Addressing Concurrent Housing Instability, Criminal Justice Involvement, and Unemployment among Veteran Health Administration Service Users

Following consistent reductions in the number of Veterans experiencing homelessness in the United States between 2010 and 2016, progress toward ending Veteran homelessness stalled. Given that Veterans with complex backgrounds, such as those who are justice-involved and/or unemployed, face additional challenges to housing stability, research to inform services and ensure they are responsive to the needs of Veterans facing intersecting vulnerabilities is crucial. This study examines the characteristics and service use of Veterans with concurrent experiences of housing instability, justice involvement, and unemployment and seeks to identify additional assistance that may help these Veterans achieve their housing, justice, and employment-related goals. A complementary mixed methods approach draws on (1) national data to describe this population (N=62,763) and (2) interviews with Veteran Health Administration (VHA) service users (N=20) to highlight the service needs and preferences of Veterans themselves. Results from the administrative data demonstrate that combat exposure, a medical or mental health diagnosis, and female gender were associated with decreased odds of accessing tailored services to address housing instability, justice involvement, and unemployment, while a substance use disorder, military sexual trauma, being unmarried, and not receiving compensation related to a service-connected disability were associated with increased odds of using these services. Qualitative findings support the supposition of cumulative adversity—that adverse events earlier in life can lead to increased vulnerability over time and disparities in individual resources, health, and well-being—and the potential for VHA services to moderate its impacts. Study implications include the need to engage Veterans in services earlier, encourage Veteran help-seeking and improve implementation efforts around screening and identification, and enhance patient-centered, trauma-informed care practices. Greater flexibility and coordination in services to address social determinants of health may also provide greater support in helping Veterans reach their housing, justice, and employment-related goals.