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Abstract Public support payments may facilitate exit from homelessness for persons with mental illness. We examined data from 10,641 homeless veterans contacted from October 1, 1995 to September 30, 2002 in a collaborative outreach program designed to facilitate access to Department of Veterans Affairs (VA) disability benefits. Those who were awarded benefits (22% of contacted veterans) were more likely to report disability, poor to fair self-rated health, and were more likely to have used VA services in the past. Thus, this program achieved only modest success and was most successful with veterans who were already receiving VA ser- vices and who might have received benefits even without the outreach effort.

Keywords Disability benefits Æ Outreach Æ Homeless

During the 1980s, homelessness among persons with mental illness emerged as a serious problem, as more than half of all homeless Americans were found to suffer from psychiatric or substance abuse disorders [1]. A number of studies have shown that a major difference between homeless persons with mental illness and non- homeless persons with mental illness is their access to public support payments [2, 3]. One longitudinal study of homeless mentally ill veterans showed that increased public support payments are significantly associated with exiting homelessness, but not with increased alcohol or drug use [4].

There have been few studies, however, of outcomes associated with coordinated interagency benefits outreach, in which agencies responsible for administering public support programs join with clinicians to reach out to underserved homeless persons in the community to provide them with benefits to which they are entitled. In 1992,

J. H. Chen, B.S. Æ R. A. Rosenheck, M.D. Æ G. A. Greenberg, Ph.D. (&) Æ C. Seibyl, M.S.N., M.P.H. Northeast Program Evaluation Center, VA Connecticut Healthcare System, N.E.P.E.C./182, 950 Campbell Ave., West Haven, CT 06516, USA e-mail: [email protected]

J. H. Chen, B.S. Æ R. A. Rosenheck, M.D. Æ G. A. Greenberg, Ph.D. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

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Psychiatr Q (2007) 78:63–72 DOI 10.1007/s11126-006-9027-6

O RIG IN AL P AP ER

Factors Associated with Receipt of Pension and Compensation Benefits for Homeless Veterans in the VBA/VHA Homeless Outreach Initiative

Joyce H. Chen, B.S. Æ Robert A. Rosenheck, M.D. Æ Greg A. Greenberg, Ph.D. Æ Catherine Seibyl, M.S.N., M.P.H.

Published online: 11 November 2006 � Springer Science+Business Media, LLC 2006

the Social Security Administration (SSA) and the Department of Veterans Affairs (VA) initiated a Joint Outreach Initiative designed to improve access to Social Security benefits (including Social Security Disability Insurance (SSDI) and Sup- plemental Security Income (SSI)) among homeless veterans with mental illness served by the VA’s Health Care for Homeless Veterans (HCHV) program.

An evaluation of that initiative showed that a concerted co-location approach to benefits outreach modestly increased the proportion of homeless veterans that ap- plied for SSI or SSDI from 11% to 19%, as well as the proportion that was awarded benefits from 7% to 11% [5]. Another study [6] showed that veterans who were awarded benefits had a higher quality of life 3 months after receiving benefits than those who were not, and had higher total income and expenditures on transporta- tion, necessities, and tobacco, but not on alcohol or drug use.

In 1994, as authorized by Public Law 102-590, a joint Veterans Benefits Admin- istration (VBA)/Veterans Health Administration (VHA) Homeless Outreach Ini- tiative was implemented to expand the VBA’s efforts to assist homeless veterans through collaboration and sharing of resources. The goal of this national, multi-site benefits outreach effort was to create an ongoing, working partnership that would join VBA and VHA staff to make the benefits claim process more accessible, responsive, timely, and efficient for eligible homeless veterans. Similar to the SSA/ VA Joint Outreach Initiative, the VBA/VHA Homeless Outreach Initiative focused on improving the interaction between two agencies (an ‘‘agency-specific’’ approach) rather than on the entire system (‘‘system-wide’’ approach) [5, 7].

In this study we present data from the VBA/VHA Homeless Outreach Initiative. We first examine the proportion of homeless veterans contacted through outreach who were subsequently awarded new VA pension or compensation benefits, and personal characteristics associated with such awards. A VA pension is a monthly payment that is awarded to applicants who were honorably or medically discharged, who served during wartime, have a limited income, and are permanently and totally disabled (or at least 65 years old), while compensation benefits are monthly pay- ments made to honorably or medically discharged applicants who were disabled by injury or disease that developed or worsened in the line of duty. We then compare the characteristics of those who received benefits from the VA’s disability com- pensation program, which provides funds for veterans who incurred health problems during their military service, with those who received means-tested VA pension benefits, which provide income support to low-income, disabled veterans who served during a wartime period, even if the disability was not related to military service.

