The Plight Of America’s Veterans –Homelessness And The Remedy – Sara Patterson
From the sunny sidewalks of Southern California to the shivering streets of New England, homelessness is an ever-present public health problem. Veterans comprise a significant percentage of the homeless population, and many seem to believe there is nowhere to turn for support. Men and women returning from war face hardships of reintegration. Suffering both mental and physical scars, they endure great difficulty while attempting to readjust to their former way of life.
Surely, the United States is one of the most affluent countries in the world. Why then, are hundreds of thousands of men and women who were honorably discharged from military service living in squalor? Veterans make up nine percent of the U.S. population, but 23% of the homeless population (1). Among homeless men, veterans make up 33% of the population (1). In addition, 67% of homeless veterans served in the military for at least three years, and 89% received an honorable discharge from the service (11).
“In the United States, however, homeless veterans are a large group of the needy whom few Americans are aware of. As silent sufferers of homelessness, they are even less likely to receive the help they deserve and need.” (11) Not only are there twice the number of homeless Vietnam veterans living on the streets than the 58,000 that died in the war (1) but the number of veterans from the Iraq and Afghanistan wars is on the rise as well. America’s public health system is failing veterans. “Traditionally, what happens to you after you leave has not been a concern of [the] service,” said Peter Dougherty, the Department of Veterans Affairs (VA) Director of Homeless Veterans programs (1). The estimates of homeless veterans range in numbers between 175,000 and 275,000 and include soldiers that served in World War II, the Korean War, the Vietnam War, the Persian Gulf War, and the wars in Iraq and Afghanistan.
There are various probable reasons why veterans become homeless. Post-traumatic stress syndrome, lack of affordable housing, service connected disability, separation from family for extended time periods (6), substance addiction (2), mental and emotional problems (3), “unemployment, poor education, frayed family relations” (1), limited applicability of military training in the civilian workplace (6), or a combination of these and other factors could be what leads up to a life on the streets. Whatever the cause of homelessness, the methods of prevention and intervention by public health are clearly falling short. “…the government is willing to praise its military before and during battle, but judging by the astonishing number of homeless veterans on the streets, has a diminishing commitment to them when they return home.” (11)
Flaws of Interventions
Public health, in general, employs models of intervention that deal with people on the individual level and require the assessment of the individual of their own situation. In the case of veterans, many do not know that they are at-risk for homelessness. Linda Boone, Executive Director of the National Coalition for Homeless Veterans (NCHV), states that “there’s a steady stream of wounded veterans coming home [from Iraq and Afghanistan] who don’t even know they’re casualties.” (5)
Of all the existing public health programs, realizing and understanding you are at-risk for a situation/behavior is a key factor for an individual to implement any of the models. The Health Belief Model, especially for the veteran population, would be inappropriate to use in that perceived susceptibility and perceived severity (4) (to homelessness) would not necessarily be taken into account by veterans, thus they would not realize intervention or a change in behavior is necessary. If a person does not see themselves as susceptible to homelessness, they are not going to take the necessary steps to prevent the outcome. The Health Belief Model falls short in this case. In addition, many of the factors that lead to veteran homelessness are ultimately out of their control.
A second critique of the Health Belief Model is that it assumes everyone has equal access to relevant services and information regarding their ability to make a decision to change a behavior. It is well documented that homeless veterans do not have the collective information they need to assist them when they return home from military service. Cheryl Beversdorf, President and CEO of the National Coalition for Homeless Veterans (NCHV), in an editorial to the Washington Post in 2008, stated that the United States needs public education for homeless veterans and at-risk veterans informing them of where to get services, not only at the VA but from community service providers throughout the country (10). She went on to say that the United States needs “a continuing public education campaign about the resources that are available to help America’s former guardians address their problems and rebuild their lives.” (10) To date, there are no existing public health programs that address these issues on a country-wide scale.
The Theory of Reasoned Action is also a poor model to base an intervention on for homeless veterans because it deals with people’s attitudes toward a specific behavior (4). In the case of veterans, there is not one specific behavior that causes the problem of homelessness. This theory is very precise and requires that a person individually assess a certain behavior that will cause either a positive or negative outcome. If a veteran does not consider themselves at risk for homelessness, then this intervention falls short.
Perhaps veterans become homeless as a result of an issue on a larger scale, for example, cultural anthropological factors such as norms. The Theory of Reasoned Action places emphasis on an individual’s perception of subjective norms associated with a behavior (4). However, there has not been much, if any, research into what influences a veteran’s social norms. Could it be family norms, military norms, civilian’s norms? Much like the different codes that military personnel use in the service to communicate with each other, there could be norms misunderstood by the general public that come into effect when trying to create successful public health interventions. In order to understand which programs and health intervention models will work for veterans, research into what the acceptable norms are for a veteran is crucial.
Lack of Resources for Veterans
Among soldiers, one of the biggest reasons for homelessness is a lack of available resources and services (9). “Compounding the difficulty of homeless veterans is the widely accepted belief that the [Department of Veteran Affairs (VA)] takes care of all veterans in need…the VA…will reach fewer than 20 percent of homeless veterans in this country.” (6) Lack of research and general knowledge about how homelessness affects veterans and a lack of adequate resources for public health programs to assist veterans, homeless or not, is a second way public health has failed these men and women living on the streets.
The VA alone is not responsible for the well-being of veterans. Public health needs to become more of a factor in helping veterans before and after they become homeless. Overall, there is a lack of knowledge by the general public that veterans are in need, therefore, there is not enough research of the homeless veteran population including causes, which leads to a deficiency of programs.
“In the past, data quantifying homelessness among veterans did not exist. It’s been precisely the lack of research that had us groping in the dark as far as what our response should be,” said Philip Mangano, head of U.S. Interagency Council on Homelessness (1). For this unique population, research needs to be collected on what causes veterans to become homeless and how they want to be helped, if at all, after becoming homeless. Research of the veteran population is the key to understanding, preventing and intervening in homelessness.
There were no VA funded programs to assist homeless veterans until 1987 (2). In 1990, service providers created the NCHV to raise public awareness of homeless veterans and to advocate for more federal aid (12). Even through the valiant efforts of the NCHV, there is currently not enough funding for programs to aid homeless veterans in the US. As recently as 2007, there was a lack of 9,600 transitional beds for vets which are supposed to serve as a starting point for independence from the streets (2). Homeless service providers are strained by veterans from the Vietnam War, and veterans from the wars in Iraq and Afghanistan requiring assistance have already begun to enter the system.
