Dataset Information

Impact of an unannounced standardized veteran program on access to community-based services for veterans experiencing homelessness.

ABSTRACT:

Background

The United States Department of Veterans Affairs established a program in which actors incognito portray veterans experiencing homelessness with pre-determined needs to identify barriers to access and services at community-based organizations.

Methods

From 2017 to 2019, actors who varied in gender, skin color and age portrayed one of three scripts at all VA Community-Based Resource and Referral Centers (CRRCs) serving veterans experiencing homelessness in 30 cities and completed an evaluative survey. They carried authentic VA identification and were registered in a VA patient database for each identity. CRRCs were provided with reports annually and asked to implement corrective plans. Data from the survey were analysed for change over time.

Results

Access to food, counselling, PTSD treatment, and hypertension/prediabetes care services increased significantly from 68-77% in year 2 to 83-97% in year 3 (each P < 0.05 adjusted for script present). A significant disparity in access for African American actors resolved following more uniform adherence to pre-existing policies.

Conclusions

The 'unannounced standardized veteran' (USV) can identify previously unrecognized barriers to needed services and care. Audit and feedback programs based on direct covert observation with systematic data collection and rapid feedback may be an effective strategy for improving services to highly vulnerable populations.

SUBMITTER: Weiner SJ

PROVIDER: S-EPMC8904198 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Impact of an unannounced standardized veteran program on access to community-based services for veterans experiencing homelessness.

Weiner Saul J SJ Schwartz Alan A Binns-Calvey Amy A Kass Benjamin B Underwood Timothy D TD Kane Vincent V

Journal of public health (Oxford, England) 20220301 1

<h4>Background</h4>The United States Department of Veterans Affairs established a program in which actors incognito portray veterans experiencing homelessness with pre-determined needs to identify barriers to access and services at community-based organizations.<h4>Methods</h4>From 2017 to 2019, actors who varied in gender, skin color and age portrayed one of three scripts at all VA Community-Based Resource and Referral Centers (CRRCs) serving veterans experiencing homelessness in 30 cities and ...[more]

PMID: 33929036

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Project description:BackgroundStudies suggest female Veterans are under-identified as homeless in the VA healthcare system, which may impact their ability to access necessary services. In addition, the increasing number of female Veterans experiencing homelessness requires a better understanding of their access to necessary healthcare and social care.ObjectivesThe purpose of this systematic review was to examine the barriers and facilitators for access to healthcare and social care among women Veterans experiencing homelessness.DesignA mixed methods systematic review was conducted and includes quantitative and qualitative primary research studies.Data sources and methodsSeven databases were searched for quantitative or qualitative research studies. Studies which addressed access or use of healthcare or social services, which were focused on female Veterans or allowed for comparison between male and female Veterans were included. Data were synthesized using a convergent integrated approach.ResultsThirty-five studies met inclusion criteria; 27 quantitative, 6 qualitative and 2 mixed methods studies. Three main themes resulted: (1) the comparison of access and use of healthcare and social services between women and men; (2) female specific barriers to access or use of social and health services; (3) female specific facilitators to access or use of social and health services.ConclusionsResults showed although women Veterans had similar or better outcomes with permanent housing programming compared to men, gaps remain in the provision of emergency and short-term housing accommodations. In addition, many studies found that homeless women Veterans were unaware of the healthcare and social services available through the VA. Programs and policies need to ensure they are maximizing their reach to women Veterans experiencing homelessness by providing outreach and education, so they understand the benefits available when they discharge from the military and to understand the unique healthcare and social needs of women Veterans.

Project description:PurposeHigh-quality, comprehensive care of vulnerable populations requires interprofessional ambulatory care teams skilled in addressing complex social, medical, and psychological needs. Training health professionals in interprofessional settings is crucial for building a competent future workforce. The impacts on care utilization of adding continuity trainees to ambulatory teams serving vulnerable populations have not been described. We aim to understand how the addition of interprofessional trainees to an ambulatory clinic caring for Veterans experiencing homelessness impacts medical and mental health services utilization.MethodsTrainees from five professions were incorporated into an interprofessional ambulatory clinic for Veterans experiencing homelessness starting in July 2016. We performed clinic-level interrupted time series (ITS) analyses of pre- and post-intervention utilization measures among patients enrolled in this training continuity clinic, compared to three similar VA homeless clinics without training programs from October 2015 to September 2018.ResultsOur sample consisted of 37,671 patient- months. There was no significant difference between the intervention and comparison groups' post-intervention slopes for numbers of primary care visits (difference in slopes =-0.16 visits/100 patients/month; 95% CI -0.40, 0.08; p=0.19), emergency department visits (difference in slopes = 0.08 visits/100 patients/month; 95% CI -0.16, 0.32; p=0.50), mental health visits (difference in slopes = -1.37 visits/month; 95% CI -2.95, 0.20; p= 0.09), and psychiatric hospitalizations (-0.005 admissions/100 patients/month; 95% CI -0.02, 0.01; p= 0.62). We found a clinically insignificant change in medical hospitalizations.ConclusionsAdding continuity trainees from five health professions to an interprofessional ambulatory clinic caring for Veterans experiencing homelessness did not adversely impact inpatient and outpatient care utilization. An organized team-based care approach is beneficial for vulnerable patients and provides a meaningful educational experience for interprofessional trainees by building health professionals' capabilities to care for vulnerable populations.

