{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:01:27Z","timestamp":1790776887149,"version":"4.1.0"},"reference-count":18,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Homelessness is a persistent and growing problem. What role health systems should play and how that role is incorporated into larger strategic efforts are not well-defined.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare homelessness among veterans with that in the general population during a 16-year study period before and after implementation of the Ending Veteran Homelessness Initiative, a program to rehouse veterans experiencing homelessness.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This national retrospective cohort study using a mixed-methods approach examined annualized administrative (January 1, 2007, to December 31, 2022) and population data prior to (2007-2009) and during (2010-2022) the Ending Veteran Homelessness initiative. Participants included unhoused adults in the US between 2007 and 2022.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Enrollment in Veterans Health Administration (VHA) Homeless Program Office components providing housing, case management, and wrap-around clinical and supportive services.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Point-in-time (PIT) count data for unhoused veterans and nonveterans during the study period, number of Section 8 housing vouchers provided by Housing and Urban Development\u2013Veterans Administration Supportive Housing, number of community grants awarded by Supportive Services for Veterans and Families, and total number of veterans housed each year. Semistructured interviews with VHA leadership were performed to gain insight into the strategy.<\/jats:p><\/jats:sec>Results<\/jats:title>In 2022, 33\u202f129 veterans were identified in the PIT count. They were predominantly male (88.7%), and 40.9% were unsheltered. During the active years of the Ending Veteran Homelessness initiative, veteran homelessness decreased 55.3% compared with 8.6% for the general population. The proportion of veterans in this cohort also declined from 11.6% to 5.3%. This change occurred during a shift to \u201chousing first\u201d as agency policy to create low-barrier housing availability. It was also coupled with substantial growth in housing vouchers, grants to community partner agencies, and growth in VHA clinical and social programming to provide homeless-tailored wrap-around services and support once participants were housed. Key respondent interviews consistently cited the shift to housing first, the engagement with community partners, and use of real-time data as critical.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of the federal Ending Veteran Homelessness initiative, after program implementation, there was a substantially greater decrease in homelessness among veterans than in the general population. These findings suggest an important role for health systems in addressing complex social determinants of health. While some conditions unique to the VHA facilitated the change in homelessness, lessons learned here are applicable to other health systems.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.53778","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T16:31:47Z","timestamp":1706545907000},"page":"e2353778","source":"Crossref","is-referenced-by-count":20,"title":["Changes in Homelessness Among US Veterans After Implementation of the Ending Veteran Homelessness Initiative"],"prefix":"10.1001","volume":"7","author":[{"given":"Thomas P.","family":"O\u2019Toole","sequence":"first","affiliation":[{"name":"US Veterans Health Administration, Washington, DC"},{"name":"Providence Veterans Affairs Health System Center for Innovation in Long Term Services and Support, Providence, Rhode Island"},{"name":"Division of Medicine and Biology, Alpert Medical School at Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Pape","sequence":"additional","affiliation":[{"name":"US Veterans Health Administration, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Kane","sequence":"additional","affiliation":[{"name":"US Veterans Health Administration, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Diaz","sequence":"additional","affiliation":[{"name":"US Veterans Health Administration, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Dunn","sequence":"additional","affiliation":[{"name":"US Veterans Health Administration, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Providence Veterans Affairs Health System Center for Innovation in Long Term Services and Support, Providence, Rhode Island"},{"name":"Division of Medicine and Biology, Alpert Medical School at Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shereef","family":"Elnahal","sequence":"additional","affiliation":[{"name":"US Veterans Health Administration, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,1,29]]},"reference":[{"key":"zoi231574r1","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1093\/epirev\/mxu004","article-title":"Risk factors for homelessness among US