In New York City, homeless veterans outnumber the amount of other homeless people living in shelters (13). However, there are only two housing projects in the entire metropolitan area specifically for veterans and is located in the Bronx (13). There seems to be ample support for troops overseas fighting on the battlefields, but it is apparent what becomes of many soldiers when they return home. As a result of the current wars in Iraq and Afghanistan, the number of veterans in need is expected to rise.
A once homeless Vietnam veteran, Ken Smith, says “This [homelessness] is what happens when you don’t debrief your troops, when you [put them] red-hot from combat…on a plane. In Israel, when they pull a kid form the field, they give him as much support and counseling as he needs. Is that expensive to do? Probably, but did you ever see a homeless vet in Jerusalem? Whereas here…the shelters are packed solid. You tell me which is the more expensive approach.” (14) Public health needs more resources to help veterans who are returning from military service before they become at-risk for homelessness. It is much more effective to prevent homelessness for these men and women prior to their becoming homeless than it is to create affordable housing where none is available.
Another hurdle to providing assistance is exemplified by a recent report from the Department of Defense Mental Health Task Force which states that “nearly 50 percent of National Guard members and reservists report symptoms of mental disorders…and many return to homes in rural communities, from where they find it difficult to access military-provided clinical care and support groups.” (17) Services, as described by some homeless veterans, are “often difficult to obtain because the delivery system is unwieldy, inadequate, and inaccessible.” (16) It was further stated that the method of delivery is “a complex mass of programs and services with limited resources, staff that are excessively spread out, and inadequate funding to effectively address the severe problems facing homeless veterans.” (16)
The VA boasts of billions of dollars in funding for programs, which makes one wonder where all of the money is going and if the programs that are in place are the most effective use of the VA’s funds. Linda Boone, Executive Director of NHCV, states, “You see…cars with yellow ribbons saying ‘Support Our Troops.’ What you don’t see are signs saying ‘Support Our Veterans.’ But when those men and women take off their uniforms, that’s when they need support the most.” (5)
A Different Kind of Population
A third argument against the interventions that are currently being offered for homeless veterans is that they expect veterans to ask for assistance or come to a shelter of their own volition. Most veterans, at least traditionally, will not seek out help. There need to be programs that seek homeless veterans out and not the other way around. Most of the programs, even locally, require that a veteran come to them for support. Veterans are a proud bunch. Pete Dougherty, the VA’s director of homeless programs in Washington says that, “military service is a great place to learn in the harsh environment. They’re much better prepared [for homelessness] than non-veterans. They seem to have a higher tolerance and a certain degree of pride and toughness that they – more than the rest of us – can endure tough circumstances.” (7)
Veterans are a different kind of population to deal with because they “are very independent people,” (8) says Tammy Duckworth, Director of the Illinois Department of Veterans’ Affairs, “and we want to make them understand that this is not charity; this is the least of what they deserve for serving their country.” (8) Homeless veterans who see themselves as extremely independent and able to take care of themselves will not come to a shelter or ask anyone for aid. Studies indicate that an average of 12 years elapse before Vietnam veterans seek help for mental and emotional problems (3), providing strong evidence that veterans are less likely than the average person to ask for help. When they do, it is often on the brink of being too late for help to have a positive outcome.
There is a common distrust by veterans, especially the homeless, of the Department of Veterans Affairs. When asked to come to a shelter, a homeless veteran responded with, “I fought for the flag, but the flag never fought for me.” (1) His response typifies most soldiers’ sentiments of distrust for the VA and government in general, making it unlikely that veterans will seek any assistance provided by public health or government programs.
Veterans are more likely to favor a dangerous life on the streets rather than risk being in the hands of the VA. An attitude that implies a lack of responsibility for certain American veterans in need has been part of the problem of homelessness. According to Ralph Cooper, Executive Director of the Veterans Benefits Clearinghouse in 1995, the VA was run until recently by World War II vets, whose sentiment was, “We won our war and you lost yours, so we don’t owe you cowards and baby-killers anything.”(14)
Even though more than 30 years have passed since the war ended, still some Vietnam veterans exist who believe they returned to their country in dishonor and that they continue to be disrespected, a direct result of how the public health system and the government handled their homecoming. A Vietnam veteran living in a privately run Boston shelter wanted an interviewer to ask the VA a question on his behalf, “See, they gave amnesty to all the ones that ran away to Canada. In ’77, President Carter told ‘em all to come home and everything’d be forgiven, and it was. What I wanna know is, when will we be forgiven? We didn’t try to lose that war; we tried to serve our country. When can we come home?” (14)
Distrust and lack of awareness of assistance programs makes it difficult for homeless and at-risk veterans to take advantage of benefits. The Department of Veteran Affairs “relies on a system of self-help in which veterans must first be aware of the services that the VA provides and secondly want help in order to receive care.” (11) One of the most challenging factors is to convince proud, independent men and women that they might need help. It is very difficult to go about that task without damaging a person’s pride and sense of dignity. Upon being asked what he had been given at a local Boston shelter, a homeless veteran responded, “Hope…they’re willin’ to try to help me. That’s what the Vietnam vet needs – not a handout, a hand up.”(14)
The Future
As concern for the future of homeless veterans grows, a campaign by the National Coalition for Homeless Veterans has been implemented to increase awareness and to educate the public of the increasing crisis (6). Greater public knowledge should result in more effective intervention programs for veterans. The campaign has also “highlighted the need to recognize community-based organizations as a critical component of a coordinated, national strategy to increase the availability of services.” (6)
“Little is known about whether veterans served by VA’s homeless programs remain housed or employed, or whether they instead relapse into homelessness” therefore an evaluation of the effectiveness of VA programs should be initiated (15). It is time for public health to take responsibility for veterans and to not think of them as someone else’s problem. The VA has done what they can with their limited resources. Communities in which the homeless veterans live must now lend a helping hand to the men and women who once served the country with pride and honor in their rise from the streets.
In the words of a professor of social science at University of Massachusetts Boston and a Vietnam Veteran, Paul Camacho, “What are they going to do for these guys when they come home…other than wave a flag and buy them a beer?” (1)
Homelessness is a crisis facing an untold number of the most important citizens of the United States, veterans who may have already faced terrible circumstances defending their country and the people who live there. To better care for our returning heroes, several issues must be addressed. First, the types of interventions currently employed are not effective. Second, the types of resources available at present are only beginning to scratch the surface. Third, veterans are a unique faction with diverse circumstances that need to be considered.
The Right Kind of Intervention
In general, Public Health issues deal with choices made voluntarily. Since homelessness is not what individuals would typically choose as a lifestyle, the problem of veteran homelessness is an extraordinary Public Health dilemma for a unique group. The Social Expectations Theory asks the question, "How do groups change their behavior?" rather than "How does an individual change his/her behavior?" With research, this intervention would explore the social norms most important to veterans as a whole.
