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Running Head: RESEARCH PAPER 2
Research Paper 2
Anna Gressman
Wayne State University
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RESEARCH PAPER 2
Research Paper 2
Problem Formulation
This article specifically addresses the issue of veteran homelessness and the rates and risk
factors for them to return to homelessness after being successfully housed according to the
Housing and Urban Development-Veterans Affairs Supported Housing. (HUD-VASH) The
population that was researched in this study was homeless veterans, mostly men, from San
Francisco, San Diego, New Orleans, and Cleveland. The goal of this study while looking at this
specific population is to better understand why, even after being successfully placed into
housing, do the majority of them return to homelessness within a five year period. They also try
and prove that subsidized housing combined with mental health services may be an effective
intervention for successfully placing individuals who have a mental health illness and a history
of homelessness into community housing. (O’Connell, Kasprow, & Rosenheck, 2008)
Research Design
The design used for this research study was a mixed method. They used qualitative
research in their goal of trying to have a deeper understanding of why successfully housed
homeless veterans return to homelessness. They use quantitative research when they log the data
sets from surveys they receive from the veterans that were placed in the program. Threats to the
external validity of this research are that the population is not very generalizable because they
use almost all men in the program so it does not assess the women homeless veteran population
adequately. (O’Connell, Kasprow, & Rosenheck, 2008)
Sampling
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In order to be considered for inclusion to the HUD-VASH program, you had to be
eligible for Veterans Affairs (VA) services, living in a shelter or on the street for at least 30 days,
have a psychiatric disorder, substance use disorder or both at the time of initial contact with the
VA’s Health Care for Homeless Veterans program. (HCHV) The sampling for this study took
place between June 1, 1992 and December 31, 1995. During this time, 460 people were enrolled
into the experimental component of the HUD-VASH evaluation at four sites. 107 people from
San Francisco, 91 from San Diego, 165 from New Orleans and 97 from Cleveland. (O’Connell,
Kasprow, & Rosenheck, 2008)) After the brief intake assessment conducted by the HCHV
program, participants had a detailed baseline assessment at the time of enrollment into the study.
Each veteran was assigned to one of the three conditions: HUD-VASH (section 8 voucher plus
intensive case management); intensive case management only; and standard care, which
consisted of short-term broker case management provided by HCHV program outreach workers.
Participants also provided written informed consent, and the protocol was approved by the
Human Investigations Committees at each VA medical center. They also were paid $20 after
each interview. (O’Connell, Kasprow, & Rosenheck, 2008)
Out of the 460 veterans who were enrolled, 392 were housed at some point after the
baseline interview. Of the 392 veteran participants, 19 of them were women. (O’Connell,
Kasprow, & Rosenheck, 2008)This sample does not have enough people in it to be really
representative of the homeless veteran population as a whole. Also, since there were only 19
women who were able to participate in the study it does not adequately represent the homeless
women veteran population. Lastly, not all homeless veterans suffer from a psychiatric or
substance use disorder so limiting the study to only veterans who suffer from these disorders
does not cover the whole homeless veteran population as a whole.
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Measurement
There were a few key variables in this study. This study lists its key variables as
demographic and clinical characteristics. Composite scores from the Addiction Severity Index
(ASI) were used to assess alcohol, drug, medical, legal, employment, and psychiatric status.
Possible scores from the ASI subscale range from 0 to 1, with higher scores indicating more
serious problems. They evaluated Quality of life with selected subscales from the Lehman
Quality of Life Interview. Possible scores on each subscale range from 1 to 7, with higher scores
being a better quality of life. Employment was assessed by the number of days employed out of
the last 30 days. Social Support was measured by the number of people in nine different
categories to whom the participant reported feeling close, an index of the total frequency of
contacts with these people, and the average number of types of people who would help with a
loan, transportation, or help in an emotional crisis. (O’Connell, Kasprow, & Rosenheck, 2008)
Data Collection
The methods used to collect data were through intake assessments, detailed baseline
assessments at enrollment, and through the follow up interviews every 3 months for up to five
years. The advantages to these data collection methods were that you could keep in contact with
the participants and if they left the program you could find them by contacting collateral sources
and visiting local shelters. The disadvantages to these data collection methods are that the
number of participant decreased every year for five years so the amount of data that was
collected also decreased. Findings may have been different if they ensured the housing for the
five year period of the program rather than finding them housing and then having them fend for
themselves. (O’Connell, Kasprow, & Rosenheck, 2008)
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Ethical and Cultural Considerations
The research did not exactly cover many cultural issues. They did address the percentage
of men and women, how old they were, whether or not they were married, economic class,
psychiatric disorders, and drug and alcohol use. However, they did not address the entire
homeless veteran population, only the ones with psychiatric and substance abuse disorders. They
also did not have a large enough number of women to truly represent the homeless women
veteran culture. In order to address more of the cultural concerns they could have included more
women, included all the homeless veterans, and had more case managers who have military
background. (O’Connell, Kasprow, & Rosenheck, 2008)
The ethical issues in this study were covered when the participants provided written
informed consent. They took into consideration that the veterans needed to be informed of what
exactly was going to happen when they decided to participate in the study so they had the
veterans provide written informed consent. They did not address the issue of confidentiality in
this study which could have been covered in the informed consent forms but they do not state
that in the research. They do not use any names but they could have addressed the issue of
anonymity when they were discussing the study as a whole. (O’Connell, Kasprow, & Rosenheck,
2008)
Results and Implications
The results in this study were that participants were primarily male veterans. Forty-three
percent were homeless between one and six months before the assessment and twenty-seven
percent were homeless for two or more years prior to. Over the course of a five year period, 44%
of all participants experienced a period of homeless for at least one day after successful
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placement into housing. After one year, 374 veterans remained in the study. After two years, 333
remained in the study, and after five years 150 veterans remained in the study. As you can see it
was a steady decline for the five years of the program. (O’Connell, Kasprow, & Rosenheck,
2008) I think that this study is generalizable for the homeless male veteran population with
psychiatric or substance abuse disorders but not for the entire homeless veteran population. The
study could have been improved if they would have included more women veterans or just the
general homeless veteran population. They also did not have a large enough sample because
there are hundreds of thousands homeless veterans and they only had a sample of 392 veterans.
The intervention in the article could prove effective because it have accurate information on how
many people returned to homelessness after being successfully housed. It also proved successful
because it shows that people with intensive case management and housing were likely to stay
housed longer than veterans with just standard care. The intervention was sensitive to the target
population because it went though the VA and they only serve veterans. Challenges and barriers
that may make it difficult for implementation of the program would be funding because to house
that many homeless people can get costly so they have to apply for many grants. The
intervention relates to the problem of homeless veterans because it is giving some the chance to
be off of the street for at least a little while and providing them with case management. The
research study shows that too many individuals return to homelessness after being housed but the
numbers are promising. (O’Connell, Kasprow, & Rosenheck, 2008)
Summary
Evidence based practice (EBP) is an interdisciplinary approach to clinical practice. It
integrates the practitioner’s individual expertise with the best resources. Advantages to using
evidence based practice are that the practice is well rounded because it can combine research,
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practice wisdom and even client preference. When using it at an agency or personal practice it
allows social workers to make up the best intervention when it comes to their client. A
disadvantage to using EBP is that it can be challenged because it used your own wisdom which
some can say is biased based on your own personal experiences.
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References
O’Connell, M. J., Kasprow, W., Rosenheck, R. A. (2008) Rates and Risk Factors for
Homelessness After Successful Housing in a Sample of Formerly Homeless Veterans,
PSYCHIATRIC SERVICES, V. 59 (3), 268-275.