Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI 02908, USA.
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI 02903, USA.
Mil Med. 2024 Jul 3;189(7-8):e1443-e1449. doi: 10.1093/milmed/usad485.
The U.S. DVA Grant and Per Diem (GPD) program funds community agencies to provide housing and case management services to Veterans experiencing homelessness. GPD is one of the few VA programs that can enroll Veterans with Other-than-Honorable (OTH) military discharges. The characteristics of OTH Veterans and their outcomes in GPD are unknown.
We linked the Homeless Operations and Management Evaluation System database and VA Corporate Data Warehouse to identify Veterans with complete GPD enrollment and discharge data between 2018 and 2020. We categorized Veterans into three military discharge groups: Honorable, OTH, or Punitive. We evaluated key GPD process and outcomes measures: days enrolled in GPD, use of VA-funded emergency department care while in GPD, and whether a Veteran was successfully discharged from GPD, their housing status at program exit, employment status at program exit, and connection to mental health and substance abuse treatment at discharge. We conducted multivariable regressions to determine the adjusted association (controlling for demographics and comorbidities) between military discharge status and process and outcome measures.
Among 21,646 Veterans in the GPD program, 20,517 (95%) were honorably discharged; 811 (4%) had an OTH discharge; and 318 (1%) had a Punitive discharge. There was no difference in GPD length of enrollment by discharge status. Compared to honorably discharged veterans, OTH and Punitive discharged Veterans were less likely to successfully exit GPD, more likely to be homeless and employed at program exit, and were less likely to have a VA-funded emergency department visit while in GPD and less likely to be connected to mental health care or substance use treatment at program exit.
The GPD program serves hundreds of homeless Veterans with OTH and Punitive discharges every year, but they seem to be at greater risk for negative health and psychosocial outcomes and do not have the same access to VA services as other Veterans. These findings may inform policy considerations about expanding VA care and opportunities for community providers to serve Veterans with OTH and Punitive discharges.
美国 DVA 补助金和按日计算津贴（GPD）计划为社区机构提供资金，为无家可归的退伍军人提供住房和个案管理服务。GPD 是 VA 为数不多的可以招收有非荣誉性（OTH）兵役退役记录的退伍军人的项目之一。OTH 退伍军人的特征及其在 GPD 中的结果尚不清楚。
我们将无家可归者运营和管理评估系统数据库与 VA 公司数据仓库相链接，以确定在 2018 年至 2020 年期间有完整 GPD 注册和出院数据的退伍军人。我们将退伍军人分为三类兵役退役群体：荣誉，OTH 或惩罚性。我们评估了 GPD 的关键流程和结果指标：在 GPD 中注册的天数，在 GPD 中使用 VA 资助的急诊护理，以及退伍军人是否成功从 GPD 出院，他们在计划退出时的住房状况，在计划退出时的就业状况以及在出院时与心理健康和药物滥用治疗的联系。我们进行了多变量回归分析，以确定兵役退役状况与流程和结果指标之间的调整关联（控制人口统计学和合并症）。
在 GPD 计划中的 21646 名退伍军人中，有 20517 名（95％）是荣誉退伍；811 名（4％）是 OTH 退伍；318 名（1％）是惩罚性退伍。退伍军人在 GPD 注册的时间长短与退役状况无关。与荣誉退伍军人相比，OTH 和惩罚性退伍军人更不可能成功退出 GPD，在计划退出时更有可能无家可归和就业，在 GPD 中更不可能使用 VA 资助的急诊护理，并且更不可能在计划退出时接受心理健康护理或药物使用治疗。
GPD 计划每年为数百名有 OTH 和惩罚性兵役退役记录的无家可归退伍军人提供服务，但他们似乎面临更大的健康和心理社会结果风险，并且无法像其他退伍军人一样获得 VA 服务。这些发现可能为扩大 VA 护理和为有 OTH 和惩罚性兵役退役记录的退伍军人提供社区服务的机会提供政策考虑。
