Universal Screening for Homelessness and Risk for Homelessness in the Veterans Health Administration

Montgomery, Ann Elizabeth; Fargo, Jamison D.; Byrne, Thomas; Kane, Vincent; Culhane, Dennis P

doi:10.2105/ajph.2013.301398

Cited by 97 publications

(66 citation statements)

References 2 publications

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“…First, in the fall of 2012, the VA implemented a two-question homelessness screening clinical reminder, which is administered system-wide to all veterans who have an outpatient visit (Montgomery, 2013). The intent of this screener is to identify veterans who are currently homeless or at imminent risk of homelessness and to facilitate linkages of those veterans who screen positive to needed social work or homeless services available at the VA. Second, the VA has recently introduced the Supportive Services for Veteran Families (SSVF) program, a homelessness prevention and rapid rehousing program, which is funded by the VA, but operated by community-based providers of homeless assistance (Funding Availability Under Supportive Services for Veteran Families Program, 2012).…”

Section: Discussionmentioning

confidence: 99%

Health Services Use Among Veterans Using U.S. Department of Veterans Affairs and Mainstream Homeless Services

Byrne¹,

Montgomery²,

Treglia³

et al. 2013

World Med & Health Policy

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We examined the use of health and behavioral health services for two groups of homeless veterans (N ¼ 1,302) in the New York City area who were enrolled in the U.S. Department of Veterans Affairs (VA) healthcare system-veterans who use VA homeless programs, and veterans who use mainstream homeless programs only. Using administrative records from the VA and the New York City Department of Homeless Services, we compared the characteristics of users of VA and mainstream homeless programs and examined between-group differences in VA inpatient and outpatient services use and within-group changes in services use prior and subsequent to onset of homelessness. Roughly 41 percent of veterans only used mainstream homeless services. There were no significant differences between users of VA and mainstream homeless services in terms of gender, age, ethnicity, and level of VA eligibility. Veterans who used only mainstream homeless assistance services were less likely to be engaged with-and made less intensive use of-VA health and behavioral health inpatient and outpatient services than those who used VA homeless services. Efforts should be made to identify and engage veterans who, while enrolled in VA healthcare, may go unidentified as homeless by the VA.

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Section: Discussionmentioning

confidence: 99%

Health Services Use Among Veterans Using U.S. Department of Veterans Affairs and Mainstream Homeless Services

Byrne¹,

Montgomery²,

Treglia³

et al. 2013

World Med & Health Policy

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“…Prior research efforts have relied on primary data collection during a health care or social service encounter (Gelberg, Andersen, and Leake ; Montgomery et al. ; Braciszewski, Toro, and Stout ) or on use of secondary databases of homeless service users maintained for administrative purposes (Byrne and Culhane ).…”

mentioning

confidence: 99%

“…In addition to primary data collection using a screening tool in the electronic health record (Montgomery et al. ), VA researchers have examined secondary data indicating use of VA‐supported homeless services and/or diagnoses of lack of housing (Edens et al. ).…”

mentioning

confidence: 99%

“…Yet efforts to identify homeless Medicaid populations using secondary health care data in research or clinical care have been limited. Prior research efforts have relied on primary data collection during a health care or social service encounter (Gelberg, Andersen, and Leake 2000;Montgomery et al 2013;Braciszewski, Toro, and Stout 2016) or on use of secondary databases of homeless service users maintained for administrative purposes (Byrne and Culhane 2015).…”

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confidence: 99%

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Identifying Homeless Medicaid Enrollees Using Enrollment Addresses

Vickery

Shippee

Bodurtha

et al. 2017

Health Services Research

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“…An alternative approach relies on self‐reported information about housing status collected through the use of screening tools administered to patients in clinical settings . The U.S. Department of Veterans Affairs’ (VA) Homelessness Screening Clinical Reminder (HSCR) is one such screening instrument that has been deployed on a wide scale.…”

Section: Introductionmentioning

confidence: 99%

Predictive modeling of housing instability and homelessness in the Veterans Health Administration

Byrne

Montgomery

Fargo

2018

Health Services Research

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Objective To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (VHA). Data Sources/Study Setting Electronic medical record data from 5.8 million Veterans who responded to the VHA's Homelessness Screening Clinical Reminder (HSCR) between October 2012 and September 2015. Study Design We randomly selected 80% of Veterans in our sample to develop predictive models. We evaluated the performance of both logistic regression and random forests—a machine learning algorithm—using the remaining 20% of cases. Data Collection/Extraction Methods Data were extracted from two sources: VHA's Corporate Data Warehouse and National Homeless Registry. Principal Findings Performance for all models was acceptable or better. Random forests models were more sensitive in predicting housing instability and homelessness than logistic regression, but less specific in predicting housing instability. Rates of positive screens for both outcomes were highest among Veterans in the top strata of model‐predicted risk. Conclusions Predictive models based on medical record data can identify Veterans likely to report housing instability and homelessness, making the HSCR screening process more efficient and informing new engagement strategies. Our findings have implications for similar instruments in other health care systems.

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Universal Screening for Homelessness and Risk for Homelessness in the Veterans Health Administration

Cited by 97 publications

References 2 publications

Health Services Use Among Veterans Using U.S. Department of Veterans Affairs and Mainstream Homeless Services

Health Services Use Among Veterans Using U.S. Department of Veterans Affairs and Mainstream Homeless Services

Identifying Homeless Medicaid Enrollees Using Enrollment Addresses

Predictive modeling of housing instability and homelessness in the Veterans Health Administration

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