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2019 HSR&D/QUERI National Conference Abstract

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1020 — Universal Screening for Homelessness: Lessons Learned and Implications for Future Implementation

Lead/Presenter: Ann Elizabeth Montgomery,  Birmingham VAMC, National Center on Homelessness Among Veterans
All Authors: Montgomery AE (Birmingham VAMC, National Center on Homelessness Among Veterans, University of Alabama at Birmingham School of Public Health ), Byrne TH (Boston University School of Social Work, National Center on Homelessness Among Veterans, Center for Healthcare Organization & Implementation Research), Chhabra M (Corporal Michael J. Crescenz VAMC) Cusack MC (Center for Health Equity Research and Promotion, Philadelphia) Dichter ME (Center for Health Equity Research and Promotion, Philadelphia; University of Pennsylvania Perelman School of Medicine) Fargo JD (Utah State University) True JG (South Central MIRECC, Southeast Louisiana Veterans Health Care System, Tulane University School of Medicine)

To address homelessness among Veterans, VA implemented the Homelessness Screening Clinical Reminder (HSCR) in October 2012. The objective of this brief electronic medical record-based universal screen for homelessness and risk is to identify Veterans experiencing housing instability and link them with assistance. This presentation will share lessons learned from a 4-year study of the HSCR's implementation and effectiveness, including implications for future implementation.

We conducted a mixed methods study, analyzing administrative data for nearly 6 million Veterans who responded to the HSCR and interviewing Veterans who screened positive for housing instability (n = 60), providers who administered the HSCR (n = 22), and social work and nursing staff who responded to positive screens (n = 6).

Among Veterans who screened positive for housing instability, one-third received services through VHA Homeless Programs within 30 days of screening. Qualitative data revealed a mismatch between the needs of Veterans who screened positive for housing instability and the eligibility criteria for VHA Homeless Programs. Findings suggest several changes to HSCR practices to improve implementation: (1) narrowing the screening population to Veterans with an increased risk of a positive screen based on known characteristics (e.g., treatment for opioid use disorder, unsheltered status, diagnosis of serious mental illness or substance use disorder); (2) using predictive analytics to identify and target the strata of highest-risk Veterans for more intensive service linkage interventions; and (3) identifying appropriate providers to conduct the screening and training providers on how to administer the HSCR and respond to positive screens.

Studies of the HSCR have indicated its effectiveness at identifying Veterans experiencing homelessness or risk and linking them with appropriate resources; effectiveness may be increased by implementing variations to the HSCR and studying implementation strategies to facilitate uptake across the service system.

The HSCR is administered to millions of Veterans each year. Among Veterans who screen positive, not all are connected with VHA Homeless Programs that may mitigate their housing instability. Research suggests promising strategies to improve the performance of the HSCR.