Veterans are disproportionately affected by homelessness, and almost 10% of all Veterans have experienced homelessness at some point. Cognitive impairment may contribute to homelessness­; executive functioning impairment and related cognitive dysfunction may be prevalent in up to 80% of homeless individuals. These impairments may compromise the ability to sustain income for stable housing and hinder rehabilitation efforts. We sought to examine the effects of a cognitive rehabilitation intervention on long-term housing, work, and school outcomes in Veterans with trans-diagnostic mental health conditions who were homeless or at risk of homelessness.

In a randomized controlled trial, we compared Compensatory Cognitive Training (CCT) to a Holistic Cognitive Education (HCE) control condition. Participants were 79 post-9/11 Veterans who were homeless or unstably housed, receiving residential mental health treatment, with neuropsychological impairment (>1 SD below mean on at least one measure). Following the active phase of the trial, they were contacted once per month for 12 months after their discharge from the residential treatment program to provide updates on their housing, employment, and education status. 36/79 participants had at least one month of post-discharge follow-up data. These 36 participants were all men, 67% White/non-Hispanic, and had between 1 and 12 months of post-discharge follow-up data. We calculated mean housing, employment, and education status over the follow-up period using the data available, then conducted independent samples t-tests to analyze group differences in these outcomes.

There were no statistically significant differences between groups in terms of days of stable housing (t=.405, df=26, p=.689), days of homelessness (t=-.388, df=26, p=.701 ), days of employment (t=-1.147, df=34 , p=.259 ), hours worked per week of employment (t=-1.019, df=34, p=.316), or days enrolled in school (t=1.015, df=34, p=.317).

We did not find evidence of CCT-associated effects on long-term rehabilitation outcomes post-discharge from residential mental health treatment. Study limitations include follow-up data on less than half of the randomized participants and variable lengths of follow-up among those with any follow-up data, illustrating some of the challenges of research with this population. Larger samples with more complete follow-up data are required to demonstrate whether cognitive rehabilitation improves outcomes of robust residential mental health treatment in homeless or unstably-housed Veterans with psychiatric conditions.