Online Program

Assuring Quality of Care of Veterans in the Homeless Service System

Monday, November 2, 2015

Jennifer Knapp, LCSW, Health Care for Homeless Veterans, VA Palo Alto Health Care System, Menlo Park, CA
Stacy Studebaker, LCSW, Domiciliary Service, VA Palo Alto Health Care System, Livermore, CA
Allison Ulrich, J.D., Ulrich Consulting, LLC, Health Care for Homeless Veterans (HCHV), San Mateo, CA
Tanya Tabon, LCSW, Supervisory Social Worker VA Supportive Housing VA Palo Alto, HUD-VASH Menlo Park, VA Palo Alto Health Care System- HUD-VASH Program, Menlo Park, CA
Research has shown that partnerships between agencies have a positive effect on services. (1)  However research also calls for greater strategy and organization of these collaborations to increase efficiency. (1, 3) Furthermore, meaningful engagement between federal and local partners to ending homelessness is a key component to the plan put forth by the United States Interagency Council on Homelessness. (2)   On top of this need for partnership, there is also a trend of quality assurance in social services.

The concept of “Quality Assurance” originated in the business community.   Implementing "Quality Assurance" in homeless services is assumed to raise professionalism as well as provide better, more efficient services for the homeless population (4). Many Continuum of Cares (CoCs) throughout the country have implemented Quality Assurance Standards in their own jurisdiction.  Similarly many non-profit agencies have internal QA mechanisms.  However, the lack of standardization between agencies leads to varying definitions of “quality.”  When partnerships are formulated between agencies and across systems, this lack of standardization can lead to discrepancies between the services intended to be provided to program participants and those actually received.

Common themes through these various CoC Quality Assurance Standards include: Accessibility, Accommodation, Advocacy, and Service. These standard themes have been adopted as indicators in the VA Palo Alto Health Care System’s Health Care for Homeless Veterans Quality Assurance Surveillance Plan (HCHV QASP) to ensure that quality services are delivered to homeless Veterans.  

The HCHV program currently has nine contract providers. The effectiveness of these partnerships are furthered by operational definition of “quality services” in the contract as well as the “Quality Assurance Surveillance Plan” (QASP).   Drawing on data from VA program performance and comparing this to changes made in policies in contracted shelters, the article explains why concrete, standardized,  QA protocols are an important evolutionary step in the homeless service system. The article then presents the results of a data review conducted among VA contracted shelter programs. 

1. Andrews, R and E, Tom "Does Cross-Sectoral Partnership Deliver? An Empirical Exploration of Public Service Effectiveness, Efficiency and Equity," Journal of Public Administration Research and Theory 20.3 (2010)

2. Applewhite SL.  Homeless veterans: perspectives on social services use.  Social Work.  1997: 42:19-30.

3.  Poppe, B "Interagency Collaboration Moves U.S. Closer to Ending Homelessness," The Public Manager 40.4 (2011),

4. Wolf, J and Edgar B “Measuring Quality of Services and Provision in Homelessness,” European Journal of Homelessness Vol 1 (Dec 2007) 15-40

Learning Areas:

Administration, management, leadership
Advocacy for health and health education
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Evaluate the quality of services for homeless Veterans within contracted emergency shelters designed for homeless Veterans Describe 4 indicators that link quality assurance measures with a positive outcome Discuss the current state of quality assurance in many homeless systems. Formulate ongoing education around quality assurance amongst emergency shelter providers

Keyword(s): Veterans' Health, Community-Based Partnership & Collaboration

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a licensed social worker who has worked as a liason for hte VA for 5 years. During this time I have overseem multiple contracts and monitored the quality of both general and speciality programs and have learned to assure the quality of services to veterans in all these sites. I am currently a supervisory social worker and oversee the work of other liason who in turn monitor the quality of services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.