UCLA HEALTH RESEARCH ALERT
Researchers at UCLA Health have found that Housing First, a national program to provide housing and support for homeless persons, was effective in helping homeless veterans access housing and remain in their homes five years after it was implemented.
The Housing First (HF) model provides permanent supportive housing to people experiencing homelessness and prioritizes access to housing for those who are chronically homeless and who have high psychosocial and medical needs. It works by providing subsidies for independent housing, case management and services such as home visits, care coordination and transportation to services.
The goal of HF is to help homeless persons improve their quality of life without mandating sobriety or mental health treatment and stay in their homes through community-based and recovery-oriented services. Substantial research has shown that HF increases access to housing, reduces the use of costly emergency room visits, promotes self-sufficiency and helps to keep homeless persons in their homes.
Given its effectiveness, the HF model was implemented at the Veterans Administration of Greater Los Angeles (VAGLA) following a federal priority to end Veteran homelessness in 2009 through a collaboration between the Department of Housing and Urban Development (HUD) and the Department of Veteran Affairs permanent supportive housing (VASH) program (HUD-VASH). Robust efforts to implement HF took place between 2016 and 2017 and led to a dramatic increase in HUD-VASH services. Nearly 80,000 homeless Veterans had been provided supportive services by 2020, with a 49% reduction of homeless Veterans from 73,000 counted on a single night in 2009 as compared to 36,000 in 2020.
Despite the success of intensive efforts to implement HF at the VAGLA, however, once these implementation efforts stopped, little was known about how well HF would continue to work over time and in this setting.
Guided by a framework that examined the internal and external influences on HF’s effectiveness over time, the researchers studied how factors such as organizational resources, leadership, staff turnover and/or operational processes such as partnering with community organizations, training and expertise of service providers impacted adherence to the HF model – against a backdrop of a high-cost housing, competitive rental markets and housing scarcity in Los Angeles.
In the study, the researchers conducted interviews with 31 Veterans and 51 providers selected at random from six of seven HUD-VASH teams at the VAGLA five years after implementation efforts had ended. During the interviews, Veterans were asked about their perspectives on HF, the housing process, services they received, relationships with staff and any unmet needs they had. Likewise, providers were asked to describe any changes they saw to HF over time, any structural challenges, effectiveness of community partnerships as well as strengths and needs of the program.
Providers in the study were also asked to complete a survey that measured five core components of the HF program: 1) housing process and structure; 2) separation of housing and services; 3) service philosophy; 4) array of services; and 5) team structure.
Following an analysis of the data, the researchers found that HF was sustained over time, but that strong leadership, organizational resources and community partnerships were needed for it to remain effective over the long-term.
Adapting HF practices in response to both internal and external contexts as well as the organization’s capacity to administer the program may improve its effectiveness while allowing for flexibility in providing the services needed over time.
The senior author is Alexander S. Young, M.D. and the first author is Erica Hua Fletcher, PhD, both of the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA and the Veterans Administration Greater Los Angeles Healthcare System. Other authors are Sonya Gabrielian, MD, MPH; Anthony W.P. Flynn, BA; Jared M. Greenberg, MD; Sona Hovesepian, LCSW; and Rebecca S. Oberman, MSW, MPH.
Stakeholder perspectives on sustainment of Housing First in a VA permanent supportive housing program, Health Services Research, DOI: 10.1111/1475-6773.13904 Published March 03, 2022
This study was supported by the Corporation for Supportive Housing, Los Angeles, and the Department of Veterans Affairs, Veterans Health Administration, Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC).
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Stakeholder perspectives on sustainment of Housing First in a VA permanent supportive housing program
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No potential conflicts exist. The views expressed in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs, the U.S. government or affiliated institutions.