Method

The VBA/VHA Homeless Outreach Initiative

In 1994, the VBA/VHA Homeless Outreach Initiative was implemented. Veteran Benefits Specialists were placed at 13 VA Health Care for Homeless Veterans (HCHV) programs to provide dedicated outreach, benefits counseling, referral, and other assistance to eligible veterans. Participating sites were located in Baltimore, MD; Brooklyn, NY; Cleveland, OH; Dallas, TX; Detroit, MI; East Orange, NJ; Milwaukee, MN; Pittsburgh, PA; San Diego, CA; San Francisco, CA; West Haven,

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CT; and West Los Angeles, CA. HCHV outreach staff identified homeless veterans to be referred to Veteran Benefits Specialists for assistance with pension or com- pensation benefit claims, and helped obtain medical evidence needed to support these claims. Veteran Benefits Specialists also referred homeless veterans to other VA services (i.e., Veterans Administration Medical Centers, Vet Centers, Regional Offices), as well as to Veteran Service Organizations and local community agencies.

Sources of data and measures

Veterans Benefits Administration counselors completed a standard form for each veteran whose needs they assessed, that documented sociodemographic status, military history, medical factors, and current and past benefits. They also docu- mented planned referrals to VA and non-VA services.

Data on receipt of benefits was extracted from the VA Compensation and Pen- sion file, an electronic file of payments that provided information on which veterans received benefits, which benefit was received (i.e., compensation or pension), and the month and year in which the benefit was first received, from December 1, 1995 up to March 1, 2003. Social security numbers were used to link intake forms with benefits records.

Statistical analyses

Any veterans that had missing data on the dependent variable (i.e., receipt of pension or compensation benefit) or on any of the independent variables (e.g., so- ciodemographic characteristics, military history, medical factors, current and past benefits) were classified as having incomplete data, and were excluded from analy- ses. They were compared with veterans with complete data to identify significant biases in the analytic sample.

Bivariate analyses were then conducted to identify independent variables that were associated with receipt of benefits (i.e., either pension or compensation), using v2 tests for categorical variables and t-tests (two-tailed test) for continuous variables. Then, among new beneficiaries, those who received pension benefits were compared with those who received compensation benefits.

Logistic regression analyses were then conducted to evaluate the independent effect of factors found to be statistically significant in the bivariate analyses. The stepwise method (backward selection) was used to determine the most parsimonious model of independent factors that predicted receiving benefits (i.e., pension or compensation), as well as those factors that predicted receiving pension benefits versus compensation benefits.

Results

Sample characteristics

Of the 16,071 veterans interviewed at intake, 3,285, or 20%, were already receiving VA income benefits at the time of intake assessment and were excluded from further analysis. Another 2,145 veterans (13%) had incomplete data and were also excluded

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from analyses. The study sample thus included 10,641 veterans enrolled in the VBA/ VHA Homeless Outreach Initiative between October 1, 1995 and September 30, 2002 who were not receiving VA income benefits at the time of enrollment.

Subjects who were missing any data on the independent variables significantly differed from those with complete data in the following variables: they were less likely to be divorced or separated, more likely to be unemployed, to be receiving social security benefits, to be totally or partially disabled, to have poor or fair health, to have planned to file for verification of military status, and to be referred to SSI or SSDI, non-VA services, basic services, and general assistance.

Most veterans were contacted through direct community outreach initiated by VBA or HCHV staff (N = 6,802; 64%), but others were contacted through referral from VAMC outpatient programs (N = 1,168; 11%), VA presence at a non-VA homeless program (N = 1,860; 18%), or through referrals from other sources such as Vet Centers, State VA Agencies, VAMC inpatient units, or non-VA shelter staff (N = 807; 8%).

Table 1 shows that, as one would expect in a veteran population, the sample was predominantly male (97%), and the average age was 45.5 years (SD = 9.5). As with other samples of homeless veterans, the majority of the sample was Black (59%), while 33% was White, 5% was Hispanic, and 3% was another ethnicity. Just over half (54%) were separated or divorced, had graduated from high school (55%), were employed full-time or part-time (56%), and were living in a homeless shelter (54%).

