Identifying Homelessness Among Veterans Using VA Administrative Data: Opportunities To Expand Detection Criteria

Aim of Study

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

By

Rachel Peterson, Adi V. Gundlapalli, Stephen Metraux, Marjorie E. Carter, Miland Palmer, Andrew Redd, Matthew H. Samore, and Jamison D. Fargo

Journal

PLoS ONE (published by Public Library of Science)

The aim of this study is to assess the usage of VA (Veterans Affairs) conventional identification criteria (codes) in VA health care facilities for the sake of identifying the number of homeless U.S. veterans (Peterson, et al., 2015).

The U.S. Department for Veteran Affairs employs different techniques and criteria to gathering statistics on U.S. Veterans.

U.S. Soldiers, U.S. Veterans, U.S. Government, VA health care facilities, and Serving American Soldiers

There are two main purposes for this study:

1.  To explore the usage of v60 codes in VA health care facilities as a means of identifying th number of homeless veterans in the United States of America(Peterson, et al., 2015).
2. To create prevention and intervention measures that will mitigate the number of American soldiers who end up as homeless veteran. In addition, to lower the risk of soldiers ending up homeless due to a number of social, economic, and mental issues(Peterson, et al., 2015).   

Identify the population under study

The population relates to all individual that served in the U.S. military in the recent Iraq and Afghanistan wars. More specifically it related to military personnel who were deployed in either of these two countries as art of the following units (Peterson, et al., 2015): Operation New Dawn (OND), Operation Enduring Freedom (OEF), and Operation Iraqi Freedom (OIF). In total the population size under consideration consisted of 941,970 individuals.

A qualitative, descriptive, comparative study was employed as the research design. Where the participants were classified into three distinct groups for analysis and comparison purposes.

In terms of recruitment the participants had to have severed in at least one of the following military expeditions  OEF, OIF, and OND. Secondly, the participants must be eligible for VA health care services; and lastly, the participants must belong to either one of three mutually exclusive groups for homeless veterans i.e. V60.0, V60.x, and non-ICD indicators of homelessness (Peterson, et al., 2015).

The data was collected from two primary sources: the medical archives relating to VA health care facilities, and VA research database of administrative and clinical data (controlled by Veterans Informatics and Computing Infrastructure). Since, the records were retrieved from VA archives and databases the consent of the participants was implied in the pursuit of knowledge (Peterson, et al., 2015).

About the Veterans shortlisted

1. The veterans were homeless and did not possess a fixed home address (rented or permanent premise)
2. The veterans have to have visited a VA health care center in the past 90 days. In addition they should have acquired in/outpatient services relating to mental health, homelessness, or addiction (substance abuse)(Peterson, et al., 2015).

The participants were splinted into three groups that would be evaluated based on different statistical techniques meant to collect vital information regarding homelessness amongst U.S. veteran who served in Iraq and Afghanistan under one or more of these three deployment teams; OEF, OIF, and OND (Peterson, et al., 2015).

There are several statistical analysis that were performed on the data:

1. Descriptive statistical analysis was performed on all variables with stratified attention to each of the three study groups.
2.  Usage of Chi-square statistics for the assessment of type of clinical service awarded the veteran either V60.0 or V60.x.
3. Three binary logistic regression to assess the relationship with three distinct dependent variables i.e. either one of the three groups. The independent variable also varies from one binary logistic regression to the next; however, several covariates were also added to each of the regression models such as race, marital status, VA evidence of mental health, receipt of substance abuse, rank in the military, and level of education (SPSS version 21)(Peterson, et al., 2015).
4. For the purpose of assessing geographical variation in VA healthcare systems across all four regions, cartographic and statistical modeling were performed in R.  

Role of the Agency

Summarize the summary of the findings (relationships, differences, etc.)

Out of the shortlisted 845,593 individuals, the descriptive results revealed that 30,886 veterans visited the VA clinic in the past 90 days. The composition of the three groups based on the figure presented above are indicated as follows:

Following a chi-square  test (p<0.0001), the results showed that all demographic variables in the data varied significantly across different regions. The frequency analysis for the first indicator  with regard to v60. revealed that 57% received V60.0 while 43% received V60.x. All three binary logistic regression models were found to be significant (Peterson, et al., 2015).

Differences were noted with regard to the usage of homelessness-related diagnostic codes across all VA health care facilities found in the united states. Also difference were observed in homelessness-related diagnostic codes usage and provision of services depending on race, marital status, mental health records, and other covariates in the model (Peterson, et al., 2015). In conclusion, we can see that the three indicators are related to on another based on the results of three regression models. It is expected that services are not awarded evenly to all homeless veteran; as such, we do expect there to be discrimination based on  social, economic, demographic, and mental factors e.g. rank of the veteran (Peterson, et al., 2015).

Identify the main findings

1. Difference in homelessness-related diagnostic codes utilization in Veteran Affairs clinic countrywide
2. The number of veterans who identified as homeless varied with demographic factors.

Strength

1. Large data set leading to reliable inferences
2. Appropriate data analysis techniques were applied
3. Practical data collection and recruitment procedures were employed

Limitation

1. Usage of one regression modeling technique
2. Researcher biasness leading to favoring of given analytical outcome
3. Limited time to conduct the assessment (more could have been done)

Give a summary of how the study’s findings may have implications for social work practice, research, and policy. Specifically state whether the study contributes to evidence based practice and improving prevention and intervention models.

The study has provided information on the percentage of military personnel who are at risk of homeless due to a number of social, psychological, and economic reason (Peterson, et al., 2015). The study has provided information on how difference issues can be corrected to ensure that VA services are issued without discrimination. Lastly, the study has addressed how policymakers can make amendments to current laws and pension funds to ensure that military veterans do not end up homeless (Peterson, et al., 2015).

Does the research address issues of diversity (race, class, culture, etc.)?

Yes, the paper addressed these issues by including them as covariates (additional independent variables) in the regression models.

Are there any ethical dilemmas in the research that was conducted? If so, how did the researchers address the ethical dilemmas?

Yes, the uneven distribution of participants based on gender and race. The researchers assumed that majority of the people recruited into the military are white male. Hence, the researchers conclude the analysis was appropriate to conduct as is. 

Please discuss what you learned from reading the article and how the information may or may not inform your final paper and practice in the future.

I have learnt that there is a large number of veterans who are homeless and in need of VA facilities in order to make it from one day to the next. In addition, I have learnt that changes have to be made to ensure that discrimination (based on race, marital status and so on) is eradicated when it comes to the provision of services to homeless veterans. Lastly, policies and provisions have to be put in place in order to reduce the high number of individuals that end up homeless or poor after they leave the military.

References

Peterson, R., Gundlapalli, A. V., Metraux, S., Carter, M. E., Palmer, M., Redd, A., et al. (2015). Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria. PLoS ONE , 10 (7), 1-14.

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