Homelessness has always existed in the United States, but only in recent years has the issue become a more prevalent and noticeable phenomenon. Homeless veterans began to come to the attention of the public at the same time. News accounts chronicled the plight of veterans who had served their country but were living (and dying) on the streets. The Department of Veterans Affairs estimates about 250,000 veterans are homeless on any given night. (2012, pg. 4) My research will examine how homelessness is impacting our veterans and what interventions are available to homeless veterans.
Whether it is wartime or peacetime, the men and women who serve our country live an unusual life style. Whether it is in the barracks or in the fields, military personnel form close alliances and bonds, which are necessary because they must depend on one another for survival. Once these veterans return home from the Gulf, Iraq or Afghanistan war or even if they just decide to discharge honorably, they face a whole new set of problems.
These problems can be as small as reintegrating with their family, finding a job or finding a place to live. An ongoing problem that our veterans learn to cope with is how to deal with combat issues such as physical and mental disabilities. Today’s veterans find that he/she has more difficulty because they are not looked at in the way veterans were looked upon in the past. America’s patriotism has changed. Men were drafted into the military with the promises for a better future because they served their country.
The country got behind them because they were fighting a World War. But Vietnam was the turning point for our veterans and upon their return home, they became society’s problem. Many young veterans who returned home were between 18 – 31 years old. Some were physically wounded and some were physically disabled. These veterans were sent home to our veterans hospitals for treatment.
There were also those who had mental health issues and some help was given to them but not enough. Veterans were discharged much too quickly. Where were these veterans to go? Many tried to reintegrate into society by securing housing (apartment or room) and others tried to move back home with their families. However, many veterans faced considerable challenges as a result of their physical disabilities and PTSD (post-traumatic stress disorder). This caused many veterans to become homeless. First, society could not deal with veterans up close and personal and second, another reason was because the war haunted many veterans every day (PTSD). Therefore, for some veterans, they would rather live on the streets because they actually felt safer. According to data from Department of Veterans Affairs office of Inspector General, “ veterans who became homeless after military separation were younger, enlisted with lower pay grades and were more likely to be diagnosed with mental disorders at the time of separation from active duty.” (2012, pg. 4) Our veterans are our most important resource.
We (Americans) do not live in a closed world anymore and when trouble comes to our shores, it is our veterans we depend upon to defend us. Our military is voluntary at this time and society and our government should protect and preserve their lives because without the veterans who would we count on? The military that protects us are strong, well trained, intelligent men and women who are willing to lay their lives on the line for their country. And for that reason, they deserve our respect, our support and our care. The social worker plays a major role in helping the veterans to stay connected to family and their community. The social worker’s role is to help the veteran and his family to access all resources that can be beneficial to the veteran’s recovery and a smoother re-entry back into his/her life. My research will attempt to answer the following questions:
How common is homelessness among veterans? What are the risk factors: gender, age, race and ethnicity, disability and how does it impact housing placement? What interventions are provided to address veteran homelessness? Do female veterans feel more isolated?
Comparison of Outcomes of Homeless Female and Male Veterans in Transitional
Housing Homelessness among female veterans is of national concern but few studies have been conducted on regards to how homelessness among female veterans differs from male veterans. The healthcare of female veterans has become an important priority for the Department of Veterans Affairs (VA) as female veterans represent one of the fastest growing groups of new VA healthcare users. Studies have shown female veterans are less healthy and are in poorer mental health compared to male veterans, which has been attributed to barriers for women in accessing VA health services and allegations that the VA is male-dominated and not attentive enough to the needs of women (MacGregor et al. 2011: Weiss 1995, pg. 705). Homelessness among female veterans is a central issue as the VA strives to end homelessness among all veterans. Although women constitute about 8% of sheltered homeless veteran population, that number is expected to increase and women veterans have been found to be at higher risk of being homeless than their male counterparts (U. S. Department of Housing and Urban Development & U. S. Department of Veterans Affairs 2009, pg. 705). The literature on homeless female veterans is small with only two previous studies identified in a comprehensive review.
One study concluded that risk of homelessness is two to four times greater for women veterans (Gamache et al. 2003, pg. 706), and the other study found that compared to homeless male veterans, homeless female veterans are younger, less likely to be employed, more likely to have a major mental illness, but less likely to have a substance abuse use disorder (Leda et al. 1992, pg. 706). A small case-control study also found that sexual assault during military service, being unemployed, being disabled and having physical and mental health were risk factors for homelessness among female veterans (Washington et al. 2010, pg. 706). In the current study, the data used came from multi-site outcome study of homeless veterans enrolled in VA-funded transitional housing services (McGuire et al. 2011, pg. 706), through cross-sectional comparisons of homeless male and female veterans at the time of entry into transitional housing and examining outcomes 12 months after discharge.