In the 60s and 70s, “epidemiology was developing holistic, community based models of disease that began to incorporate social and cultural factors. But this movement faded.” (18) Modern interventions for the homeless population should deal not only with the individual affected but also with social and cultural levels.
As with any population, veterans need an intervention that addresses the multiple levels that caused their homelessness. Some factors include social, cultural norms (both civilian and military), psychological and anthropological. Public Health needs to consider the contextual reasons that veterans become homeless and to look beyond the individual level. All levels (family, city, state, government and beyond) must be taken into account. The fundamental cause of veteran homelessness is likely to lie in one of those levels and, until all are addressed and studied, it is unlikely that veteran homelessness will be completely eliminated. Current programs are not effective in reaching out and extending help to returning veterans. Most do not know where to turn.
The Veterans Administration needs to understand that its responsibility to the men and women who served the United States on the battlefield does not end once the troops return home. The VA has a lifelong responsibility to the health and well-being of American soldiers. An effective intervention by the VA, with the help of public health organizations, must take into account the many factors which cause a veteran to become homeless and should occur before homelessness becomes the problem. Mandatory therapy for all soldiers returning from war has to be a number one priority. Veterans who engage in combat or witness things unknown to civilians need to talk about their feelings to someone who understands. Whether the therapy is individual or group, it does not matter, it should take place before a veteran is left on his or her own to deal with any possible trauma.
Another priority is to ensure that returning veterans can secure adequate employment. Currently, there are existing organizations available to assist with job search and placement for veterans. The VA works with public health organizations that are funded both privately and through the government. The organizations extend aid to veterans, but they often work independently from one another. If the various organizations learn to communicate with each other regarding the successes and failures of their programs, it may be beneficial to a local shelter that is battling a similar issue.
The most effective intervention is to increase public knowledge of the hardships that homeless veterans face, while the necessary types of interventions must be multilevel and encompass information obtained from other populations and social sciences. The intervention needs to “consider health and disease within the context of the total human environment.” (18)
Getting the Necessary Resources
The public is beginning to understand that veterans are a unique population and that many need support after they come home. Privately-funded programs are beginning to emerge across the United States. For example, at a Sears’ department store in Braintree, Massachusetts, volunteers solicit donations from Christmas shoppers to support the Heroes at Home program. Heroes at Home is just one of several outreach programs to aid military personnel that Sears supports and “is a program Sears Holdings has created in partnership with Rebuilding Together in response to an urgent need to assist military families facing hardship. By providing necessary repairs or adaptations to homes, Sears Holdings strives to improve the lives of military families across America. Heroes at Home is one of the many initiatives through which Sears Holdings acknowledges the sacrifice made by our troops every day in the line of duty, while supporting and honoring those heroes who remain at home." (21) According to Sears, “Homes are the foundation of our families, neighborhoods and nation. Home equity creates wealth for low- and middle-income families. It’s easy to see that helping home owners maintain their homes may be one of the most effective ways to strengthen the foundation of our country.” (21) Finding support from such a program must be a tremendous boost to the morale of returning soldiers, especially because scarcity of affordable housing is a major obstacle for veterans.
In 2007, the Department of Housing and Urban Development (HUD) and Veterans Affairs Supportive Housing (VASH), collectively called HUD-VASH received $75 million for 10,000 housing vouchers from Congress (20). HUD has asked for another $75 million dollars for 2009 and, if they get the requested money for the next few years, all chronically homeless veterans could potentially be living with a roof over their heads, saving taxpayers money in the long run (20).
Currently, Congress is considering multiple bills that would directly assist homeless veterans. One of the bills already passed, entitled Homes for Heroes Act, will help non-profit organizations provide housing for low-income veterans. While still a senator, President-elect Barack Obama introduced the Homes for Heroes Act on June 8, 2006. Obama has long been an advocate for homeless veterans, showing his support by offering bills to provide assistance. Ushering in a new generation of politics and politicians, Obama continues to show support to troops returning from Iraq and Afghanistan, by offering this bill. The bill finally passed on July 9, 2008 with a total of 413 ayes and 9 nays (27). Once enacted, the veteran homeless legislation will "establish a $225 million program to buy, build or rehabilitate housing for low-income veterans, expand rental assistance programs nearly tenfold, and create a position for a homeless veterans’ coordinator with the VA." (26)
Another bill allows for income tax forms to include an option for a taxpayer to donate $3 to aid homeless veterans (20). Increasing knowledge and empathy of the American public is crucial to creating successful pro-veteran programs. “We have to provide for the men and women coming home from the war. It would be a tragedy if we weren't prepared. We need to get ready to accept them back and give them the assistance they need to settle back into their lives," says James Jajuga, Haverhill Chamber of Commerce President (22).
One complaint of organizations that try to help homeless veterans get back on their feet is the lack of resources. Until 1987 there were no VA-funded programs specifically for the homeless veteran population and according to Peter Dougherty, the VA’s director of homeless programs, there are now more than 200. Unfortunately, with more than 200,000 veterans living on the streets the mere 200 programs that are funded by the VA are radically under representing the veteran population (2).
Helping a Different Kind of Population
Care for homeless veterans needs to be implemented by people who understand where they are coming from and with whom they can relate. Veterans helping veterans should be the public health motto, as well as Americans helping Americans. There is an entire continuum of care available, for veterans, which is essential to their recovery and rebuilding processes. The continuum has to start with "outreach and trust-building: a simple hand-shake and hello." (20) The purpose of outreach teams is to make contact with as many homeless veterans as possible, to get the word out that there are existing programs to help them and that all they need to do is drop by. In Las Vegas, there is a VA program encompassing a mobile outreach assistance clinic. The program "employs individuals who seek out homeless veterans, explain what can be done to help them, and entice them to go to a clinic." (25)
One type of outreach program is called a standdown. In the military, standdown means rest and recovery, a cessation of offensive military action. Stand downs are part of the VA's effort to provide services to homeless veterans. According to the VA's website, standdowns are "one to three day events providing services to homeless veterans such as food, shelter, clothing, health screenings, VA and Social Security benefits counseling, and referrals to a variety of other necessary services, such as housing, employment and substance abuse treatment. Stand Downs are collaborative events, coordinated between local VAs, other government agencies, and community agencies who serve the homeless." (23) Veterans seem to flock to these events as a result of the commonality that they feel with other veterans. Ed Whitley, a retired Air Force veteran, decided to become involved in a local standdown to "make amends for all the broken promises Vietnam veterans have had to endure from government and society...It's good to socialize with people who know what we went through, to have that camaraderie aspect." (24)
Because homeless veterans are a population that comes from a different background, they are less likely to trust someone from a government organization. That is the reason many groups are using veterans as volunteers. They are able to make a connection with the homeless veterans they are trying to reach. Helping Homeless Veterans and Families (HVAF) uses veterans in their organization to give them credibility. According to Philip Thomas, a homeless veterans coordinator for HVAF, "Our job is to try to meet them where they're at, find out what they want. A lot of them don't want to stop drinking...right away. They want to get off the street. It's hard for them to buy into a program when we say, 'You know, there are a few strings attached to our housing.' So it's our job to have faith and hope in them." (20)
Not enough veterans take advantage of the programs that are available to them, either through lack of knowledge or lack of understanding. Michael Ingham, Haverhill Director of Veteran Services, states that "...a lot of veterans think there's nothing wrong with them or that they are taking services away from other veterans so they don't go. The more people that take advantage of what's being offered, the better the programs will get." (22) Veterans, homeless or not, are also less likely to seek out help or assistance than someone from the general population.
