Health Care Experts Discuss Technological Interventions to Tackle Veteran Homelessness at HSPH Seminar

Two healthcare experts affiliated with the U.S. Department of Veterans Affairs discussed how mobile phone technology can be deployed to tackle veteran homelessness at a Harvard School of Public Health seminar on Wednesday.

D. Keith McInnes — a professor at Boston University’s School of Public Health — headlined the event, which was moderated by HSPH instructor Jill S. Roncarati.

The seminar focused on McInnes’ current research, which explores the feasibility of using cell phone data to prevent and combat homelessness among veterans in the greater Boston area. His research is funded through the Center for Healthcare Organization and Implementation Research, a public health and research institute at the VA, with which Roncarati is also affiliated.

The issue of veteran homelessness has decreased over the past decade but remains a top priority for the VA, according to McInnes.

“There are about 37,000 veterans, it’s estimated in the United States, who are experiencing homelessness,” he said in an interview with The Crimson after the event. “About two-thirds have various shelters, kind of roof over their head, and one-third is what we might call street-homeless.”

McInnes and Roncarati both said accessing healthcare is a primary concern for many veterans experiencing homelessness, especially those managing chronic illnesses, chronic pain, substance use, post-traumatic stress disorder, depression, and suicidality.

McInnes’ team provided a few dozen local veterans — both homeless or at risk of becoming homeless — with mobile phones that they can use to call a health care provider or log a daily mood self-identification as a part of a mental health intervention.

The phones serve a dual purpose: they are also automatically collecting data that can later be harnessed to improve veterans’ access to health care services. By tracking movements, calls, and texts, McInnes hopes to gain a better understanding of which health services and social networks veterans are availing themselves of — and where there are gaps that need to be filled.

McInnes said the phones will also collect data around major transitions or health events in veterans’ lives, with the goal of identifying patterns that lead to detrimental outcomes.

“For example, somebody is staying with a friend, maybe couch surfing, and then a week later they’re in a shelter, that would be a transition. A major health event could be hospitalization or an emergency room visit,” McInnes explained. “We’d like to understand what is happening in the days and maybe even hours before one of these events.”

Prior studies examining risk factors for homelessness among veterans have typically relied on surveys. However, McInnes said surveys may not be the right tool in this research area due to recall bias.

“Even if one does surveys every three months on a group, trying to get somebody to remember what they felt like the day or two before a housing transition is quite hard,” he said.

McInnes said in the interview after the seminar that he anticipates that the number of veterans experiencing homelessness will spike due to the economic fallout of the Covid-19 pandemic.

However, Roncarati said she remains optimistic about the potential of mobile phone technology to support this vulnerable population.

“One of the messages that I heard was that it is possible to do technology-enabled care among a population that is homeless or primarily homeless,” Roncarati said in an interview after the event, summarizing her major takeaways from the seminar.

At the seminar, McInnes stressed that efforts to support public health among homeless populations should also include non-veterans.

“I think we have to keep pressing and pushing and trying,” he said. “It’s just such a complex issue that it’s going to need multidisciplinary teams.”