Written by Howard Rosen & William D. Harms
About 1.4 million veterans are considered at risk of homelessness. Although flawless counts are difficult – the transient nature of homeless populations presents an obvious major difficulty – the U.S. Department of Housing and Urban Development (HUD) estimates that 47,725 veterans are homeless on any given night. Contacting Vets who are homeless, particularly those suffering from substance use disorders, is very challenging.
Why are a disproportionate of Veterans homeless? A large number of homeless or at-risk to be homeless veterans live with lingering effects of post-traumatic stress disorder (PTSD) and substance use (SU). The impact of these disorders is compounded by alienated family and lack of social support networks. Tsai, Kasprow, and Rosenheck found that 60% of entrants into an HUD-VA program had comorbid substance use disorders, and 54% of those had both alcohol and drug use disorders. There is no simple solution as there are complex set of factors influencing all homelessness such as the extreme shortage of affordable housing, a livable income, access to health care and transitioning careers to the civilian world.
Homeless Veterans require a balanced psychosocial environment to make substantive social change. This requires a coordinated effort to supply secure housing, nutritional meals, basic physical health care, substance abuse care and aftercare, mental health counseling, personal development and empowerment. Specific to employment, veterans need specialized assistance bridging their military skills with civilian job assessments, training, and placement. Ironically, most of these services are currently funded and available, but remain invisible to the Veteran who is most in need.
With over 3,500 insights from working with the Veteran population, LifeWIRE has looked to address the problem with our clients by addressing the problem by connecting the veteran back to the community of care creating the conditions that will help the Vet return to a productive life.
LifeWIRE’s patented, asynchronous communication platform allows a practitioner, whether case managers, schedulers, pharmacy, or clinicians to build a ‘virtual” dialogue and relationship with their homeless Veteran populations. A core-factor in successfully working with the homeless population is the ability to have an ‘anonymous relationship’– a relationship because the Veteran can have multiple interactive conversations with the treatment team, and anonymous because the Veteran can address recovery issues without having to directly confront a perceived authority figure. This is particularly salient when addressing mentally illness, SU, or PTSD affectations that manifest issues such as problems with authority or paranoia.
Our clients have found that success improves when the Veteran has the “power” to address how they want to communicate, what to communicate, where to communicate, when to communicate. Clients were not as successful attempting to fit treatment messages and protocols into standardized patterns, or those most expedient or convenient to the team. Integrating their feedback, the Veteran is empowered to become engaged in making the “5 W” decisions of Who, What, Where, When and Why for their own treatment. The resulting LifeWIRE conversation allows the Vet to express how they feel in the language and mode that best suits them and provide insights for their community of care.
Veteran empowerment extends to them being able to initiate outreach with the clinical or treatment teams. For example, by texting the keyword “maps” to “59937” the Veteran is electronically screened, scheduled, and referred to the appropriate resource. This also helps optimize efficiencies by automating the bottlenecks of scheduling and appointments. The system responds, pre-screens, and then refers based on the reported need (NOTE: the military resilience assessment demo is a live sample of a larger outreach). The Veteran initiates the outreach and controls the pace of interaction and disclosure.
Our client’s veteran populations have an average contact rate of over 75%. Veteran utilization is as high as 94%. In these studies, staff time to manage the Veteran has actually been reduced by as much as 80%. Other noted outcomes include reduction of SU relapse from 30% to 13%, appointment no-shows from 30% to 7% and reduction in re-admission by approximately 32%. The net result of these reductions in one VA facility resulted in providing 38 more Vets access to treatment.
At our core, every human craves intimacy and communication. Feelings of alienation and inadequacy, common symptoms of PTSD, SU, and even suicidality, are boulevards of access to those we deem to serve. But, we must contextualize to the patient; meet them using their language, their media, to fulfill these basic human needs; and in doing so begin the trusting relationships so critical for healing. People are different, and so are the messages that meet their needs. One size NEVER fits all.
LifeWire is the link between the Vet and the human connection they reject but desperately need. As one Vet said “After 18 months of using LifeWIRE I am still here, and some of my buddies who didn’t, aren’t”.