Almost half (44%) of respondents rated their health as poor or fair, and a similar proportion of respondents (49%) described themselves as disabled. A majority (70%) had used VA health care services in the past, while 40% had received other VA benefits. A majority of respondents (81%) reported receiving an honorable discharge from the military, had served during a wartime era (60%), and had served in the army (55%). Only 18% had experienced hostile fire.

Receipt of benefits

Of the 10,641 veterans in the study sample, approximately 22% (N = 2,312) were awarded benefits. The median time between intake assessment and receipt of ben- efits was 9 months, with a range from 1 day to 7.2 years.

Table 2 shows the results of the logistic regression model of receipt of benefits (i.e., either pension or compensation). Veterans who had served during a wartime era, who had experienced hostile fire in a combat zone, or who had received an honorable discharge were more likely to receive benefits than others. Veterans who described themselves as totally or partially disabled, who considered themselves to have a serious psychiatric or medical problem, or who considered themselves to have poor or fair self-rated health were also more likely to receive benefits, as were veterans who were divorced, separated, or unemployed. Veterans who were cur- rently receiving social security benefits were less likely to receive VA benefits.

Two variables related to past use of VA services were positively related to receipt of benefits—past use of VA health care services, and past use of other VA benefits. A planned filing by the VBA counselor for a re-evaluation of a previous benefit claim, and a planned referral to SSI or SSDI were also positively associated with receipt of VA benefits. Planned referrals to non-VA health care services, to basic services (e.g., food, clothing, shelter), or to general assistance, on the other hand, were negatively associated with receiving VA benefits. Planned applications for

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Table 1 Sample characteristics (N = 10,641)

N or Mean % or SD

Sociodemographics Age 45.5 9.5 Race Black 6,236 59.1 White 3,520 33.4 Hispanic 482 4.6 Other 314 3.0

Gender Male 10,215 96.9 Female 326 3.1

Education Less than 12 years 1,053 9.9 High school graduate 5,798 54.8 Greater than 12 years 3,739 35.3

Marital status Married 713 6.7 Widowed 330 3.1 Divorced/separated 5,737 53.9 Never married 3,861 36.3

Employment Full time 3,072 28.9 Part time 2,925 27.5 Disabled 1,556 14.6 Unemployed 2,534 23.8 Other 554 5.2

Has dependents 2149 20.2 Residence Apartment 785 7.4 Temporarily with friends or family 1,697 16.0 Homeless shelter 5,719 53.7 Halfway house 700 6.6 Outdoors, abandoned buildings 1,192 11.2 Other 548 5.2

Military history Military branch of service Army 5,899 55.4 Navy 1,936 18.2 Air Force 1,071 10.1 Marine Corps 1,527 14.4 Other 208 1.9

Served during wartime era 6,340 59.6 Experienced hostile fire 1,937 18.2 Prisoner of war 35 0.3 Type of discharge Honorable discharge 8,619 81.0 General 1,352 12.7 Medical 193 1.8 Bad conduct/undesirable 398 3.7 Dishonorable 179 1.7 Other 370 3.5

Medical factors (self-assessment) Self-rated health Poor to fair 4,688 44.0 Good to excellent 5,953 56.0

Serious health problem Medical 4,932 46.4

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discharge upgrade or verification of military service were also negatively associated with receiving VA benefits.

Approximately 21% (N = 2,176) of the study sample were especially likely to be eligible for benefits because they met the following criteria: (1) they reported poor or fair self-rated health; (2) they described themselves as totally or partially disabled; (3) they had received an honorable discharge; and (4) they had served during a wartime era. Of this likely eligible sub-sample, approximately 50% (N = 1,222) were awarded benefits.

Receipt of pension benefits versus compensation benefits

The majority (72%) of veterans who received any benefit in this sample received a pension benefit. Table 3 shows the results of the logistic regression model of receipt of pension benefits, versus receipt of compensation benefits. Consistent with eligi- bility criteria for compensation benefits, our results showed that veterans who had experienced hostile fire in a combat zone were more likely to receive compensation for injuries during military service than pension benefits. Consistent with the pop- ulation eligible for pension benefits, those who had served during wartime were more likely to receive these benefits.

