Objective-Many homeless consumers who enroll in supported housing programs-which offer subsidized housing and supportive services-disengage prematurely, before placement in permanent community-based housing. This study explored factors associated with exiting a supported housing program before achieving housing placement.Methods-With the use of administrative data, a roster was obtained for consumers enrolled in the Veterans Affairs (VA) Greater Los Angeles supported housing program from 2011 to 2012. Fewer (4%) consumers exited this program before achieving housing ("exiters") compared with consumers described in national VA figures (18%). Exiters with available demographic data (N=51) were matched 1:1 on age, gender, marital status, and race-ethnicity with consumers housed through this program ("stayers," N=51). Medical records were reviewed to compare diagnoses, health care utilization, housing histories, vocational history, and criminal justice involvement of exiters versus stayers. Exiters' housing outcomes were identified. Recursive partitioning identified variables that best differentiated exiters from stayers.Results-Several factors were associated with premature exits from this supported housing program: residing in temporary housing on hospital grounds during program enrollment, poor adherence to outpatient care, substance use disorders, hepatitis C, chronic pain, justice involvement, frequent emergency department utilization, and medical-surgical admissions. The first of these factors and poor adherence to outpatient medical-surgical care best differentiatedThe contents of this article are those of the authors and do not represent the views of the U.S. Department of Veterans Affairs or the U.S. government.Dr. Young reports receipt of compensation for participating on a scientific advisory board for Ameritox, Ltd. The other authors report no financial relationships with commercial interests. U.S. Department of Veterans Affairs VA Author ManuscriptVA Author Manuscript VA Author Manuscript exiters from stayers. Moreover, >50% of exiters became street homeless or incarcerated after leaving the program.Conclusions-In that diverse social factors, diagnoses, and health care utilization patterns were associated with premature disengagement from supported housing, future research is needed to implement and evaluate rehabilitative services that address these factors, adapted to the context of supported housing.Homeless persons have high rates of illness and fragmented health care utilization (1-3). Supported housing programs, which offer permanent, community-based housing with supportive services, improve the health and housing of homeless consumers (4-7). Yet many consumers who enroll in supported housing programs disengage prematurely, before receiving permanent housing. We know little about factors associated with such disengagement.This population is of interest to the U.S. Department of Veterans Affairs (VA), which aims to end homelessness among veterans (2,8). Toward this aim, the VA partners wit...

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On September 19 and 20, 2017, Hurricane Maria severely damaged the island of Puerto Rico. Coming just two weeks after Hurricane Irma, the storm significantly damaged local infrastructure and interrupted the provision of services essential to the people of Puerto Rico. In the aftermath, the president signed a Major Disaster Declaration for Hurricane Maria on September 20, 2017 (DR-4339) under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act). 1 As attention turned from response to long-term recovery, Congress enacted a Supplemental Appropriation Bill authorizing funding for rebuilding efforts. The Act required the governor of Puerto Rico, in coordination with the Federal Emergency Management Agency (FEMA), the Department of Treasury, Department of Energy, and other federal agencies having responsibility under the National Disaster Recovery Framework, to submit within 180 days of enactment of the legislation a report to Congress that describes Puerto Rico's 12-and 24-month economic and disaster recovery plan.The plan was developed in coordination with the Federal Oversight and Management Board (FOMB) established under the Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA), the federal interagency, and key partners from private and nongovernmental entities using an agile process to identify recovery solutions. Under contract with FEMA, the Homeland Security Operational Analysis Center (HSOAC) provided substantial support in developing the plan by soliciting and integrating inputs from a wide variety of stakeholders, contributing analysis where needed, and drafting the plan. The plan included an overview of damage and needs, courses of action (COAs) to meet those needs, costs of the courses of action, and potential funding mechanisms for those costs.The governor's team finalized the economic and disaster recovery plan for Puerto Rico, and the Governor submitted Puerto Rico's final plan to the U.S. Congress on August 8, 2018. The plan defined priorities, goals, and expected outcomes that address both immediate needs and provide a foundation for longer-term sustainability.The planning effort was organized into 12 sectors (reflecting the National Disaster Recovery Framework). The purpose of this report is to describe the development of plan elements for the health and social services sector via the Health and Social Services (HSS) Sector team, including analytical material that was not included in the recovery plan but informed the planning process. We also describe the methodology behind the damage and needs assessment and discuss themes for recovery. Long-form COAs that provide greater detail than found in the plan (e.g., cost estimations, implementation considerations) can be found at the end of this report. As described

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org For more information on this publication, visit www.rand.org/t/RR1861Library of Congress Cataloging-in-Publication Data is available for this publication.ISBN: 978-0-8330-9884-9 Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2017 RAND CorporationR® is a registered trademark. Cover: U.S. Air Force photo/Airman,1st Class Deana Heitzman.iii This report provides detailed findings of RAND NDRI's analy sis based on two surveys provided to program participants-the first two to three weeks after participating in counseling sessions and the second three months later. We designed the surveys to gain information on improvement in the prob lems for which the participant sought help; whether negative impacts on their work and daily lives had subsided; whether improvements were sustained in the short and long term (i.e., over three months); and participant perceptions about the program itself and the counselors with whom they worked.The report should be of interest to policymakers and program leadership. Policymakers can use study findings as they make decisions about continuation and expansion of nonmedical counseling provided through MFLC and Military OneSource. Program leadership can determine where the program is most effective and for whom, and can use the findings to pinpoint program areas in need of improvement or greater attention.This research was sponsored by ODASD (MC&FP) and conducted within the Forces and Resources Policy Center of RAND NDRI, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.For more information on the RAND Forces and Resources Policy Center, see http:// www.rand.org/nsrd/ndri/centers/frp.html or contact the director (contact information is provided on the web page). SummaryMilitary families face normal stresses that most families face, such as financial strain, stressful life...

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