Exploring. military 2002.

Transcription

1 Exploring Initial Outcomes and Service Utilization of Homeless Veterans in a Jail Diversion and Trauma Recovery Program Stacey Stevens Manser, Sam Shore, Gilbert Gonzales, Laura Kaufman INTRODUCTION In 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) introduced the Jail Diversion and Trauma Recovery Priority to Veterans Initiative (JDTR). Texas received JDTR funding in 2009, the second cohort of six states. The intent of this initiative is to support local implementationn leading to statewide expansion of trauma informed jail diversion programs for people with post traumatic stress disorderr (PTSD) and other trauma related conditions, with a priority to veterans. Texas JDTR pilot is located in Bexar County, home to ~150,000 veterans and six military installations. The Center for Healthcare Services (CHCS) is the public mental health authority and nationally recognized for successful jail diversion programs, which began in Presently, Bexar County has 46 intervention points, 34 community partners and diverts 7,000 individuals yearly. In the JDTR pilot, CHCS focuses on Intercept Point 1, which includes a high number of veterans who have been chronically homeless and are frequent utilizers of the Restoration Center s Sobering Unit. CHCS Intercept Point 1: Law Enforcement pre booking diversion too the Restoration Center Services in the program focus on improving trauma symptoms (using Seeking Safety, Navajits, 1992) and addressing mental health and substance abuse issues. Ass a majority of the veterans in the pilot are homeless, a major focus at the pilot is ensuring stable housing in an environment that promotes recovery. The CHCS partners with and is immediately adjacent to Haven for Hope, a transitional homeless facility and alsoo works closely with the Veteran s Health Administration VISN 17 to determinee eligibility and benefits of participating veterans. These collaborations allow the multiple issues of these veterans to be addressed at one time. Learning Objectives: Examine veteran housing status and change overr time. Examine differences in outcomes/service use based on veteran housing status. Determine if veterans homeless at baseline havee different outcomes at 12 months

2 DESIGN/SAMPLE In one year, approximately 3,500 public intoxicants are diverted from the legal system into the Restoration Center Sobering Unit. Of these, about 15% are veterans. JDTR enrollment began in March 2011, and as of September 2012, 96 veterans have consented to participate in the JDTR program. Recovery Support Specialists (RSS) in the Sobering Unit (often veterans) screen individuals for military status. If identified as a veteran or active military, a 7 item PTSD checklist is administered. Those who screen positive are referred to the JDTR case manager (also a veteran peer) and if the veteran consents, are entered into the program. This is a prebooking intercept and veterans do not have to participate. If they decline, they receive services as usual. The case manager conducts the baseline, 6 month, and final 12 month interview. During the 12 month program, the case manager coordinates service provision, works with Haven for Hope on housing, and particularly important, works with the VA, VISN 17 and local veteran providers to upgrade discharge status, determine benefits eligibility, and access veteran housing. If services are still needed at program end, the veteran continues in services at CHCS. Completed Interviews: Baseline interviews: 96; 6 month interviews: 83 (86%); 12 month interviews: 64 (77%) Decreasing interview numbers do not necessarily reflect program attrition. As enrollment is ongoing, interview dates will vary per participant. To date, 3 veterans have left the program. METHODS/PROCEDURES For these analyses, a new housing variable was created (baseline, 6 month and 12 month). Housing status selections were collapsed into two categories: homeless or not homeless. Although veterans living in someone else s home, apartment, or trailer are considered unstably housed, this is considered an improvement for this typically homeless population. Descriptive statistics were conducted. Pearson Chi square was used to test for significant differences in response distribution by homeless or not homeless veterans and GLM repeated measures were used to examine PTSD outcomes from baseline to 12 month. Baseline, 6 month, and 12 month outcome measures included: Employment status, Median income, Alcohol and Illegal drug use, PTSD diagnosis (PCLC C), and the Behavior and Symptom Identification Scale (BASIS 24) full scale and subscales (Depression, Relationships, Self Harm, Emotional Lability, Psychosis, or Substance Use). 6 month and 12 month service use measures included past 6 month receipt (yes/no) of: Trauma specific treatment (Seeking Safety), Psychiatric medications, Mental health treatment, Detoxification, Substance abuse outpatient treatment, Case management, Vocational rehabilitation, Transportation, Peer support or Housing services.

