UHHS Appointment Line
The UHHS appointment phone number uses an automatic call distributor, a call-center technology. Thus, 1 phone number can be answered by multiple people working in separate locations. The challenge was how to connect phones associated with offices located offsite from the VANTHCS campus. The solution was to use Internet phones in addition to existing staff phones.
Results
During the review period from August 26, 2013, to November 27, 2013 (65 workdays), 392 unique veterans attended a UHHS assessment. Four veterans who were screened twice were included only once in the analysis; outcomes from only their initial screenings were evaluated. Three hundred fifty-six veterans completed a UHHS assessment; 36 had an assessment but did not complete it. Rates of veterans not presenting for their scheduled appointments increased over time, from 24% in August 2013 to 50% in November 2013. To address the no-show rate, program managers decreased the number of offered scheduled appointments and increased the number of walk-in visits. Overall, the schedule distribution consisted of about twice as much time allotted for walk-in appointments compared with scheduled appointments. The UHHS appointment line received 873 calls, where the number decreased over time.
The typical screened veteran who completed a UHHS assessment was a non-Hispanic, African American male aged 51 years with no service connection or history of combat who served either in the Vietnam War era, post-Vietnam War era, or Persian Gulf War. He had accessed VANTHCS care in the year prior to screening; owned a working phone; and was staying in a shelter, a place not meant for human habitation, or a substance use treatment program the night prior to screening (Table 1). Only 20 veterans (5%) were ineligible for participation in all programs, because they did not meet core eligibility criteria as defined by the UHHS Decision Tree, their income surpassed the program limit, or they were not eligible for VA care (Table 2).
To determine the housing outcome of the veterans screened during the reviewed period, a 3-month follow-up from the end of the review period was used. During this time, 269 veterans (76%) who completed the UHHS process were housed, with 215 (60%) veterans housed in a UHHS-associated housing program (Table 3). Of the veterans who completed a UHHS assessment, 45 veterans (13%) did not complete the screening process; admitting program staff documented in CPRS unsuccessful attempts at reaching 12 veterans (3%), among whom 4 had no working phone at the time of their UHHS assessment. Time to admission depended on the program mission, openings, and the veteran’s UHHS engagement. Admission date indicates the date that programs housed veterans except in the case of the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH), where admission date indicates the date the veteran gave all required documents to HUD-VASH staff.
Discussion
Prior to the inception of UHHS, the staff of the CHCP housing program did not have a standardized process for communication across programs about veterans’ housing status and outcomes. Veterans went to multiple locations for screening if they were interested in > 1 program or if they were not admitted to the first program they approached. The UHHS process improved communication across CHCP housing programs, resulting in increased veteran accessibility to these programs as suggested by 3 CHCP housing programs having fewer days with openings post-UHHS implementation. Furthermore, a new screener position did not need to be created, because existing CHCP social workers were all capable screeners due to process standardization.
Fifty-five percent of the screened veterans were interested in and eligible for participation in > 1 housing program. They were eligible for 3 programs on average and were usually admitted to the housing program with the earliest opening. The need for screenings across all the CHCP housing programs was potentially decreased by ≥ one-third. This increased available time for the screeners to accomplish their other clinical responsibilities.
Limitations
A limitation of the review period evaluation is little information on noncompleters. The available data are confined to information documented in CPRS regarding why 45 veterans (13% of those who completed UHHS assessment) did not complete the screening process. For 12, admitting staff of the housing program documented in CPRS that they had been unable to reach the veteran; 9 of these veterans attended subsequent non-UHHS VANTHCS visits. To further improve the homeless housing delivery service, the creation of a CPRS-related process that informs VA clinicians that a housing program is attempting to contact a veteran is needed.
