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  1. Szymkowiak, Dorota PhD
  2. Montgomery, Ann Elizabeth PhD
  3. Tsai, Jack PhD
  4. O'Toole, Thomas P. MD


Objective: To assess sociodemographic, diagnostic, and services use factors associated with veterans' repeated, episodic use of Veterans Health Administration (VHA) Homeless Programs.


Design: This retrospective cohort study used stepwise multivariate logistic regression to assess the odds of veterans being frequent episodic utilizers of VHA Homeless Programs (ie, >=4 services use episodes during the observation period).


Setting: The study used administrative data from veterans who accessed VHA services across the United States.


Participants: The sample comprised 31 098 veterans who completed a VHA Homeless Program intake assessment in 2013 and accessed VHA Homeless Programs during 2013-2016.


Main Outcome Measure: Frequent episodic use of VHA Homeless Programs (ie, >=4 services use episodes during the observation period).


Results: Only 2.4% of the study sample had 4 or more episodes of VHA Homeless Program use during the observation period; risk factors included experience of military sexual trauma, history of incarceration, diagnosis of psychosis and substance use disorder, and use of acute care.


Conclusions: Addressing veterans' needs related to poverty, income, and postincarceration reintegration may reduce the frequent episodic use of VHA Homeless Programs. Interventions embedded in emergency departments and inpatient units may also be considered.