Center of Excellence – Outcomes for Veteran Families Experiencing Homelessness

Outcomes for Veteran Families Experiencing Homelessness

Homelessness is a humanitarian crisis in Los Angeles. Families experiencing homelessness face stressors such as trauma, family separation, finding housing, parent substance use, lack of supports, and family challenges, such as communication. Veteran families experiencing homelessness face similar stress as civilian families, but may also be dealing with parent deployment, parent PTSD, and the stress of community reintegration. Unfortunately, youth growing up in families experiencing homelessness are at risk for mental health problems, substance use problems, and later homelessness. An 8-session intervention, called the Families Over Coming Under Stress (FOCUS) program, was developed for military families with trauma and found to help with family coping, communication, and shown to improve family mental health. We have adapted this program for the needs of families experiencing homelessness through interviews with families experiencing homelessness—including Veteran parents, and providers of homeless services. In our prior work we have found that Veteran families want family care delivered within the VA, but often do not receive it. In this project we propose to deliver the FOCUS program to Veteran families experiencing homelessness. We will assign Veteran families to the intervention and assign families to receive usual care from their homeless providers. We will then study the intervention to see if it is feasible to deliver to Veterans experiencing homelessness. We will also explore the impact on family mental health, family functioning, and housing. We will interview a subset of Veteran parents to better understand the experiences of Veteran families during homelessness, which will further help us deliver the intervention. We hope that this program can improve care for Veteran families—a very important part of our Veteran population.

Specific Aims

Family homelessness is a public health crisis in Los Angeles County (LAC). This is related to the affordable housing crisis, economic problems, and persistent homelessness among women, who are most likely to be heads of families. Despite heroic policy efforts to combat homelessness, results from the 2018 LA Point in Time Count showed that the number of homeless families have not fallen this past year. Youth in homeless families are at risk for poor mental health, school failure, and later homelessness.

Veteran families experiencing homelessness face similar stressors as civilian families, yet grapple with the additional strains of dealing with parent deployment, parental PTSD, and reintegration stress, among others. Our prior research with Veteran families experiencing homelessness found that parents struggled with PTSD related to military combat and/or military sexual trauma and felt a need for greater family supports.

We are adapting and piloting the Families Overcoming Under Stress program for families experiencing homelessness (FOCUS-HF), a trauma-informed, preventive intervention, to strengthen families and improve youth outcomes. As the first phase of our adaption, we conducted extensive qualitative interviews with families experiencing homelessness and homeless service providers, throughout LAC. We found that many families struggled with separation, lack of supports, and trouble communicating. In our two prior studies with Veteran parents experiencing homelessness, parents voiced a need for a family intervention to address family communication and family stress, support with interacting with others, and a need for ongoing advocacy and assistance. Families we interviewed emphatically described a need for family services to be delivered within the VA. To address this gap in services for Veteran families experiencing homelessness, we propose to expand our intervention to include Veteran families with a history of homelessness.

This study has the potential to address not only the Veteran parent, but the whole Veteran household, and transform services for Veteran families experiencing homelessness.

PI: Roya Ijadi-Maghsoodi, MD, MSHPM