Graduation Year

2007

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Public Health

Major Professor

Martha Coulter, Dr.P.H.

Co-Major Professor

Bruce Lubotsky Levin, Dr.P.H.

Committee Member

Julie Baldwin, Ph.D.

Committee Member

Roger Boothroyd, Ph.D.

Committee Member

Robert Rosenheck, M.D.

Keywords

Behavioral model, Public health, Program design, Predictors, Vulnerable populations

Abstract

Mental illness among homeless populations is a significant public health issue. Community-based programs that assist the homeless are most often developed to meet local housing needs, not the needs of mental health populations. Transitional housing, a model frequently utilized to address homelessness in communities, provides program-based housing with supportive services.

The purpose of this study was to examine the associations between participant- and program-level factors on the utilization of community-based transitional housing by homeless veterans diagnosed with a mental illness. The study tested a revised framework of the behavioral model of utilization for vulnerable populations theory.

The sample was comprised of male homeless veterans diagnosed with a mental illness who participated in community-based transitional housing programs in 2004 and 2005 (n = 2,502). Data were collected on 288 programs throughout the United States, operated by local nonprofit or local government agencies and monitored by the U.S. Department of Veterans Affairs under the Homeless Providers Grant and Per Diem Programs. Success was defined as either completion of a course of treatment as determined by a master's prepared clinician, or if housing was obtained upon discharge, as reported by the participant.

Initial bivariate results indicated that both demographic and situational variables predicted success in transitional housing. However, upon further statistical analyses, limited predictors were revealed. Participants were more likely to be successful if they were white, reported combat experience, were interested in the program prior to admission, and were enrolled in cognitive behavioral models. Participants were more likely to be housed upon discharge if they were white, received some type of public support, were homeless less than 30 days before admission, and showed interest in the program at the time of the initial interview. Participants were less likely to be successful if they were diagnosed as schizophrenic. There was an indication that participants enrolled in programs designated as faith-based were less likely to be housed than those enrolled in secular programs. No statistically significant associations were found between the level of services offered in the transitional housing programs with either successful completion or participants' housing upon discharge.

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