Table 1 continued

N or Mean % or SD

Substance abuse 5,780 54.3 Emotional/psychiatric 4,691 44.1

Totally or partially disabled 5,240 49.2 Current and past benefits Current benefits Public assistance 1,711 16.1 Social security 1,505 14.1 VA education benefits 13 0.1 Military retirement 83 0.8 Other annuity/retirement 129 1.2 Workman’s compensation 41 0.4

Department of Veterans Affairs (VA) benefits Past use of VA benefits (e.g., education, disability) 4,202 39.5 Past use of VA health care services 7,400 69.5

Receipt of benefits after VBA/VHA outreach Receipt of compensation benefits 655 28.3 Receipt of pension benefits 1,657 71.7

Veterans benefits administration interventions planned Applications Verification of military service 4,246 39.9 Re-evaluation of previous benefits claim 739 6.9 Discharge upgrade request 728 6.8 10-10 for health care services 1,725 16.2

Referrals Basic services (food, clothing, shelter) 6,123 57.5 Department of Veterans Affairs medical services 4,739 44.5 Non-Department of Veterans Affairs medical services 2,361 22.2 Legal assistance 758 7.1 Supplemental Security Income (SSI) or Social Security

Disability Insurance (SSDI) 1,448 13.6

General assistance 4,152 39.0

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Those who received compensation benefits were more likely to be female, to have one or more dependents, to be employed full-time, and to have had less than 12 years of education. They were also more likely to be residing in their own apartment or to be temporarily residing with friends or family. A planned referral by the VBA counselor for a re-evaluation of a prior benefit claim or to legal services was associated with greater likelihood of receiving a compensation benefit.

Those who received pension benefits were more likely to be older, to have poor or fair self-rated health, and to be currently receiving public assistance. Veterans who served in the Navy were also more likely to receive pension benefits. A planned referral by the VBA counselor to SSI or SSDI was associated with receiving a pension benefit.

Discussion and conclusions

This study examined receipt of benefits among homeless veterans contacted through a joint outreach program based on collaboration between the staff of the Veterans Benefits Administration and the Veterans Health Administration. Altogether 2,312 veterans (22%) received newly awarded benefits, and of those who received benefits, 28% received compensation benefits, while 72% received pension benefits. Most notably, veterans who received benefits (i.e., pension or compensation) were more

Table 2 Logistic regression model of variables predicting recei1pt of benefits (N = 10,641)

Variable Parameter estimate

Wald Chi-sq

P Odds ratio

95% Confidence interval

Lower limit

Upper limit

Socioeconomic Divorced or separated 0.17 10.02 0.002 1.19 1.07 1.32 Unemployed 0.24 14.36 0.0002 1.27 1.12 1.43 Currently receiving social Security –0.39 25.08 <0.0001 0.68 0.58 0.79

Military experience Served during wartime 1.72 527.35 <0.0001 5.58 4.82 6.46 Experienced hostile fire in a combat zone 0.32 26.93 <0.0001 1.38 1.22 1.56 Received honorable discharge 0.40 20.11 <0.0001 1.49 1.25 1.77

Medical factors (self-assessment) Totally or partially disabled 0.70 86.54 <0.0001 2.02 1.74 2.34 Serious psychiatric problem 0.21 12.66 0.0004 1.23 1.10 1.38 Serious medical problem 0.25 14.22 0.0002 1.28 1.13 1.46 Poor or fair health 0.32 24.65 <0.0001 1.38 1.21 1.56

VA services Past use of VA health care services 0.53 55.39 <0.0001 1.71 1.48 1.96 Past use of other VA benefits 0.17 8.76 0.003 1.18 1.06 1.32

Filings/referrals planned Verification of military service –0.19 10.30 0.002 0.83 0.73 0.93 Re-evaluation of previous benefit claim 0.48 27.96 <0.0001 1.62 1.35 1.94 Basic services (e.g., food, clothing, shelter) –0.23 13.71 0.0002 0.80 0.71 0.90 Non-VA health care services –0.16 4.26 0.04 0.85 0.73 0.99 General assistance –0.21 10.89 0.001 0.81 0.72 0.92 Discharge upgrade –0.94 21.72 <0.0001 0.39 0.26 0.58 Referred to social security insurance 0.21 6.92 0.009 1.23 1.05 1.43

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likely to have used VA health care or other VA services in the past, to have reported total or partial disability, and to have reported poor to fair health. Veterans who did not receive benefits were more likely to be planning to file for verification of military service or for a discharge upgrade.

