UCLA/VA Center of Excellence for Training and Research
in Veteran Resilience and Recovery
Primary Care Treatment of Depression for Veterans with Experiences of Homelessness
Depression disproportionately affects homeless Veterans, who are afflicted by severe psychosocial stressors, and the VA has designated additional resources to better integrate care for them. Because they commonly lack regular care access and receive fragmented services, homeless Veterans are among the highest utilizers of emergency, inpatient, and specialty mental health and substance abuse services. Since 2012, VA facilities have set up homeless-tailored primary care teams (H-PACTs), which aim to tighten linkages between primary care, mental health, and social services. They also allow primary care to be the point of VA care entry for Veterans not wishing to engage with VA’s social service and housing programs. Early evaluations are promising, in that Veterans in H-PACTs use more primary care services and report more positive care experiences than homeless Veterans in other PACTs in the same facilities. H-PACT enrollment is associated with some reductions in emergency department (ED) and specialty mental health visits, which may represent efficient service delivery.
While various VA initiatives have tackled care integration (i.e., PC-MHI, PACT) and been linked with improved clinical care quality, less is known about the newer H-PACT programs. Beginning 2012, VA facilities have set up homeless-tailored primary care teams to tighten linkages between primary care, mental health, and social services. Early evaluations are promising, in that Veterans in H-PACTs use more primary care services and report more positive care experiences than homeless Veterans in other PACTs in the same facilities. H-PACT enrollment is associated with some reductions in emergency department (ED) and specialty mental health visits. Yet, there are no published investigations of mental health services quality or outcomes for homeless patients cared for by H-PACT versus other PACTs. To design systems-level interventions to improve depression outcomes for homeless patients, we need to understand mental health care access across primary care settings and the quality of depression care in H-PACT versus other PACTs.
Specific Aims:
- To describe mental health-related service utilization over time for a regional cohort of newly diagnosed homeless Veterans across different VA primary care settings.
- To examine if newly diagnosed Veterans cared for by homeless-tailored primary care are associated with higher depression care quality.
PI: Lucinda Leung, MD, MPH, PhD
Evaluating Impacts of the Care Treatment and Rehabilitation Services (CTRS) for Veterans Experiencing Unsheltered Homelessness During the Covid-19 Pandemic
The CTRS is an innovative low barrier housing program that serves a highly vulnerable group of Veterans experiencing homelessness (VEHs). This quality improvement project aims to identify program enhancements (e.g., provider training, clinical processes, Veteran resources) that can be implemented and tested using a rapid-cycle improvement approach that engages the COE. Should results from this project suggest the value of the CTRS for VEHs – within and beyond the COVID-19 pandemic – it will also inform plans to disseminate this innovation at VA facilities throughout the nation.
PIs: Lisa Altman, MD, Sonya Gabrielian, MD, MPH
This project will train VA and community partner staff in community-based interventions to address eviction, grounded in a structural understanding of how racism contributes to eviction and homelessness. The training will be evaluated using qualitative methods.
PI: Peter Capone-Newton, MD, MP
Improving Outcomes for Veteran Families Experiencing Homelessness
This pilot study will develop a peer-facilitated group intervention to improve community integration and reduce self-stigma among Veterans experiencing homelessness with schizophrenia or other psychotic spectrum disorders.
PI: Ippolytos Kalofonos, MD, PhD
Veteran Voices and Visions: A Peer-facilitated Group Intervention Improving Community Integration for Veterans Experiencing Homelessness and Serious Mental Illness
This pilot study will develop a peer co-facilitated group intervention to improve community integration and reduce self-stigma among Veterans experiencing psychosis. This meaning-centered approach is inspired by the Hearing Voices Movement.
PI: Ippolytos Kalofonos, MD, PhD