After being in the military, veterans many times lack the necessary skills to re-acclimate themselves to society. The Valley Works Career Center in Haverhill, "helps unemployed veterans find jobs. Representatives advocate for veterans in the workplace, help them with resumes and use workshops to teach them how to present themselves in an interview." (22)
There are programs in use that cater to the homeless veteran population that are extremely effective. One such program is the New England Center for Homeless Veterans located locally in Boston, MA. In 1990, the nation's first and largest veteran-specific homeless shelter was opened by three Vietnam veterans. The New England Center offers a wide range of services through five different programs and support services that include Emergency Shelter, Transitional Housing, Single Room Occupancy Apartments, Training and Employment, and Health Care and Case Management. Each of these services assists veterans in solving the problems that led him/her to homelessness. Many of the staff and board are fellow veterans who understand and help their comrades back to recovery. Since opening their doors, they have provided aid to more than 12,000 veterans (19).
One therapist at the Center, Leslie Lightfoot, herself a Vietnam-era medic, says the program is so effective because it lets the homeless veterans talk about their anger and to get it out in the air. She says, “That… is why this works and the VA doesn’t—we care about these guys…because at some level they are us…either you’re a vet like they are and have been through some hell of your own, or as a rule, they won’t engage with you.” (14)
Although there has been much progress in reaching out to veterans to make their re-entry to the civilian world seamless, even more still needs to be done. Programs need to be more publicized and more available, and the government for whom the veterans gave their service should be the cornerstone of implementation. Veterans are too important a population to be left behind to fend for themselves. The entire country owes them a debt of gratitude for their sacrifice and must respond accordingly to solve the homelessness epidemic.
REFERENCES
1. Stewart, Jocelyn Y. The Nation: Column One. “From the Ranks to the Street.” Los Angeles Times; May 2004.
2. Ignelzi, Lenny. “Too Few Beds Available for Homeless Veterans.” Associated Press: Augusta Chronicle, San Diego; 2007.
3. PR Newswire. “National Coalition for Homeless Veterans Uniting Government and Public and Private Efforts to End Homelessness Among Veterans.” First Call, Washington; May 2005.
4. Edberg, Mark. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers; 2007. p35-39, 73- 74.
5. Michelson, Andrea. “Survey Offers First Glimpse of ‘War on Terror.’ US Newswire. Washington; January 2005.
6. Pavich, Al. “Who Is Helping America’s Homeless Veterans?” Reserve Officers Association. Washington; November 2003.
7. Smith, Vicki. “Former Sailor Returned to West Virginia to Try to Rebuild His Life.” Associated Press: Charleston Daily Mail, South Carolina; 2005.
8. Chinwah, Larissa. “Veterans’ Chance at a Haircut.” Chicago Daily Herald: Chicago; 2007.
9. Bolding, Grady. “Americans Lack of Awareness of Homeless Veterans.” University Wire: Kansas State Collegian, Manhattan, Kansas; 2008.
10. Beversdorf, Cheryl. “How Can We Serve Homeless Veterans.” Washington Post, Washington; 2008.
11. Manushi. “Invisible Homeless Poor of America: The Plight of American War Veterans.” Contemporary Women’s Issues Database; 2003.
12. Science Letter Staff and Editors. “National Coalition for Homeless Veterans Holds Annual Conference in Washington, DC.” NewsRx.com: Science Letter; 2008.
13. Romney, Lynthia. “The Jericho Project Purchases Second Site for Homeless Veterans in the Bronx.” US Newswire: New York; May 2008.
14. Solotaroff, Paul. The House of Purple Hearts: Stories of Vietnam Vets Who Find Their Way Back. New York, NY: Harper Collins Publishers, Inc; 1995. p6-10, 17, 21, 42, 48, 60-61.
15. Government Accounting Office Report. Chairman: Honorable Arlen Specter. Homeless Veterans – VA Expands Partnerships, but Homeless Program Effectiveness Unclear. Federal Document Clearing House, 1999.
16. McMurray-Avila, Marsha. Homeless Veterans and Health Care: A Resource Guide For Providers. National Health Care for the Homeless Council. March 2001. p1-5.
17. Mental Health Weekly Digest Editors. “Veterans Mental Health Issues: Where Is Help Coming From?” NewsRx.com: Mental Health Weekly Digest; July 2007.
18. Shy, Carl M., “The Failure of Academic Epidemiology: Witness for the Prosecution.” American Journal of Epidemiology 1997; 145:479-84.
19. New England Center for Homeless Veterans Website. 13 Court Street, Boston, MA 02108. http://www.nechv.org/historyatnechv.html.
20. Callaghan, Philip M. "Nothing to Lose." The American Legion Magazine, Indianapolis, IN. December 2008. p34-40.
21. Heroes at Home Sears Holdings Program. http://www.searsholdings.com/communityrelations/hero/
22. Quinn, Joni. "Community Rallying Behind Veterans Returning Home." Haverhill Gazette: Haverhill, MA; May 2008.
23. U.S. Department of Veteran Affairs Stand Down. http://www1.va.gov/homeless/page.cfm?pg=6.
24. McGrath, Gareth. "Forgotten Generation Project Aims to Assist Homeless Veterans." Morning Star: Wilmington, NC; 2001.
25. Baker, Chuck N. "Helping Homeless Veterans: The Challenge of Coordinating Compassion." Las Vegas Review-Journal: Las Vegas, NV; 2003.
