History of TBI increases VA service use frequency among Veterans experiencing homelessness: a national examination

BACKGROUND: Veterans experiencing homelessness are clinically complex, often requiring myriad Department of Veterans Affairs (VA) services to manage their health and social service needs. Conditions common among these Veterans, including traumatic brain injury (TBI), may impact their VA service use; nonetheless, examination of the intersection of TBI and service use among Veterans experiencing homelessness remains understudied. METHOD: Electronic medical record data for 1,088,328 Veterans identified as experiencing homelessness who were accessing Veterans Health Administration (VHA) services from 2005 to 2024 were examined. Crude and adjusted models were conducted to examine VA service use based on documented TBI diagnosis. RESULTS: In total, 12.7% of Veterans experiencing homelessness had a documented TBI diagnosis. TBI diagnosis was associated with increased frequency across all VHA service use settings. Associations appeared most robust in VA rehabilitative, mental health, and emergency service settings. CONCLUSIONS: Veterans experiencing homelessness with TBI histories appear to access several VHA services to manage their health and social service needs. Given this, interdisciplinary approaches (e.g. VA Homeless Patient Aligned Care Teams) are likely pragmatic for these Veterans. Further dissemination and evaluation of the utility of brain health-informed care within novel VHA service settings (e.g. justice programs, emergency services) may hold merit.