UCLA/VA Center of Excellence for Veteran Resilience and Recovery, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.
Health Services Implementation Unit, VA Greater Los Angeles, Mental Illness Research, Education, and Clinical Center, Los Angeles, California, USA.
Health Serv Res. 2022 Apr;57(2):374-384. doi: 10.1111/1475-6773.13904. Epub 2022 Mar 3.
To evaluate the sustainment of Housing First (HF) implementation in a permanent supportive housing program for homeless-experienced veterans, 5 years after practice implementation.
From 2016 to 2017, primary data were collected from providers and veterans in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program at Los Angeles.
Guided by the integrated sustainability framework, we performed a mixed-methods study to evaluate the sustainment of HF, an evidence-based practice implemented to improve housing outcomes. To assess sustainment, we measured fidelity to HF in six of seven HUD-VASH teams. These data were integrated with qualitative interviews with providers and veterans who described perceived sustainment to HF and contextual factors that supported or impeded sustainment.
Fidelity to HF at 5 years after practice implementation, as a proxy for sustainment, was quantified via surveys with HUD-VASH teams. HUD-VASH providers (n = 51) and 31 veterans participated in semi-structured interviews. Team-based template analyses were used to develop an emergent understanding of stakeholder perspectives on HF sustainment.
Overall, HUD-VASH teams reported HF sustainment. The lowest fidelity scores were found in the domains of client-to-staff ratios, frequency of client-provider contact, and time to housing. Qualitative findings indicated that outer contextual factors (e.g., housing scarcity) and organizational factors (e.g., staff turnover) impacted HF sustainment. Providers identified changes in leadership and unmet resource needs as impediments to practice sustainment. All stakeholders identified positively with the HF practice and believed that the approach benefited veterans.
This snapshot of HF sustainment demonstrates that this practice can be sustained over time. However, strong leadership, organizational resources, and community partnerships are needed. Adaptations to HF in response to outer contextual factors and organizational capacity may result in practice sustainment while allowing for flexibility in service provision.
评估在为有流浪经历的退伍军人提供的永久性支持性住房项目中，住房优先（HF）实施 5 年后的维持情况。
2016 年至 2017 年，在洛杉矶的住房和城市发展部-退伍军人事务部支持性住房（HUD-VASH）计划中，从提供者和退伍军人那里收集了主要数据。
本研究采用混合方法，以住房优先的综合可持续性框架为指导，评估一种循证实践的维持情况，该实践旨在改善住房成果。为了评估维持情况，我们测量了七个 HUD-VASH 团队中的六个团队对 HF 的保真度。这些数据与提供者和退伍军人的定性访谈相结合，他们描述了对 HF 的感知维持情况以及支持或阻碍维持的背景因素。
通过对 HUD-VASH 团队进行调查，以 HF 实施 5 年后的保真度作为维持的代理，来量化 HF 的维持情况。HUD-VASH 提供者（n=51）和 31 名退伍军人参加了半结构化访谈。采用基于团队的模板分析方法，对利益相关者对 HF 维持的看法进行了深入了解。
总体而言，HUD-VASH 团队报告 HF 得到维持。在客户与员工比例、客户与提供者接触频率和住房获得时间等领域的保真度得分最低。定性研究结果表明，外部环境因素（例如住房短缺）和组织因素（例如员工流动）对 HF 的维持产生了影响。提供者认为领导层的变化和未满足的资源需求是实践维持的障碍。所有利益相关者都对 HF 实践持积极态度，并认为该方法使退伍军人受益。
本 HF 维持情况的快照表明，该实践可以随着时间的推移得到维持。然而，需要强有力的领导力、组织资源和社区伙伴关系。为了适应外部环境因素和组织能力，HF 可能需要进行调整，这可能会导致实践的维持，同时允许在服务提供方面具有灵活性。
