Making Housing First happen: Organizational factors in VA's expansion of permanent supportive housing

Objectives

The US Department of Veterans Affairs has adopted Housing First (HF), an evidence-based intervention to rapidly house chronically-homeless individuals; this requires an ambitious organizational transformation of the VA’s existing HUD-VASH voucher program.

Methods

A multidisciplinary team interviewed senior leadership, mid-level managers, and front-line staff at 8 VA facilities representing 4 regions of the US using a semi-structured interview guide. The team then developed narrative descriptions of each site; these were coded to identify key organizational factors associated with successful implementation of HF based on constructs derived from the Organizational Transformation Model.

Results

Impetus to house homeless veterans was strong across all 8 facilities. Strong involvement from senior leadership (e.g., demonstrated by creating new supervisory positions, developing multidisciplinary case management teams) was essential to HF implementation. Participation in process improvement activities helped identify and overcome barriers to HF implementation. Lack of collaboration with community partners impeded efforts to rapidly house veterans.       

Conclusions

This analysis found meaningful variations in HF implementation, which appear to be associated with differences in the organizational practices included in the Organizational Transformation Model. Leadership commitment, integration with other partners, and a sense of urgency to meet the goal of rapidly housing homeless veterans were all crucial factors in successful HF implementation at the sites studied. This study provides crucial insight into the organizational challenges associated with adoption of HF which may be applied to other efforts to implement evidence-based interventions on a broad scale.