Twenty-Six Veterans

A Longitudinal Case Study of Veterans Experiencing Homelessness in Los Angeles, 2019–2020

by Sarah B. Hunter, Benjamin F. Henwood, Rajeev Ramchand, Stephanie Brooks Holliday, Rick Garvey

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Research Questions

  1. Over the course of a year, what factors facilitate or serve as barriers to entry into stable housing among VEH in West LA?
  2. Does stable housing improve mental health, quality of life, or physical health, and does it increase service utilization and security?
  3. How acceptable and feasible is it for VEH to use smartphones for data collection, and is it possible to conduct ecological momentary assessment surveys requiring participants to respond several times a day?
  4. How were VEH affected by the COVID-19 pandemic in terms of their perceptions of risk, protective behaviors, symptoms, and psychological distress?

Veteran homelessness in Los Angeles (LA), California, is a pervasive public health problem, with the county having the highest concentration of veterans experiencing homelessness (VEH) in the United States. Despite significant investments and many programs and services available to VEH, eliminating homelessness has proven to be a major public policy challenge.

In this report, the authors describe a first-of-its-kind longitudinal study conducted in 2019/2020 that followed 26 VEH in West LA. The information obtained about the veterans' housing, health, and service experiences can be used by policymakers and public health practitioners to identify specific factors that are related to engagement in care and housing attainment and stability.

The COVID-19 pandemic began during the study, and the research team had to adapt to remote data collection protocols to complete the follow-up data collection. As a result, important lessons about the feasibility of remote data collection with VEH both before and during the COVID-19 pandemic were learned.

The authors make a number of recommendations, including allocating more resources to fully meet the needs of VEH in LA (including more-robust outreach services, substance use disorder treatment, and other health care treatment), implementing additional temporary and permanent housing solutions, and building in accountability measures to make progress toward these goals more transparent to a larger audience.

This report should be of interest to entities serving populations that experience homelessness, including governments, health care organizations, practitioners, advocacy groups, researchers, and others interested in addressing the homelessness crisis.

Key Findings

  • Seventeen of 26 VEH received some type of housing, and all but two retained housing during the study. However, only three veterans had received a permanent housing solution by the time the study ended.
  • Nine of 26 VEH were never stably housed for more than half of a month over the study period despite all engaging at some point with the homeless service system.
  • Participants' stories help confirm the need to more deeply invest in outreach service provision that can lead to tangible support more quickly and efficiently.
  • The extent to which outreach teams engage with informal support networks (as opposed to focusing exclusively on the coordinated entry system to access housing) is unclear.
  • It is important to respond to individual housing preferences. Several participants made clear that not all housing options are equivalent and that some options will not be acceptable.
  • Aligning the housing options that the homeless service system provides with the preferences and needs of the unhoused population appears to clearly facilitate a pathway into housing, but data about housing preferences in this population are limited.
  • Data support the idea that once veterans were stably housed, mental health symptoms, quality of life, and social support improved.
  • Participants received more housing, legal, financial, and Department of Veterans Affairs (VA) benefits when they were stably housed.

Recommendations

  • Align housing options with veterans' housing preferences.
  • Open services to the most-vulnerable veterans, taking VA eligibility into account.
  • Identify ways in which systems can more efficiently house veterans.
  • Rather than considering clients as "service resistant," consider how services may be "client resistant."
  • Strengthen and consider services to connect veterans with both formal and informal supports outside of LA.
  • Prioritize Housing First services, which is an evidence-based approach to increasing housing stability for people experiencing chronic homelessness and behavioral (i.e., mental health and/or substance use) disorders.
  • Develop targeted services for subpopulations of VEH, and for VEH that are not eligible or appropriate for Housing First or the U.S. Department of Housing and Urban Development–VA Supported Housing programs, develop clearer routes to other permanent housing solutions.

Table of Contents

  • Chapter One

    Veteran Homelessness in Los Angeles

  • Chapter Two

    Study Methods

  • Chapter Three

    Characteristics of the Sample

  • Chapter Four

    Housing

  • Chapter Five

    Health and Well-Being

  • Chapter Six

    Use of Supportive Services

  • Chapter Seven

    Ecological Momentary Assessment Pilot Study

  • Chapter Eight

    Impact of the COVID-19 Pandemic

  • Chapter Nine

    Conclusions

  • Appendix A

    Individual Case Summaries

  • Appendix B

    Services for Veterans Experiencing Homelessness

Research conducted by

This research was funded by the Daniel Epstein Family Foundation and carried out within the Access and Delivery Program in RAND Health Care.

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