Risk of homelessness among Veterans with and without criminal legal system involvement

Abstract: Among military veterans in the United States, criminal legal system involvement is a risk factor for homelessness; however, the magnitude of and contributors to this association are not well understood. This study used national Electronic Health Record data from the Veterans Health Administration (VHA) to determine homelessness risk among veterans after legal involvement compared with veterans without legal involvement. Among veterans who received VHA health care in fiscal year 2022 and had no prior year homelessness or receipt of VHA homeless services, all veterans were coded as with legal involvement, defined by having an encounter with the VHA’s Veterans Justice Programs (VJP), or without legal involvement; veterans without legal involvement were randomly selected without replacement by a 1:2 ratio. A Cox proportional hazards regression model was used to assess the risk of homelessness in the year after a veteran’s index date (first VJP encounter for veterans with legal involvement, first clinical encounter for veterans without legal involvement). There were 24,679 veterans with legal involvement (33%) and 49,358 veterans without legal involvement (67%), with homeless rates of 22% and 2%, respectively. Veterans with legal involvement had a six times higher risk of homelessness over 1 year compared with veterans without legal involvement (adjusted hazard ratio = 6.15, 95% CI [5.73, 6.60], p < .0001). Veterans are at elevated risk for homelessness after legal involvement, suggesting the value of implementation approaches to engage VJP-involved veterans in primary prevention services and policy changes that enable engagement in housing services for legal-involved veterans.

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