Our data suggest that a limited number of homeless veterans qualify for VA benefits and even these have only partial success in obtaining benefits after outreach. Only 21% of the sample fit the high-priority category for VA benefits (i.e., reported poor/fair health, disability, wartime service, and honorable discharge), and of these, only half actually received benefits. While 76% of the general population of veterans served in wartime [8], only 59% of the homeless population in this study served in wartime. Wartime veterans may be underrepresented among the homeless veterans because of their eligibility for a broader array of benefits that may have prevented them from becoming homeless in the first place.

Nonetheless, among our sample of homeless veterans, wartime service was strongly associated with receipt of benefits, and especially with receipt of pension benefits. It is striking that while only 13% of the general population of beneficiaries receive pensions [8], 71% of beneficiaries in the homeless population receive pen- sion benefits after outreach. Wartime service is easier to document than adverse health effects of military experience. In addition, a previous study suggested that homeless veterans become homeless 12 years on average after they are discharged from military service [9]. Those who obtain compensation have likely received it by then, presumably reducing their risk of homelessness.

Table 3 Logistic regression model of variables predicting receipt of pension benefits (versus compensation) (N = 2,301)

Variable Parameter estimate

Wald Chi-sq

P Odds ratio

95% Confidence interval

Lower limit

Upper limit

Socioeconomic factors Age 0.08 86.59 <0.0001 1.08 1.06 1.10 Employed full-time –0.44 11.75 0.0006 0.65 0.50 0.83 Gender –0.76 4.18 0.04 0.47 0.23 0.97 Less than 12 years education –0.55 6.38 0.01 0.58 0.38 0.88 Has dependents –0.61 18.80 <0.0001 0.55 0.42 0.72 Residing in own apartment –1.12 28.50 <0.0001 0.33 0.22 0.49 Temporarily residing with

friends and family –0.55 12.41 0.0004 0.58 0.43 0.79

Currently receiving public assistance 0.56 11.43 0.0007 1.75 1.27 2.42 Military experience Served during wartime era 2.97 212.04 <0.0001 19.57 13.12 29.21 Experienced hostile fire in a

combat zone –1.32 110.49 <0.0001 0.27 0.21 0.34

Served in navy 0.45 7.28 0.007 1.57 1.13 2.17 Medical factors (self-assessment) Poor or fair health 0.62 25.92 <0.0001 1.85 1.46 2.35

Filings/referrals planned Re-evaluate prior benefit claim –0.77 23.50 <0.0001 0.46 0.34 0.63 Referral to SSI or SSDI 0.34 4.74 0.03 1.40 1.03 1.89 Referral to legal services –0.52 6.00 0.01 0.59 0.39 0.90

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Veterans planning to file for verification of military service or for a discharge upgrade were less likely to receive benefits, presumably because they were less likely to have been honorably or medically discharged and thus eligible for benefits, while veterans who needed to file for a re-evaluation of a prior benefit claim were more likely to receive benefits. These veterans may have obtained necessary documen- tation of military and medical history to make re-evaluation worthwhile.

A prior study of factors associated with admission to a domiciliary care program for homeless veterans showed that admission procedures appeared to favor either those already ‘‘in the VA orbit’’ [10], or those who had used VA health care, education, disability, and other benefits in the past. While the present study repli- cated this finding for receipt of pension or compensation benefits, the explanation for this is not clear. Perhaps the selection process for receiving benefits favored those already in the ‘‘VA orbit’’ because those veterans already had the proper paperwork on file regarding their wartime service and related health problems. Or, perhaps those veterans in the VA orbit were more persistent in completing their applications and obtaining the necessary evidence of military service (i.e., they were more skilled in dealing with bureaucratic procedure). Veterans who were referred to non-VA health care services, in contrast, were less likely to receive benefits. Referral outside the VA system may reflect a preference for non-VA health care or ineligibility for VA services for reasons not documented on our forms.

Veterans who reported poor or fair health, serious psychiatric problems, serious medical problems, and total or partial disability were more likely to receive benefits. While it may seem obvious or even tautological that veterans’ own assessment of their state of poor health or disability is a strong predictor of receipt of disability benefits, this is actually a novel piece of information. Adjudicators for disability benefits make their judgments not on veterans’ self-assessment but rather on available medical evidence. Although one might expect that veterans’ own reports of their illness may be exaggerated, and may not necessarily coincide with the findings of official adjudicators, our results indicate that their assessment actually has sub- stantial predictive value.

