QI Intervention for VA Programs Serving Homeless Veterans
Annual Homeless Management Information data indicate that approximately 144,000 homeless Veterans receive services in shelters and/or transitional housing programs annually. This is a 12% decrease from prior years and modest progress toward VA's goal of eliminating Veteran homelessness by the end of 2015. To achieve the goal, VA must continue to accelerate its focus on homeless prevention, permanent supportive housing, and the implementation of evidence-based practices (EBPs). However, clinicians and other staff members working in VA homeless programs have faced difficulty in implementing EBPs. An approach called Getting To OutcomesÂ® (GTO) outlines a series of 10 steps practitioners should follow in order to make programs more effective, which are organized around planning, implementation, and self-evaluation. GTO provides written tools, training, and technical assistance to help select and implement EBPs and monitor improvement in their delivery. This study piloted the GTO approach (initially developed for non-VA community-based organizations) in three VA homeless programs to test its feasibility and acceptability. The three programs were Healthcare for Homeless Veterans, Domiciliary Care for Homeless Veterans, and Vocational Services. The study engaged staff members (n=32) in four GTO projects (one for each program, and one across all three programs) to improve program quality. The intervention began with one half-day training for all staff members, with a second half-day training held 16 months into the intervention. Technical assistance was provided over a two-year period. Results of the GTO intervention were assessed via e-mails, focus groups, and interviews with staff members from each homeless program.
- Through the GTO intervention, staff members at three homeless programs were able to make noticeable improvements in their programming. Although none of the improvements incorporated the wholesale adoption of a specific evidence-based program, most improvements involved programs becoming more evidence-based; e.g., using evidence-based guidelines to manage high-risk patients (i.e., Veterans at risk of suicide) and supporting additional substance abuse treatment for Veterans who had relapsed, while keeping them in their current VA housing.
- Many staff members experienced some challenges adding GTO activities to their already busy workload, and some felt the process could be more transparent and inclusive. Staff members stated that high levels of communication, commitment to the program, and technical assistance were critical to the success of the intervention.
- This was a pilot study in three homeless programs at one site, and no control or comparison groups were used, limiting the ability to draw firm conclusions about the intervention's impact.
- This study was exploratory in nature and had a qualitative design.
This study was funded through VA's National Center on Homelessness among Veterans. All authors are part of the VISN 4 Mental Illness Research, Education and Clinical Center at the VA Pittsburgh Healthcare System. The authors are currently assessing how GTO can aid the implementation of an evidence-based treatment for homeless Veterans in HUD-VASH in a multi-site QUERI-funded study.
Chinman M, Hannah G, and McCarthy S. Lessons Learned from a Quality Improvement Intervention with Homeless Veteran Services. Journal of Health Care for the Poor and Underserved
August 2012 (Supplement);23(3):210-224.