For the past year, a screening program at the West Haven campus of the Veterans’ Affairs Connecticut Healthcare System has been connecting homeless veterans with housing and clinical services to assist with cognitive and functional impairments. The program, the first of its kind, has so far been an overall success for connecting veterans to resources, according to Theddeus Iheanacho, professor of psychiatry. The program has helped an average of eight veterans per month.
The program, called the “Screening Program to Identify Needs Due to Geriatric Syndromes,” was started last year by Adam Mecca, a resident in the department of psychiatry. SPRING is the first program to screen veterans in search of housing for cognitive and functional impairments in addition to other clinical needs, with the goal of referring them to health services in conjunction with resources for housing needs. According to the U.S. Department of Veterans’ Affairs, in 2009, President Barack Obama set a goal of ending veteran homelessness by the end of 2015. But according to the 2014 Point-in-Time Count, the number of homeless veterans had dropped just 33 percent since the challenge was issued. Iheanacho said researchers are monitoring the SPRING program for six to 12 months in order to assess its overall impact.
“We had this idea that if we could identify cognitive impairment and functional impairment in vets and help get them … resources that they need, that they would have better … health outcomes and better housing outcomes,” said Marcia Mecca, professor of geriatric medicine at the VA and collaborator in the clinic.
Cognitive and functional impairment are distinct from mental disease, making the focus of SPRING unique, said Iheanacho, who connected SPRING to the homeless clinic at the VA.
In addition to pairing veterans with resources to improve cognitive function, the program hopes to discover whether improving cognitive and functional impairments can ultimately lead to better housing outcomes, Marcia Mecca said. The program organizers were particularly interested in the connection between cognitive impairment and housing instability. In 2011, a group of researchers in Boston showed that homeless adults had much higher rates of cognitive and functional impairment, and were cognitively “aged” a decade more than would otherwise be expected.
“This [research] group showed that in homeless adults, there’s really a lot of problems with memory, thinking and functional impairment,” Adam Mecca said. “It’s much more than you’d expect, based on how old the population that they assessed was.”
The researchers in the 2011 study had speculated that the experience of homelessness may have placed adults at higher risk for age-related diseases such as cognitive impairment. However, Mecca and the other program collaborators of SPRING are investigating whether the reverse might be true — that cognitive impairment would place adults at risk for housing instability and homelessness.
Although cognitive impairment creates many difficulties in navigating daily life, there are several primary factors related to cognitive function that can contribute specifically to housing instability, according to the SPRING team. The ability to fill out paperwork, manage money and maintain social connections can all be negatively impacted by cognitive difficulty, Adam Mecca said.
The researchers said they hope that success with this model of screening leads to broader use by other clinics encountering homeless patients. SPRING is becoming popular at the West Haven clinic, with physicians referring patients to be screened even if they are not currently homeless, Iheanacho said.
“We’re actually getting quite good results, at this point, where people come in, and we screen them, and it’s becoming a very well-liked service in the VA,” Iheanacho said. “People who are veterans who have problems, [clinicians] send them to us, even though they might not be homeless.”