Several limitations of this study must be noted. First, it does not provide a complete picture of the effectiveness of the VBA/VHA Homeless Outreach Pro- gram, in that it lacks a comparison group of veterans who were seen in the HCHV program who did not have access to a benefits outreach worker. It is possible that even without the outreach program, either none of these veterans would have gotten benefits or just as many would have received them. Second, this study did not determine whether benefits were not received by veterans contacted through out- reach because: (1) they were not eligible; (2) they were not motivated to follow through on their applications; (3) outreach staff could not establish rapport with their population; or (4) needed medical evidence of disability could not be obtained. A third limitation is that 14% of the data were missing. While comparative analyses showed that subjects who were missing any data on the independent variables were not significantly different from subjects having complete data with respect to the factors predicting receipt of pension versus compensation benefits, there were sig- nificant differences in approximately half of the factors predicting receipt of any benefit. One final limitation is that it is possible that social security numbers ob- tained at outreach were not accurate, and therefore linkages with VA compensation and pension file data were under-detected. Further studies would be needed to address these questions.

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The findings of this study are consistent with what might be called the paradox of outreach. Outreach efforts are designed to reach out to those with least access to benefits or other services. It follows, however, that those contacted through the outreach process are, for that very reason, least likely to be eligible for benefits, or least capable of following through on their applications. As a result the yield of outreach programs such as this one may be destined to be small. The important unanswered question is whether facilitating access to benefits sufficiently improves the lives of the modest number of veterans who eventually received them to justify the investment in the outreach effort. Such outreach efforts, even if their effects are modest, may significantly contribute to the reduction of homelessness not only among veterans but among other homeless people who may be eligible for other types of benefits such as Social Security Disability Insurance and Social Security Insurance. Further research is needed on the costs and benefits of community out- reach.

In 2002, President Bush set a goal of ending chronic homelessness in the next 10 years [11]. Veterans are a major responsibility of the federal government and are a prominent subgroup of the chronically homeless. Ending homelessness among veterans will likely require enhanced access to benefits and may also require more effective outreach efforts.

References

1. Tessler R, Dennis D: A Synthesis of NIMH-Funded Research Concerning Persons Who Are Homeless and Mentally Ill. Rockville, MD, National Institute of Mental Health, 1989

2. Rossi P: Down and Out in America: The Causes of Homelessness. Chicago, University of Chicago Press, 1989

3. Sosin MR, Grossman S: The mental health system and the etiology of homelessness: A comparison study. Journal of Community Psychology 19: 337–350, 1991

4. Rosenheck RA, Frisman LK, Gallup PG: Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans. Psychiatric Services 46:1131–1139, 1995

5. Rosenheck RA, Frisman LK, Kasprow W: Improving access to disability benefits among homeless persons with mental illness: An agency-specific approach to services integration. American Journal of Public Health 89(4):524–528, 1999

6. Rosenheck RA, Dausey DJ, Frisman L et al.: Outcomes after initial receipt of social security benefits among homeless veterans with mental illness. Psychiatric Services 51(12):1549–1554, 2000

7. Rosenheck RA, Kasprow W, Frisman L, et al.: Cost-effectiveness of supported housing for homeless persons with mental illness. Archives of General Psychiatry 60:940–951, 2003

8. US Census Bureau: Statistical Abstract of the United States: 2003. 123rd Ed. Washington, DC, US Census Bureau, 2003

9. Mares A, Rosenheck RA: Perceived relationship of military service and homelessness among homeless veterans with mental illness. Journal of Nervous and Mental Disease 192(10):715–719, 2004

10. Rosenheck RA, Leda C: Who is served by programs for the homeless? Admission to a domi- ciliary care program for homeless veterans. Hospital and Community Psychiatry 42:176–181, 1991

11. Interagency Council on Homelessness: White House Interagency Council Announces New Strategy to Combat Chronic Homelessness [online]. Washington, DC. Available from World Wide Web: www.ich.gov/library/pr02–078.html, 2002

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/ENU <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> >> >> setdistillerparams << /HWResolution [2400 2400] /PageSize [2834.646 2834.646] >> setpagedevice