Chinchilla Melissa, Gabrielian Sonya, Hellemann Gerhard, Glasmeier Amy, Green Michael
VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, United States.
VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.
Front Psychiatry. 2019 Jun 26;10:472. doi: 10.3389/fpsyt.2019.00472. eCollection 2019.
Community integration is recognized as a meaningful goal that is highly relevant to the long-term success of supportive housing programs. Research to date highlights concerns that some individuals in permanent supportive housing remain socially isolated and have limited success in other domains of community integration. However, we know little about what factors impact formerly homeless veterans' ability to achieve community integration. To identify factors associated with community integration among homeless veterans housed through the Department of Veterans Affairs' (VA's) Supportive Housing program (HUD-VASH), we performed secondary database analyses of Veterans ( = 560) housed HUD-VASH in the VA Greater Los Angeles Healthcare System from 10/1/14-9/30/15. We conducted ordinal and logit regressions to examine associations between baseline HUD-VASH participant characteristics, supportive housing voucher type, health service utilization in the year post-housing, and three types of community integration outcomes (i.e., change in community adjustment, status of housing stability, and change in employment). Data were obtained from HOMES (VA's homeless registry) and Corporate Data Warehouse (CDW) (VA's a national administrative dataset of VA inpatient and outpatient care). Mental health service utilization was negatively associated with community adjustment, housing stability, and employment. Employment at baseline was positively associated with housing stability and employment. Also, substance use disorder visits was positively associated with employment, and combined medical and substance use disorder diagnoses was positively associated with change in community adjustment. We considered 29 variables and found relatively few were associated with community integration. Consistent with previous research, our study highlights the importance of mental health needs, and suggests that utilization of mental health services is an important indicator of improvements in community adjustment, housing stability, and employment.
社区融合被视为一个有意义的目标，与支持性住房项目的长期成功高度相关。迄今为止的研究突出了一些担忧，即一些居住在永久性支持性住房中的人仍然社会孤立，并且在社区融合的其他领域取得的成功有限。然而，我们对哪些因素影响曾经无家可归的退伍军人实现社区融合的能力知之甚少。为了确定通过退伍军人事务部（VA）的支持性住房项目（HUD-VASH）安置的无家可归退伍军人中与社区融合相关的因素，我们对2014年10月1日至2015年9月30日在VA大洛杉矶医疗系统中通过HUD-VASH安置的退伍军人（n = 560）进行了二次数据库分析。我们进行了有序和逻辑回归，以检验基线HUD-VASH参与者特征、支持性住房券类型、住房后一年的医疗服务利用情况与三种社区融合结果（即社区适应变化、住房稳定状况和就业变化）之间的关联。数据来自HOMES（VA的无家可归者登记处）和企业数据仓库（CDW）（VA的一个关于VA住院和门诊护理的全国行政数据集）。心理健康服务利用与社区适应、住房稳定和就业呈负相关。基线时的就业与住房稳定和就业呈正相关。此外，物质使用障碍就诊与就业呈正相关，医疗和物质使用障碍综合诊断与社区适应变化呈正相关。我们考虑了29个变量，发现与社区融合相关的变量相对较少。与先前的研究一致，我们的研究突出了心理健康需求的重要性，并表明心理健康服务的利用是社区适应、住房稳定和就业改善的一个重要指标。
