Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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2010 — Ending Veteran Homelessness: Can Housing First Meet the Needs of an Increasingly Vulnerable Homeless Population?

Lead/Presenter: Sonya Gabrielian, COIN - Los Angeles
All Authors: Gabrielian SE (VA Greater Los Angeles) Kertesz SG (Birmingham VA) Young AS (VA Greater Los Angeles) O'Toole TP (National Center on Homelessness Among Veterans)

Brief description of panelists:
Sonya Gabrielian is a psychiatrist and researcher focused on improving community functioning among homeless Veterans. Stefan Kertesz is an internist and researcher with expertise in housing interventions and primary care for homeless Veterans. Alexander Young is a psychiatrist and researcher committed to improving care for Veterans with serious mental illness. Thomas O'Toole, the operations partner and moderator, is the Director of the National Center on Homelessness Among Veterans. He supports VA's comprehensive initiatives to end Veteran homelessness.

Description of the question or issue that will be discussed:
Homeless consumers have significant medical, psychiatric, and social vulnerabilities. Housing First--which combines permanent housing with community-based supportive services, without treatment mandates--is the preeminent paradigm to address homelessness. To advance its goal to end Veteran homelessness, VA adopted Housing First in its VA Supportive Housing (VASH) program, which has served > 80,000 Veterans. However, increasing vulnerability among homeless consumers raises questions about how and whether Housing First can respond to participants' clinical needs. We will describe three VASH-focused studies. First, we will report on a structured fidelity analysis of Housing First at eight VA facilities. There was substantial fidelity in housing-focused domains, but areas of concern included the adequacy of supportive and clinical services for vulnerable Veterans. Second, to inform intervention development for vulnerable VASH participants, we will examine associations between participants' cognition, problem-solving approaches, and functioning. Problem-solving approaches were highly relevant to day-to-day functioning and cognition was universally poor; skill-building surrounding described problems may improve VASH outcomes. Third, we will describe implementation fidelity and Veteran and provider experiences in a program that augments VASH with Assertive Community Treatment: Intensive Housing First (IHF). IHF facilitated rapid housing, but providers and Veterans described disconnects between Housing First tenants--particularly the lack of treatment mandates--and substantive barriers to housing retention. Panelists will engage each other and the audience surrounding Housing First's accomplishments and limitations, VA priorities, and ways to enhance the model to meet participants' needs.

Significance—Description of why the issue is important for Veterans, VA, and the audience:
Insights from VASH--VA's central initiative to end Veteran homelessness--are poised to inform Housing First implementation worldwide. Within and outside VA, there is a pressing need to advance Housing First policy and services to address participants' vulnerabilities.