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2023 HSR&D/QUERI National Conference Abstract

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1005 — Establishing an Engagement Committee of Homeless-Experienced Veterans Residing in a VA-Sanctioned Tiny Structure Community

Lead/Presenter: Matthew McCoy,  COIN - Los Angeles
All Authors: McCoy M (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System), Cannedy S (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System) Sherrell T (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System) Altman L (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System) Hamilton AB (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System) Santini S (Community Engagement and Rehabilitation Services, VA Greater Los Angeles Healthcare System) Daugharty MW (Community Engagement and Rehabilitation Services, VA Greater Los Angeles Healthcare System) Moten EA (Community Engagement and Rehabilitation Services, VA Greater Los Angeles Healthcare System) Boatwright M (Community Engagement and Rehabilitation Services, VA Greater Los Angeles Healthcare System) Gabrielian S (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System)

Objectives:
During the coronavirus 2019 (COVID-19) pandemic, VA Greater Los Angeles leadership sanctioned a novel tent encampment (Care, Treatment and Rehabilitation Service (CTRS)) for Veterans experiencing homelessness (VEHs). CTRS evolved from tents to 100 tiny homes, enabling VEHs to live in pallet shelters (private sleeping cabins with lights, heaters, and air conditioning) with on-site hygiene facilities and three meals a day on medical center grounds. This innovation addressed the longstanding needs of a subset of VEHs whose housing preferences do not align with traditional transitional housing settings. Yet, little is known about the preferences and experiences of VEHs at CTRS. To enable a patient-centered approach to improve in health and housing services at CTRS, a homeless Veteran Engagement Committee (VEC) was formed. The VEC holds weekly meetings to gather VEHs’ input on CTRS services and inform iterative quality improvement of this homeless program innovation.

Methods:
In partnership with CTRS staff, we identified VEHs (n = 12) residing at CTRS who were willing and eager to participate in the VEC; three Veteran peer supports at CTRS facilitated weekly discussions. The VEC Veterans invited a medical anthropologist with previous experience engaging in quality improvement on-site to be a civilian member of the committee. We used an iterative, stakeholder-led process to develop ground rules for the VEC and processes and procedures for recording and disseminating recommendations to CTRS staff and leadership. Detailed fieldnotes were taken at meetings to date (n = 10).

Results:
The VEC meetings bolstered communicative pathways between VEHs and CTRS management to report urgent needs, offer improvements, and emphasize the positive aspects of healthcare and service delivery. The meetings are well attended, with an average of 10 Veteran attendees (range 4-20), including an average of 2 women Veterans. The VEC facilitated visits with physicians, mental health clinicians, and occupational therapists to discuss how to organize and increase access to healthcare services. We also learned from the VEC that VEHs at CTRS wanted basic hygiene supplies and education about housing services and processes. Veteran participants reported the VEC increased a sense of community at CTRS and offers a non-hierarchical safe space for VEHs to speak candidly about their needs and experiences. Focusing on “small victories,” the quality improvement team fulfilled several requests from VEHs, including acquiring coffeemakers, headphones to listen to music, more outdoor lighting, materials for bingo nights, and plans for courses on basic hygiene and housing processes.

Implications:
We used community-engaged methods to develop a homeless VEC that serves a highly vulnerable cohort of VEHs residing in a sanctioned encampment. The VEC provides a safe space to discuss, debate, and ultimately communicate improvements to management. This committee serves as a model for other VAs that desire to create a quality improvement feedback loop incorporating the perspectives of homeless-experienced or other vulnerable Veterans.

Impacts:
The VEC contributed to tangible, Veteran-centric improvements in the encampment environment and facilitated knowledge-exchange about health and housing services.