BrainWise and Homeless Veterans

Posted On: December 20, 2018

In 2018, Sage Open published research on BrainWise which had been taught to homeless men living in a transitional housing facility provided by an urban nonprofit organization.  Marilyn Welsh, Ph.D. and her research team found that men who received BrainWise training, compared with a control group, had significant improvements on all measures on the Behavior Research Inventory of Executive Functions (BRIEF) and the Coping Self-Efficacy Scale (CSE).

Dr. Jared Greenberg, a psychiatrist who works with homeless Veterans at the VA Greater Los Angeles Healthcare System (GLA), read the article and contacted the BrainWise team about writing a grant to conduct a pilot program that would teach BrainWise techniques to homeless Veterans.

Although considerable progress has been made to end Veteran homelessness, more than 40,000 Veterans remain unsheltered.

VA GLA cares for the largest population of homeless Veterans nationwide; LA County alone has 4,476 homeless Veterans, of whom 76% are still without shelter. This pattern is repeated nationwide.

Dr. Greenberg and his team conducted an extensive review of the literature on the complexity of the problem, including research that found deficits in executive functions (EF) appear to have both direct and indirect effects on housing stability. He gives the example of how poor planning (failure to pay the rent) and poor inhibitory control can lead to risk behaviors that contribute to housing loss and instability. Additionally, deficits in EF are associated with alcohol abuse, substance-related risk-taking behaviors, behavioral problems, low levels of social support, and relationship difficulties.

The VA GLA has committed substantial resources to providing care for homeless Veterans, but Dr. Greenberg found that aside from standard mental health treatments available to all Veterans, their homeless services do not include components which specifically address deficits in executive functions. He cites research that shows positive EF has been associated with improved self-care, positive behavioral change, and less turbulent behavior among recently homeless persons, but says he and his team are unaware of VA programs that test or implement EF interventions.

His study proposes to address this need by using BrainWise as an intervention for this population. He submitted the grant, “Adapting and Pilot Testing a Group Intervention to Improve Executive Functions Among Homeless-Experienced Veterans with Serious Mental Illness,” to the Veterans Administration in December.

The proposed study has three aims: 1) Adapt BrainWise for use with homeless Veterans with serious mental illness; 2) Study the feasibility, acceptability, and fidelity of BrainWise with Veterans in a pilot trial; and 3) Assess executive function effects. After collecting information from VA clinicians, administrators, and patients to customize examples and problems, Dr. Greenberg and his team will deliver the pilot program to participants over 8-10 weekly group sessions.

Outcome measures include conducting focus groups with the participants to obtain Veteran feedback about the intervention as well as the Veterans’ completion of pre- and post- test measures of executive functions, coping self-efficacy, and the BrainWise Knowledge Survey.

The findings will be used to conduct a larger controlled hybrid trial to assess the effectiveness and implementation of the intervention with homeless Veterans with Severe Mental Illness.

The BrainWise Team is excited to be part of this innovative proposal. If the grant is not funded, we will find other ways to work with Dr. Greenberg and his dedicated staff at VA GLA.

The faculty and students of Hudson Elementary School, located in Colorado’s Weld County Re3J School District, started the year in a beautiful new building. The large, modern school reflects the rapid growth happening in a community near metropolitan Denver that is still dotted with once prevailing farms and ranches. The school’s mission is “Creating opportunities for student success through a safe learning environment, rigorous instruction, diverse activities, and an engaged community.”