Unique Considerations for Homeless Female Veterans

As the number of women Veterans continues to increase, so does the number of women Veterans experiencing housing instability. Homelessness or risk for homelessness among women Veterans may be directly linked to their experiences before, during, and after their military service, particularly the experience of trauma. To address homelessness among women Veterans, providers and researchers must acknowledge the gendered nature of both the military and Veteran-specific resources. Responses should include providing housing-related interventions specifically for women, assessing and addressing trauma among women Veterans, responding to the needs of younger women Veterans who may be homeless with children, and supporting women Veterans during their reintegration after discharge from the military.

Homelessness and Money Management in Military Veterans

Research has identified many factors associated with homelessness in Veterans; however, relatively less attention has been given to how poor financial decision-making may contribute to homelessness in Veterans. This chapter first outlines money management challenges and issues faced by Veterans and emphasizes unique characteristics of military service and Veteran status that may play a role. Evidence of a link between mental health problems and money management in Veterans is then presented, along with a review of empirical literature on money management and Veteran homelessness. The chapter then discusses how to effectively improve money management and financial literacy in Veterans, highlighting US Department of Veterans Affairs (VA) and military programs aimed at improving financial literacy. In the end, it is argued that striving to improve money management in Veterans’ lives should be a core component in efforts to eliminate Veteran homelessness.

Mental Illness and Substance Use Disorders Among Homeless Veterans

Mental illness and substance use disorders (SUDs) are strong risk factors for homelessness, regardless of Veteran status. This chapter describes the interplay between mental illness, SUDs, the co-occurrence of these disorders (CoD), and homelessness among Veterans; the authors consider military-specific experiences (e.g., combat) and factors associated with homelessness for both Veteran and non-Veteran adults (e.g., childhood adversity). They present epidemiology data on mental illness and SUDs among homeless Veterans, considering specific diagnoses (e.g., post-traumatic stress disorder) and experiences (e.g., military sexual trauma) that are highly prevalent within or unique to persons who served in the United States Armed Forces. In addition, the authors present qualitative and quantitative data on pathways to homelessness for Veterans with mental illness, SUDs, and/or CoD, considering distinct pathways seen in special populations (e.g., women Veterans, who have high rates of trauma, and the newest cohort of Veterans who served in Iraq or Afghanistan). Last, the authors discuss supported housing outcomes for homeless Veterans with psychiatric disorders and SUDs. They discuss the utility of these programs for homeless Veterans with mental health problems and explore the influence of psychiatric disorders and SUDs among Veterans with poor supported housing outcomes.

Homeless Veterans and Use of Information Technology

Persons experiencing homelessness, including homeless Veterans, increasingly use cell phones, computers, and other digital devices. In this chapter, the authors discuss use of technology by homeless Veterans, exploring ways that technology can facilitate access to information on resources including housing, job opportunities, health care, and personal health management. Also addressed is the role of technology in supporting development and maintenance of social networks and social capital for these marginalized Veterans. There have been several research reports specifically on homeless Veterans’ access to and use of information technologies. One study found that 89% of homeless Veteran survey participants had a cell phone. Like housed cell phone users, homeless Veterans use cell phones to stay in touch with family and friends and to complete specific tasks and transactions. Special challenges exist regarding technology use among homeless Veterans, including loss and theft of phones, keeping phones charged, and affording the service costs. The discussion in this chapter is informed by the Technology Acceptance Model (TAM), which states that perceived ease of use and perceived usefulness affect attitudes toward use, intention to use, and ultimately, actual use in light of contextual, external variables. External variables for homeless Veterans include tenuous living arrangements, significant financial challenges, military culture, diverse experiences during military service, and complex medical and mental health conditions. The chapter concludes by looking at advances in technology that may be beneficial for homeless Veterans and also the challenges, related to technology, that are likely to continue for this population.

Primary Care for Homeless Veterans

In many ways homelessness is both a health issue and a reflection of the viability of our social safety net and health care system. Despite advances made in our understanding of how to best provide care and assist homeless persons, significant health disparities and gaps in care persist, as does the conundrum of chronic and persistent homelessness. Primary care tailored to homeless persons provides a unique opportunity to address some of these health disparities and vulnerabilities as well as the platform on which to engage them in an array of additional services over a continuum of time and need. Core tenets of the most successful models capture several key elements: (1) availability of care based on an open-access, on-demand, and non-contingent model; (2) one-stop, wrap-around services that are integrated and coordinated; (3) capacity for intensive, longitudinal and community/social service–linked case management; (4) high-quality, evidence-based, and culturally sensitive care that both destigmatizes seeking care and supports professionalism among the providers delivering that care; and (5) accountability to specific measurable goals and outcomes. However, it will not happen without deliberate planning and organization and a commitment to the capacity needed to bring services to scale.

