Homeless Solutions in a VA Environment (H-SOLVE)
Stefan G. Kertesz MD MSc
Birmingham VA Medical Center, Birmingham, AL
Birmingham, AL
Funding Period: September 2011 - August 2015

BACKGROUND/RATIONALE:
The Veterans Health Administration has formally committed to ending veteran homelessness by 2015. Central to VA efforts to end homelessness among vulnerable veterans is the provision of housing in the form of rental vouchers accompanied by supportive services. Traditionally the provision of housing and services has followed a "linear" approach in which individuals are required to participate in rehabilitative treatment programs as a precondition for being provided permanent housing. A newer housing intervention approach, Housing First/Supported Housing (HF/SH), involves immediate provision of housing support, targeting clients at greatest risk without requirements for successful performance in rehabilitation or sobriety. The goal of this study is to empirically assess current VA practices with regard to the provision of permanent housing to homeless veterans, with an eye toward how Housing First can be implemented in the VA environment.

OBJECTIVE(S):
The objectives of this study are to: (a) Identify organizational facilitators and barriers to implementation of Housing First in a VA context through qualitative data collection among 4 VA facilities that are currently adopting this approach, in contrast to 4 VA facilities that are not adopting Housing First; (b) Identify manipulable service elements for VA facilities seeking to implement Housing First programs with the use of presently available housing vouchers; (c) Compare homeless vulnerability indicators (homeless chronicity, homelessness immediately preceding referral, health diagnoses, utilization history) among veterans served through more traditional homeless veteran programs at 4 VA sites, in contrast to veterans served at 4 VA sites that have implemented a Housing First approach; and (d) assess whether VA-based Housing First programs achieve results that are superior to conventional programs in regard to housing.

METHODS:
This project consists of four phases. In Phase I we conducted expert panels with VA leadership involved in housing homeless veterans along with nationally-known experts on homelessness. Deliberations of the expert panel guided the tailoring of the organizational assessment tool used in the subsequent phase of the study. Phase II involves in-person and telephone interviews with leadership, mid-level management, and front-line staff involved in housing homeless veterans at eight VA facilities throughout the country. Phase III will use client-level data to assess both the vulnerability of homeless veterans who are provided permanent housing through each approach as well as their outcomes following placement. Lastly, in Phase IV we will develop a guidance statement for VA housing policy based on best practices identified through the expert panels, organizational assessments, and client-level data analysis.

FINDINGS/RESULTS:
In May 2012 we prepared and submitted to Vincent Kane and Roger Casey (National Center on Homelessness Among Veterans) a set of preliminary observations on barriers and facilitators to the implementation of a Housing First approach for the allocation of HUD-VASH vouchers, based on our first 3 site visits. Our overarching observation deals with the fluidity of current policies for the distribution of HUD-VASH vouchers; while we had initially intended to compare 4 sites who had adopted Housing First against 4 which had not, it became clear that all sites are in the process of transition to a Housing First approach. In addition, we identified a number of specific barriers facing facilities as they attempt to distribute housing vouchers more rapidly and to more vulnerable veterans. In many instances the infrastructure was lacking in terms of personnel, physical space, and IT support necessary for them to function. We also observed variations in the degree to which leadership and the facility as a whole were engaged in ending homelessness among veterans and the level of support offered to front-line staff.

IMPACT:
This study is designed to provide a formal organizational assessment that will help VA leadership and housing research/policy experts elsewhere to understand the factors conducive to, or impeding, change in long-established housing policy.

PUBLICATIONS:

Conference Presentations

1. Kertesz SG. Housing, Housing Vouchers and the H-SOLVE Study. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; Washington, DC.

DRA: Other Conditions, Health Systems
DRE: Treatment - Observational
Keywords: Homeless, Social Support
MeSH Terms: none