It is further hypothesized that, due to suggestions that there may be increased barriers for female veterans in accessing VA health services, female veterans would have worse outcomes than their male counterparts after transitional housing. Traumatic Stressor Exposure and Post-Traumatic Symptoms in Homeless Veterans The Department of Housing and Urban Development (Carlson et al. 2012, pg. 970) recently reported that 13% of all homeless persons were veterans and an estimated 63,000 veterans were homeless on one night in January 2012.
High rates of mental health problems have been reported in military and veteran populations. These problems may be related to trauma exposure and contributing to homelessness. Approximately 70% of homeless veterans have substance abuse issues and 45% are diagnosed with mental illness. (Carlson et al. 2012, pg. 970) Combat exposure has been found to increase risk for post-traumatic stress disorder (PTSD), which in turn, is thought to increase risk for homelessness. One study examining the rates of PTSD pre- and post deployment in a combat unit found that rates of PTSD increased from 9.4% to 18%, suggesting that exposure to combat raised the prevalence of PTSD in the unit (Hoge et al. 2004). Military veterans may also have an elevated risk of PTSD as a result of noncombat military stressors, such as dangerous or unstable conditions, witnessing injury, death or atrocities. Military trauma exposure puts individuals at risk for both PTSD and homelessness, but it is less clear whether civilian trauma exposure increases risk for PTSD and homelessness in veterans.
In a study of Vietnam veterans, both PTSD and exposure to combat and other war-related atrocities indirectly increased risk for homelessness, whereas interpersonal violence, and other types of nonmilitary trauma appeared to have direct effects on risk for homelessness (Carlson t al. 2013, pg. 970). A better understanding of the types of trauma that homeless veterans are exposed to could help identify veterans at increased risk for PTSD and homelessness and inform treatment (Carlson et al. 2013, pg. 970). Homeless Veterans of the All-Volunteer Force: A Social Selection Perspective The dramatic increase in urban homelessness in the United States has included large numbers of veterans. As with other Americans, poverty, alcohol, drugs, mental illness and social isolation have been documented as the primary risk factors for homelessness among veterans. As would be expected of an age cohort effect, in 1986 – 1987 the overrepresentation was highest among veterans of ages twenty to thirty-four, and in 1996 the odds of being a homeless veteran were highest among veterans aged thirty-five to forty-four (Tessler et al. 2003, pg.509)
In this article, the explanatory factors all derive from a social selection perspective that refers to the idea that individuals with personal characteristics that would later put them at risk for homelessness were recruited to military service in disproportionate numbers during the early years of the all-volunteer force (AVF). Culturally Competent Social Work Practice with Veterans: An Overview of U. S. Military If social workers are to serve veterans effectively and efficiently, a basic understanding of the United States military is essential. Despite a longstanding and intimate relationship between social workers and veterans, the profession has been criticized for the lack of veteran-specific practitioner resources. The literature has been characterized as providing little practical guidance while universities and professional organizations failed to develop and incorporate the curriculum, information and tools needed to prepare social workers to serve this special population (Savitsky et al. 2009, pg. 863). Recently more information seems to be revolving with additional resources becoming available through social work journals, the development of advanced practice standards for military social workers, as well as academic course and degree specializations focusing on military social worker (Zoroya, 2009, pg. 864).
The common theme has been the importance of military cultural competency. The acknowledgment of military culture is complex and not well understood by civilians and continues to impact veterans after discharge. This article presents information in anticipation of a Department of Veteran Affairs funded research project with veterans experiencing homelessness. Also, the article presents a structural and historical overview of the United States military, the propensity to enlist in armed forces, military culture and training methods and outcomes. It concludes with a discussion of implications for social work practice. Generally, military culture differs from the larger society in the United States as it is paternalistic and maintains a strict hierarchy. The military is characterized by a collectivist approach; encouraging interdependency; group orientation and group cohesion. Highly criticized qualities of military culture include misogyny and homophobia. The integration of females into armed forces has been hampered by fear of cohesiveness among males would be undermined. Experience indicates servicewomen are no more vulnerable to stress than servicemen and are able to complete physical tasks required of them.
Unfortunately, women are subject to gender-based bias, stereotypes and harassment, both mental and physical. Alarming incidences of sexual harassment and sexual violence has increased in the military. A 2004 survey indicates 52% of women experienced sexual harassment while serving; 10% did not feel it would do any good and 42% feared they would suffer adverse consequences (Zeiger & Gunderson, 2005. Pg. 867). Although changing with the repeal of Don’t’ Ask, Don’t Tell, the military has been strongly criticized for banning homosexuals from serving opening (Herek & Belkin, 2006. Pg. 867). Reason being it would undermine unit bonds and effectiveness and that privacy could not be provided. Ultimately, it is important to note that the attitudes of heterosexual servicemen and women may not have been as biased against homosexuality as previously thought. The belief that gays be allowed to openly serve in the military had increased in recent years, indicating the obstacle to integration was not the attitudes of servicemen and women, but of military tradition.