26. Slater, Grant. "Obama Files Bill to Help Homeless Veterans." Post-Dispatch Washington Bureau: Washington, DC; April 2007. http://obama.senate.gov/news/070411-obama_files_bil/
27. House Vote On Passage: H.R. 3329: Homes for Heroes Act of 2008. http://www.govtrack.us/congress/vote.xpd?vote=h2008-478.
Surely, the United States is one of the most affluent countries in the world. Why then, are hundreds of thousands of men and women who were honorably discharged from military service living in squalor? Veterans make up nine percent of the U.S. population, but 23% of the homeless population (1). Among homeless men, veterans make up 33% of the population (1). In addition, 67% of homeless veterans served in the military for at least three years, and 89% received an honorable discharge from the service (11).
“In the United States, however, homeless veterans are a large group of the needy whom few Americans are aware of. As silent sufferers of homelessness, they are even less likely to receive the help they deserve and need.” (11) Not only are there twice the number of homeless Vietnam veterans living on the streets than the 58,000 that died in the war (1) but the number of veterans from the Iraq and Afghanistan wars is on the rise as well. America’s public health system is failing veterans. “Traditionally, what happens to you after you leave has not been a concern of [the] service,” said Peter Dougherty, the Department of Veterans Affairs (VA) Director of Homeless Veterans programs (1). The estimates of homeless veterans range in numbers between 175,000 and 275,000 and include soldiers that served in World War II, the Korean War, the Vietnam War, the Persian Gulf War, and the wars in Iraq and Afghanistan.
There are various probable reasons why veterans become homeless. Post-traumatic stress syndrome, lack of affordable housing, service connected disability, separation from family for extended time periods (6), substance addiction (2), mental and emotional problems (3), “unemployment, poor education, frayed family relations” (1), limited applicability of military training in the civilian workplace (6), or a combination of these and other factors could be what leads up to a life on the streets. Whatever the cause of homelessness, the methods of prevention and intervention by public health are clearly falling short. “…the government is willing to praise its military before and during battle, but judging by the astonishing number of homeless veterans on the streets, has a diminishing commitment to them when they return home.” (11)
Flaws of Interventions
Public health, in general, employs models of intervention that deal with people on the individual level and require the assessment of the individual of their own situation. In the case of veterans, many do not know that they are at-risk for homelessness. Linda Boone, Executive Director of the National Coalition for Homeless Veterans (NCHV), states that “there’s a steady stream of wounded veterans coming home [from Iraq and Afghanistan] who don’t even know they’re casualties.” (5)
Of all the existing public health programs, realizing and understanding you are at-risk for a situation/behavior is a key factor for an individual to implement any of the models. The Health Belief Model, especially for the veteran population, would be inappropriate to use in that perceived susceptibility and perceived severity (4) (to homelessness) would not necessarily be taken into account by veterans, thus they would not realize intervention or a change in behavior is necessary. If a person does not see themselves as susceptible to homelessness, they are not going to take the necessary steps to prevent the outcome. The Health Belief Model falls short in this case. In addition, many of the factors that lead to veteran homelessness are ultimately out of their control.
A second critique of the Health Belief Model is that it assumes everyone has equal access to relevant services and information regarding their ability to make a decision to change a behavior. It is well documented that homeless veterans do not have the collective information they need to assist them when they return home from military service. Cheryl Beversdorf, President and CEO of the National Coalition for Homeless Veterans (NCHV), in an editorial to the Washington Post in 2008, stated that the United States needs public education for homeless veterans and at-risk veterans informing them of where to get services, not only at the VA but from community service providers throughout the country (10). She went on to say that the United States needs “a continuing public education campaign about the resources that are available to help America’s former guardians address their problems and rebuild their lives.” (10) To date, there are no existing public health programs that address these issues on a country-wide scale.
The Theory of Reasoned Action is also a poor model to base an intervention on for homeless veterans because it deals with people’s attitudes toward a specific behavior (4). In the case of veterans, there is not one specific behavior that causes the problem of homelessness. This theory is very precise and requires that a person individually assess a certain behavior that will cause either a positive or negative outcome. If a veteran does not consider themselves at risk for homelessness, then this intervention falls short.
Perhaps veterans become homeless as a result of an issue on a larger scale, for example, cultural anthropological factors such as norms. The Theory of Reasoned Action places emphasis on an individual’s perception of subjective norms associated with a behavior (4). However, there has not been much, if any, research into what influences a veteran’s social norms. Could it be family norms, military norms, civilian’s norms? Much like the different codes that military personnel use in the service to communicate with each other, there could be norms misunderstood by the general public that come into effect when trying to create successful public health interventions. In order to understand which programs and health intervention models will work for veterans, research into what the acceptable norms are for a veteran is crucial.
Lack of Resources for Veterans
Among soldiers, one of the biggest reasons for homelessness is a lack of available resources and services (9). “Compounding the difficulty of homeless veterans is the widely accepted belief that the [Department of Veteran Affairs (VA)] takes care of all veterans in need…the VA…will reach fewer than 20 percent of homeless veterans in this country.” (6) Lack of research and general knowledge about how homelessness affects veterans and a lack of adequate resources for public health programs to assist veterans, homeless or not, is a second way public health has failed these men and women living on the streets.
The VA alone is not responsible for the well-being of veterans. Public health needs to become more of a factor in helping veterans before and after they become homeless. Overall, there is a lack of knowledge by the general public that veterans are in need, therefore, there is not enough research of the homeless veteran population including causes, which leads to a deficiency of programs.
“In the past, data quantifying homelessness among veterans did not exist. It’s been precisely the lack of research that had us groping in the dark as far as what our response should be,” said Philip Mangano, head of U.S. Interagency Council on Homelessness (1). For this unique population, research needs to be collected on what causes veterans to become homeless and how they want to be helped, if at all, after becoming homeless. Research of the veteran population is the key to understanding, preventing and intervening in homelessness.
There were no VA funded programs to assist homeless veterans until 1987 (2). In 1990, service providers created the NCHV to raise public awareness of homeless veterans and to advocate for more federal aid (12). Even through the valiant efforts of the NCHV, there is currently not enough funding for programs to aid homeless veterans in the US. As recently as 2007, there was a lack of 9,600 transitional beds for vets which are supposed to serve as a starting point for independence from the streets (2). Homeless service providers are strained by veterans from the Vietnam War, and veterans from the wars in Iraq and Afghanistan requiring assistance have already begun to enter the system.
In New York City, homeless veterans outnumber the amount of other homeless people living in shelters (13). However, there are only two housing projects in the entire metropolitan area specifically for veterans and is located in the Bronx (13). There seems to be ample support for troops overseas fighting on the battlefields, but it is apparent what becomes of many soldiers when they return home. As a result of the current wars in Iraq and Afghanistan, the number of veterans in need is expected to rise.
