Improving a Sanctioned Homeless Encampment for Veterans During COVID-19 Through Multilevel Partnerships.

A veteran-clinician-researcher partnership-the Care, Treatment, and Rehabilitation Service (CTRS)-enabled quality improvement within a U.S. Department of Veterans Affairs-sanctioned homeless encampment created in response to the COVID-19 pandemic. Although the differing concerns of clinicians and operational leaders led to challenges in defining CTRS's goals and quality metrics, partnering with frontline social work and peer staff (N=11) and veterans (N=21 of 381 CTRS participants) and considering their feedback resolved those differences. Multilevel partnerships improved care within the encampment, leading to the development of an encampment medicine team (providing onsite integrated health care) and a veteran engagement committee (providing feedback).

A 1-Year Review of a Nationally Led Intervention to Improve Suicide Prevention Screening at a Large Homeless Veterans Clinic.

BACKGROUND: Suicide is a national public health concern and veterans are a particularly vulnerable population. The Veterans Health Administration (VHA) Office of Mental Health and Suicide Prevention implemented a national, standardized process for suicide risk screening in October 2018, which was instituted at the West Los Angeles Veterans Affairs Medical Center Homeless Patient Aligned Care Team (HPACT) clinic. METHODS: This article examines the results of the screening initiative after implementation, describes difficulties faced in implementation, and suggests strategies that might be used to overcome those challenges. RESULTS: Over 1 fiscal year (October 1, 2018 to September 30, 2019) the HPACT clinic had 2932 unique veterans assigned to its care; 1876 (64%) received a primary screen of suicide risk, 523 (18%) were not screened, and 533 (18%) were exempt from screening by protocol. Of the 523 (18%) unscreened patients, 331 (11%) patients had no HPACT visit and 132 (5%) did not visit any VHA site during the period. There were 192 (7%) patients who visited but were not screened of which 19 (1%) declined screening. CONCLUSIONS: Most missed screening opportunities were due to patients being lost to follow-up. There were 5 challenges identified for screening implementation, including health record factors, communication, clinician buy-in, system factors, and patient factors. Thus, promoting interprofessional collaboration, visualizing effective process flows, establishing clear lines of communication and roles for involved staff, and opening avenues for continuous feedback and troubleshooting were all effective in increasing comfort with suicide assessment and screening rates.

Comparing Tenant and Neighborhood Characteristics of the VA's Project- vs. Tenant-Based Supportive Housing Program in Los Angeles County.

The United States Department of Housing and Urban Development (HUD)-Veteran Administration Supportive Housing (VASH) program uses project- and tenant-based vouchers to provide permanent supportive housing for homeless Veterans. We compared Veteran characteristics, health service utilization, and neighborhood characteristics between HUD-VASH participants with project-based (n=114) vs. tenant-based (n=978) vouchers. We found that project-based voucher holders were older and more ill than tenant-based voucher holders. Project-based vouchers were also associated with higher-quality neighborhoods and higher rates of health service utilization than tenant-based vouchers. With the limited availability of project-based vouchers, juxtaposed with the increased service use and better neighborhood quality with this voucher type, our findings suggest a need to think strategically about how best to allocate housing vouchers to meet homeless Veteran's needs.