Introduction and History of Veteran Homelessness

Homelessness among US Veterans is a problem that has existed for more than five decades, and the health and social well-being of our Veterans are of major public concern. This introductory chapter sets the tone for the book and describes what Veteran homelessness is, how it is defined, and key historical events in the conceptualization and approach to Veteran homelessness. The chapter begins with a case study of a homeless Veteran, followed by a brief discussion of how homelessness is defined and why homeless Veterans are a population of public health importance. The author provides a selective detailed history of Veteran homelessness starting in the 1800s and the Civil War to the present day with ongoing conflicts in the Middle East. The chapter concludes with a brief overview of the other 10 chapters in this book and the work of leading thinkers in the field that together provide a comprehensive text on the programs, services, and research related to the care of homeless US Veterans.

Criminal Justice Issues Among Homeless Veterans

While there is not research that demonstrates that homelessness causes incarceration or that incarceration causes homelessness, there has long been an understanding that the two influence and create risk for one another. This chapter examines the prevalence of and risk factors for criminal justice involvement among homeless Veterans and the prevalence of and risk factors for homelessness among criminal justice–involved Veterans. The lack of shared definitions of homelessness and criminal justice involvement results in a wide range of prevalence estimates, few risk factors have been identified, and the cyclical nature and mechanisms explaining the link between homelessness and criminal justice involvement among Veterans is largely unknown. The US Department of Veterans Affairs currently has two programs designed to address treatment needs, including homelessness, among criminal justice–involved Veterans. As these programs expand and evolve, research is needed to fill our extensive knowledge gaps and develop programs and interventions to attenuate Veterans’ risks for chronic homelessness and criminal justice involvement.

Epidemiology of Homelessness Among Veterans

Accurately estimating the incidence, prevalence, and composition of the population of Veterans who experience homelessness is important for planning and evaluating prevention and intervention strategies. However, several methodological considerations exist that are relevant to establishing and interpreting epidemiological estimates of homelessness among Veterans. These issues include the conceptual definition of homeless and Veteran status; the various time frames used in enumeration efforts and the implications of these time frames on resulting estimates; and the strengths and limitations of primary and administrative data sources. This chapter discusses methodological issues and present a national epidemiological estimates based on various sources and methodologies. Recent point prevalence, period prevalence, and incidence estimates are summarized, as are segmentation of estimates by demographic, geographic, and housing status characteristics, and trends over time. In the past decade, several indicators have suggested that homelessness among Veterans has decreased substantially. Since 2009, point-in-time estimates have declined nearly 50%, and 1-year estimates have declined by 11%. Despite these improvements, Veterans continue to be overrepresented among the population of homeless adults in the United States.

Aging and Mortality in Homeless Veterans

In this chapter the authors describe and discuss two emerging related issues in the homeless Veteran population: aging and mortality. To facilitate the presentation of the current status of these issues, the authors have divided the chapter into four sections. The first section provides an overview on the current state of homelessness in Veterans and a perspective on the factors contributing to Veteran homelessness. The second and third sections present reviews of aging and mortality in homeless Veterans. These are two separate yet related issues, given that the homelessness is disproportionately represented in older Veterans, the Veteran homeless population is aging, and homeless Veterans have increased mortality risk across the age range but especially in older age. The last section provides a summary with comments on intervention strategies for older homeless Veterans.

Homeless Risk Among Post-9/11 Era Veterans

Media and advocacy outlets have expressed alarm about homelessness among post-9/11–era Veterans, with little systematic research available to evaluate these claims and to offer an empirically based profile of the nature and extent of homelessness. In this chapter, the authors draw on research, media, and advocacy accounts to identify the factors that are particular to homelessness among this most recent cohort of Veterans, with a particular focus on defining military-based factors of this era and broader systemic forces that were formative to Veterans’ experiences after returning to civilian life. These factors, the authors argue, interact to create a set of circumstances that do not appear to currently create substantially elevated rates of homelessness among post-9/11 Veterans but that potentially warrant policy attention and interventions in specific areas, as well as further monitoring of homelessness risk over the cohort’s collective life course.