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Oni J. Blackstock, MD Yale RWJF Clinical Scholars Program/VA Connecticut Health Care System

Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan Veterans. Oni J. Blackstock, MD Yale RWJF Clinical Scholars Program/VA Connecticut Health Care System Cynthia Brandt, MD MPH, Sally Haskell, MD, Rani Desai, PhD MPH

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Oni J. Blackstock, MD Yale RWJF Clinical Scholars Program/VA Connecticut Health Care System

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  1. Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan Veterans Oni J. Blackstock, MD Yale RWJF Clinical Scholars Program/VA Connecticut Health Care System Cynthia Brandt, MD MPH, Sally Haskell, MD, Rani Desai, PhD MPH Yale School of Medicine/VA Connecticut Health Care System

  2. The authors have no potential conflicts of interest to disclose • Disclaimer: The views expressed in this presentation are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

  3. Veterans Health Administration (VHA) specialized homeless services programs

  4. Operation Enduring Freedom (OEF) Operation Iraqi Freedom (OIF) The OEF/OIF Veteran cohort has the largest proportion of women to serve and to be exposed to combat of any Veteran era cohort.

  5. Homelessness Use of homeless services programs

  6. Research Questions 1. What is the risk of using a VHA homeless program among OEF/OIF Veterans in VHA care? 2. Is there a difference in risk between female and male Veterans? 3. How do the characteristics of female and male Veterans who used a homeless program compare?

  7. Methods: Study population OEF/OIF Veterans (~1.1 million) Enrolled in VHA system 10/1/01 to 9/30/09 (~500,000) • Nonmissing gender • Nonmissing separation date • At least 1 VHA clinical visit • (445,319)

  8. Time to first use of a VHA homeless program Gender

  9. Primary Outcome:Time to first use of a VHA homeless program Separation Date 1st visit indicating use of VHA homeless program

  10. Use of VHA homeless programs identified using program codes Health Care for Homeless Veterans Housing and Urban Development- VA Supported Housing Compensated Work Therapy/ Transitional Residences Domiciliary Care for Homeless Veterans Grant and Per Diem Program

  11. Socio-demographic variables Age, race/ethnicity, marital status, education Rank (officer vs. enlisted) Rural vs. urban location, geographic region

  12. Clinical variables Service-connected disability rating Mental health conditions

  13. Data Analysis • Survival analysis • Cox proportional hazards regression • Adjusting for socio-demographic & clinical variables • Χ2 and Wilcoxon rank-sum tests to compare female and male Veterans who used a VHA homeless program

  14. Results OEF/OIF Veterans (~1.1 million) • Median age, 26 years (IQR, 23 – 37) • 12% female • 62% White, 18% Black, 12% Hispanic, 6% Other • 56% unmarried • 80% high school diploma or less • 22% Post-traumatic stress disorder • 2% - 8% with psychiatric /substance use disorders Median duration of follow-up 3.21 years (IQR, 1.74-4.52) Enrolled in VHA system (~500,000) Study population (445,319)

  15. Research Questions 1. What is the risk of using a VHA homeless program among OEF/OIF Veterans in VHA care? 2. Is there a difference in risk between female and male Veterans? 3. How do the characteristics of female and male Veterans who used a homeless program compare?

  16. Risk of using a VHA homeless program Study population 445,319 Used a VHA homeless program 7,431 (1.7%) Median time to first use: 1.88 years (IQR, 0.81-3.29) IQR, interquartile range

  17. Research Questions 1. What is the risk of using a VHA homeless program among OEF/OIF Veterans in VHA care? 2. Is there a difference in risk between female and male Veterans? 3. How do the characteristics of female and male Veterans who used a homeless program compare?

  18. Risk of using a VHA homeless program by gender Study population (445,319) Female 53,650 (12%) Male 391,667 (88%) Used a VHA homeless program 961 (1.8%) Used a VHA homeless program 6,470 (1.7%)

  19. No difference in risk of using a homeless program Male Female Hazard ratio for use of a VHA homeless program *Adjusted for age, race/ethnicity, marital status, education, rank, rural/urban, geographic region disability rating, mental health diagnoses

  20. Time to first use of VHA homeless program

  21. Research Questions 1. What is the risk of using a VHA homeless program among OEF/OIF Veterans in VHA care? 2. Is there a difference in risk between female and male Veterans? 3. How do the characteristics of female and male Veterans who used a homeless program compare?

  22. Selected characteristics of Veterans who used a VHA homeless program

  23. Limitations • Includes only OEF/OIF Veterans in VHA care • Does not capture Veterans who accessed only non-VHA-directed homeless services programs • Lack of data to explore the role of dependents, military sexual trauma, and employment status

  24. What we learned • About 1.7% of OEF/OIF Veterans in VHA care used a VHA homeless program • Overall, female Veterans were as likely as male Veterans to use a VHA homeless program • Differences exist between female and male Veterans who used a homeless program • Females more likely to have depression, less likely to have substance/alcohol use disorder or PTSD

  25. Implications • Determine whether homeless program use shortly after return represents vulnerability for this group of young Veterans • Ensure homeless programs are tailored to also meet the needs of female Veterans • Expand services in areas that may disproportionately affect female Veterans such as depression and programs for families

  26. Stakeholders Northampton VA Medical Center

  27. Acknowledgements • Women Veterans Cohort Study • Cynthia Brandt, MD MPH • Sally Haskell, MD • Rani Desai, PhD MPH • Melissa Skanderson, MSW • Yale RWJF Clinical Scholars Program • Department of Veterans Affairs/VA Connecticut Healthcare System • OEF/OIF Veterans for their service

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