A once homeless Vietnam veteran, Ken Smith, says “This [homelessness] is what happens when you don’t debrief your troops, when you [put them] red-hot from combat…on a plane. In Israel, when they pull a kid form the field, they give him as much support and counseling as he needs. Is that expensive to do? Probably, but did you ever see a homeless vet in Jerusalem? Whereas here…the shelters are packed solid. You tell me which is the more expensive approach.” (14) Public health needs more resources to help veterans who are returning from military service before they become at-risk for homelessness. It is much more effective to prevent homelessness for these men and women prior to their becoming homeless than it is to create affordable housing where none is available.
Another hurdle to providing assistance is exemplified by a recent report from the Department of Defense Mental Health Task Force which states that “nearly 50 percent of National Guard members and reservists report symptoms of mental disorders…and many return to homes in rural communities, from where they find it difficult to access military-provided clinical care and support groups.” (17) Services, as described by some homeless veterans, are “often difficult to obtain because the delivery system is unwieldy, inadequate, and inaccessible.” (16) It was further stated that the method of delivery is “a complex mass of programs and services with limited resources, staff that are excessively spread out, and inadequate funding to effectively address the severe problems facing homeless veterans.” (16)
The VA boasts of billions of dollars in funding for programs, which makes one wonder where all of the money is going and if the programs that are in place are the most effective use of the VA’s funds. Linda Boone, Executive Director of NHCV, states, “You see…cars with yellow ribbons saying ‘Support Our Troops.’ What you don’t see are signs saying ‘Support Our Veterans.’ But when those men and women take off their uniforms, that’s when they need support the most.” (5)
A Different Kind of Population
A third argument against the interventions that are currently being offered for homeless veterans is that they expect veterans to ask for assistance or come to a shelter of their own volition. Most veterans, at least traditionally, will not seek out help. There need to be programs that seek homeless veterans out and not the other way around. Most of the programs, even locally, require that a veteran come to them for support. Veterans are a proud bunch. Pete Dougherty, the VA’s director of homeless programs in Washington says that, “military service is a great place to learn in the harsh environment. They’re much better prepared [for homelessness] than non-veterans. They seem to have a higher tolerance and a certain degree of pride and toughness that they – more than the rest of us – can endure tough circumstances.” (7)
Veterans are a different kind of population to deal with because they “are very independent people,” (8) says Tammy Duckworth, Director of the Illinois Department of Veterans’ Affairs, “and we want to make them understand that this is not charity; this is the least of what they deserve for serving their country.” (8) Homeless veterans who see themselves as extremely independent and able to take care of themselves will not come to a shelter or ask anyone for aid. Studies indicate that an average of 12 years elapse before Vietnam veterans seek help for mental and emotional problems (3), providing strong evidence that veterans are less likely than the average person to ask for help. When they do, it is often on the brink of being too late for help to have a positive outcome.
There is a common distrust by veterans, especially the homeless, of the Department of Veterans Affairs. When asked to come to a shelter, a homeless veteran responded with, “I fought for the flag, but the flag never fought for me.” (1) His response typifies most soldiers’ sentiments of distrust for the VA and government in general, making it unlikely that veterans will seek any assistance provided by public health or government programs.
Veterans are more likely to favor a dangerous life on the streets rather than risk being in the hands of the VA. An attitude that implies a lack of responsibility for certain American veterans in need has been part of the problem of homelessness. According to Ralph Cooper, Executive Director of the Veterans Benefits Clearinghouse in 1995, the VA was run until recently by World War II vets, whose sentiment was, “We won our war and you lost yours, so we don’t owe you cowards and baby-killers anything.”(14)
Even though more than 30 years have passed since the war ended, still some Vietnam veterans exist who believe they returned to their country in dishonor and that they continue to be disrespected, a direct result of how the public health system and the government handled their homecoming. A Vietnam veteran living in a privately run Boston shelter wanted an interviewer to ask the VA a question on his behalf, “See, they gave amnesty to all the ones that ran away to Canada. In ’77, President Carter told ‘em all to come home and everything’d be forgiven, and it was. What I wanna know is, when will we be forgiven? We didn’t try to lose that war; we tried to serve our country. When can we come home?” (14)
Distrust and lack of awareness of assistance programs makes it difficult for homeless and at-risk veterans to take advantage of benefits. The Department of Veteran Affairs “relies on a system of self-help in which veterans must first be aware of the services that the VA provides and secondly want help in order to receive care.” (11) One of the most challenging factors is to convince proud, independent men and women that they might need help. It is very difficult to go about that task without damaging a person’s pride and sense of dignity. Upon being asked what he had been given at a local Boston shelter, a homeless veteran responded, “Hope…they’re willin’ to try to help me. That’s what the Vietnam vet needs – not a handout, a hand up.”(14)
The Future
As concern for the future of homeless veterans grows, a campaign by the National Coalition for Homeless Veterans has been implemented to increase awareness and to educate the public of the increasing crisis (6). Greater public knowledge should result in more effective intervention programs for veterans. The campaign has also “highlighted the need to recognize community-based organizations as a critical component of a coordinated, national strategy to increase the availability of services.” (6)
“Little is known about whether veterans served by VA’s homeless programs remain housed or employed, or whether they instead relapse into homelessness” therefore an evaluation of the effectiveness of VA programs should be initiated (15). It is time for public health to take responsibility for veterans and to not think of them as someone else’s problem. The VA has done what they can with their limited resources. Communities in which the homeless veterans live must now lend a helping hand to the men and women who once served the country with pride and honor in their rise from the streets.
In the words of a professor of social science at University of Massachusetts Boston and a Vietnam Veteran, Paul Camacho, “What are they going to do for these guys when they come home…other than wave a flag and buy them a beer?” (1)
Homelessness is a crisis facing an untold number of the most important citizens of the United States, veterans who may have already faced terrible circumstances defending their country and the people who live there. To better care for our returning heroes, several issues must be addressed. First, the types of interventions currently employed are not effective. Second, the types of resources available at present are only beginning to scratch the surface. Third, veterans are a unique faction with diverse circumstances that need to be considered.
The Right Kind of Intervention
In general, Public Health issues deal with choices made voluntarily. Since homelessness is not what individuals would typically choose as a lifestyle, the problem of veteran homelessness is an extraordinary Public Health dilemma for a unique group. The Social Expectations Theory asks the question, "How do groups change their behavior?" rather than "How does an individual change his/her behavior?" With research, this intervention would explore the social norms most important to veterans as a whole.