Project description:ImportanceHomelessness is a persistent and growing problem. What role health systems should play and how that role is incorporated into larger strategic efforts are not well-defined.ObjectiveTo compare homelessness among veterans with that in the general population during a 16-year study period before and after implementation of the Ending Veteran Homelessness Initiative, a program to rehouse veterans experiencing homelessness.Design, setting, and participantsThis national retrospective cohort study using a mixed-methods approach examined annualized administrative (January 1, 2007, to December 31, 2022) and population data prior to (2007-2009) and during (2010-2022) the Ending Veteran Homelessness initiative. Participants included unhoused adults in the US between 2007 and 2022.ExposureEnrollment in Veterans Health Administration (VHA) Homeless Program Office components providing housing, case management, and wrap-around clinical and supportive services.Main outcomes and measuresPoint-in-time (PIT) count data for unhoused veterans and nonveterans during the study period, number of Section 8 housing vouchers provided by Housing and Urban Development-Veterans Administration Supportive Housing, number of community grants awarded by Supportive Services for Veterans and Families, and total number of veterans housed each year. Semistructured interviews with VHA leadership were performed to gain insight into the strategy.ResultsIn 2022, 33 129 veterans were identified in the PIT count. They were predominantly male (88.7%), and 40.9% were unsheltered. During the active years of the Ending Veteran Homelessness initiative, veteran homelessness decreased 55.3% compared with 8.6% for the general population. The proportion of veterans in this cohort also declined from 11.6% to 5.3%. This change occurred during a shift to "housing first" as agency policy to create low-barrier housing availability. It was also coupled with substantial growth in housing vouchers, grants to community partner agencies, and growth in VHA clinical and social programming to provide homeless-tailored wrap-around services and support once participants were housed. Key respondent interviews consistently cited the shift to housing first, the engagement with community partners, and use of real-time data as critical.Conclusions and relevanceIn this cohort study of the federal Ending Veteran Homelessness initiative, after program implementation, there was a substantially greater decrease in homelessness among veterans than in the general population. These findings suggest an important role for health systems in addressing complex social determinants of health. While some conditions unique to the VHA facilitated the change in homelessness, lessons learned here are applicable to other health systems.

Project description:AimsTo investigate the scope of practice of nurse-led services for people experiencing homelessness, and the influence on access to healthcare.DesignA scoping review.Data sourcesOn 20 November 2020, the following databases were searched: CINAHL, Embase, MEDLINE, PubMed and Scopus.Review methodsIncluded studies focused on people experiencing homelessness aged 18 years and over, nurse-led services in any setting and described the nursing scope of practice. Studies were peer-reviewed primary research, published in English from the year 2000. Three authors performed quality appraisals using the mixed methods assessment tool. Results were synthesized and discussed narratively and reported according to the PRISMA-ScR 2020 Statement.ResultsNineteen studies were included from the United States (n = 9), Australia (n = 4), United Kingdom (n = 4) and Canada (n = 2). The total participant sample size was n = 6303. Studies focused on registered nurses (n = 10), nurse practitioners (n = 5) or both (n = 4), in outpatient or community settings. The nursing scope of practice was broad and covered a range of skills, knowledge and attributes. Key skills identified include assessment and procedural skills, client support and health education. Key attributes were a trauma-informed approach and building trust through communication. Important knowledge included understanding the impact of homelessness, knowledge of available services and the capacity to undertake holistic assessments. Findings suggest that nurse-led care facilitated access to healthcare through building trust and supporting clients to access services.ConclusionOptimized nursing scope of practice can facilitate access to healthcare for people experiencing homelessness. Key factors in enabling this include autonomy in nursing practice, organizational support and education.ImpactThe broad range of skills, knowledge and attributes reported provide a foundation from which to design an educational framework to optimize the nursing scope of practice, thereby increasing access to healthcare for people experiencing homelessness.

Dataset Information

Impact of an unannounced standardized veteran program on access to community-based services for veterans experiencing homelessness.

Background

Methods

Results

Conclusions

Publications

Impact of an unannounced standardized veteran program on access to community-based services for veterans experiencing homelessness.

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