Suchergebnisse

Young adults (ages 18-24) are especially vulnerable to homelessness in the United States, and those experiencing homelessness exhibit high prevalence for many kinds of abuse and negative health outcomes. This article reviews common behavioral health issues facing homeless youth and assesses collective wisdom on effective treatments and services for this vulnerable population. On the whole, the research remains focused on individual-level risk and protective factors and service use patterns and preferences, which detracts from the structural issues that have shaped these individuals' experiences in the first place and are key to resolving them.

Veterans who are discharged from military service due to misconduct are vulnerable to negative health-related outcomes, including homelessness, incarceration, and suicide. We used national data from the Veterans Health Administration for 218,608 veterans of conflicts in Iraq and Afghanistan that took place after the events of September 11, 2001, to compare clinical diagnoses between routinely-discharged (n = 203,174) and misconduct-discharged (n = 15,433) veterans. Misconduct-discharged veterans had significantly higher risk for all mental health conditions (adjusted odds ratio [AOR] range, 2.5–8.0) and several behaviorally linked chronic health conditions (AOR range, 1.2–5.9). Misconduct-discharged veterans have serious and complex health care needs; prevention efforts should focus on behavioral risk factors to prevent the development and exacerbation of chronic health conditions among this vulnerable population.

Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.

Effectiveness of screening for homelessness in a large healthcare system was evaluated in terms of successfully referring and connecting patients with appropriate prevention or intervention services. Screening and healthcare services data from nearly 6 million U.S. military veterans were analyzed. Veterans either screened positive for current or risk of housing instability, or negative for both. Current living situation was used to validate results of screening. Administrative evidence for homelessness-related services was significantly higher among positive-screen veterans who accepted a referral for services compared to those who declined. Screening for current or risk of homelessness led to earlier identification, which led to earlier and more extensive service engagement.

OBJECTIVE: To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a VA homelessness program on these outcomes. DATA SOURCES/STUDY SETTING: Combined Department of Veterans Affairs (VA) administrative and Medicare claims data. STUDY DESIGN: Observational study using longitudinal data from Veterans engaged with the VA system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006–2010 were matched on period of military service to Veterans with no evidence of homelessness. PRINCIPAL FINDINGS: Experience of homelessness was associated with 1.37 (95 percent CI = 1.34–1.40) and 0.16 (95 percent CI = 0.14–0.17) more outpatient encounters per quarter in VA and non‐VA settings, respectively, and 1.31 (95 percent CI = 1.30–1.32) and 0.49 (95 percent CI = 0.48–0.49) more inpatient days per quarter in VA and non‐VA hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65 years of age, those enrolled in a VA homelessness program had 94.4 percent (95 percent CI = 90.7 percent–98.1 percent) more VA outpatient visits but 5.5 percent (95 percent CI = 3.0 percent–7.9 percent) fewer Medicare outpatient visits. CONCLUSIONS: Homelessness was associated with an increase in VA and Medicare utilization and cost. A VA homelessness program decreased use of Medicare outpatient services.

BACKGROUND: In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model (called H-PACT) to improve care processes and outcomes for homeless Veterans. OBJECTIVE. To determine whether H-PACT offers a better patient experience than standard VHA primary care. RESEARCH DESIGN: We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey. SUBJECTS: Homeless-experienced survey respondents enrolled in H-PACT (n=251) or standard primary care in facilities with HPACT available (n=1,527) and facilities without H-PACT (n=10,079). MEASURES: Patient experiences in eight domains from the Consumer Assessment of Healthcare Provider and Systems surveys. Domain scores were categorized as positive versus non-positive. RESULTS: H-PACT patients were less likely than standard primary care patients to be female, have four-year college degrees, or to have served in recent military conflicts; they received more primary care visits and social services. H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access (adjusted risk difference[RD]=17.4), communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3). Standard primary care patients in facilities with H-PACT available were more likely than those from facilities without H-PACT to report positive experiences with communication (RD=4.7) and self-management support (RD=4.6). CONCLUSIONS: Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, compared to standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other healthcare settings.