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Principal Investigator: Steven Bacchus Zeliadt
Organization: VA PUGET SOUND HEALTHCARE SYSTEM
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: There is a paucity of reliable, household-level data on evictions. We have no data on how
many Veterans are evicted each year, whether they regain housing or not after eviction, or the costs to VA of
rehousing evicted Veterans and treating eviction-related health conditions. If we knew these costs to be
substantial, we could better budget for programs, such as the Supportive Services for Veteran Families
(SSVF), that are designed to reduce housing insecurity.
Significance: We will acquire the names and addresses on all eviction filings starting in 2013 from Minnesota,
Indiana, Cook County (Chicago), IL and the Puget Sound (Seattle) region of Washington State. We will match
these filings by name and address to VA clinical and housing databases. This offers three major opportunities
for VA. First, it allows VA researchers to estimate the effects of eviction on health and housing outcomes and
VA costs. Knowing the costs of evictions informs the level of effort the VA should apply to mitigate those costs.
Second, it provides an opportunity to intervene proactively to prevent homelessness because the eviction data
can be extracted monthly. Third, because eviction data covers all Veterans and not just those receiving VA
care, it provides an opportunity for VA to proactively reach all enrolled Veterans, including non-VA users who
might not be aware of the housing, health, and social assistance available to them at VA.
Innovation and Impact: This is the first VA study to: carefully match evicted persons to non-evicted persons
at the time of eviction to minimize risks of reverse causation and confounding; estimate the probability of
homelessness following an eviction; comprehensively estimate the effect of evictions on health and healthcare
costs; pilot-test a system to identify Veterans before they become housing insecure that does not rely on a
Veteran having a healthcare visit with a housing screen; and use newly released data on the socioeconomic
status of Veterans from the USVETS database. If successful, we will be able to proactively contact Veterans
and refer them to VA housing services before they become homeless. We will also better understand the costs
of evictions to Veterans and VHA.
Specific Aims:
1. Aim 1: Estimate the effect of evictions on Veterans’ health, housing outcomes and costs.
Hypotheses: a) Veterans who were evicted were more likely to experience subsequent homelessness,
have increased need for physical and mental health services, and to generate more costs to the VA
than Veterans who were not evicted.; b) Black and Hispanic Veterans were more likely to face eviction
than were white Veterans.
2. Aim 2: Conduct a prospective survey of evicted and non-evicted Veterans to estimate the association
between evictions and patient reported outcomes:
Hypothesis: Veterans who were evicted will have less favorable patient reported outcomes than
Veterans who were not evicted.
3. Aim 3: Design and pilot test an intervention to proactively reach out to Puget Sound Veterans with court
fillings for eviction. Primary outcomes: a) requests for information on housing assistance from Veterans
who received outreach, and b) acceptability of the pilot intervention by Veteran users and VA staff.
Methodology: Aim 1 is retrospective statistical analyses of housing and health databases. Aim 2 conducts a
survey of evicted and non-evicted Veterans. Aim 3 conducts qualitive interviews with newly evicted Veterans,
holds a human centered design workshop to create the intervention, and pilot-tests the intervention.
Next Steps/Implementation: We ultimately hope to widely implement the intervention(s) designed and pilot-
tested in Aim 3 in order to better reach Veterans facing eviction and help prevent Veteran homelessness.
Terms: <Active Follow-up><Address><Affect><Appointment><Area><Awareness><Black><Black race><Budgets><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Case Management><Causality><Characteristics><Charge><Chicago><Chronic><Clinical><Collaborations><County><Data><Data Bases><Data Set><Databases><Educational workshop><Enrollment><Etiology><Face><Family><Financial Support><Funding><Goals><Grant><Health><Health Care Costs><Health Care Visit><Health Costs><Healthcare><Healthcare Costs><Healthcare Visit><Hispanic><Home><Homelessness><Household><Housing><Housing and Urban Development><Indiana><Individual><Intervention><Intervention Strategies><Interview><Investigators><Link><Literature><Marketing><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Methodology><Minnesota><Names><Natural Language Processing><On-Line Systems><Online Systems><Out-patients><Outcome><Outpatients><Patient Outcomes Assessments><Patient Reported Measures><Patient Reported Outcomes><Personal Satisfaction><Persons><Probability><Psychological Health><Records><Research><Research Personnel><Researchers><Risk><Risk Factors><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Socio-economic status><Socioeconomic Status><Source><Statistical Data Analyses><Statistical Data Analysis><Statistical Data Interpretation><Survey Instrument><Surveys><System><Time><U.S. Department of Housing and Urban Development><United States Department of Veterans Affairs><United States Veterans Administration><Veterans><Veterans Administration><Veterans Affairs><Washington><Workshop><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><active followup><adjudication><adjudicative process and procedure><causation><cohort><computer based prediction><cooking><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cost><court><data base><design><designing><disease causation><enroll><experience><faces><facial><financial assistance><flexibility><flexible><follow up><follow-up><followed up><followup><health care><health care access><health care availability><health care service access><health care service availability><health equity><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><homeless><homes><housing instability><human centered design><improved><innovate><innovation><innovative><instably housed><interventional strategy><mental health care><mental healthcare><name><named><naming><natural language understanding><novel><online computer><outreach><pandemic><pandemic disease><physical conditioning><physical health><physical health service><pilot test><poor health outcome><predictive modeling><prevent><preventing><primary outcome><programs><prospective><reduced health outcome><risk minimization><screening><screenings><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social health determinants><socio-economic><socio-economic position><socio-economically><socioeconomic position><socioeconomically><socioeconomics><sound><statistical analysis><supported housing><supportive housing><unhoused><unstable housing><unstably housed><web based><well-being><wellbeing><worse health outcome>