A 2023 report reveals that 50% of veterans grapple with unaddressed social and health needs like housing instability, financial difficulties, and limited access to healthcare, yet only 14% seek help through the VA. Despite efforts by various organizations, a significant gap remains in meeting these needs effectively.
Since 2022, the Network for Nonprofit and Social Impact (NNSI) has been developing a metric to measure the effectiveness of veteran referral networks. This initiative aims to improve veterans’ well-being by recommending the providers and services most likely to improve well-being over time. Emerging evidence shows that compounded negative effects of unmet social determinants can severely impact their quality of life and mental health, even raising the odds of suicidal ideation by 65%. It is imperative to address this critical issue now.
Developing the Trajectory of Care Metric
The research began with qualitative interviews with 21 intake specialists and network providers, supplemented by surveys of 130 organization leaders from veteran-serving entities. These efforts helped us identify three levels of veteran needs: basic needs (food, shelter, medical care), stressors (legal issues, money management), and nonessential needs (entrepreneurship, recreational activities). Additionally, surveys with coordination center employees and service providers helped identify the comparative acuteness of each social need and what needs tend to co-occur. These preliminary findings are available in further detail in our two blogs on veteran care. The key idea behind the Trajectory of Care metric stems from Maslow’s Hierarchy of Needs. We propose that if a client’s well-being improves over time, the acuteness of their needs will decrease. In developing the trajectory of care metric, we categorized services into basic needs, stressors, and non-essential needs. Using systems data from two community resource referral platforms, we mapped the trajectory of care for 16,787 clients who requested services at least twice (~30% of clients). The metric accounts for the changes in the acuteness and volume of needs and the time between service episodes.
Validating the Metric
We conducted two additional analyses to ensure the validity of our trajectory of care metric.
1. World Health Organization Five Well-Being Index (WHO-5): We examined the relationship between our metric and the WHO-5, a widely recognized tool for assessing well-being. The WHO-5 survey includes questions such as, “Over the last two weeks, have you felt cheerful and in good spirits?” We gathered data from 3,144 clients who completed the WHO-5 survey within two weeks of contacting a network for assistance. Clients who requested help with basic needs had a lower WHO-5 score than those who requested services for stressors or non-essential needs. This result provides some support for the metric.
2. Distinctness from Average Success Rate of Receiving Services: Next, we examined whether the trajectory of care is distinct from the average success rate of receiving services. Our results confirm that the percentage of successfully rendered services is unrelated to well-being. In short, receiving a service due to efficient referral processes does not necessarily resolve the underlying need. This finding emphasizes the importance of evaluating the actual impact of services on veterans’ well-being rather than just the efficiency of service delivery.
Conclusion
Developing the Trajectory of Care metric is crucial in evaluating the effectiveness of referral networks for veterans. Recognizing that referral processes do not necessarily predict issue resolution, we want to create a system that evaluates client improvement without relying on client surveys or screeners. We aim to ensure veterans receive comprehensive, sustained support, leading to long-term improvements in their overall well-being. By refining these metrics and understanding the interconnectedness of support services, we hope networks can better assess and enhance their practices to address veterans’ needs.
