No Wrong Door: Can Clinical Care Facilitate Veteran Engagement in Housing Services?

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It is well established that providing stable housing to homeless persons improves health outcomes. It is less clear whether engagement in clinical care facilitates housing outcomes. We present a post hoc analysis of a prospective, community-based randomized controlled trial of homeless veterans not actively receiving or assigned to a primary care. Study subjects were interviewed at baseline, 1 month and 6 months and survey results were supplemented/verified by review of all notes in their VA electronic medical record for 6 months postenrollment. A total of 142 subjects with complete data were included in this analysis: 82 (57.7%) were in a stable sheltering/housing arrangement (transitional housing, stably doubled-up, independent housing) at baseline and stayed stable; 36 (25.4%) started in an unstable sheltering arrangement (unsheltered, emergency sheltered, unstable doubled-up arrangement) and moved into stable sheltering/housing while 24 (17.0%) individuals either started in and stayed unstably sheltered or went from a stable to an unstable arrangement. Of 36 individuals who transitioned from unstable to stable sheltering/housing, 25 (69.4%) accessed primary care within 1 month compared with 37.5% of the persistently unstable sheltering group and 57.3% of the stably sheltered/housed group (p = .05). Of those with care within 1 month, their average time from unstable to stable housing was 84.8 days compared with 165.9 days for those who do not access care (p = .02). Of those receiving primary care within 1 month of enrollment, 88.9% were in stable sheltering at 6 months. These findings suggest an important role for clinical engagement in helping achieve housing stability for homeless veterans.

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