Affairs or the U.S. Government.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the U.S. Department of Veterans Affairs Health Services Research and Development Program [Grant IIR-13-334].

Notes on contributors

Meagan Cusack

Meagan Cusack has over a decade of research experience related to social justice and equity. In her current role at the VA Center for Health Equity Research and Promotion (CHERP), she manages and conducts mixed methods research integrating Veteran and stakeholder voices with secondary data. Her primary research interests include homelessness, housing instability, and social determinants of health.

Ann Elizabeth Montgomery

Ann Elizabeth Montgomery has morethan 15 years' experience conducting research and evaluation related to homelessness and housing. Since its inception in 2009, she has worked with the National Center on Homelessness among Veterans (NCHAV) to develop and implement a diverse research agenda emphasizing homelessness prevention, interventions to prevent and end homelessness among high-need Veterans, and the demography, epidemiology, and services utilization of Veterans experiencing homelessness. Her work—including research, evaluation, and policy analysis—informs U.S. Department of Veterans Affairs (VA) programs and policies at the national level directed toward ending homelessness among Veterans. Her primary research interests are identifying homelessness and risk among Veterans seeking healthcare, assessing interventions intended to mitigate this risk, and studying vulnerable populations and related health disparities.

Anneliese E. Sorrentino

Anneliese E. Sorrentino is a Program Specialist at the VA Center for Health Equity Research and Promotion (CHERP) and a Staff Therapist at Council for Relationships in Philadelphia, PA. Her research and clinical interests include trauma, adaptation, and healing relationships.

Melissa E. Dichter

Melissa E. Dichter is a Core Investigator with the VA Center for Health Equity Research and Promotion (CHERP) in Philadelphia, PA, and Assistant Professor in Family Medicine and Community Health at the University of Pennsylvania. Dr. Dichter's research focuses primarily on intimate partner violence and related social health conditions, including housing instability and mental health, as well as system responses to social health conditions broadly. Dr. Dichter has expertise in mixed-methods research and primary data collection. Dr. Dichter earned her PhD in Social Welfare and Masters in Social Work from the University of Pennsylvania and her BA in Child Development from Tufts University.

Manik Chhabra

Manik Chhabra is a primary care physician at the Corporal Michael J Crescenz VA Medical Center in Philadelphia, and the medical director of the Indigo Patient Aligned Care Team (PACT) — a clinic serving high risk patients with chronic pain and substance use disorders. Dr. Chhabra recently completed a fellowship with the Robert Wood Johnson Clinical Scholars Program at the University of Pennsylvania, and has research interests in management of substance use disorders in primary care, and the role of health systems addressing housing insecurity.

Gala True

Gala True is an Investigator with the South Central Mental Illness Research and Education Center (MIRECC) at the Southeast Louisiana Veterans Health Care System and Associate Professor in the Section of Community and Population Medicine at Louisiana State University School of Medicine. With a background in folklore and anthropology, her research focuses on improving access to care and the health of individuals and communities through patient-centered and community-engaged research approaches. Her most recent research employs participatory action research methods to collaborate with Veterans, military families, and other key stakeholders on identifying barriers to post-deployment care and proposing solutions for improving community reintegration after separation from military service.