Social workers encounter veterans in public and private practice and effectively serving them demands military cultural competency. Social worker must have a foundation of general understanding of the larger military, its basic history and the complimentary roles played by the different branches (Petrovich, 2012. pg. 871). Veterans will have divergent service experiences and their opinions regarding service could vary widely. The more the social worker knows, this will help develop rapport with the clients, facilitate a more individualized understanding of their service history and other relevant areas.
In the end, it is likely that veterans experience ambivalence regarding military culture and service experience and some military-oriented traits may be viewed as problematic in civilian life. However it’s important for the veteran and the social worker to explore and interpret these issues with respect the veteran’s sense of affiliation with and attachment to the military (Petrovich, 2012. pg. 872). Thus, a review of the literature has revealed helpful information about: How common is homelessness among veterans?
What are the risks factors: gender, age, race, and ethnicity and disability and its impact? What interventions are provided to address this homeless problem among veterans? Do female homeless veterans feel more isolated?
This research study will examine the impact of these four research questions from the most recent data from the Veteran Affairs transitional housing programs. Specifically this study hypothesizes that participants in the different VA-funded transitional housing services will: Is the rate of homelessness increased and/or decreased between homeless female and male veterans? Are there increased barriers for female veterans in accessing VA services, in which female veterans would have worse outcomes than male counterparts after transitional housing?
The research approach that will be utilized for my chosen topic is qualitative research. Qualitative research is flexible; it uses open-ended questions in interviews, participant observations and is often the best fit for diverse and at-risk populations such as homeless veterans whereas quantitative methods involve analysis of numbers; structured surveys, observations and examines existing information/reports. Also, in qualitative research, the research methods are not as dependent upon the sample sizes as in quantitative methods.
Three major forms of VA-funded transitional housing service for homeless veterans will be included in this study: the health care for homeless veterans (HCHV) program; the grant and per diem (GPD) program and the domiciliary care for homeless veteran program (DCHV). The first two programs provide assistance to veterans through contracts with or grants to community service providers while the DCHV provides service directly through the VA staff at the local VA facility. Data were collected for a prospective, naturalistic study to compare these three transitional housing services across five different VA administrative regions (North, South, East, Wets and Mid-West).
The study focused on 59 female participants and 1181 males. The female participant were Black (53%) or White (41%) and had a mean age of 43.89 years; while the majority of male participants were Black (59%) or White (35%), and had a mean age of 48.13 years. This information utilizes the variable of value (gender) and the constant (homelessness). Age is variable that can be measured by asking the participants to write down their age in the blank space.
The data collection was conducted from May 2002 through September 2005. Independent evaluators recruited, consented and conducted baseline and follow-up interviews with veterans in the transitional housing programs. Intake interviews were conducted before entering VA housing program, baseline interviews completed after admission and follow-up interviews were conducted 6 and 12 months after program discharge. Participation rate was very high (99.16%), and each participant gave informed consent. They were paid $10 for baseline interview and $25 for each follow-up interview.
When doing the initial intake interview, a paper form would be used to gather information from the participants to document their socio-demographic characteristics, combat exposure, housing and work history, psychiatric diagnoses, brief hospitalization history and a assessment of mental and physical health status. At baseline interview, participants were asked to complete a measure of the social climate of their residential care service. At follow-up interviews, a series of measures were administered to participants to assess: Housing: They were asked how many days in the last 30 days they have slept in different types of places such as housed (room or apartment) somebody else’s apartment; days in an institution (hospital, hotel or jail) and days homeless. Income and Employment: They were asked about their current employment pattern and classified as employed or unemployed; number of days they worked for pay and their employment income in 30 days.
Also how much money they received from disability and public assistance. Substance Abuse Status: Alcohol and drug use in the past month. General Physical and Mental Health Status: Medical conditions were assessed with 12 questions that asked participants yes/no whether they had any of 12 common serious medical problems (e.g. hypertension, liver disease, cardiovascular problems, and orthopedic problems). Also includes an 8-item psychiatric composite scale which was used to assess general mental health status. Quality of Life: General quality of life and quality of social life were assessed. Residential Social Climate: At baseline, participants were asked to rate their perceptions of the treatment environment of their residential care program.
At intake the female participants were significantly younger; report more psychiatric symptoms, more likely to be diagnosed with mood disorders, has shorter histories of homelessness and less likely to be working than male veterans. Male participants were reported to have higher risk factors of homelessness due to substance abuse (70%) and PTSD (45%) due to combat exposure. Between one to six months in transitional housing services, both genders were showing improvement on employment income and overall psychiatric scores. At six months, female participants showed some decrease in employment and an increase in their psychiatric scores whereas the male participants continued to show improvements. After a one year period, female participants showed improvement in housing, employment and incomes, substance abuse use and general physical and mental health and quality of life compared to male participants.
