Our Work

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Our Experience and Impact

Impact of an unannounced standardized veteran program on access to community-based services for veterans experiencing homelessness

Co-author T. Underwood

In a groundbreaking three-year, evidence-based quality improvement study, our team led a specialized working group that revolutionized access to services for seniors and veterans facing homelessness. This pivotal initiative not only identified but systematically eradicated race and age-based barriers in 30 communities nationwide. The transformative impact of this project has been documented and validated in a published study, setting a new national standard for equitable service access.

Study Results: “Access to food, counseling, PTSD treatment, and hypertension/prediabetes care services increased significantly from 68–77% in year 2 to 83–97% in year 3 (each P < 0.05 adjusted for script present). A significant disparity in access for African American actors resolved following more uniform adherence to pre-existing policies.”

Essential Findings:

  1. Actionable Insights for Policy Change: The program generated critical, actionable data via direct observation, equipping the Homeless Program Office to enact meaningful changes in policy and practice.

  2. Concrete Improvements in Year 3: The third year of the program marked pivotal improvements in multiple areas, including:

    • Enhanced access to food

    • More readily available counseling services

    • Efficient referrals for PTSD treatment

    • Improved hypertension and prediabetes services

  3. Elimination of Racial Disparities: A glaring racial disparity between African American and Caucasian veterans in service access was completely eliminated.

  4. Increased Responsiveness by CRRCs: The Community Resource and Referral Centers (CRRCs) showcased increased adaptability by offering on-site services or transportation, thereby reducing prior barriers like long walking distances.

  5. Inconsistent Enforcement Corrected: The program identified and rectified inconsistencies in the enforcement of VA policy, specifically regarding the DD-214 documentation, which was contributing to racial disparity in service access.

  6. Early Changes Less Persistent: While some changes were noted in the program's second year—like altered intake process timings—these did not persist and are difficult to interpret.

  7. Feedback Mechanism Effective: The feedback loop between the Homeless Program Office and CRRCs appears to be effective. We hypothesize that the substantial improvements observed in year 3 may have been due to CRRCs taking the feedback more seriously over time.

This program demonstrates the power of sustained, evidence-based initiatives to bring about systemic improvements and equitable service access, particularly for vulnerable communities like homeless veterans.

Lessons Learned to Scale Impact

The success of the Homeless Program Office's quality improvement program provides valuable lessons that can be translated to other federal initiatives and programs aiming to optimize service delivery and eliminate disparities. Here are some major learnings:

Importance of Data-Driven Decision-Making:

  1. Actionable Insights: Collecting data through direct observation or user surveys can provide actionable insights that inform effective changes in policy and practice.

  2. Longitudinal Study: Multi-year studies offer more reliable data and can trace the effectiveness of interventions over time.

Engagement and Responsiveness:

  1. Feedback Loops: Creating a systematic feedback mechanism between policy offices and field units can lead to more rapid and effective implementation of changes.

  2. Flexibility in Approach: Programs should be willing to adapt and evolve, taking into account feedback and emerging data. CRRCs demonstrated this by offering on-site services or transportation.

Addressing Disparities:

  1. Policy Auditing for Equity: Continuous monitoring can identify inequities in service access due to inconsistencies in policy enforcement. Once these are identified, targeted action can eliminate these disparities, as seen with the issue regarding the DD-214 documentation.

  2. Communication & Training: Clear and repetitive communication, both written and verbal, can aid in the consistent application of policies across various service centers.

Stakeholder Involvement:

  1. Cross-Functional Teams: The study involved a working group comprising various stakeholders, highlighting the importance of multidisciplinary teams in tackling complex issues.

  2. Leadership Involvement: Senior leadership’s backing and active involvement can serve as a catalyst for significant improvements, as field units may be more likely to take feedback seriously when they know it comes from the top.

Sustained Commitment:

  1. Long-Term View: Lasting change often requires a long-term commitment. While early changes were noted, it wasn't until the third year that substantial improvements materialized.

  2. Continuous Monitoring: Ongoing tracking and adjustment are crucial to maintaining gains and driving further improvements.

By applying these learnings, other federal programs can develop more effective, equitable, and adaptive services. These best practices can help create a framework for continuous improvement in a range of federal initiatives.