Psychiatr Serv. 2014 Jun 1;65(6):751-7. doi: 10.1176/appi.ps.201300104.
This study examined use of U.S. Department of Veterans Affairs (VA) and non-VA services and predictors of service use among veterans and nonveterans who resided in a low-demand emergency shelter.
Equal numbers (N=110) of veterans and nonveterans recruited between January and June 2008 at a low-demand emergency shelter were interviewed about demographic characteristics, histories of military service and homelessness, general medical and mental functioning, current alcohol and drug problems and substance use, and use of medical, psychiatric, and substance abuse services. The Behavioral Model for Vulnerable Populations was used to identify need-based, enabling, and predisposing variables for analysis.
Both groups reported high rates of arrest and incarceration, very low incomes, extensive histories of homelessness, and a similar need for services. However, significantly more veterans than nonveterans used psychiatric services, nonemergency medical services, and inpatient substance use services. Similar proportions of veterans and nonveterans used public non-VA health care services. Need-based variables appropriately predicted service use, but veterans and individuals with insurance were also more likely to access services.
The veterans and nonveterans residing in a low-demand shelter faced several barriers to escaping homelessness. Both groups made similar use of non-VA services, but veterans used more services overall because of their access to VA services. The predictive power of insurance indicated that veterans may experience barriers to care despite the availability of VA services. The presence of veterans in this low-demand shelter may represent evidence of barriers to veteran and other public housing services.
本研究调查了居住在低需求紧急避难所的退伍军人和非退伍军人对美国退伍军人事务部（VA）和非 VA 服务的使用情况，以及服务使用的预测因素。
2008 年 1 月至 6 月期间，在一个低需求的紧急避难所招募了数量相等（N=110）的退伍军人和非退伍军人，对其进行了人口统计学特征、兵役和无家可归史、一般医疗和精神功能、当前酒精和药物问题以及物质使用、以及医疗、精神病和药物滥用服务的使用情况。采用脆弱人群行为模型来确定基于需求的、使能的和易感性变量进行分析。
两组均报告了高逮捕和监禁率、极低收入、长期无家可归史，以及类似的服务需求。然而，退伍军人比非退伍军人更倾向于使用精神科服务、非紧急医疗服务和住院药物滥用服务。退伍军人和非退伍军人使用公共非 VA 医疗保健服务的比例相似。基于需求的变量适当预测了服务的使用，但退伍军人和有保险的人也更有可能获得服务。
居住在低需求避难所的退伍军人和非退伍军人面临着许多摆脱无家可归的障碍。两组都相似地使用了非 VA 服务，但由于退伍军人可以获得 VA 服务，因此他们总体上使用了更多的服务。保险的预测力表明，尽管有 VA 服务，但退伍军人可能会面临获得医疗保健的障碍。退伍军人在这个低需求避难所的存在可能表明退伍军人和其他公共住房服务存在障碍。
