National Dissemination of Supported Housing in the VA: Model Adherence versus Model Modification

Yale Department of Psychiatry, Yale Program for Recovery and Community Health 319 Peck St. Building 1 New Haven, CT 06513, USA.
Psychiatric Rehabilitation Journal (Impact Factor: 1.16). 03/2010; 33(4):308-19. DOI: 10.2975/33.4.2010.308.319
Source: PubMed


The continuing development and dissemination of emerging evidence-based practices may be facilitated by the availability of descriptive information on the actual delivery of the service, and its variability, across sites. This paper presents data on the participation of 2,925 homeless veterans in the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program at 36 sites across the country, for up to five years. While most conceptual models emphasize rapid placement, sustained intensive case management, rehabilitation services, and "permanent" housing, no program has yet presented empirical data on the actual delivery of such services over an extended period of time.
Using extensive longitudinal data from the VA's national homeless outreach program, the Health Care for Homeless Veterans (HCHV) program, a quantitative portrait presents what happens in supported housing in a large real-world dissemination effort.
Program entry to HUD-VASH was generally slow with 108 days (sd = 92 days) on average passing between program entry and housing placement. Total program participation lasted 2.6 years on average (sd = 1.6 years)-just half of the possible 5 years. Service delivery became substantially less intensive over time by several measures, and three-fourths of the veterans terminated within five years, although the vast majority (82%) were housed at the time. Few veterans received rehabilitation services (6%) or employment assistance (17%) and most service delivery focused on obtaining housing.
These data suggest that real-world supported housing programs may not adhere to the prevalent model descriptions either because of implementation failure or because veteran needs and preferences differ from those suggested by that model.

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    ABSTRACT: The US Department of Veterans Affairs (VA) is quickly becoming a leader in psychosocial rehabilitation and in implementing evidence–based practices for people with severe mental illnesses. Transformation efforts within the VA system also emphasize that veterans with mental illnesses are to be respected as persons and not defined by their illness; they have the right to direct their own treatment and are encouraged to develop a recovery oriented action plan for themselves. Peer Support Services are provided by trained individuals who themselves are in recovery from a mental illness and who serve as clinically supervised members of the mental health care team. Partnering with families, with the veteran's consent, is an essential component of recovery-oriented services. A range of vocational experiences and employment are offered to help veterans achieve their goals and enhance their quality of life. We hope that the work included in this Special Issue of the Psychiatric Rehabilitation journal inspires others to contribute to the advancement of recovery–oriented services and supports for veterans and other adults living with serious mental illnesses. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
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    ABSTRACT: The Housing and Urban Development-Department of Veterans Affairs Supportive Housing (HUD-VASH) program is the largest supported housing program in the country for homeless veterans who are seeking rapid entry into permanent independent housing. This study examined factors related to how rapidly clients were housed in the early years of the program and how long they stayed in the program. Mental health, substance abuse, work/income, criminal history, and site were examined as predictors of process times. Regression analyses based on 627 HUD-VASH clients who entered the program between 1992 and 2003 showed that client characteristics were not rate-limiting factors for obtaining HUD-VASH housing; i.e., clients who had greater substance abuse problems or more extensive criminal histories did not take longer to obtain housing. The large differences associated with site of entry partly reflected a curvilinear relationship between the duration of operation of the HUD-VASH program and process times; i.e., at relatively younger and older programs, clients entered housing slightly faster than at programs in the middle range. Lastly, HUD-VASH clients whose case managers reported good therapeutic alliances stayed in the program longer. These findings have implications for the continued expansion of the HUD-VASH program.
    Preview · Article · Jan 2011 · The Journal of Rehabilitation Research and Development
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