David Smelson, Psy.D.Professor of PsychiatryVice Chair for Clinical ResearchDepartment of PsychiatryUniversity of Massachusetts Medical SchoolDirector, Bedford Node National Center on Homelessness Among VeteransThe mission of the National Center on Homelessness Among Veterans is to promote recovery-oriented care for Veterans who are homeless or at-risk for homelessness. The Center is a national resource that informs practices designed to meet the VA’s Five Year Plan to End Homelessness among Veterans.

The mission of the National Center on Homelessness Among Veterans is to promote recovery-oriented care for Veterans who are homeless or at-risk for homelessness. The Center is a national resource that informs practices designed to meet the VA’s Five Year Plan to End Homelessness among Veterans.

BackgroundBackground

“President Obama and I are personally committed to ending homelessness among Veterans. Those who have served this nation as a Veteran should never find themselves on the street, living without care and without hope.” –Secretary Shinseki

End Veteran homelessness by 2015

ZERO-tolerance policy on homeless Veterans

1/3rd of homeless population were Veterans

NCHV Established in 2009 response to President Obama’s call to:

VA Funded– 1.9 million annually across 3 nodes

– 5 years of funding

Goals– Track/Reduce Number of Homeless Veterans

– Strategic Alignment• Research

• Education

• Clinical Care

• Policy/Administration

– Oversight of $801 Million Budget (Doubled 2009)

Model Development

Core

Research and Methodology

Core

Bedford VA

Philadelphia VA

Tampa VA

Program CoresProgram Cores

Bedford, MABedford, MA

Model Development and Implementation Core• Test Evidenced Based Practices• Adapt Practices for Veterans• Develop New Practices• Provide Technical Assistance

Model Development

Core

David Smelson, PsyD (Director, NCHV Bedford Node) Gerardo Gonzalez, MD (NCHV Site PI/Director Division of Addiction Psychiatry)Marsha Langer Ellison, PhD (Investigator, Supported Employment/Supported Ed.)Lisa Najavits, PhD (Investigator, PTSD and Addictions)Stephanie Rodrigues, PhD (Investigator, Stigma)Matthew Chinman, Ph.D. (Investigator, Implementation Science)Gregg DiGirolamo, PhD (Cognitive Neuroscience)Lisa Fortuna, MD, MPH (Technology Development in TAY)Rich Fletcher, PhD (Technology Development)Leon Sawh, MPH (Site Project Director)Liz Aaker (Project Director)Julianne Siegfriedt, MA (Research Coordinator)Emily Munoz (Program Support)Kathryn O’Connor (Research Assistant, Technology Program)

Bedford VA/UMass Model Development NodeBedford VA/UMass Model Development Node

1. Manual Development Projects• Goal:

• Standardize Practices

• Dissemination Practices

• Manuals to Date

1. MISSION-VET Treatment Manual

2. MISSION-VET Consumer Workbook

3. Supported Education Manual

4. HUD-VASH Resource Guide

https://umassmed.edu/psychiatry/VANationalCenteronHomelessnessAmongVeterans.asp

2. Co-Occurring Disorders Treatment Research Area

1. MISSION-Vet HUD-VASH Implementation Study (2011-2015)• Use Getting To Outcomes (GTO) to Implement MISSION in 3 VISN’s

2. HUD-VASH SUD Randomized Controlled Trial (2010-2013)• Test 3 Interventions (varying in intensity) to Augment HUD-VASH

3. MISSION DIRECT VET Jail Diversion Program (2008-2013)• Divert Veterans and offer MISSION Services

4. ATTOC in Homeless Residential Care • Adopt and Implement ATTOC Model for Smoking Cessation

3. Housing Placement and Retention

1. Safe Haven• Serves severely mentally ill Veterans with co-occurring disorder

• Does not punish relapse

2. Housing First• Shift of focus to rapid placement of Veterans in housing and

intensive wraparound services

3. HUD-VASH Exiter Study• Evaluation of HUD-VASH clients who leave program early

4. Peer Support/Supported Education Research AreaSupport Education Research:1. Needs assessment for supported education among OIF/OEF Veterans

2. Pilot RCT of Supported Ed among OIF/OEF Veterans with PTSD

3. Pre-implementation Planning Supported Education Rollout in VA

Peer Support Research: 1. Unbundling MISSION to Test Peer Support in HUD-VASH

2. Peers in Homeless Medical Home Primary Care Setting

5. Anti-Stigma Research Area

• Self-Stigma and Treatment Engagement1. Survey of self-stigma among co-occurring disorders

and homelessness Veterans

2. Adopt “Coming Out Proud” for Veteran population

Public Stigma 1. Public service announcement on homelessness Veterans

2. Pilot anti-stigma campaign for high school students

6. Mobile Technology Development Research Area• Use of mobile technologies to enhance treatment engagement among

hard-to-reach HUD-VASH clients via:

Current Projects:

1. Needs assessment of technologies homeless Veterans can access

2. Test feasibility of text messaging to promote treatment

3. Real time Relapse Prevention via mobile device & connected sensor band

•Massachusetts : 2011 Doubled Reduction in Homeless Veterans(23% Massachusetts Vs. 11% US)

*Data collected jointly by VA and HUDVeteran Homelessness: A Supplemental Report to the 2009 & 2010 Annual Homeless Assessment Report to Congress (2009 & 2010 Veteran AHAR)

Incidence (new homeless cases)

Questions?Questions?