3083 — Incorporating evidence-based dual-diagnosis treatments into VA homelessness Services
McCarthy SA, MIRECC Pittsburgh PA; Chinman M, MIRECC Pittsburgh PA; Smelson D, Edith Nourse Rogers VA Bedford MA; Hannah G, MIRECC Pittsburgh PA;
Objectives: Ending chronic homelessness is a significant goal of the VA. Because many homeless Veterans have a co-occurring disorder, VA homelessness programs are challenged to incorporate evidence-based dual diagnosis services, e.g., MISSION-VET. The objective of this Hybrid Type II Implementation study was to assess the uptake of MISSION-Vet in three large VA housing programs, split in half, with half randomly assigned to receive an implementation support called Getting To Outcomes (GTO) and the other continuing routine operations. GTO provides written tools, training, and technical assistance.
Methods: Within the GTO intervention group, housing clinicians used GTO to plan, implement, monitor, and improve MISSION-VET implementation. The study assessed fidelity, reach and penetration of MISSION-Vet through record review over a two year period. The Organizational Readiness for Change survey was administered at baseline to all housing staff. MISSION-VET implementation was diagnosed using the CFIR (Consolidated Framework for Implementation Research), which provides five domains and multiple constructs related to implementation and routinization of innovation in organizations. Each CFIR construct was rated as supportive, neutral, or hindering implementation success"”for the group of GTO sites and each GTO site individually.
Results: Most clinicians implemented MISSION-VET in the GTO intervention group (Penetration), but for fewer Veterans than expected (Reach). Fidelity varied widely. Veterans who received MISSION Vet had more treatment contact. CFIR ratings systematically highlighted implementation challenges overall (lack of external incentives, complex evidence-based program) and at each site (variation in perception of importance). CFIR also highlighted facilitators (MISSION-Vet's adaptability, GTO's support). Challenges are related to fidelity and uptake data in specific domains of the CFIR, with implementation support by GTO positively influencing CFIR's Process domain.
Conclusions: It is feasible to implement MISSION-VET in VA housing programs with significant attention to implementation barriers. The CFIR is a strong tool for evaluating implementation of challenging interventions. Based on CFIR, recommendations for incorporating MISSION-VET will be shared with VA housing programs.
As a result of this study, Veterans in three HUD VASH programs have seen increased services via MISSION-Vet. The findings from this study will be used to improve implementation of comprehensive evidence-based services for dual diagnosed Veterans in other Homelessness programs.