The effect of a Veterans Affairs rapid rehousing and homelessness prevention program on long-term housing instability

Objective: To evaluate the effect of enrolling in Supportive Services for Veteran Families (SSVF) on short- and long-term housing outcomes among Veterans experiencing housing instability.

Study setting and design: We analyzed data from the Department of Veterans Affairs (VA) electronic health record (EHR) between October 2015 and December 2018 using the target trial emulation framework. Veterans were included in one or more trials if they were 18 years or older, had recent evidence of housing instability, had received care in VA for at least 1 year, and had never before enrolled in SSVF. Patients who enrolled in SSVF after meeting eligibility were assigned to the treatment group, while patients who did not enroll in SSVF were assigned to a control group. We extracted patients' housing outcomes from the EHR and modeled the probability of being unstably housed each day while accounting for confounders and irregular visit times.

Data sources and analytic sample: We extracted housing status and covariates from the VA Corporate Data Warehouse. Housing instability was ascertained using a combination of structured data elements and natural language processing.

Principal findings: We identified 238,059 unique patients who met the eligibility criteria for one or more trials. The risk of housing instability decreased in both arms over the three years after initiating a trial but was lower among SSVF enrollees, with a risk difference of -12.9% (95% confidence band -14.6%, -11.2%) on Day 120 and an attenuated difference of -2.4% (-4.0%, -0.7%) on Day 1095.

Conclusions: SSVF is one of the largest rapid rehousing and homelessness prevention programs in the nation. We found that SSVF improves housing outcomes over the three years following enrollment, but the effect reduces over time. These findings can inform policy and program design for improving housing outcomes for homeless-experienced individuals.