VA HSR&D Center of Excellence for Study of Healthcare Provider Behavior, Los Angeles, California 90073, USA.
Womens Health Issues. 2011 Jul-Aug;21(4 Suppl):S203-9. doi: 10.1016/j.whi.2011.04.005.
Veterans comprise a disproportionate fraction of the nation's homeless population, with women veterans up to four times more likely to be homeless than non-veteran women. This paper provides a grounded description of women veterans' pathways into homelessness.
Three focus groups were held in Los Angeles, California, with a total of 29 homeless women veterans.
Five predominant "roots" (precipitating experiences) initiated pathways toward homelessness: 1) childhood adversity, 2) trauma and/or substance abuse during military service, 3) post-military abuse, adversity, and/or relationship termination, 4) post-military mental health, substance abuse, and/or medical problems, and 5) unemployment. Contextual factors, which promoted development of homelessness in the setting of primary roots, included women veterans' "survivor instinct," lack of social support and resources, sense of isolation, pronounced sense of independence, and barriers to care. These contextual factors also reinforced persistence of the roots of post-military adversity and mental health and substance abuse problems, serving to maintain cycles of chronic homelessness.
Collectively, these multiple, interacting roots and contextual factors form a "web of vulnerability" that is a target for action. Multiple points along the pathways to homelessness represent critical junctures for VA and community-based organizations to engage in prevention or intervention efforts on behalf of women veterans. Considering the multiple, interconnected challenges that these women veterans described, solutions to homelessness should address multiple risk factors, include trauma-informed care that acknowledges women veterans' traumatic experiences, and incorporate holistic responses that can contribute to healing and recovery.
退伍军人在全国无家可归者中所占比例不成比例，女性退伍军人无家可归的可能性是非退伍军人女性的四倍多。本文对女性退伍军人无家可归的途径进行了深入描述。
在加利福尼亚州洛杉矶举行了三次焦点小组会议，共有 29 名无家可归的女性退伍军人参加。
五个主要的“根源”（促成经历）导致了无家可归的途径：1）童年逆境，2）军旅生涯中的创伤和/或药物滥用，3）退伍后的虐待、逆境和/或关系破裂，4）退伍后的心理健康、药物滥用和/或医疗问题，以及 5）失业。促进主要根源背景下发展为无家可归的情境因素包括女性退伍军人的“生存本能”、缺乏社会支持和资源、孤立感、强烈的独立感以及获得医疗服务的障碍。这些情境因素也加剧了退伍后逆境和心理健康以及药物滥用问题根源的持续存在，从而维持了慢性无家可归的循环。
总的来说，这些相互作用的多重根源和情境因素构成了一个“脆弱性网络”，是采取行动的目标。无家可归途径上的多个点代表了 VA 和社区组织代表女性退伍军人进行预防或干预努力的关键节点。考虑到这些女性退伍军人所描述的多重、相互关联的挑战，解决无家可归问题的方案应解决多个风险因素，包括承认女性退伍军人创伤经历的创伤知情护理，并纳入有助于治疗和康复的整体应对措施。
