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National Center for Homelessness Among Veterans

With President Obama’s goal of preventing and ending homelessness among Veterans by 2014 comes tremendous pressure on VA to address the root causes of chronic homelessness. Previously identified factors that contribute to chronic and recurrent homelessness include mental illness and substance abuse, specifically, the co-occurrence of psychiatric and substance use disorders. As such, achieving President Obama’s goal of preventing and ending homelessness among Veterans by 2014 would be impossible without effective integrated treatment and service linkage interventions to address the various and potentially devastating psychosocial issues faced by many homeless Veterans. However, it remains unclear how best to deliver mental health and substance abuse treatment, along with other necessary supports, to this population.

Recognizing that stable housing must first be obtained before treatment services can be delivered effectively, the VA’s National Center on Homelessness Among Veterans has included the University in its charter as the key academic partner in the Model Development Core, charged specifically to address these issues.

Due to the Department of Psychiatry’s expertise in co-occurring disorder research and behavioral therapy development, the VA awarded UMass Chan Medical School a sole-source research contract to determine the optimal modality, delivery, and intensity of treatment services for homeless Veterans with co-occurring psychiatric and substance use disorders. By examining various augmentations to traditional VA services already provided to homeless Veterans struggling with mental illness, substance abuse, unemployment, and other psychosocial issues, the Model Development Core and the Department of Psychiatry will be on the front lines of VA’s efforts to get Veterans off streets, away from shelters, and out of transitional housing into safe, stable, and permanent residences.

As an academic affiliate of the National Center for Homelessness among Veterans, the University has also played a central role in the refinement and development of the Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION) treatment approach, which was adapted specifically for Veterans (MISSION-VET). MISSION-VET, a flexible, integrated, time-limited, yet assertive service delivery platform was designed specifically to provide direct treatment, ongoing support, and care coordination to homeless Veterans suffering from co-occurring disorders transitioning and/or adjusting to independent living in the community. The model assists Veterans as they strive to become functioning members of the community, and has been enhanced and revised to better meet the multi-faceted and comprehensive service needs of this Veteran population. Dr. David Smelson, Leon Sawh, and Dr. Douglas Ziedonis served as editors of the treatment manual and accompanying workbook, and have incorporated the expertise of homeless prevention, treatment, and research experts including dually-appointed VA-University faculty Dr. David Kalman and Dr. Marsha Ellison.

The goals and objectives of MISSION-VET further substantiate the deeply collaborative relationship between the University and the ENRM VA Hospital. Drawing on the research and implementation skills of the Department’s faculty and staff, UMass supplied the Model Development Core with clinical experts, behavioral scientists, and medical and technical editors who coupled their subject matter expertise with an understanding of complex VA services to create the MISSION-VET Treatment Manual, for case managers and peer support specialists, and the MISSION-VET Consumer Workbook, for Veterans working toward recovery goals.

Building on the department’s successes in leading VA efforts to keep their interventions current and applicable, UMass also played a key role in the development of a toolkit for case managers and clinicians working for or in partnership with the joint Department of Housing and Urban Development -Department of Veterans Affairs Supportive Housing (HUD-VASH) program. The Toolkit, developed as a resource for both VA and non-VA providers who serve homeless veterans through HUD-VASH, focuses on recovery and provision of tools that will assist providers in helping Veterans make the most of their lives by drawing on housing, clinical, and vocational supports. Because this vulnerable population may be served through HUD-VASH by both VA and non-VA providers, UMass’s particular expertise in relating to both public- and private-sector providers resulted in a recovery-focused compilation of tools and resources. The Toolkit will assist case managers and clinicians in the field as they help Veterans achieve their recovery goals by drawing on housing, clinical, and vocational supports.