In the 60s and 70s, “epidemiology was developing holistic, community based models of disease that began to incorporate social and cultural factors. But this movement faded.” (18) Modern interventions for the homeless population should deal not only with the individual affected but also with social and cultural levels.
As with any population, veterans need an intervention that addresses the multiple levels that caused their homelessness. Some factors include social, cultural norms (both civilian and military), psychological and anthropological. Public Health needs to consider the contextual reasons that veterans become homeless and to look beyond the individual level. All levels (family, city, state, government and beyond) must be taken into account. The fundamental cause of veteran homelessness is likely to lie in one of those levels and, until all are addressed and studied, it is unlikely that veteran homelessness will be completely eliminated. Current programs are not effective in reaching out and extending help to returning veterans. Most do not know where to turn.
The Veterans Administration needs to understand that its responsibility to the men and women who served the United States on the battlefield does not end once the troops return home. The VA has a lifelong responsibility to the health and well-being of American soldiers. An effective intervention by the VA, with the help of public health organizations, must take into account the many factors which cause a veteran to become homeless and should occur before homelessness becomes the problem. Mandatory therapy for all soldiers returning from war has to be a number one priority. Veterans who engage in combat or witness things unknown to civilians need to talk about their feelings to someone who understands. Whether the therapy is individual or group, it does not matter, it should take place before a veteran is left on his or her own to deal with any possible trauma.
Another priority is to ensure that returning veterans can secure adequate employment. Currently, there are existing organizations available to assist with job search and placement for veterans. The VA works with public health organizations that are funded both privately and through the government. The organizations extend aid to veterans, but they often work independently from one another. If the various organizations learn to communicate with each other regarding the successes and failures of their programs, it may be beneficial to a local shelter that is battling a similar issue.
The most effective intervention is to increase public knowledge of the hardships that homeless veterans face, while the necessary types of interventions must be multilevel and encompass information obtained from other populations and social sciences. The intervention needs to “consider health and disease within the context of the total human environment.” (18)
Getting the Necessary Resources
The public is beginning to understand that veterans are a unique population and that many need support after they come home. Privately-funded programs are beginning to emerge across the United States. For example, at a Sears’ department store in Braintree, Massachusetts, volunteers solicit donations from Christmas shoppers to support the Heroes at Home program. Heroes at Home is just one of several outreach programs to aid military personnel that Sears supports and “is a program Sears Holdings has created in partnership with Rebuilding Together in response to an urgent need to assist military families facing hardship. By providing necessary repairs or adaptations to homes, Sears Holdings strives to improve the lives of military families across America. Heroes at Home is one of the many initiatives through which Sears Holdings acknowledges the sacrifice made by our troops every day in the line of duty, while supporting and honoring those heroes who remain at home." (21) According to Sears, “Homes are the foundation of our families, neighborhoods and nation. Home equity creates wealth for low- and middle-income families. It’s easy to see that helping home owners maintain their homes may be one of the most effective ways to strengthen the foundation of our country.” (21) Finding support from such a program must be a tremendous boost to the morale of returning soldiers, especially because scarcity of affordable housing is a major obstacle for veterans.
In 2007, the Department of Housing and Urban Development (HUD) and Veterans Affairs Supportive Housing (VASH), collectively called HUD-VASH received $75 million for 10,000 housing vouchers from Congress (20). HUD has asked for another $75 million dollars for 2009 and, if they get the requested money for the next few years, all chronically homeless veterans could potentially be living with a roof over their heads, saving taxpayers money in the long run (20).
Currently, Congress is considering multiple bills that would directly assist homeless veterans. One of the bills already passed, entitled Homes for Heroes Act, will help non-profit organizations provide housing for low-income veterans. While still a senator, President-elect Barack Obama introduced the Homes for Heroes Act on June 8, 2006. Obama has long been an advocate for homeless veterans, showing his support by offering bills to provide assistance. Ushering in a new generation of politics and politicians, Obama continues to show support to troops returning from Iraq and Afghanistan, by offering this bill. The bill finally passed on July 9, 2008 with a total of 413 ayes and 9 nays (27). Once enacted, the veteran homeless legislation will "establish a $225 million program to buy, build or rehabilitate housing for low-income veterans, expand rental assistance programs nearly tenfold, and create a position for a homeless veterans’ coordinator with the VA." (26)
Another bill allows for income tax forms to include an option for a taxpayer to donate $3 to aid homeless veterans (20). Increasing knowledge and empathy of the American public is crucial to creating successful pro-veteran programs. “We have to provide for the men and women coming home from the war. It would be a tragedy if we weren't prepared. We need to get ready to accept them back and give them the assistance they need to settle back into their lives," says James Jajuga, Haverhill Chamber of Commerce President (22).
One complaint of organizations that try to help homeless veterans get back on their feet is the lack of resources. Until 1987 there were no VA-funded programs specifically for the homeless veteran population and according to Peter Dougherty, the VA’s director of homeless programs, there are now more than 200. Unfortunately, with more than 200,000 veterans living on the streets the mere 200 programs that are funded by the VA are radically under representing the veteran population (2).
Helping a Different Kind of Population
Care for homeless veterans needs to be implemented by people who understand where they are coming from and with whom they can relate. Veterans helping veterans should be the public health motto, as well as Americans helping Americans. There is an entire continuum of care available, for veterans, which is essential to their recovery and rebuilding processes. The continuum has to start with "outreach and trust-building: a simple hand-shake and hello." (20) The purpose of outreach teams is to make contact with as many homeless veterans as possible, to get the word out that there are existing programs to help them and that all they need to do is drop by. In Las Vegas, there is a VA program encompassing a mobile outreach assistance clinic. The program "employs individuals who seek out homeless veterans, explain what can be done to help them, and entice them to go to a clinic." (25)
One type of outreach program is called a standdown. In the military, standdown means rest and recovery, a cessation of offensive military action. Stand downs are part of the VA's effort to provide services to homeless veterans. According to the VA's website, standdowns are "one to three day events providing services to homeless veterans such as food, shelter, clothing, health screenings, VA and Social Security benefits counseling, and referrals to a variety of other necessary services, such as housing, employment and substance abuse treatment. Stand Downs are collaborative events, coordinated between local VAs, other government agencies, and community agencies who serve the homeless." (23) Veterans seem to flock to these events as a result of the commonality that they feel with other veterans. Ed Whitley, a retired Air Force veteran, decided to become involved in a local standdown to "make amends for all the broken promises Vietnam veterans have had to endure from government and society...It's good to socialize with people who know what we went through, to have that camaraderie aspect." (24)
Because homeless veterans are a population that comes from a different background, they are less likely to trust someone from a government organization. That is the reason many groups are using veterans as volunteers. They are able to make a connection with the homeless veterans they are trying to reach. Helping Homeless Veterans and Families (HVAF) uses veterans in their organization to give them credibility. According to Philip Thomas, a homeless veterans coordinator for HVAF, "Our job is to try to meet them where they're at, find out what they want. A lot of them don't want to stop drinking...right away. They want to get off the street. It's hard for them to buy into a program when we say, 'You know, there are a few strings attached to our housing.' So it's our job to have faith and hope in them." (20)
Not enough veterans take advantage of the programs that are available to them, either through lack of knowledge or lack of understanding. Michael Ingham, Haverhill Director of Veteran Services, states that "...a lot of veterans think there's nothing wrong with them or that they are taking services away from other veterans so they don't go. The more people that take advantage of what's being offered, the better the programs will get." (22) Veterans, homeless or not, are also less likely to seek out help or assistance than someone from the general population.
