Experiences and Knowledge of US Department of Veterans Affairs Clinical Services, Research, and Education: Results From a National Survey of Veterans.

OBJECTIVE: This study examined (1) sociodemographic, health, and psychosocial characteristics associated with using the Department of Veterans Affairs (VA) health care system as a primary health care provider; (2) veterans' experience and knowledge of VA clinical services, research, and education; and (3) veteran characteristics associated with VA experience and knowledge. DESIGN: A nationally representative survey was conducted in 2018; eligibility criteria for participation were adults aged 18 years or older, currently living in the United States, and having served on active duty in the US military. SETTING: The survey was conducted online using large national survey panels. PARTICIPANTS: A sample of 1002 veterans across 49 states participated. MAIN OUTCOME MEASURES: The survey assessed experience and knowledge of majority of VA clinical services, research, and education. RESULTS: One-quarter of the total sample reported that the VA was their primary health care provider. Among veterans who had ever used VA health care, the majority (68%) reported overall high satisfaction with VA health care but also agreed with "privatizing parts of the VA" (70%). The majority (51%-73%) of veterans reported knowledge of major VA clinical services, with the exception of comprehensive management for chronic pain (24%) and treatment of opioid use disorders (31%). One-quarter to one-half also reported knowledge of several VA research and education centers. Less than 10% of veterans reported having ever used a VA mobile app. CONCLUSIONS: The US veterans generally reported positive experiences and good knowledge of VA services and resources. Greater awareness of available VA services for chronic pain and opioid use disorders, as well as VA mobile apps, may help promote more comprehensive care in this population.

Making Connections: Understanding How Screening, Triage, and Referral Processes Can Promote Veteran Housing Stability.

To improve understanding of the screening, triage, and referral processes within social determinant of health-Electronic Medical Record (EMR) integration, we explored how Veterans connect with needed resources following screening for housing instability using three data sources: administrative Homelessness Screening Clinical Reminder (HSCR) data, administrative Supportive Services for Veterans Families (SSVF) data, and chart review data. The cohort included Veterans who had responded to the HSCR in the 90 days prior to presenting for SSVF services between October 2012 and 2015 (N = 134); chart reviews were abstracted for a sample (n = 53). Most Veterans who presented for SSVF services had screened negative for housing instability (68.7%) on the HSCR, yet chart abstractions demonstrated that more than half connected to triage assistance prior to seeking services irrespective of their screening outcome. Future screening efforts should consider the role of the person administering the screening instrument and critical areas for assessment.

Pathways into homelessness among post-9/11-era veterans.

Despite the scale of veteran homelessness and government-community initiatives to end homelessness among veterans, few studies have featured individual veteran accounts of experiencing homelessness. Here we track veterans' trajectories from military service to homelessness through qualitative, semistructured interviews with 17 post-9/11-era veterans. Our objective was to examine how veterans become homeless-including the role of military and postmilitary experiences-and how they negotiate and attempt to resolve episodes of homelessness. We identify and report results in 5 key thematic areas: transitioning from military service to civilian life, relationships and employment, mental and behavioral health, lifetime poverty and adverse events, and use of veteran-specific services. We found that veterans predominantly see their homelessness as rooted in nonmilitary, situational factors such as unemployment and the breakup of relationships, despite very tangible ties between homelessness and combat sequelae that manifest themselves in clinical diagnoses such as posttraumatic stress disorder. Furthermore, although assistance provided by the U.S. Department of Veterans Affairs (VA) and community-based organizations offer a powerful means for getting veterans rehoused, veterans also recount numerous difficulties in accessing and obtaining VA services and assistance. Based on this, we offer specific recommendations for more systematic and efficient measures to help engage veterans with VA services that can prevent or attenuate their homelessness. (PsycINFO Database Record