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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1076 — VA Intensive Housing First in Southern California: Implementation and Veteran Experience

Lead/Presenter: Alexander Young, COIN - Los Angeles
All Authors: Young AS (Greater Los Angeles VA & UCLA) Flynn A (Greater Los Angeles VA) Hovsepian S (Greater Los Angeles VA) Medina H (Greater Los Angeles VA) Oberman S (Greater Los Angeles VA)

VA has made considerable efforts to address homelessness using HUD-VASH, based on the housing first model. There have been large reductions in Veteran homelessness nationally. In Southern California, there have been substantial reductions in homelessness, however, homelessness remains a substantial problem. Recently, VA has implemented Intensive Housing First (IHF), which supplements HUD-VASH with assertive community services. To improve service provision, we studied implementation of IHF teams in the Los Angeles region, and patient and provider experiences.

Six of the seven regional IHF teams enrolled. Veterans were randomly sampled from each team. Veterans completed qualitative and quantitative interviews and had their medical records reviewed. Providers and leaders were interviewed, and fidelity to the housing first model assessed. Team-based grounded theory analyses developed an emergent understanding of patient and provider experiences.

To date, 169 of 367 eligible Veterans have been contacted. 108 Veterans and 48 providers have enrolled. Veterans are 94% male, 56% African American, and 24% White. During the past 3 years, 55% had been homeless for more than 6 months and 29% had multiple episodes of homelessness. 55% have a serious mental illness, and 80% have an alcohol or drug use disorder. Fidelity to housing first varies among teams. Veterans identified habituation to life on the streets, housing scarcity, substance abuse, and mental health as barriers to stable housing. They emphasized the importance of transitional housing for people who lose vouchers or require additional stabilization. Providers discussed challenges due to staff turnover and sharing space and equipment with local housing authorities. They noted the strengths of IHF to quickly secure housing, but expressed concerns about the absence of mandatory substance abuse and mental health treatment, which impacts Veterans' ability to maintain housing. Associations between team fidelity, service provision and Veterans' experiences will be discussed.

Challenges to maintenance of housing include Veterans with multiple challenging needs; limitations in access to mental health and substance use services; the nature of the available housing; and, staffing problems. Ongoing reductions in transitional housing could worsen outcomes.

Findings are being applied to improve services. Innovative treatments are needed for maintaining housing of challenging Veterans, and for mitigating the impact of losses in transitional housing.