This suggests that homeless female veterans can benefit as much from transitional housing services as male veterans. Transitional housing programs and shelter have been predominantly male environment focused on serving men, in the VA context. But this study found that, after adjusting for multiple comparisons, there were no differences in how homeless male and female veterans perceived the social climate of their transitional housing program or in their overall clinical benefits. These findings suggests that VA efforts to improve services for women may be successful, but need to continue.
One limitation of this study is the small sample size of homeless female veterans. Also we were not able to differentiate between female veteran who are caring for dependent children and those who were not. Validity is a standard that determines whether an instrument measures what it is supposed to measure and whether it measures it accurately. Accuracy is the key issue. Because of small sampling of female veteran participant, the question of dependent children was a valid observation. Reliability is the second key standard in determining if a measure is satisfactory. Reliability refers to the internal consistency of the measure. Dudley states that the connection between validity and reliability is triangulation. Triangulation is a process of using multiple methods to measure one concept. If it is determined that the results of one measure of the same variable are similar to the results from another measure of the same variable, they are triangulating the findings. They are deemed to be both valid and reliable because they have similar results. (Dudley, 2011).
Carlson, Eve B., Garvert, Donn W., Macia, Kathryn S., Ruzek, Josef I., Burling, Thomas A. (2013). Traumatic Stressor Exposure and post-Traumatic symptoms in Homeless Veterans. Military Medicine, Vol. 178, 9:970-973. Dudley, J.R. (2011). Research Methods for Social Work. Second edition. Boston: Pearson Education. Boston, MA: Allyn & Bacon. Gamache, G., Rosenheck, R., & Tessler, R. (2003). Overrepesentation of women veterans among homeless women. American Journal of Public Health, 93(7), 1132-1136. Herek, G. M., & Belkin, A. (2006). Sexual Orientation and Military Service: Prospects for organizational change and individual change in the United States. In T. W. Britt, A. B. Adler, & C. A. Castro (Eds.), Military Life: the Psychology of serving in Peace and Combat (pp. 119-142). Westport, CT: Praeger Security International. Hoge CW, Castro, CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. New England Journal of Medicine; 351(1): 13-22. Leda, C., Rosenheck, R., & Gallup, P. (1992). Mental illness among female veterans. Hospital & Community Psychiatry, 43(10), 1026-1028. MacGregor, C., Hamilton, A. B., Oishi, S. B., & Yano, E. M. (2011). Descriptive, development, and philosophies of mental health service delivery for female veterans in the VA: A qualitative study. Women’s Health Issues, 21(4), S138-S144. McGuire, J. F., Rosenheck, R. A., & Kasprow, W. J. (2011). Patient and program predictors of 12-month outcomes for homeless veterans following discharge from time-limited residential treatment. Administration and Policy in Mental Health and Mental Health Services Research,38, 142-154. Petrovich, James. (2012). Culturally Competent social work Practice with Veterans: an Overview of the U. S. Military. Journal of Human Behavior in the Social Environment, 22:863-874. Routledge: Taylor & Francis Group Savitsky, L., Illingworth, M., & DuLaney, M. (2009) Civilian Social Work: Serving the military and veteran populations. Social Work, 54(4), 327-339. Tessler, Richard, Rosenheck, Robert and Gamache, Gail. (2003). Homeless Veterans of the All-Volunteer Force: A social Selection Perspective. Armed forces & Society, Vol. 29, No. 4, pp. 509-524. Tsai, Jack, Rosenheck, Robert A. and McGuire, James F. (2012). Comparison of Outcomes of Homeless Female and Male Veterans in
Transitional Housing. Community Mental Health Journal, 48:705-710. United States Department of Housing and Urban Development, & United States Department of Veterans Affairs. (2009). Veteran Homelessness: A supplemental report to the 2009 annual homeless assessment report to Congress. Washington, DC: US Department of Housing and Urban Development, Office of Community Planning and Development: US Department of Veterans Affairs, National Center on Homelessness Among Veterans. Washington, D. L., Yano, E. M. Mcguire, J. F., Hines, V., Lee, M., & Gelberg, L. (2010).Risk factors for homelessness among women veterans. Journal of health Care for the Poor and Underserved. 21, 81-91. Zeigler, S. L. & Gunderson, G. G. (2005). Moving beyond G. I. Jane: Women and the U. S. Army. New York, NY: University Press of America. Zoroya, G. (2009, October 5). USA Today, p. 4a. More colleges develop classes on how to treat war vets.