3 RESULTS Participants: Veterans enrolled (N = 96) are primarily male (89.6%), White (82.3%), with a mean age of (SD=12.54) years. There were no differences in housing status for gender or race/ethnicity among participating veterans. R American Indian 2.1 Black or African American 15.6 White 82.3 Hispanic 37.9 % 10.4% 89.6% Male (N=86) Female (N=10) Veterans represent all branches (Army, 58.9%) and eras of military service (majority Vietnam 34.7% and Post Vietnam 53.7%). At baseline, a majority were homeless (70.8%). Military Service Branch Served* (N = 95) % Era(s) Served* (N = 95) % Army 58.9 Korean up to Vietnam 6.4 Navy 18.9 Vietnam 34.7 Marine Corps 12.6 Post Vietnam 53.7 Air Force 8.4 Persian Gulf Middle East 15.8 Coast Guard 1.1 Afghanistan/Iraq 16.8 * Branch is inclusive of guard/reserve service *** Total % > 100; Some served in multiple eras Response differences of Homeless and Not Homeless Veterans: Homeless veterans reported significantly less full or part time employment at baseline (χ 2 (1, N = 96) = 25.21, p =.000) and 6 month (χ 2 (1, N = 83) = 4.85, p =.035) with no significant difference in 12 month responses. There were significant differences in homeless and nothomeless veteran income at all three time points, with not homeless veterans having a higher median income. However, income of homeless veterans increased significantly over time. There were no response differences by housing status on alcohol or illegal drug use in the past 30 days; both groups improved over time, although not significantly. On the BASIS 24 full scale, homeless veterans reported moderate to extreme difficulty significantly more (χ 2 (1, N = 89) = 8.26, p =.008) at baseline but there were no significant differences in responses at 6 or 12 month.

4 Change in Outcomes, Housing Status and Service Use: Veterans experienced significant decreases in trauma symptoms, with mean PCL C scores falling below the PTSD diagnosis cut offf of 50 from Baseline to 12 month interview for both homeless (F(1, 42) = 70.68, p =.000) and not homelesss (F(1, 17) = 9.99, p =.006) veterans. Change in PCLC C Sum Scores* *A PCL C sum score of 50 is considered the threshold for a PTSD diagnosis.. Significant changes were observed in housing status, with homelessness decreasing significantly from Baseline to 6 month interview and although not significant, continuing to decrease at 12 month. Median income also increased significantly for homeless veterans from baseline to 12 month.

5 Further examination of homeless status from baseline to 12 months, revealed the types of housing changes that occurred among those veterans who were homeless at baseline. Although living in someone else s house, apartment, trailer, or room is considered unstably housed this is still an improvement over homelessness. As well, there is a large increase in the percentage who reported owning or renting from 6 months to 12 months, from 17.8% to 38.5%. Examining the continued, sustained movement of owning or renting past the 12 month interview would provide a better understanding of project outcomes. Homeless at Baseline: Change in Housing Status over Time Baseline 6 Month 12 Month N = 68 N = 45 N = 26 Housing Status a % Housing Status a % Housing Status a % Homeless b 100 Homeless b 13.3 Homeless b 3.8 a Where lived in past 30 days Someone else's c 60.0 Someone else's c 57.7 Owned or Rented c 17.8 Owned or Rented c 38.5 Transitional Living Facility 4.4 Veteran's Home 2.2 Detox/Residential SUD 2.2 treatment b Shelter, Street/Outdoors, Park c House, Apartment, Trailer, Room At 6 months, homeless veterans reported significantly more outpatient MH and SA treatment, Detox and Transportation service use than not homeless but the only significant difference in service use reporting at 12 month was transportation. % Received Services: 6 months Not Reported Service Use N Homeless Homeless N Homeless Not Homeless Outpatient MH Treatment * SA OP Treatment * Detox * Transportation * * 27.4 Seeking Safety Psychiatric Meds Case Management Vocational/Rehab Housing Self Help/Peer Support * significant at p <=.05 Reported Service Use: Homeless and Not Homeless Veterans % Received Services: 12 months

6 DISCUSSION Preliminary analysis indicates that the JDTR program benefits these veteran participants, particularly those veterans who were homeless at baseline and had been more difficult to engage. Significant PTSD symptom improvement, indicated by a PCL C score lower than 50 at 12 months, suggests the intervention(s) are working for both groups. Significant baseline response differences between homeless and not homeless veterans were not present at 12 month (employment, BASIS 24, service use) indicating additional benefits of program participation for homeless veterans. Neither group experienced significant change in alcohol or illegal drug use over time which suggests that more time in substance abuse treatment services is needed given the long term use of substances by both groups of veterans. Assessment past 12 months, when the veterans have been placed in typical treatment services, may provide a better indication of sustained improvement. This study was supported by DHHS Grant No. 1 H79SMO59275 through a contract with the Texas Department of State Health Services. Presented at the American Public Health Annual Conference, October Contact information: stacey.manser@austin.utexas.edu