261293 Chronic disease management for homeless Veterans: The role of substance use and peer support

Tuesday, October 30, 2012 : 1:10 PM - 1:30 PM

Sonya Gabrielian, MD, MPH , MIRECC, West Los Angeles VA, Los Angeles, CA
Anita Yuan, PhD, MPH , Health Services Research and Development Center, West Los Angeles VA Healthcare Center, Los Angeles, CA
Ronald M. Andersen, PhD , Department of Health Services, UCLA School of Public Health, Los Angeles, CA
Roy Brown , Vet to Vet Program, West Los Angeles VA, Los Angeles, CA
James McGuire, PhD, LCSW , Incarcerated Veterans Programs, West Los Angeles VA, Los Angeles, CA
Lisa Rubenstein, MD, MSPH , Center for the Study of Healthcare Provider Behavior, Veterans Health Administration, North Hills, CA
Negar Sapir, MPH , Health Services Research and Development Center, West Los Angeles VA, North Hills, CA
Lillian Gelberg, MD, MSPH , Family Medicine, University of California, Los Angeles, Los Angeles, CA

At VA Greater Los Angeles, the Department of Housing and Urban Development and VA Supported Housing (VASH) offers housing and case management for 1800 homeless Veterans. Given the profound substance use, mental health and medical treatment needs of this population, we developed a pilot program to increase the efficiency and effectiveness of service utilization through peer support and Care Coordination Home TeleHealth (CCHT), a chronic disease management program. Two peers in recovery from substance use disorders (SUD) and mental illness served as health coaches for Veterans with CCHT in VASH housing.


We used Plan-Do-Study-Act cycles for quality improvement. We reviewed medical records to identify baseline health conditions, service use (prior and subsequent year) and peer session content.


The 16 Veterans in VASH housing with CCHT have serious SUD, mental illness and chronic medical conditions. They are high utilizers of VA services, with a mean of 19 primary care and 19 specialty visits over the past year and no change in service use even with peer support and CCHT. Social isolation is a salient problem for homeless Veterans and many describe particular reluctance to disclose substance use to providers. The health coaches provided social support and clarified the common misconception that VASH housing requires sobriety.


Substance use is closely related to chronic disease management for homeless Veterans. Though this intervention did not decrease VA service use, it elucidates the role for peer-delivered motivational enhancement therapy to manage chronic disease for homeless veterans.

Learning Areas:
Chronic disease management and prevention
Program planning

Learning Objectives:
Describe the implementation of a peer health coach program for Veterans with a history of homelessness and chronic medical illness. Discuss the role of substance use disorders in chronic disease management for homeless Veterans.

Keywords: Homelessness, Peer Counselors

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a psychiatrist and health services research fellow focused on improving systems of care for homeless Veterans with serious mental illness and/or substance use disorders.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.