veterans.","volume":"37","author":"Tsai","year":"2015","journal-title":"Epidemiol Rev"},{"issue":"Suppl 2","key":"zoi231574r4","doi-asserted-by":"publisher","first-page":"S180","DOI":"10.2105\/AJPH.2013.301727","article-title":"Homelessness is a public health issue.","volume":"103","author":"Donovan","year":"2013","journal-title":"Am J Public Health"},{"issue":"4","key":"zoi231574r8","doi-asserted-by":"publisher","first-page":"633","DOI":"10.2105\/AJPH.2021.306640","article-title":"The annual homeless point-in-time count: limitations and two different solutions.","volume":"112","author":"Tsai","year":"2022","journal-title":"Am J Public Health"},{"issue":"S2","key":"zoi231574r10","doi-asserted-by":"publisher","first-page":"S178","DOI":"10.2105\/AJPH.2020.305821","article-title":"A theory of change for aligning health care, public health, and social services in a time of COVID-19.","volume":"110","author":"Landers","year":"2020","journal-title":"Am J Public Health"},{"issue":"2","key":"zoi231574r11","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1111\/hsc.v30.2","article-title":"Aligning healthcare, public health and social services: a scoping review of the role of purpose, governance, finance and data.","volume":"30","author":"Lanford","year":"2022","journal-title":"Health Soc Care Community"},{"issue":"2","key":"zoi231574r12","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1037\/ser0000123","article-title":"Housing First on a large scale: fidelity strengths and challenges in the VA\u2019s HUD-VASH program.","volume":"14","author":"Kertesz","year":"2017","journal-title":"Psychol Serv"},{"issue":"9","key":"zoi231574r13","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1176\/appi.ps.201200500","article-title":"Development and validation of a Housing First fidelity survey.","volume":"64","author":"Gilmer","year":"2013","journal-title":"Psychiatr Serv"},{"issue":"12","key":"zoi231574r14","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1176\/appi.ps.201400564","article-title":"Fidelity to the Housing First model and variation in health services use within permanent supportive housing.","volume":"66","author":"Gilmer","year":"2015","journal-title":"Psychiatr Serv"},{"issue":"4","key":"zoi231574r15","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1002\/jcop.2013.41.issue-4","article-title":"Housing chronically homeless veterans: evaluating the efficacy of a Housing First approach to HUD-VASH.","volume":"41","author":"Montgomery","year":"2013","journal-title":"J Community Psychol"},{"key":"zoi231574r16","doi-asserted-by":"publisher","DOI":"10.5888\/pcd9.110112","article-title":"Prevalence and risk of homelessness among US veterans.","volume":"9","author":"Fargo","year":"2012","journal-title":"Prev Chronic Dis"},{"issue":"11","key":"zoi231574r17","first-page":"e393","article-title":"Health systems tackling social determinants of health: promises, pitfalls, and opportunities of current policies.","volume":"22","author":"Chaiyachati","year":"2016","journal-title":"Am J Manag Care"},{"issue":"4","key":"zoi231574r18","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1097\/JHM-D-18-00160","article-title":"Social determinants of health: what\u2019s a healthcare system to do?","volume":"64","author":"Gottlieb","year":"2019","journal-title":"J Healthc Manag"},{"key":"zoi231574r2","unstructured":"Benioff Homelessness and Housing Initiative. Toward a new understanding: the California statewide study of people experiencing homelessness. June 20, 2023. Accessed June 30, 2023. https:\/\/homelessness.ucsf.edu"},{"key":"zoi231574r3","unstructured":"US Interagency Council on Homelessness. Opening doors: federal strategic plan to prevent and end homelessness. 2010. Accessed March 15, 2023. https:\/\/www.usich.gov\/sites\/default\/files\/document\/Opening_Doors_2010_FINAL_FSP_Prevent_End_Homeless.pdf"},{"key":"zoi231574r5","unstructured":"Department of Veterans Affairs. VHA Directive 1200.05(3): Requirements for the Protection of Human Subjects in Research. Amended July 13, 2023. Accessed December 22, 2023. https:\/\/www.va.gov\/VHApublications\/viewpublications.asp"},{"key":"zoi231574r6","unstructured":"US Department of Housing and Urban Development. Accessed December 22, 2023. https:\/\/www.HUD.gov\/Program_Offices\/com_Planning\/COC"},{"key":"zoi231574r7","unstructured":"Section 8 Information. Learn about Section 8 housing statistics. Accessed December 22, 2023. https:\/\/www.learnsection8housingstatistics\/section8-information.org"},{"key":"zoi231574r9","unstructured":"Robert Wood Johnson Foundation. RWJF\u2019s approach. Accessed September 10, 2023. https:\/\/www.alignforhealth.org\/framework\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2814324\/otoole_2024_oi_231574_1705910988.48712.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T16:31:52Z","timestamp":1706545912000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2814324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,29]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.53778","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,29]]}}}