Street Outreach and other Forms of Engagement with Literally Homeless Veterans

Adults who are literally homeless (i.e., living on the streets or in places not meant for human habitation) represent the most visible and often the most vulnerable group of homeless persons and thus are of great concern to social service and health providers, as well as the public at large. Street outreach, defined as meeting individuals on the streets to increase their access to services, is a prime method of directly engaging literally homeless individuals and providing them access to the housing and health care services they need. Street outreach can be time-consuming and difficult, particularly in reaching people who have been chronically homeless, and with whom outreach staff need to develop rapport and use specialized client-centered approaches.1,2 One study of homeless adults with severe mental illness found that those contacted through street [End Page 694] outreach, as opposed to being contacted in shelters or service agencies, had more extensive histories of homelessness, were more likely to have psychotic disorders, expressed less interest in treatment, and took longer to enroll in case management.3 But those who did enroll showed similar improvements compared to other enrollees, suggesting street outreach can be effective. A better understanding of the characteristics of those who are likely to be contacted through street outreach and the process by which they receive services through a comprehensive health care system using more recent and extensive data is needed.
The U.S. Department of Veterans Affairs (VA) operates the largest integrated health care network in the country and has implemented a campaign to end homelessness among veterans. A primary metric for measuring the goal of ending veteran homelessness by the end of 2015 is the U.S. Department of Housing and Urban Development (HUD) Point-In-Time (PIT) count. The 2013 PIT count estimated that on a single night in January, there were 57,382 veterans reported as experiencing homelessness and that of these, 23,154 (40.35%) were identified as unsheltered or street dwelling. While there have been various publicized efforts towards providing permanent supported housing for homeless veterans,4 there has been less focus on outreach methods and how to engage veterans so they can receive the benefits of permanent supported housing, health care, and other services and benefits. This study examined the proportion and characteristics of literally homeless veterans (as contrasted with those at high risk for homelessness) who were engaged with VA homeless services through street outreach as compared to those who were engaged through community outreach, through provider referral, or self-referral. Differences in referral and admission to downstream VA homeless programs between those engaged through these different approaches were also examined.