Perspectives on the Low Demand Transitional Model in Engaging and Housing hard-to-reach Veterans Experiencing Unsheltered Homelessness.

Nationwide around 226,080 homeless individuals are unsheltered each night. The U.S. Department of Veterans Affairs (VA) Low Demand program is a community-based model which provides supportive transitional housing to hard-to-reach, unsheltered veterans who often have complex needs and may be unable or unwilling to participate in supportive services which aim to prevent or rapidly re-house veterans when facing housing instability or homelessness. The goal of this study was to examine Low Demand community providers' perceptions of the facilitators and barriers to Low Demand model engagement and effectiveness among unsheltered homeless veterans. Semi-structured interviews, composed of 20 open-ended questions, were conducted with a convenience sample of VA Low Demand community providers and VA staff affiliated with the programs. Interviews were transcribed verbatim, and an inductive approach was employed allowing the data to determine the main categories and subthemes. Three coders independently summarized, coded, and compared transcripts. Qualitative analyses were performed in Atlas.ti. Forty-five Low Demand community providers completed the interview. Providers reported an average four years (range: 3 weeks-14 years) of experience in their current role. Five categories were identified from the qualitative data: (1) Barriers to Low Demand model success, (2) Facilitators of Low Demand model success, (3) Collaborative assessments with VA guide Low Demand program resident retention, (4) Recommendations to reduce returns to homelessness among Low Demand residents, and (5) Low Demand model areas for improvement. Community providers consider the Low Demand model to be an effective option for housing unsheltered veterans who have complex needs. Barriers to retaining and transitioning Low Demand residents to permanent housing were noted. In-facility basic life skills education, financial planning, and relationship reconstruction along with onsite mental health services may support positive program exits. Engaging veterans in aftercare programs and/or retention case management is crucial in the prevention of returns to homelessness. Strong community and VA collaborations are essential to maximizing positive Low Demand program outcomes.