After being in the military, veterans many times lack the necessary skills to re-acclimate themselves to society. The Valley Works Career Center in Haverhill, "helps unemployed veterans find jobs. Representatives advocate for veterans in the workplace, help them with resumes and use workshops to teach them how to present themselves in an interview." (22)
There are programs in use that cater to the homeless veteran population that are extremely effective. One such program is the New England Center for Homeless Veterans located locally in Boston, MA. In 1990, the nation's first and largest veteran-specific homeless shelter was opened by three Vietnam veterans. The New England Center offers a wide range of services through five different programs and support services that include Emergency Shelter, Transitional Housing, Single Room Occupancy Apartments, Training and Employment, and Health Care and Case Management. Each of these services assists veterans in solving the problems that led him/her to homelessness. Many of the staff and board are fellow veterans who understand and help their comrades back to recovery. Since opening their doors, they have provided aid to more than 12,000 veterans (19).
One therapist at the Center, Leslie Lightfoot, herself a Vietnam-era medic, says the program is so effective because it lets the homeless veterans talk about their anger and to get it out in the air. She says, “That… is why this works and the VA doesn’t—we care about these guys…because at some level they are us…either you’re a vet like they are and have been through some hell of your own, or as a rule, they won’t engage with you.” (14)
Although there has been much progress in reaching out to veterans to make their re-entry to the civilian world seamless, even more still needs to be done. Programs need to be more publicized and more available, and the government for whom the veterans gave their service should be the cornerstone of implementation. Veterans are too important a population to be left behind to fend for themselves. The entire country owes them a debt of gratitude for their sacrifice and must respond accordingly to solve the homelessness epidemic.
REFERENCES
1. Stewart, Jocelyn Y. The Nation: Column One. “From the Ranks to the Street.” Los Angeles Times; May 2004.
2. Ignelzi, Lenny. “Too Few Beds Available for Homeless Veterans.” Associated Press: Augusta Chronicle, San Diego; 2007.
3. PR Newswire. “National Coalition for Homeless Veterans Uniting Government and Public and Private Efforts to End Homelessness Among Veterans.” First Call, Washington; May 2005.
4. Edberg, Mark. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers; 2007. p35-39, 73- 74.
5. Michelson, Andrea. “Survey Offers First Glimpse of ‘War on Terror.’ US Newswire. Washington; January 2005.
6. Pavich, Al. “Who Is Helping America’s Homeless Veterans?” Reserve Officers Association. Washington; November 2003.
7. Smith, Vicki. “Former Sailor Returned to West Virginia to Try to Rebuild His Life.” Associated Press: Charleston Daily Mail, South Carolina; 2005.
8. Chinwah, Larissa. “Veterans’ Chance at a Haircut.” Chicago Daily Herald: Chicago; 2007.
9. Bolding, Grady. “Americans Lack of Awareness of Homeless Veterans.” University Wire: Kansas State Collegian, Manhattan, Kansas; 2008.
10. Beversdorf, Cheryl. “How Can We Serve Homeless Veterans.” Washington Post, Washington; 2008.
11. Manushi. “Invisible Homeless Poor of America: The Plight of American War Veterans.” Contemporary Women’s Issues Database; 2003.
12. Science Letter Staff and Editors. “National Coalition for Homeless Veterans Holds Annual Conference in Washington, DC.” NewsRx.com: Science Letter; 2008.
13. Romney, Lynthia. “The Jericho Project Purchases Second Site for Homeless Veterans in the Bronx.” US Newswire: New York; May 2008.
14. Solotaroff, Paul. The House of Purple Hearts: Stories of Vietnam Vets Who Find Their Way Back. New York, NY: Harper Collins Publishers, Inc; 1995. p6-10, 17, 21, 42, 48, 60-61.
15. Government Accounting Office Report. Chairman: Honorable Arlen Specter. Homeless Veterans – VA Expands Partnerships, but Homeless Program Effectiveness Unclear. Federal Document Clearing House, 1999.
16. McMurray-Avila, Marsha. Homeless Veterans and Health Care: A Resource Guide For Providers. National Health Care for the Homeless Council. March 2001. p1-5.
17. Mental Health Weekly Digest Editors. “Veterans Mental Health Issues: Where Is Help Coming From?” NewsRx.com: Mental Health Weekly Digest; July 2007.
18. Shy, Carl M., “The Failure of Academic Epidemiology: Witness for the Prosecution.” American Journal of Epidemiology 1997; 145:479-84.
19. New England Center for Homeless Veterans Website. 13 Court Street, Boston, MA 02108. http://www.nechv.org/historyatnechv.html.
20. Callaghan, Philip M. "Nothing to Lose." The American Legion Magazine, Indianapolis, IN. December 2008. p34-40.
21. Heroes at Home Sears Holdings Program. http://www.searsholdings.com/communityrelations/hero/
22. Quinn, Joni. "Community Rallying Behind Veterans Returning Home." Haverhill Gazette: Haverhill, MA; May 2008.
23. U.S. Department of Veteran Affairs Stand Down. http://www1.va.gov/homeless/page.cfm?pg=6.
24. McGrath, Gareth. "Forgotten Generation Project Aims to Assist Homeless Veterans." Morning Star: Wilmington, NC; 2001.
25. Baker, Chuck N. "Helping Homeless Veterans: The Challenge of Coordinating Compassion." Las Vegas Review-Journal: Las Vegas, NV; 2003.
26. Slater, Grant. "Obama Files Bill to Help Homeless Veterans." Post-Dispatch Washington Bureau: Washington, DC; April 2007. http://obama.senate.gov/news/070411-obama_files_bil/
27. House Vote On Passage: H.R. 3329: Homes for Heroes Act of 2008. http://www.govtrack.us/congress/vote.xpd?vote=h2008-478.
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