Preventing Homelessness in Transitioning Service Members with Mental Illness

Massachusetts General Hospital, Boston MA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Homelessness among individuals with mental illness is an under-studied and under-addressed area in the United States. Transitioning service members (TSMs)--individuals transitioning from active-duty military service to civilian life--are particularly vulnerable to homelessness given their high burden of mental illness that develops before, during, and after service and unique challenges of their transition. The transition period for TSMs is characterized by a high risk of homelessness, suicide, unemployment, financial strain, and disruptions in social support networks. This transition period provides an important opportunity for intervention to potentially reduce the risk of homelessness. Despite homelessness increasing nationally, there is a paucity of research into interventions to prevent homelessness among individuals with mental illness. There is a lack of rigorous literature that predicts who is at highest risk of homelessness and limited evidence on interventions targeted to high-risk individuals with mental illness. This K proposal addresses these gaps in knowledge by targeting the prevention of homelessness in high-risk TSMs with mental illness. Applying implementation research and mixed methods principles, this project seeks to adapt and refine the existing model of critical time intervention (CTI), a time-limited case management intervention that mobilizes and sustains client supports during challenging life transitions, to target the prevention of homelessness in a high-risk TSM population with mental illness. To date, though CTI has been shown to reduce homelessness in certain populations at risk, little is known about the effect of CTI: 1) on the prevention of homelessness among TSMs, who may have particular challenges around transitions 2) delivered virtually, allowing for reach across geographic locations and 3) among the highest-risk subgroups for homelessness, which have previously been difficult to identify. TSMs at high risk of homelessness will be identified for CTI services using a version of the prediction model previously developed with an interdisciplinary team at Harvard Medical School, the Department of Defense, and U.S. Department of Veterans Affairs, with 16,589 soldiers that accurately predicted TSMs at the highest risk of becoming homeless---showing that the strongest predictive factors were depression, PTSD, suicidality, and trauma-related. In addition, this work evaluates the feasibility of implementing virtual CTI vs. minimally enhanced usual care in high-risk TSMs with mental illness. Dr. Katherine Koh is well-qualified to execute the proposed aims with her background as a psychiatrist caring for homeless patients and research experience in homelessness and mental health. This five-year training plan will foster development toward independent investigator status and generate preliminary data necessary for a R01 application which will evaluate effectiveness and maintenance of the intervention. She has established a team of mentors and advisors with expertise in implementation science, qualitative and mixed methods, RCTs, homelessness, and veterans. The collaborative research environment is ideal for furthering Dr. Koh's goal of becoming an independent researcher focused on reducing suffering in homeless adults with mental illness, a population that has been under-studied despite the magnitude of need.