Lessons Learned from a Quality Improvement Intervention with Homeless Veteran Services

VISN 4 Mental Illness Research, Education and Clinical Center at VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.
Journal of Health Care for the Poor and Underserved (Impact Factor: 1.1). 08/2012; 23(3 Suppl):210-24. DOI: 10.1353/hpu.2012.0125
Source: PubMed


Homeless veterans are a vulnerable population, with high mortality and morbidity rates. Evidence-based practices for homelessness have been challenging to implement. This study engaged staff members from three VA homeless programs to improve their quality using Getting-To-Outcomes (GTO), a model and intervention of trainings and technical assistance that builds practitioner capacity to plan, implement, and self-evaluate evidence-based practices. Primarily used in community-based, non-VA settings, this study piloted GTO in VA by creating a GTO project within each homeless program and one across all three. The feasibility and acceptability of GTO in VA is examined using the results of the projects, time spent on GTO, and data from focus groups and interviews. With staff members averaging 33 minutes per week on GTO, each team made significant programmatic changes. Homeless staff stated GTO was helpful, and that high levels of communication, staff member commitment to the program, and technical assistance were critical.

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    • "GTO-UD was developed to address the gap between prevention research and practice by building prevention capacity—or the knowledge and skills—needed to conduct critical prevention practices (choosing, planning, implementing, evaluating, and sustaining specific prevention activities) as applied to EAP strategies. Getting To Outcomes (GTO) has also been applied to the prevention of teen pregnancy (Lesesne et al. 2008), drug use (Chinman et al. 2008, 2009), positive youth development (Chinman et al. 2012a), and homelessness (Chinman et al 2012b). In quasi-experimental and randomized controlled trials, GTO has been shown to improve practitioner capacity (e.g., knowledge and skills of good prevention practice) and standardized ratings of prevention practice (e.g., the carrying out of key tasks associated with high quality prevention: Chinman et al. 2008, 2009, 2013). "
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    ABSTRACT: Underage drinking is a significant problem facing US communities. Several environmental alcohol prevention (EAP) strategies (laws, regulations, responsible beverage service training and practices) successfully address underage drinking. Communities, however, face challenges carrying out these EAP strategies effectively. This small-scale, 3-year, randomized controlled trial assessed whether providing prevention coalitions with Getting To Outcomes-Underage Drinking (GTO-UD), a tool kit and implementation support intervention, helped improve implementation of two common EAP strategies, responsible beverage service training (RBS) and compliance checks. Three coalitions in South Carolina and their RBS and compliance check programs received the 16-month GTO-UD intervention, including the GTO-UD manual, training, and onsite technical assistance, while another three in South Carolina maintained routine operations. The measures, collected at baseline and after the intervention, were a structured interview assessing how well coalitions carried out their work and a survey of merchant attitudes and practices in the six counties served by the participating coalitions. Over time, the quality of some RBS and compliance check activities improved more in GTO-UD coalitions than in the control sites. No changes in merchant practices or attitudes significantly differed between the GTO-UD and control groups, although merchants in the GTO-UD counties did significantly improve on refusing sales to minors while control merchants did not.
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